Working with Pain

Working with Pain – Summary of Mindfulness Strategies

At one time or another, we will all want to learn how to utilize our meditation practice to work with pain. There is no literal, paint-by-numbers prescription for relating to pain; however, there are several important teachings and skillful awareness practices to consider when working with pain and unpleasant sensations.

Key Teaching: “Pain is inevitable; suffering is optional.”

  Anything we bring awareness to deepens our presence and freedom. Because pain is an inevitable and frequent visitor, the intention to let this be a gateway to awakening will powerfully energize your path.

  Relating to pain with curiosity and kindness directly transforms your experience into a pathway of freedom.

  When we resist pain – by physical tensing, emotional reactivity, mental judgment or behavioral avoidance – our identity, becomes linked with pain. Resisting turns unpleasantness into suffering. This is sometimes presented as an equation: Pain x Resistance = Suffering.

  Awareness is the antidote to suffering, i.e., bring on the mindfulness! By purposefully bringing mindful attention to pain and the resistance to pain, the identification that creates suffering is dissolved.


What follows are a range of strategies for finding balance and presence in the midst of challenging sensations:

Mindfulness of sensations: Purposefully attending to the changing sensations of moment-to-moment experience. This means bringing a clear, allowing, investigative, kind presence to the unpleasant sensations, and to the physical resistance around the most intense sensations. Be aware of the ways the sensations change. For instance: increasing or decreasing intensity; spreading or consolidating; heavy, light … or any other related kinesthetic experiences (texture), or visual experiences (color), that are predominant.

Mindfulness of attitude: Purposefully attending to our reaction to the pain. This includes whatever emotions or thoughts are arising in relating to the pain. You might ask: How am I relating to this uninvited sensation? What is my attitude? Am I pushing away in some form of aversion? Is there judging? Am I feeling oppressed? Victimized? Am I afraid of what else will happen? Or, maybe there exists an equanimous non-grasping or non-pushing. Maybe you are relating with interest, with friendliness. Often, simply “checking the attitude weather” can increase presence, space and freedom in responding to the unpleasantness.

Arousing More Sense of Space: Consider this: A heaping tablespoon of salt in a 4 oz glass of water offers a very salty experience – the same heaping tablespoon of salt in Lake Superior … not so much.

One way of sensing more space is by becoming aware of a larger set of phenomena than just the area of physical pain. For instance, the touch of air on your skin, the touch of clothing, sounds, colors, or the dance of shadows with the dappling sunlight, etc. Essentially, you are increasing the number and nuance of phenomena that you are directly experiencing, thus diluting the strong sensation. It becomes one of 30+ phenomena as opposed to the center of the known universe.

You can also expand your sense of space by becoming aware of the neutral and pleasant sensations within the body. You might consider unpleasant sensations as Domain 1 and neutral and pleasant sensations as Domain 2. Take some time to notice the areas within your body that are not filled with unpleasant sensation, and then establish a mindful presence in the space of Domain 2. Naturally you will be drawn to the unpleasant sensations; simply notice that and arrive again in the domain of neutral or pleasant sensations. As you find some stability there, gradually explore, with mindfulness, the unpleasant sensations. Sense the possibility of the space of Domain 2 loosening and dissolving your identification with, and reactivity to, unpleasant sensations.

Yet another way to find more space around pain is by using your breath. Breathe in and gently contact the area of pain. With the outbreath, imagine letting go into the boundless space around you. Sense the pain floating in vast space.

Extending on this, by using your imagination, visual attention and listening, you can reconnect to the space that is always here. This usually begins by attending to the space around you – perhaps by utilizing a soft “far mountain gaze” or listening to sounds and sensing the space in which they are happening. You can then sense that space within you…sense that there is a soft space of awareness around the strong sensations. Imagine that sensations are floating in that space. With some training, it is possible to begin to sense the space inside sensations. Just as there is vast space inside an atom, within all cells, within all mass, there is vast space inside sensations as well. Inner and outer space are actually continuous space.

Pendulate Between Contact and Space: Once you have reconnected to a sense of space, then it can be skillful to move back and forth between the intensity of direct contact with the painful sensations and the sense of the larger space around them. Gradually you will be able to experience the space bathing and infusing the sensations, allowing them to move more freely, and the identification with them to loosen. Alternately, you will notice the sensations releasing into space, and floating more freely there. Eventually you’ll find that this infusing and dissolving are the same – and that there can be unpleasantness without suffering.

Along with pendulating, you can also use the breath to deepen contact with both sensation and the remembrance of space. With the in-breath, allow yourself to fully experience the sensations, without resistance. With the out-breath, let your awareness merge with the vastness of continuous space that is within and around you.

