Christiane Wolf - Outsmart Your Pain: Mindfulness and Self-Compassion to Help You Leave Chronic Pain Behind

Introduction

An Opportunity to Change Your Brain

We are in the middle of an unprecedented pain epidemic and a related opioid epidemic. There have never before been so many people struggling with chronic pain or higher demand for pain relief. Today, the leading form of pain relief is pharmacologicaland while the existence of pain medication is without a doubt a blessing, its use also comes with many unwanted side effects, including potential addiction to opioids.

The Centers for Disease Control and Prevention (CDC) state in their 2016 recommendations that non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain. Alternative treatments such as mindfulness and compassion practices, then, are paramount to fighting the epidemic, but they are not yet widely accessible as a treatment for chronic pain.

Over the past several decades, mindfulness and compassion practices have entered the mainstream and are now introduced and prevalent in settings as diverse as schools, workplaces, community centers, and government offices. Theyre being adapted for use by doctors and nurses, athletes, police officers, firefighters, and in the military, as well as for veterans with post-traumatic stress disorder. One of the biggest arenas for the application of mindfulness is in health care, especially but not exclusively in mental health treatment. Mindfulness-based interventions are increasingly accepted as evidence-based practices, supported by a growing number of health-care insurers and health-care professionals. Each year there are more scientific studies of mindfulness than the year before: While there were a handful of articles published in scientific journals on mindfulness in 2000, by 2018 there were nearly 850.

Mindfulness practices are increasingly popular because they are effective, easy to learn, and have few, if any, side effects. The most common so-called side effect is that it gets worse before it gets better. Why is that? Because as we turn toward our experience, instead of turning away, we start to understand and feel whats been there all along. This practice teaches us the equation:

suffering = pain x resistance

In other words, if we resist an experience like pain, or worry about it, our overall struggling and suffering increase. And while we often cant change the pain, we can change the level of resistance.

If this realization feels too overwhelming, simply back off. Go slower. Take baby steps. Its OK to be a slow learner!

I encountered mindfulness and meditation as a young adult while looking for a spiritual path and a deeper meaning to life. Many people helped me find my way, including some Buddhists who also practiced Insight Meditation. I was taken in by the relaxed, loving, and joyful way they showed up in life, and I started practicing and studying these ancient wisdom teachings. Entering medical school and then doing my residency as a gynecologist at the university hospital in Berlin, Germany, these practices helped me stay sane and grounded through many, many hours of rigorous training. I specialized in gynecological oncology, where dealing with emotional and physical pain is a daily occurrence. My meditation practice helped me become a better physician by allowing me to be more fully present with patients and their familiesto listen deeply to the fullness of their experience no matter where the course of the cancer was taking them.

Back then I never taught meditation to my patients because secular mindfulness wasnt as well known and accepted as it is today. I wished, though, that every patient and everyone around them affected by the cancer could have these amazing tools to learn how to hold all of life in loving awareness.

In 2003, my husband and I, with our then five-month-old daughter, moved to Los Angeles for just one year. Now, seventeen years later, we are still living in Los Angeles andto my own biggest surpriseI never went back into gynecology. While the process of moving on from that career was long and did not unfold easily, but which I loved dearly nevertheless, I found a new central focus for my professional life. I became an Insight Meditation teacher and discovered the power of secular mindfulness, becoming a teacher and teacher-trainer for Mindfulness-Based Stress Reduction (MBSR), the transformational program Jon Kabat-Zinn, PhD, founded in 1979 that has since spread worldwide. Since 2005, I have been teaching mindfulness classes for people who suffer from chronic disease and pain, and have been learning and growing together with my students ever since.

Because English is not my first language, I am acutely aware of the power, importance, and pitfalls of translation. My goal, then, is to translate complex practices and theories of these ancient wisdom traditions as well as scientific concepts into clear and easy-to-understand languageand to make the practices relevant and applicable to you, the reader of this book.

How can mindfulness and compassion help you with chronic pain?

Pain is a complex experience in which the physical component plays a major role, but not the only one. The two other main players are as follows:

1. emotions , how we feel about the pain, such as anxious or resentful, and
2. thoughts about the pain, which we call the pain story (what happened, what went wrong, what that means for our future, and so on).

The three components influence each other significantly: If we are able to lessen the impact of emotions and the pain story, we can lessen the overall level of pain experienced. This is how mindfulness can help.

Compassion eases pain by bringing a loving or caring presence to the painful experience. We all know how good and healing it is to feel compassion from another person, whether a loved one, a nurse, or a doctor. Many people find it hard to be compassionate to themselves, but it can be just as therapeutic as from another person, so its a worthwhile skill to learn. Together, mindfulness and compassion are powerful allies to have on your healing team.

Many patients wonder: Will mindfulness free you of your pain for good? I honestly cant say, since each persons journey is unique. I have seen some patients migraines, back pain, and other pains resolve completely with this approach after a just a few months, almost miraculously. Most people who engage in these practices in a serious and committed way find relief, calm, renewed energy, and joy. I have also seen virtually no change in some others. Pain is too complex for an easy fix, however much we wish for it. There is strong evidence that trauma, especially repeated childhood trauma, is connected to an increase in physical symptoms and disease in adulthood. How could it not be?

We know about the devastating effect of chronic, toxic stress on the body. The practice of mindfulness and compassion is a doorway into unwinding and releasing stress. When stress levels decrease, it can be felt in all three of the major players: thoughts, emotions, and physical sensations. The practices you will learn in this book are meant to be complementary to other methods that you have found helpful on your healing journey.

Is the goal of mindfulness to get off all pain medication?

This is such a common question! No, getting off all pain medication is not the goal. I have often seen people who think that this is the goal get stressed-out in their meditations. This belief also suggests that as long as you are on medication, you are a bad/not-good-enough meditator. In my experience, meditation and medication work really well together. It is true that mindfulness practitioners often find that they can lower their dose through regular meditation and get more of a feel for how much is enough and when more is needed. As the emotional pain decreases through the practices mentioned here, so does the dosage of their meds. Often, people can go off of their medication for longer periods of time or can switch to an as-needed basis. This is true not only for pain medication but also for those that treat insomnia and for mood-stabilizing drugs.