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kalikshama -> RE: The Problem of (non-BDSM) Pain (1/2/2013 1:45:39 PM)
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Can Buddhist practice liberate us from the prison of physical pain? How can meditation help when medicine falls short? Jon Kabat-Zinn, Ph.D., professor emeritus of medicine at the University of Massachusetts medical School, speaks to these questions as a long-time practitioner of Buddhist meditation and hatha yoga, and as a pioneer in the use of mindfulness to treat chronic pain and illness. More than 13,000 people have visited the world-renowned Stress Reduction Clinic that Kabat-Zinn established in 1979 at the UMass medical Center, and the eight-week program- described in Kabat-Zinn’s bestseller “Full Catastrophe Living”- is now also offered at some two hundred medical facilities worldwide.
Tricycle editor-at-large Joan Duncan Oliver spoke with Kabat-Zinn in September 2002.
Let's start with a basic question: What is pain?
Physical pain is the response of the body and the nervous system to a huge range of stimuli that are perceived as noxious, damaging, or dangerous. There are really three dimensions to pain: the physical or sensory component; the emotional, or affective component, how we feel about the sensation; and the cognitive component, the meaning we attribute to our pain.
Let's say you've got a pain in your back. You can't lift your children; getting in and out of the car is difficult; you can't sit in meditation. Maybe you can't even work. That's the physical component. But you're having to give up a lot, and you're going to have feelings about that—anger, probably—and you're susceptible to depression. That's the emotional response. And then you have thoughts about the pain—questions about what caused it, negative stories about what's going to happen. Those expectations, projections, and fears compound the stress of the pain, eroding the quality of your life.
There is a way to work with all this, based on Buddhist meditative practices, which can liberate you, to a very large extent, from the experience of pain. Whether or not you can reduce the level of sensory pain, the affective and cognitive contributions to the pain— which make it much worse—usually) can be lessened. And then, very often, the sensory component of the pain changes as well.
You mean that once you've changed your relationship to the pain, the physical discomfort may decrease?
That's the key point: You change your relationship to the pain by opening up to it and paying attention to it. You "put our the welcome mar.' Not because you're masochistic, but because the pain is there. So you need to understand the nature of the experience and the possibilities for, as the doctors might put it, learning to live with it," or, as the Buddhists might put it, "liberation from the suffering." If you distinguish between pain and suffering, change is possible. As the saying goes, "Pain is inevitable; suffering is optional."
There have been studies looking at how the mind processes acute pain at the sensory level. Subjects are randomized between two groups, then given the cold pressor test, where a tourniquet is placed around your bicep, then you stick your arm into ice water. There's no more blood flow, so your arm gets very painful very fast. They measure how long you can keep your arm in the water as a function of whether you are given an attentional strategy, such as paying attention to the sensations and really moving into them and being with them as nonjudgmentally as you can—a mindfulness strategy, in other words—or a distraction strategy, where you just try to think about other things and tune out the pain. What they found was that in the early minutes of having your arm in the ice water, distraction works better than mindfulness: You're less aware of the discomfort because you're telling yourself a story, or remembering something, or having a fantasy. But after the arm is in the cold water for a while, mindfulness becomes much more powerful than distraction for tolerating the pain. While distraction alone, once it breaks down and doesn’t work, you’ve got nothing.
The Mindfulness-Based Stress Reduction program uses the body scan as well as sitting meditation to manage pain. Can you explain how the body scan works?
The Body Scan is a variation on a traditional Burmese practice- called sweeping, from the school of U Ba Khin. that S. N. Goenka teaches in his ten-day Vipassana retreats. The traditional method involves tuning in to sensation in a narrow horizontal band that is slowly brought down through the entire body as if you were giving yourself a CAT scan. This is analogous to the way certain metals such as zinc are purified in a circular zone furnace. I thought it would be hard for people in chronic pain to sir for forty-five minutes, so I modified the practice. It is done Iying down starting at the toes and moving up through different regions of the body.
This practice is a way of getting out of the head and developing intimacy with the body. The challenge is, can you feel the toes of your left foot without wiggling them. You tune in to the toes, then gradually move your attention to the bottom of the foot and the heel, and feel the contact with the floor. Then you move to the ankle and slowly up the leg to the pelvis. Then you go to the toes of the right foot and move up the right leg. Very slowly you move up the torso, through the lower back and abdomen, then the upper back and chest, and the shoulders. Then you go to the fingers on both hands and move up the arms to the shoulders. Then you move through the neck and throat, the face and the back of the head, and then right on up through the top of the head.
And all the while, you’re in contact with the breath. I tend to have people feel the breath moving in and out of the body region they're attending to, so that there's a sort of dual awareness. As you move up the body, you're learning how to focus on a particular region, then let go of it and move on. It's like cultivating concentration and mindfulness simultaneously, because there is a continual flow. You're not staying with one object of attention.
Read more: http://www.bemindful.org/kabatzinnart.htm
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