PAIN EDUCATION 101: MANAGING PAIN THROUGH MINDFULNESS
By Ari Witkin, DPT
This is Part Two of a two-part series. Click here to read Part One.
In recent years, mindfulness and meditation have crept into the mainstream. Not too long ago, we thought of this practice as religious or mystic. It was either inaccessible or too scary for most of us. With the inclusion of meditation in society at large comes a great deal of scientific research into its effects on various aspects of life. One of those is how mindfulness affects pain.
As discussed in part one of this series, pain is a multifactorial experience in which the brain modulates how, where, and when someone experiences pain. Today we’ll dive into how mindfulness affects the neurophysiology of the brain and how that translates into the pain experience.
How your brain processes pain
Ok, here is your neuro lesson for the day. When something happens at the tissue level such as bumping your toe into the kitchen table, nociceptors, or “danger receptors,” send a signal up your spinal cord to your thalamus. The spinal cord and thalamus act as the first gatekeepers of the pain experience, deciding how much signal to relay and where in your brain to send it. In your brain, there are various neuronal networks called neurotags. These highways are developed over time based on past experience, stress, and various sensory inputs. If and when signals from the spinal cord and thalamus are directed at specific neurotags, you experience pain. These networks exist in your brain, but can and do change over time in a process called neuroplasticity.
That was a lot to take in, but I hope you keyed in on this – your neurotags are plastic; they can and do change. One of those ways they change is through mindfulness.
How Mindfulness Can help Alleviate Pain
Mindfulness is defined as a conscious awareness of your present moment without judgement. Being mindful is simply removing the automaticity in your thoughts and actions while introducing purposeful behavior.
Think for a moment about how much of your day to day is on autopilot. Get down to the basics. When was the last time you noticed your breath? It’s coolness entering your body, its length and depth. What about when you walk? Do you really feel your heel strike the ground, the rocking motion, or push off? What if we go even further? What do your socks feel like? The seams, the fabric, its stretch and contraction in your shoe. We could do this with millions of aspects of our lives. The automaticity is part of our lives, and as is in the case of breathing, it often keeps us alive, but it also reduces our ability to be aware in our own lives.
Studies on neuroplasticity show that our brains can change more effectively when we’re aware, ready, and conscious. What does that sound like?! Mindfulness.
One of the effects of pain neurotags is that they distort our perception of our own selves and our bodies. Think for a second about the last time you were in pain. Didn’t it seem hard to remember what it was like to feel healthy? The places on our bodies can seem unfamiliar or even alien. Mindfulness is the direct counter to this process – bringing acute awareness of your body and rewiring the pain neurotag.
Now that you understand how it works, the harder part is finding a way of introducing mindfulness practice into your life. There are endless forms of the practice, but we’ll introduce two different forms here.
Simple ways to practice mindfulness
Find a comfortable seat, it can be on a pillow, on the ground, or in a chair. Do a full body scan, paying close attention to what you’re feeling right now. Start at your feet. Take notice of temperature, the feeling of a stretch on your toes, or the texture of the carpet underneath your heel. Once you’re done there, without judgement or compulsion to fix or change, move on to the next area of your body.
For many of us, a still or sitting mindfulness practice is too uncomfortable, so we’ll discuss a moving mediation. We’ll use a walking practice as our example, but the same principles apply to running, biking, swimming, etc.
Set a time for a dedicated walk. This doesn’t have to be long; around the block or down the street to the coffee shop is perfect. Start to become aware of your senses. What does it smell like outside? What do you see? What do you hear? What do you feel – on your feet, your skin, your mouth? What can you taste? Be specific, be aware.
Experts on mindfulness will tell you that the practice will improve your emotional regulation, giving you a greater ability to transform stress into calmness. Pain scientists call this neuroplasticity. Mindfulness rewires the neurotags in your brain allowing you to be more aware of your body and decrease your pain experience.
At Rose City Physical Therapy we focus on each individual and discuss not only where they hurt and how they hurt themselves; but also get a history of one’s past injury and pain experiences, their beliefs of their current condition and its impact on their physical and social life. Evidence supports that insufficient diaphragm control and shallow breathing has an impact on one’s physiology and pain. Breathing is one component of mindfulness that we address for management of neck pain and back pain treatment. It’s not only the painful site we treat; but the patient as a whole.