CD Review: Mindfulness Meditation for Pain Relief

Although the purpose of meditation is not to relieve pain, it often does. I suppose you could call this a beneficial side effect. In Mindfulness Meditation for Pain Relief: Guided Practices for Reclaiming Your Body and Your Life, Jon Kabat-Zinn shares meditation practices that were developed at Massachusetts General Hospital’s Mindfulness Based Stress Reduction Clinic. Over 30 years of research has demonstrated the effectiveness of medication for many conditions such as blood pressure, stress and pain relief.

This CD set includes two discs. In the first, Kabat-Zinn explains how and why meditation works and gives a soothing pep talk for those ready to try this for the first time. He outlines the seven principles that underlie mindfulness:
1. “As long as you are breathing, there is more right with you than wrong.”
2. The power of the present moment is a resource that is often overlooked.
3. The present moment isn’t always to our liking. That’s true whether you have chronic pain or not. Most of us spend a lot of energy distracting ourselves from the present.
4. The common two ways to deal with the present are to turn away from it through escape activities or to obsess on it and feel victimized.
5. A third way is to open to and befriend current experience to the degree you choose.
6. Whatever is happening, have kindness and compassion toward oneself. And suspend judgment, which contracts the mind and body and compounds pain and suffering.
7. The purpose is to not make anything go away or fix something. It is simply to find a respite through non-doing so life’s natural propensity for change and healing can take its course.

If you’re already familiar with the history and effectiveness of mindfulness practices, you might be tempted to skip to the second disc and that’s OK, but the first one is quite interesting.

The second disc includes several meditations of varying lengths, starting with a simple, short breathing meditation and one 18 minute practice. Even if you’re not the type to sit still with hands folded in your lap for any length of time, I think the way it is presented is a good start for anyone who is coping with chronic pain.

In The Pain Chronicles, Melanie Thernstrom tells of Franz Mesner who was able to tranquilize patients with his voice, which coined the term “mesmerize.” Jon Kabat-Zinn’s voice has this quality. Just by listening to the CDs, without even doing the meditations, I dropped into the calm, soothing nature of his voice and let go of a layer of stress.

The Wide Road or the Tightrope

Everyone has a range of two little or too much exercise. For the average person, one weekend of gardening can cause a back ache. Or it might take a couple weeks without moderate or vigorous physical activity for weakness to turn into stiffness and achiness. Most people do fine with regular exercise here and there with not too much at any one time.

I liken this to a wide road with shallow shoulders. When we exercise the right amount we stay on the road. If we verge to the side of overexertion and strain a muscle, we stray off the pavement and get bogged down in the gravel. It takes some work, maybe seeing a health care provider or doing some stretches or extra time in the hot tub, to get back on the road. Sometimes we get too busy with work to walk, do yoga, lift weights, whatever our usual exercise routine is, so our muscles lose strength, our cardiovascular system loses steam, our organs lose vitality. This is the other side of the road. We’re heading for the ditch of lethargy, aches and pains.

The better our physical condition, the wider the road and the easier the shoulder. With inattention or injury, the road narrows, the banks steepen, the ditches turn to ravines. For people with chronic pain, the road has dwindled to the thickness of a tightrope strung high. This isn’t a glamorous high wire circus act; this is a trembling person, already off balance by pain, who doesn’t want to fall.

Managing the tightrope can be a full-time job. Every activity must be considered as potentially being too much or too little. Vacuuming the house might send one tumbling off the rope into a free fall to the net below, so that an arduous journey is required to climb the ladder back to the rope. Each person’s ladder is a unique combination of treatments. Finding the personal combination of therapy is as relevant as discovering what throws one off balance and into the net.

The other side of the tightrope – inactivity – is just as dangerous. Chronic pain creates and exacerbates weakness. Every day some exercise is required or else one risks falling off the other side of the wire with a similar climb up to the rope of equilibrium.

My teacher, Donna Bajelis, taught me the analogy of the tightrope. My clients, especially those with chronic pain, find it useful to keep on track with activity. They use continual self-care to lower the rope to ground-level, widen it to a balance beam and eventually recreate a broad road. Everyone can broaden their path with regular exercise. If you’re on a tightrope, work toward a balance beam. If you’re on a beam, work toward a narrow path. If you’re on a path, create a road for yourself. If your road is already broad, what will it take to make it an eight lane highway?

