Working with Physical Pain
Since it is a guaranteed experience from birth onward, there is an abundance of wisdom out there about how to work with physical pain. Everyone reading this knows pain and has learned different ways to deal with it. This post is a tiny contribution that will hopefully help with some piece of your journey. This post will focus on ways to work with the mental side of pain and ways to work with your neurology for increased support and ease.
The first thing to say about pain is that it is essentially the sensation of your body and mind experiencing something that it clearly does not want. The more intense the pain, the harder it is to focus on anything else. Pain is an attentional vortex that is really good at sucking you in. It’s super easy for the intellect to say, “just focus on something else” or “pain is temporary” or “suffering is optional.” And, it turns out that those kind of comments usually are a great way to just lump anger and/or shame onto the pain you are already feeling.
So, when working with pain, it’s really good to start with kindness and compassion. Dealing with pain means your mind and body is working diligently just to keep you somewhere near your normal. Which means being at lower capacity for just about everything else that takes energy. This usually shows up as being emotional and reactionary in places you usually wouldn’t. This is going to happen. It makes sense. It’s a good place for some compassion for self and others. Because pain is going to be there and working with it is a process, we are focusing on what helps and makes it and/or your relationship with it better as opposed to what makes it go away. Unfortunately, nothing in this post will make pain go away forever :(
A Few Things to Consider About Pain Itself
The actual physical sensation of pain (see the ISOMA post for more on sensation) is a really tricky thing to pin down when you pay attention to it. So many sensations fall under the category of pain, and sometimes the same sensation will be pain in one context but pleasure in another context. One perspective about pain is that it is the nervous system’s way of saying that there is simply too much information happening at once. Pain comes hand in hand with aversion, meaning that the mind wants to get rid of it. So one way to understand pain practically is to break it down into the 1) the mental reactivity and 2) the actual physical sensation.
Mental pain is like the white triangle that you see in the below image:
Did you see the white triangle? Look again and see if there is actually a white triangle.
Actually, there are six black shapes and no triangles at all in this image. While this is a fun illusion, it is also a profound revelation of how our minds work. Our minds are made to make meaning and sense out of an unbelievable amount of incongruent information. If our minds didn’t do this, we wouldn’t be able to find our shoes, let alone tie them. Or really do anything else. It’s how the human mind works (along with so many other beings.) This is helpful until it is not. With pain, we are getting a whole lot of different physical sensations that the mind is lumping together as the “white triangle” of pain. We end up reacting to this white triangle more than we are to the actual sensations. When the mind lumps all of the sensations together as pain, then it goes into the core pattern of aversion. Aversion is an embodied commandment to “make it go away.” When this happens, our attention gets pulled into fixating on how to make it go away. This is a negative reinforcement cycle, which basically says, “I’ll feel good when it’s gone.” So this usually ends up hoarding our attention (for days or years in some cases) toward the pain: toward fixing it or testing to see if it’s better or seeing if it is worse or trying to make sure it is really gone when you don’t feel it as much or trying to “figure it out.” All of these are wonderful impulses that are trying to serve you.
These impulses turn into suffering when they run the attentional show of your life.
But there is good news here :) While we can’t make pain go away, there are a lot of opportunities in this cycle to do something different that will increasingly reduce your suffering and let more positives and simple pleasure into your life.
The Attentional Game
The negative reinforcement cycle that fixates on making the pain go away can pull so much of your attention that it edits out low-intensity pleasure. It will equate the cessation of pain with feeling good, and in many cases it won’t let you feel good until you can be absolutely sure that it is absolutely gone. Which keeps you fixated on the pain or any associated experiences that might trigger it. Which can turn your experience of the body or the world into something like trying to navigate a mine field. When you are walking a mine field, you don’t tend to stop to smell the roses. That’s a tendency of the human mind.
Low intensity pleasure is happening in your experience almost all of the time. The same way that the smell of roses is actually there whether you stop to pay attention to it or not. The attentional vortex is just dimming the low intensity pleasure to almost or completely undetectable. It’s editing out the nerve signal because, in the negative reinforcement cycle, that signal is not important. Just because you got novocaine at the dentist and you can’t feel your teeth, it doesn’t mean your teeth aren’t there. Same with the pleasure. And, if you attend to the pleasure, the nervous system will start registering it as important. It will grow. And this will shift that cycle. And then, instead of a mine field, you may notice that there are some rest areas in your environment and some nice walking paths that seem totally safe. Your nervous system will switch toward more of the “rest, digest, repair, connect” side of things, which is essential for the body’s healing process.
