Last week I had the honor of presenting to the New Mexico Nurse Practitioner Council’s Spring Conference on: “Mindfulness: Working with Chronic Pain from the Inside Out.” It was an opportunity for me to reflect again on the fact that, on this planet at least, to be human is to have some familiarity with pain. Each one of us, over time, will hear the knock at the door of illness, injury, aging, and eventual death.
Yet, as inevitable a visitor as pain is, most of us have no formal training in how best to cope with it, or how we might develop our internal resources to live well in the midst of experiences of pain that can and will arise in a human lifetime. And when pain persists and becomes chronic, stretching our resources thin, the need for support in the form of effective training grows and can become acute.
This is exactly where we find ourselves today in health care, given what experts are calling the “opioid epidemic.” Over 100 million Americans cope with chronic pain, as well as more than 1.5 billion people worldwide. In the last 12 years in the U.S., Medicare expenditures for opioid treatment have increased by an astounding 423% (1). The widespread use of prescription opioids to alleviate chronic pain has led to an exponential increase in opioid misuse, abuse and addiction, affecting more than 10 million lives directly, not to mention the lives of friends and loved ones. In response to this crisis, the Center for Disease Control has recommended developing and employing fast-acting, nonpharmacological treatment options. (2)
Enter: Mindfulness. It’s now well established from over four decades of research that mindfulness meditation is significantly effective in alleviating pain. Studies of patients who participate in an eight-week mindfulness course show that they experience decreased levels of pain intensity, pain unpleasantness (even when intensity remained high), reductions in anticipatory stress over expected impending pain, and increased regulation of attention, cognition (particularly negative thoughts), and emotions. (3)
What astonishes me about these results is the fact that these participants are discovering through an 8-week course that they already have what’s required to attenuate pain: their inner resources, or you might say, “superpowers”, that can be cultivated for learning, growing and healing. What are these innate superpowers, ours by virtue of being human, that mindfulness explicitly develops and refines?
• Our capacity to bring interest and attention to experience, including experience we don’t like or want.
• Our capacity to accept what’s here because it is here, already—as a creative act of engagement, rather than a habitual default toward denial, resistance, or repression.
• Our capacity to recognize and acknowledge our thoughts about what’s happening, e.g. “I can’t stand this. What if this pain never diminishes, or worsens? What did I do to deserve this? Why me?”—and not believe these thoughts as ‘facts’ or ‘the truth’, but rather as events in the mind, decoupling the sensations of pain from our thoughts about them.
No one is saying this is easy. Pain isn’t easy, nor is the training involved in cultivating our capacities to tolerate what feels intolerable. And yet, we have the capacity, already hard-wired in our DNA, to be aware of and learn to regulate the reactivity that understandably arises when pain persists. Walt Whitman wrote, “I am large. I contain multitudes.” With training, we can discover, uncover, and recover our own “largeness”, our innate superpowers of awareness and care so as to work with what’s here and not feel ourselves and our lives diminished by it.
(1) Journal of the American Board of Family Medicine, 2009.
(2) Han B. et al, 2015, “Nonmedical prescription Opioid Use and Use Disorders Among Adults Aged 18 Through 64 Years in the United States”. JAMA.
(3) Zeidan and Vago, 2016. “Mindfulness meditation-based pain relief: a mechanistic account.” Annals of the New York Academy of Sciences.