The Benefits of Appropriate Proprioception

Notice where your body is in space. Without looking, estimate how far apart your feet are, the curve of your low back, and the relationship between your cranium and tailbone. This is proprioception: the ability to sense where your body is. We’re learning that proprioceptive ability has important implications for health.

First of all, proprioception is essential for balance. As we get older, our balance often diminishes. This is partly due to muscle weakness (see the article on the Single Leg Stance), but another factor is the ability for the body to sense where each part of itself is in relationship to the ground and up.

Proprioception is also a factor in pain perception. Proprioceptive nerve endings sense the body’s location. Nociceptive nerve endings sense pain. Scientists are finding an inverse relationship between proprioception and nociception. When proprioceptive nerves are not functioning optimally, the nociceptive nerves become more active and pain is perceived more easily. It’s worthwhile to improve your proprioceptive abilities; if you’re in pain, it’s essential.

There are several ways to improve your proprioceptive abilities. The field of rehabilitation uses balance exercises; wobble boards have been found to be very effective. Bodywork is another option, especially bodywork like structural integration where the client stays aware and involved while the practitioner is manipulating tissue. Yoga and Pilates are also helpful, since attention is maintained on how parts of the body relate to each other during the exercises. Undulations also have the same effect. Since undulations focus on the relationship between one vertebra to another, it is helpful to improve proprioception in that area.

If you have signs that your proprioception is waning, you might want to use multiple techniques to improve it. We don’t necessarily need enough awareness to do gymnastics, but we all need appropriate proprioception to walk (which includes standing on one leg with each step), balance and accurately perceive pain.

5 Ways to Stop a Pain Cycle

“Pain is an experience produced by a body and mind trying to interpret sensation and determine whether a threat is present.”

Neil Pearson, MSc (RHBS) BscPT, BA, BPHE
International Journal of Yoga Therapy, Vol 18 (2008)
“Yoga for People in Pain”

As a warning signal, pain is helpful. It usually indicates injury and encourages change to promote healing and prevent further harm. Unfortunately, pain messages can outlive their useful purpose and take on a life of their own.

Fifty million Americans live with chronic pain and an additional 25 million have acute pain from an illness or injury according to Kathryn Weiner, PhD, the Director of the American Academy of Pain Management. More important than statistics is the fact that hurting prevents people from enjoying life. If not stopped in its early phases, pain can create a cycle that lingers and eventually becomes chronic. Therefore, it’s important to relieve pain as soon as possible.

Pain may be alerting you to one of the following five cycles, which can be resolved.

Pain Cycle Scenario #1 – Inflammation Gone Wild
Inflammation is a natural part of the acute healing process. Blood flow increases to injured areas of the body in order to bring nutrition and carry away damaged cells. When the inflammatory process doesn’t turn off, internal swelling puts pressure on sensitive tissues and creates more pain and prolonged injury.

You can control inflammation naturally with RICE: Rest, Ice, Compression, and Elevation. Notice the first criterion is rest, which means the body needs a break from all stressful activities. Ice, compression and elevation take time, but it’s worth it to spend 15 minutes icing with the body part elevated three to four times a day.

Diet is also a factor. Marcelle Pick, Ob/Gyn, NP identifies foods that help and hurt in an article about joint pain and inflammation for Women to Women. Hydrogenated oils, saturated fats, and sugar contribute to inflammation. Omega-3 oils and dark, leafy, green vegetables counteract those effects.

If natural remedies aren’t enough, there are always over-the-counter anti-inflammatories such as ibuprofen and naproxen. Note that acetaminophen does not reduce inflammation. Some people resist taking any pills. However, if you are caught in an inflammatory pain cycle, you will be tempted to take even stronger and more harmful pain relievers unless you get inflammation under control.

If all else fails, cortisone injections can be used to dramatically reduce swelling in a particular area. However, this option is used after others have failed, according to Robert Leach, MD, editor of the American Journal of Sports Medicine.

Pain Cycle Scenario #2 – Unconscious Repetitive Injury
Sometimes pain tells us that we have a bad habit which causes internal injury. The habits are so ingrained that we aren’t conscious of ourselves or the negative effects. It may start with tension in the neck and shoulders and then send pain into the arms and hands. Poor posture in front of a computer or in a car is often the culprit. Other posture habits create different injuries. Low back pain is commonly the result of sitting back on the pelvis.

This isn't a one-time injury, but instead small injuries that recur faster than the body can heal.