Some Practical Strategies
Of course, do what you know is good for your body, and work with people who are skilled and helpful with your particular kind of pain. It’s really helpful physically as well as mentally to not have to do it alone. Here are some strategies that you can experiment with:
Orient. Pain is internal, so it often pulls your attention inside. If your attention is not pulled into the physical sensation, then the attention often seeks to evacuate the body by “being in your head.” Basically, we get stuck in thoughts- which are usually not a lot of pleasant thoughts since we are still in the negative reinforcement cycle. If we do have our attention outside, it’s often turned toward what we need to get done or toward a potential problem (stuck on the negative reinforcement state of fixing and doing.) Orientation means actually connecting with your environment through your five senses. It is not fixating. You are actually not doing much. It is connecting. It is letting. The outside is already there. This is so nutritious for our nervous systems, and it is a chance to get the attention on something wholesome that is not related to pain or the negative reinforcement cycle.
Work where it is easier. Cultivate awareness of simple wholesome pleasantness in easier environments or conditions. Basically, find the places where things are NEUTRAL or where simple, wholesome, non-addictive pleasure is already happening in your life: a moment looking at the bird feeder or the dome of the sky; petting an animal; cozying up in bed; a sip of tea; the smell of something baking; the feel of leaning back in your chair. Work on cultivating this awareness here as opposed to when you are in tremendous pain.
Practice attention to the neutral and the pleasant. The power of neutral can’t be underestimated. Neutral means that it just is. You don’t have to manage it. You don’t have to assert your preferences on it. It is as it is. There are usually tons of things in your environment that just are: a pen, a door handle, a mug, a rock, a leaf on the ground. What registers as neutral is purely based on your personal experience in the moment. You can experiment by looking away from the screen right now and asking yourself what, in your immediate environment, registers as pretty much neutral.
An awareness of neutral in your environment will help you strengthen the part of the mind that just observes. This will, over time, reduce your tendency to be reactionary. And, in the immediate, noticing neutral usually ends up making you feel better.
When you find a moment of simple pleasure, intentionally notice it, and then intentionally see if you notice how the body physically (as a sensation) registers this simple pleasure. Do this with curiosity and as little attachment as you can. Notice it like you notice something pleasant in nature: a simple flower, a cloud passing, a songbird perched on a limb, a slant of sunlight. You don’t own it. It won’t last forever. You do get to enjoy it for some moments and you let it pass.
Mindfulness reduces reactivity. A contemplative practice like meditation will reduce your aversion. It will increase your ability to choose where you move your attention. It will reduce the intensity of the pain vortex, and it will disintegrate some of the pain signals so that the mind does not register them as pain.
When you work directly with the sensations:
Working with the physical sensations of pain is an art form. It is a lifelong journey of discovery in the art of living. That said, for these purposes, keep in mind that working directly with the pain is something that is best done sparingly. If you fixate on the sensations, you will trigger that negative reinforcement pattern that just wants to fix it and get rid of it.
So, using a guided body scan (you can find plenty on the web or with meditation apps) may be useful. If it is not, throw it out. If you do scan the body, make sure you notice the subtle sensations in the places that are not painful. Develop your awareness here. Notice that even pleasant and neutral sensations are actually composed of subtler sensations. You are developing the part of your mind that will not react so much to white triangles that aren’t there.
You can, sparingly, do this with the pain itself. You may find that the pain is actually composed a quite a few different sensations. And if you feel into it, you may find that you can’t even pin down what sensation is actually pain. Only linger here for a few minutes at most, then continue to other areas of the body.
Practice this all when it is easier and less intense. When it is too intense, practice any safe harbor in a storm. In times of high intensity pain, practice breathing techniques, resource supports from others or from your care providers, resource some wholesome distractions when you need to. Just help yourself get through it in the most wholesome way you can. You get the idea.
Orient again. Orientation is key. Rest in it. See what you enjoy in it. This is where you don’t do anything. Your nervous system will switch to its repair and rest state and, thankfully, you don’t have to control this any more than you have to tell your guts how to digest your breakfast.
Retire. The Tao Te Ching says, “When your work is done, retire. That is the way of the sage.” Practice for a bit, then teach yourself to let it coast and stop intentionally working. If you fixate on working, you are back to “fixing” which lands you right back in the negative reinforcement cycle. After a little practice, rest is best.
May this post give you a little extra support, skill, and grace in your journey.
Thanks and be well!
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