How to survive pain
Anxiety and stress increases pain
Pain is an intense sensation that hurts. It may be experienced as a steady, constant ache, a sharp stab or a dull aching throb. Normally pain is felt in the body, but it is as much about psychological distress, as it is about physical sensitivity. How we respond emotionally, affects the way we perceive and experience pain, or whether we find relief from it. Psychological studies show that people who suffer from depression, anxiety and stress are much more likely to suffer from pain-related conditions.
Pain is a subjective experience. For some people, pain can be an acute, intolerable and debilitating condition, which renders them helpless and in need of medical treatment – such as taking painkillers for rheumatic pain or severe injury. For others, pain can be a manageable experience, which they learn to accept by degrees. A changing state of awareness that can be adapted to with a combination of physiotherapy and pain relief exercises.
Pain is also a type of stress. The body's way of signalling that it feels harm. The way we cope with the emotional impact of stress and anxiety can, therefore, intensify our experience of pain, or reduce it. Once the fear receptors in our brains (amygdala and limbic region) have been triggered, the fight-and-flight response makes humans much more susceptible to pain stimuli once the adrenalin has passed. Exposure to chronic anxiety can induce joint inflammation, muscle tension, back pain and headaches. So our ability to self-regulate or manage emotions will enable us to deal with pain more effectively.
It may sound unrealistic to someone who experiences acute pain as a result of injury, to tell them they can manage their condition, but it is possible, over time to actively accept pain and widen our window of tolerance for it. This is about how we develop our state of mind and not simply medication or physical techniques we use to discharge pain. I am not advocating giving up medication, simply being less reliant on it.
Physical techniques to reduce pain
For example, learning mindfulness of breathing can bring about an inner state of calm, which is known to reduce inflammation, pain and stress hormones like cortisol; as well as produce higher levels of endorphins, dopamine or GABA (gamma aminobutyric acid), which is a major inhibitory neurotransmitter. These chemicals can also act as natural pain suppressants, increasing your sense of pleasure and helping you feel calmer. This is highly significant when anxiety, stress or depression can lead to flare-ups in joint pain, arthritis, back aches or chronic tension in the neck and shoulders. Over time this can also lead to a foreshortening of tendons, ligaments and nerve endings that contribute to chronic sciatica or lumbago.
Having experienced a medical condition myself, which causes me joint pain and inflammation, I have tried to experiment with a variety of psychological and physiological approaches. This involves using mindfulness to deepen awareness of my embodied experience and a sensory-motor approach to pain relief. Over the years I have used mindfulness of breathing and body scanning to pay attention to the way pain is distributed and positioned in my body. I have also experimented with muscular-skeletal exercises, stretching, hot-and-cold packs, massage, cold-water therapy, sleep and exercises to adjust my posture. Whatever I do helps me take an active role in my own healing process. And I am reliably informed that ‘the body loves movement’.
By far the most successful way I’ve learned to cope with pain is by cultivating an internal state of awareness that involves the practice of “therapeutic reverie”.
Therapeutic reverie is a trance-like state induced by mindful breathing and relaxation techniques. By trance, I don’t mean anything more complex than being physically passive, while remaining attuned to my sensory experience – focussing attention on bodily sensations and emotions. I am aware that some people find meditation challenging so I’m not promoting a perfect state of zen, but simply a deepening of awareness, while the chatter in my mind becomes quieter. Occasionally, I experience a near absence of thought processes. It comes from remaining still while slowing myself down and breathing deeply until I feel completely relaxed. This is hard when you feel pain, but not impossible if you learn incrementally over time, especially during moments when the pain has subsided.
The reverie has its own particular quality. It feels a bit like a tingling sensation or a slightly spacious fuzziness inside my head. The body feels light. I remain fully conscious and alert from within, yet relaxed and receptive to the stimuli of the outside world. As if I have created two parallel states with an ‘experiencing self’ and ‘observing self’ – both feeling and observing the world at once. I imagine this is similar to a common experience we have all have while staring at the sunset, or into a fire, or up at the stars or far out to sea. Nothing more.
In this state, it can help to listen to my heartbeat or the sound of my breath as a way of tapping into my embodied experience. And then slowly turning my attention to whatever sensation I want to focus on – for example, feelings of pain. Once I have attuned myself to the pain, I wait quietly and patiently until I notice the nature and quality of my sensory experience or how it changes over time. I try not to judge the pain as good or bad, intense or weak. I try not to give into frustration or anger or let my mind wander. Although it often does… it’s quite normal.
However, when I become anxious or stressed I stay with the feeling, rather than suppress or ignore it. I become accustomed to it. It’s important to acknowledge your negative feelings as part of this process, but not get caught up in them. Allowing them to emerge and then letting go.
What I notice about any sensation is that however, intense, subtle or faint the signals may be it is always changing. Sometimes the pain ebbs and flows in waves, sometimes in spikes and troughs, or even in erratic and unpredictable ways. What I notice in the end, is that although sensations seem to flow seamlessly from one to another, there is often a gap between my sensations, emotions and thoughts. The more I pay attention to this pause in the flow of sensation, the more I realise that I fill the gap with apprehension or foreboding of the pain to come. This gives rise to the feeling or belief that the pain will never end. I am trapped in a cycle that I can’t let go of.
For example, the inflammation in my joints often gives rise to a throbbing pain a bit like the pulsing rhythm of my heartbeat. At the peak of the throb I feel acute pain and at the bottom of the throb something else happens – there’s a tiny gap. I notice that I fill the gap with the anticipation of the pain to come, rather than find relief or rest in the gap. It may only be a few milliseconds before the throb of pain returns, but there is still a gap. As I pay closer attention to the gap, however, something else emerges from that moment…nothing.
There is no pain. There is only a gap or the absence of pain.
What I mean is a kind of sensory silence in the gap in which no pain exists at all. At first, I only notice this as a momentary pause, but the more I notice the more I turn my full attention towards the gap in which I feel no pain… only relief. It is an exquisite, yet ordinary sensation. All the more precious because I have learned it by stealth. And over time the more I notice the monetary absence of pain, the more it attains yet another quality. Cumulatively over time, I begin to realise that rather than experiencing pain or anticipating pain; I spend half the day in pain, and half the day without it.
If I am able to practice this routinely over a number of days, along with the other physical techniques of pain relief, I am now observing and experiencing far stronger feelings of relief than the pain itself. Although the pain is never entirely diminished or eliminated, I am not so caught up in it. Nor do I allow feelings of anger, despair or frustration to coalesce around it. The stress is only in the power I give to the pain, to disrupt my conscious awareness with its presence. So rather than give it airtime, I focus on the seamless flow of my lived experience – which is constantly shifting and changing – whether my mind and body are suffering or not.
That is a great relief.
While I am aware this technique sounds too simple to be true, there is really nothing complicated about it. It’s not easy to learn, but it is simple. It doesn’t bring immediate gratification. You fight it. You struggle with it and it can be frustrating. But if you stay with it and persevere you can get very real results. Be persistent and as patient as you can be, recognising that all change is incremental. What have you got to lose by practising… only the pain?
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About Gregori Savva
I am Greg Savva. An experienced counsellor at Counselling Twickenham, EnduringMind. I believe in a compassionate, open-minded approach to counselling as the best way forward for my clients. I focus on helping you make sense of erratic thoughts and emotions. Offering you a chance to gain self-awareness and change for the better.