An assessment of your posture and movement patterns can determine if your pain is the result of an ineffective movement pattern. Structural integration practitioners are trained to spot these patterns as are physiatrists and physical therapists who treat the body holistically. Once diagnosed, the challenge is to stop the behaviors that create injury and develop new, better habits for movement. But you can’t even start the process without becoming aware of the harmful patterns.

Pain Cycle Scenario #3 – Cascade of Trigger Points
Tension is a natural reaction to pain. Muscular tension adds strain to already overloaded or weakened muscles, which increases pain. Trigger points are small sections muscles that are stuck in contraction and send pain to the surrounding or a distant area. If trigger points persist, new pain points will develop in surrounding muscles which can become a web of agony that is hard to unravel – not to mention the tension that increases every step of the way.

One solution is to decrease tension with relaxation techniques and reduce stress in the muscles. Progressive relaxation is one of the easiest techniques to try on your own and can be done in as little as 15 minutes. Lie in a quiet place and tune into your breath. Tighten the muscles in your toes as you inhale and as you exhale relax them as much as possible. Work up the muscle groups in your body (calves, thighs, buttocks, etc.) squeezing the muscles on inhale and letting go as much as possible on exhale. By the time you tighten and release your jaw and eyelids, your whole body will be much calmer.

Relieving the entire pattern of trigger points is also necessary, which requires a combination of warming the muscles, pressing the points, and stretching according to Hal Blatman, MD author of Winner’s Guide to Pain Relief. Many times you can do this yourself. The Trigger Point Therapy Workbook is also an excellent resource. It’s important, however, to get every point or the pattern can return. Massage therapists who specialize in trigger point therapy can help. The most extreme cases might need trigger point injections (usually injected with an analgesic called lidocaine), which can be administered by a physician or physical therapist.

Pain Cycle Scenario #4 – Pain and Depression or Anxiety
People with chronic pain are at higher risk of developing mood and anxiety disorders according to Harvard Health Publications, and people who are depressed are more sensitive to pain sensations, as the brain pathways that process pain and mood are related. Depression or anxiety and pain can become a vicious cycle as stress increases pain and pain increases stress.

The Mayo Clinic website recommends autogenic relaxation, progressive muscle relaxation and visualization to decrease wear and tear on the body and mind. The progressive relaxation exercise noted above can be used, as well as other activities you find to be restful. Mindfulness Based Stress Reduction, a form of meditation, has been found to be extremely effective in increasing the ability to relax and the ability for patients to cope with their symptoms including pain.

Exercise produces endorphins which reduce the perception of pain and increases the feeling of well being according to WebMD. Walking is one of the most common and helpful, but any enjoyable exercise such as biking or dancing will help combat a pain and anxiety/depression cycle.

Slow breathing is also effective. Researchers at the Barrow Neurological Institute in Arizona found that study participants who tried to slow the breath rate to half could diminish pain and improve their mood pain as reported in hc2d, a global healthcare news site. One way to slow your breath is to exhale through pursed lips, like a whisper. Another technique is to count the inhale and exhale and increase the count of each (especially the exhale) slowly and incrementally.

Medication is another option if natural remedies aren’t successful enough. Certain pain conditions respond to anti-depressants or a combination of anti-depressants and analgesics. Physicians who are experienced in treating patients with chronic pain, such as physiatrists or rheumatologists, have the best knowledge to determine if this will work for you.

Pain Cycle Scenario #5 – Amplified Pain Messages
Some of the latest research is finding that pain receptors can become oversensitive and produce pain signals out of proportion to the actual condition of the body. In this case, the message is a bit like Peter crying wolf.

Neal Pearson in the article noted in the opening paragraph puts it so well. “The body and nervous system may amplify the signals to get attention. Pain could then intensify without further tissue damage, the experience of pain could spread to new areas, previously non-painful movement might become painful.”

“New Culprits in Chronic Pain” in the November 2009 issue of Scientific American details how the sensing neurons can become overly excited and create pain without a stimulus. In this case the body–mind is misinterpreting sensation, but that doesn’t change the amount of pain felt. In some cases the pain gets worse and worse.

Researchers are developing new medicines to affect the sensing neurons and combat pain in a different way. That doesn’t mean that current natural methods won’t work. Alternative health care like acupuncture and yoga therapy can affect the nervous system to restore a more accurate internal sense of sensation, called proprioception.

Finding the Right Solution
It’s also possible that pain cycles are the result of more than one cause, for example inflammation and depression or unconscious habits and tension. As a result it can take a bit of trial and error to find a combination of approaches that work for your particular situation.

