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Carolyn McManus, PT

Chronic pain means you are likely to have more stress than people who don't have pain. You have probably noticed that when your pain is worse, you feel more stressed. It's true: pain is stressful! Also, having pain means you may be able to do less in your life and this can create stress. Stress is associated with tighter muscles, poorer sleep, anxiety, shallow breathing patterns, depressed mood — and all of these lead to worse pain! Without even knowing it, you may be medicating pain flares that are fueled by stress. Instead of focusing on medication, you can learn how to reduce the stress and will find you need less medication.

Mindfulness Stress Reduction

Why should I use the Mindfulness Technique?

How you choose to respond to the physical sensation of pain has a major impact on how your nervous system creates pain and on the quality of your life. Your automatic reactions to pain often amplify the pain generating activity of your nervous system and cause an increase in your pain and distress.

Mindfulness techniques are evidence-based practices (research has been done and published in the medical literature) that help change the nervous system back towards a normal non-pain state.

Through the Mindfulness Technique:

  • You can learn skillful responses to pain that reduce pain and distress.
  • You can identify and choose skillful responses to more effectively manage pain.
  • Consider the following equation. Do you relate to it?

    Pain = unpleasant physical sensation + your physical, cognitive (thinking, understanding) and emotional reactions to the sensation

Mindfulness means present-moment awareness and offers you a constructive, practical and effective way to observe your physical, cognitive and emotional reactions and make skillful choices that can decrease your pain and distress.
Remember you may not have control over the sensation of pain, but you do have control over your reactions to the sensation of pain. Your choices directly impact your nervous system activity.

Steps to Get There

Formal Mindful Awareness Exercise

  1. Pause now and direct your awareness to your body and breathing. Listen to your present-moment experience with a stable, steady mind. Some sensations may be pleasant; others, such as pain, may be unpleasant; and still others neutral.
  2. Imagine your mind is like the sky, and the pain is like a cloud in the sky.
  3. Listen with compassion. Be kind to yourself. Listen with the same friendliness you would offer a loved one if he or she were in your situation.
  4. Avoid any tendency to judge or criticize yourself. Pay attention to your body as if you were doing so for the first time. Accept your experience just as it is without needing to change or improve anything.
  5. Deliberately scan your body. Observe your feet, legs, torso, hands, arms, shoulders, neck, face and head.
  6. When you have completed scanning your body, let your attention rest with the rhythm of your breath. Breathe deeply.
  7. Observe your abdomen and rib cage move with your in breath and out breath, here and now. Breathe into your waistband.
  8. Count each exhalation. On the first out breath, say to yourself "one," on the second out breath, say to yourself "two," and so on up to the tenth exhalation. When you reach the tenth out breath, return to "one" and begin again. When your mind wanders, label it "thinking" and return your attention to your breath and the counting practice. Begin again with "one." Continue for 5 minutes.

A wandering mind is the most common concern people have when beginning to meditate.
This is normal and not a sign that you are doing something wrong. When you become distracted from the present moment, notice that your mind has wandered like a cloud drifting by in the sky. Avoid judging your experience as right or wrong. Note "thinking" and return your attention to the present moment and your breathing.

Although these instructions may sound simple, the mind quickly wanders off and becomes lost in thought. Pain is also distracting. Just as the body can be trained to perform with greater strength and endurance through regular exercise, the mind can be trained to function with greater stability and clarity through this mindfulness practice. Begin practicing this formal mindfulness exercise for 5 to 10 minutes each day.

Informal Mindful Awareness Exercise

An informal practice involves bringing present-moment awareness into daily activities. For example, when walking, notice your present-moment experience. Notice your breath, the sensations of your feet when they touch the ground and the feeling of your legs moving through space. Or, when you wash your hands, again, notice your breath, the warm water on your fingers and palms, and the sensations in your shoulders. Any daily activity can become an informal meditation practice.

Mindfulness and Pain Management

  • You are not your pain.
  • Pain is a physical sensation, not your identity.
  • You are a whole human being who is dealing with a medical condition.
  • By learning to be mindful, you can observe pain with a stable, compassionate and curious mind. You can identify pain sensations and your physical, mental and emotional reactions to pain sensations. This alone is helpful.
  • You can experiment with new responses that reduce your distress and often decrease your pain intensity.
  • By training your mind to be in the present moment, you also worry less about the future and put your energy into skillful choices and living well today.


  • The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management by Jackie Gardner-Nix
  • Full-Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness by Jon Kabat-Zinn
  • What Meditation Really Is with Jon Kabat-Zinn, http://goo.gl/dXjpK
  • Guided Mindfulness practices with Jon Kabat-Zinn, http://goo.gl/6aQPV
  • Cognitive Neuroscience of Mindfulness Meditation with Philippe Goldin, Ph.D., http://goo.gl/Idnw
  • Guided Mindfulness Meditation Body Scan, http://goo.gl/rpk9R
  • University of Wisconsin, Department of Family Medicine: Guided Meditation Instruction by multiple teachers,
  • Mindfulness meditation CDs can be found at www.carolynmcmanus.com