Have a Little Heart: The recognition that “this hurts,” “pain is known” or “I am suffering” can elicit a softening and opening of the heart. When a two-year-old comes to you crying, do you offer an intellectual discussion about how learning to tolerate discomfort strengthens character? Generally not, you simply give them a hug and some TLC. When we recognize that we are hurting and our heart opens like a gentle soothing embrace to ourselves, a little more space is created. Care is a primordial necessity. Can we do this for ourselves? Can we help others to open to that capacity of caring for themselves?

When the Going Gets Really Tough: Temporary distraction or “resourcing” may be indicated when perspective is lost and identification is high. Resourcing is simply moving one’s attention away from the strong sensation to a pleasant or neutral area in the body, to something pleasant or neutral that is external to the body, or to an image, message, or memory that gives a sense of ease and safety. This aids the sympathetic nervous system in helping the body to relax.

For some people, it is helpful to resource by focusing and relaxing with the inflow and outflow of the breath. You might let your breath be long, slow and deep, and match the length of the in-breath and out-breath without pausing in between. This kind of directed breathing calms the nervous system and can help you to relax with what’s happening.

Sometimes it is wise to fully shift gears and engage in another activity. Pain can be exhausting to work with – you might need a break, a chance to regain some resilience and perspective, some humor and balance. Reading, watching a movie, doing light manual work, or listening to music are all ways of distracting or redirecting the attention. Yet, not all ways of shifting attention are equal. Some actually help move you toward balance – such as a walk in nature or time with a friend. Others simply distract the mind and give you a space without pain. While these distractions can be temporary skillful means, they may be overused. When you become habituated to distraction, your senses, heart and natural intelligence are closed off. Life becomes smaller….dulled out.

Naturally, it is part of a compassionate response to take appropriate care of yourself – medically and otherwise. If you need to call 911, tap the numbers mindfully.

Inquiry – Who or What is Suffering? : When pain is relentless, Zen teacher Darlene Cohen turns in this direction: “The most powerful tool I’ve found for mitigating pain’s impact is a short meditative formula repeated many times in the Buddha’s discourses: ‘Whatever feelings there may be – past, present, or future – all feeling is not mine, not I, not myself.’”

Essentially, this means connecting to the awareness of anatta, or the concept of “no-self” – the realization that there is no solid, static entity that something is happening to…no ownership, just moments of experiencing. For many people, turning to anatta can be a subtle form of dissociation; but, when we are very present, completely open and in contact with unpleasantness, then this remembrance of emptiness is directly freeing.


Below are some resources that you may find helpful in building your understanding of how to work with pain:

The Dance with Pain – Tara Brach
“Pain is inevitable and suffering is optional.” In this talk Tara explores the difference between pain and suffering and examines the most common, yet often unconscious, ways we resist pain. She then shares practices that help us find balance, equanimity and awakening in the midst.

Guided Meditation: Radical Acceptance of Pain – Tara Brach

How to Transform Your Relationship with Pain – Jonathan Foust
This talk explores strategies to help you shift how you relate to pain and physical discomfort. You’ll learn what the Buddha taught about being with physical distress, how discovering your reactive patterns can reduce unnecessary suffering and how to apply specific techniques that can help you use unpleasant sensations as a transformative practice.

My Path with ArthritisDarlene Cohen is a Zen priest in the lineage of Suzuki Roshi and has a graduate degree in physiological psychology. She is the author of Turning Suffering Inside Out and works with groups dealing with physical and/or psychological pain.

In this talk Working With Pain, Bhikkhu Bodhi describes his personal experiences with severe chronic pain since the 1970’s and discusses ways to work with and manage pain.

How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and their Caregivers, by Toni Bernhard (Wisdom Publications, September 2010). “Until forced to retire due to illness, I was a law professor for 22 years at the University of California – Davis, serving six years as the law school’s dean of students. I had a longstanding Buddhist practice and co-led a weekly meditation group with my husband. Forced to learn to live a new life, I wrote. The book is Buddhist-inspired but is non-parochial. The tools and practices in it are intended to help anyone.”

The Open-Focus Brain, by Les Fehmi, describes how the quality of our attentive awareness affects well-being. It includes guided meditations on a CD that support a less fixated, more expansive way of being in the world thus promoting healing of all sorts. It’s an excellent example of the growing wave of secular dharma offerings.

The Healing Power of the Breath: Simple Techniques to Reduce Stress and Anxiety, Enhance Concentration, and Balance Your Emotions