A journal can help you recognize and track your cycles and document what techniques that are most helpful. With practice, you can decode the incomprehensive messages of your pain and find some relief.

Book Review: Muscular Retraining for Pain-Free Living

To be blunt, and a bit simplistic, there are two types of people:
Those who are willing to do what it takes to get out of or prevent pain, and
Those who don’t want to make any changes but want pain to go away.

If you are the type of person who has been looking for changes to keep you pain-free, I recommend Muscular Retraining for Pain-Free Living by Craig Williamson, MSOT. In this enlightening text Williamson notes that kinesthetic dysfunction (the inability to sense and perceive parts of the body) creates Dysfunctional Movement Patterns (DMPs) that cause internal, repetitive injury.


Unfortunately, most people have many dysfunctional patterns that cause pain, for example sitting in front of a computer with shoulders rounded and head forward, lifting objects by hinging in the low back, straining the neck to stand up, and walking with misaligned knees to name a few. However, this book will help you discover and correct these ineffective tendencies.

“If you want to discover a new way of using your body or performing an activity, you need to break free of your DMPs. You do this by letting go, by feeling your muscles and alignment in new ways, by coordinating your movement in new ways—and by observing what happens.” (p. 49)

I like that Williamson uses easy-to-understand language and comprehensively covers sources of dysfunction, from bad habits to past injury to poor posture to unconscious emotional tightening. The movement explorations in the book help you build your kinesthetic awareness and the exercises help you replace ineffective patterns with effortless, balanced strength and flexibility.

My favorite part of this book is the emphasis on non-forced movement. “In fact, muscular retraining involves moving as easily as possible by avoiding the use of any unnecessary muscles.” (p. 46)

If you’ve suffered from chronic pain and think that the key to pain relief is to try harder and do more, Muscular Retraining for Pain-Free Living will be a pleasant and effective change of pace. If you live relatively pain-free, the advice in this book will help you stay that way.

Love Your Body

Few people truly love their bodies. We usually have more criticism for them than admiration, even though they make our lives possible—even pleasurable.

When you look in the mirror, what’s the first thing you think? It’s typical to say, “I look too fat.” Or “I need to lose __ pounds.”

Then we get into specific flaws. My breasts are too small. My hips are too large. Look at that flab. And my neck. What to do about those wrinkles? And that cellulite, ugh!

It continues with criticism about our bodies’ function. It’s not strong enough or flexible enough or energetic enough or fast enough.

How many negative comments do we make about our bodies for every positive one?

What’s ironic is that the mind is making all these nasty “observations,” as though it is the body’s fault. But what part of us decides to work nine hours a day and leave no time for exercise or healthy eating? It’s the mind, of course!

No wonder there’s an epidemic of internal conflict that shows up as lethargy and dis-ease, including immune system disorders, depression, and chronic pain. Since the mind and body can’t get a divorce, it’s time for some serious counseling.

Here’s a start. Give gratitude to your body for everything it does. Let it make some decisions in your life. You might be surprised that it wants to swim, dance, or play. If given the choice, your body will naturally lose weight, be stronger and more flexible.

Next time when you look in the mirror, send your body some love. Find ten good things about it before you allow a criticism to creep up. It truly is amazing—and it is one of the best parts of you!

Healing Starts with Compassion

If part of your body is not working properly—a sore back, drop in energy, broken toe, chronic pain, or frozen shoulder—do you want it to be fixed or healed? The attitude that you bring greatly affects the process and outcome. What's the difference?

When I think of fixing something, I remember my dad working on the car, his coveralls oily and knuckles knicked. He returned from the garage triumphant after restoring order to that darn (although I don't think that's the word he used) part.

Healing has a different character. I think of an army medic attending to a wounded soldier, his blood-stained hands administering aid as his gaze and words convey assurance.

The basic difference is compassion, the foundation of any healing process. The very idea of fixing has an adversarial component. Healing is cooperative and supportive.

Furthermore, fixing may restore to the original state, while healing allows for a situation that is better than new. A broken bone heals to be stronger than the original structure. A fixed frozen shoulder makes it possible to resume former activities, while a healed frozen shoulder brings a new sense of relationship between the arm, shoulder and spine and even greater awareness and range of motion than enjoyed before.

When part of your body is "broken" consider carefully how you approach the situation. That part is actually You and will probably respond to compassion and healing more satisfactorily than a challenge.