“Pain is a serious health issue,” Dr Bruno Cayoun says.
Pain is complex and subjective, however it is required for survival. “Interestingly, there are no pain receptors and no pain fibres in your body,” Bruno says. “Pain is a response to the perception of threat.”
The medial prefrontal cortex is the part of the brain responsible for self-referential processing. It’s the part that ruminates, remembers past experiences and projects future experiences. When we’re engaged in a task, this part of the brain goes to sleep. However, when scientists studied people with chronic pain, they found that while engaging in concentration tasks, this part of the brain remained active. People who transition from acute to chronic pain have created links within the brain between the experience of pain and learning.
“So, can we unlearn pain?” Bruno asks. “Mindful studies have shown that chronic pain can be unlearned.” Mindfulness is heightened sensory awareness without identifying with or judging what you are experiencing.
However, not all clinicians are skilled enough in mindfulness to teach their patients who suffer chronic pain, and not all people with chronic pain want to sit down and contemplate their pain – “it really is hell sometimes,” Bruno says.
Bruno tells us about a study that aimed to extract the most active component of mindfulness – equanimity – and see whether this was something they could teach pain specialists, so they could teach their patients.
Scientists asked people in the study to observe their pain objectively. A mindful exercise involved observing and measuring the pain using very different characteristics: “Is it very heavy, very hot, very still, very dense, very loose, very tight? Does it move? What shape is it?”
Bruno shares with us the experience of a woman with chronic pain after a car accident. After doing the mindful exercise, she had a significantly lower estimation of the amount of pain she was in: 3 out of 10 on the pain scale rather than 6 to 9 out of 10. The next part of the exercise was to introduce an element of unconditional acceptance. Much of the ‘negative’ qualities (heavy, dense, hot) were diffused after this, and her pain was rated only 1 out of 10. Even after the exercise had finished, she said that the pain was gone. “For years, we have been teaching this approach for emotional regulation,” Bruno says. Because there are no pain receptors and no pain fibres, this also works for physical pain.
Looking at pain, for just 30 seconds each time, and continuing to practice this mindful exercise with pain was highly successful. “It may change habits that lead to chronification, especially if we start early, before chronification begins,” Bruno says, “It is also a cost-free practice.”
Dr Bruno Cayoun is a clinical psychologist and principal developer of Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT)
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