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Mindful Awareness Programme (M.A.P) for pain management

February 7, 2019

Mindfulness was first used therapeutically in the West in 1979 by Jon Kabat-Zinn for the treatment of chronic pain. Perhaps what is mindfulness' biggest tool is to stop the tendency to try and escape your pain, either through distraction or by using substances such as prescribed or unprescribed medications to help blunt the experience. Mindfulness teaches a radical idea of turning towards your pain. A normal approach to any unpleasant stimulus is to try to avoid it. This might be public speaking,  an unruly child or dealing with pain. We learn to seek out pleasure and to avoid pain. The problem is the more we try to avoid pain, the more we tend to end up experiencing it. It is a bit like saying "do not let yourself think about a pink elephant". As soon as this has been said, we cannot stop thinking about pink elephants. Mindfulness meditation involves sitting in a calm space and listening to your breath or sound and has very real effects on pain just by this action. Anything that takes us out of fight/flight/freeze mode (the sympathetic nervous system) and puts us into the feeling of safety and relaxation (the parasympathetic nervous system) has a measurable effect on pain. This in itself is not unique to meditation, as you can gain the same response listening to pleasant music, or a relaxation recording or even having a swim in cold water.

 

What is unique to mindfulness is in this calm state to allow yourself to be open to the pain. This requires us to stop fighting it in both our mind and body, perhaps by letting go of contracting muscles that are constantly trying to protect us, which can become problematic or painful in itself. By opening up to our experience and the contents of our mind in the present moment (open monitoring) and not being overly caught up or judging  the meaning of sensations in a narrow focussed manner,  we can start to reappraise the experience and even begin to see the pain as something that we can begin to separate from, not needing to get overly involved with (decentering).

 

When we have experienced pain for a long time, it is common to try to live out in the world, through our senses, than look inwardly at our bodies own painful messages. As our body produces a constant stream of messages, we need to understand them and filter out which is most important to us in that given moment. These messages are our feelings and these feelings create our emotional life and give us information about the state of our bodies and how we need to respond. It may tell us we need to eat, drink or scratch an itch. It is important to understand also that pain is part of the same circuitry (interoception- the perception of feelings from our body, or more simply "Body Awareness"). If we have a deficit in interoception this can effect pain as we may miss or misread information arising from our bodies that can lead to an increase in pain and suffering   (https://www.sciencedirect.com/science/article/pii/S0149763416300197 ;  http://www.somasimple.com/pdf_files/difficulties_lbp.pdf ;     https://pdfs.semanticscholar.org/918c/1961b577b5eeee4dda96c34cbd8a4d0d2982.pdf ).

 

Another aspect of M.A.P is that of positive affect training. This means using techniques, such as affect labelling, gratitude and savouring to help produce positive feelings, thoughts and actions. It is often thought that mindfulness is a bit sniffy about those seeking pleasure and  is often used therapeutically as a means of relieving suffering. However Buddhism has always placed emphasis on well-being and building positive thoughts in our lives has been shown to have positive effects on pain and helps us build resilience when times get tough (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4201897/ ).

 

 

An aspect that often gets forgotten in mindfulness, or any psychological therapeutic interventions is that of exercise. True mindfulness courses do have elements of yoga and movement, but M.A.P puts more emphasis on exercise according to each participants abilities. That is why a 90 minute personal interview before the programme starts is so important. It gives us a chance to speak one to one and gives the teacher the opportunity to work out an agreed programme of exercise to use both in and outside the classroom setting to further improve outcomes. There is an emphasis in M.A.P generally in tuning into the body and (re)establishing a healthy understanding of your bodily messages.

 

There is a lot packed into this course, but with commitment and courage I believe that everyone living with pain can gain benefits from completing M.A.P.

 

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