Mindfulness and Pain Management

Last year I worked at a forensic mental health facility. Which is to say I worked with men (they were all men) who had committed crimes, usually serious ones, but who were transferred from prison due to mental illness. 

Over the nine months that I saw patients, I did three things: conducted psychotherapy with groups and individuals; did psychological assessment; and taught mindfulness. 

One mindfulness session in particular stands out for me.

I was meeting with a patient for the first time. Let's call him Alan*. Alan was in his early 30s, white, about five feet three inches tall, compact. Black hair, slicked back. Black, nervous eyes.

Most distinctive, though, was a jarringly stark underbite.

Alan had been referred to mindfulness to manage the chronic pain in his jaw, which had been broken multiple times under horrifying circumstances. 

I started by explaining that pain usually has two components: 

There is the pain of pain. Jaws that have been broken, for example, hurt. Sometimes they hurt a lot. 

Then there is our aversion to the pain. Our resistance. Our wanting the pain to be something else. What's interesting, I told Alan, is that the resistance to pain makes pain worse.

Conversely, paying close, careful attention - to the pain, to other physical sensations - eases pain. Mindfulness makes pain better. 

Alan looked skeptical. I asked him if he wanted to give it a try. He nodded. I asked him where his pain was on a scale of 1 to 10, 1 being almost no pain and 10 being the worst he'd ever felt. He told me the pain was an 8. 

Then I led Alan through a mindfulness exercise. We took three deep breaths together. I asked him to bring attention to his breath. After we had settled together, I asked him to direct a warm awareness, a calm and curious attention, straight into the pain.

From there, I asked Alan to direct his attention back to the breath. Then we alternated, first the pain, then the breath, then the pain, then the breath. Keeping the attention warm, kind, accepting. 

After about ten minutes, I asked Alan to open his eyes. "How was that?" 

"Okay," he said. 

I noted that he looked calmer.

"I feel calmer."

I asked him to scale his pain again.

"It's a 3," he said.

"A 3?" I asked, surprised.

He smiled for the first time. "Yes."

I suppose I shouldn't have been surprised. I had done mindfulness with other patents. Their pain had decreased. Just not so much. And not so fast.

Still, there is a boatload of empirical evidence for mindfulness as an intervention for chronic pain, starting with Jon Kabat-Zinn's classic 1982 article, "An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results."

In that publication JKZ laid out some impressive results. He took 51 chronic pain patients who had not improved with traditional medical care. He put them through a 10-week mindfulness program. By the end, two-thirds of the patients had experienced a 33 percent pain reduction. Half had experienced pain reduction of more than 50 percent. 

Since then, dozens of studies have been published on the effects of mindfulness interventions for chronic pain. It has become a go-to treatment in even the most conservative hospitals. 

And as my experience with Alan shows, the results often speak for themselves. 

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For information about upcoming mindfulness workshops with Craig & Devon, please click here.

*Client details have been changed to protect confidentiality

Craig Hase