Posts Tagged ‘Meditation’


In: Blog, Rheumatology

Comments Off on Mindfulness Resources for Chronic Pain

What is Mindfulness based meditation?

Mindfulness based meditation has been around for thousands of years. Whereas modern mindfulness practice has some origins in the Buddhist tradition, one does not need to subscribe to any particular faith to practice it. Mindulfness is defined as “the intentional, accepting and non-judgemental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment”. Don’t let the language used to describe it put you off….

On first look, the idea of paying MORE attention to ones pain may not initially make sense to someone suffering from it. But by paying attention to pain, Professor Mark Williams (writing in his introduction to the book, ‘Mindfulness for Health’) we become aware of the“very subtle processes which switch on automatically to turn up the volume of the very pain you want to get rid of. It is because these aggravating factors switch on automatically, without your awareness, that the spotlight of attention is needed. If it all happens ‘in the dark’ you remain lost and alone with your pain. But if you can shine a light of attention upon your suffering, then it begins to dissolve.”

There’s evidence of its effectiveness in the treatment of the symptoms of arthritis, fibromyalgia and low back pain, and also in depression and anxiety.

Most studies of the use of this type of Mindfulness are based on the work of Jon Kabat-Zinn a Massachusetts based scientist. His work demonstrated the effectiveness of mindfulness in reducing pain and the emotional reaction to pain in the setting of an 8 week course. Meditation Courses like this (i.e. specifically designed for chronic pain sufferers) are not widely available but thankfully there are now a number of web-based  / distance learning programmes available (see resources below).

There’s also variety of helpful guided meditation apps, CD’s and books. Although most of the available evidence that confirms the effectiveness of Mindfulness is based on those attending formal classes with a teacher (we don’t yet know how effective other means of learning mindfulness are yet), these resources are an excellent place to start.

Firstly, Here’s some videos I recorded about Mindfulness and pain management.



Please support your local bookseller by purchasing these locally. Dubray books don’t charge for postage if you pick up in-store.

Mindfulness for health – Vidyamala Burch and Danny Penman

This book is based on an 8 week course designed specifically with sufferers of chronic pain in mind. Written by two people who have used mindfulness to help ease their pain and help them cope with it, this an excellent book and primer for those interested in learning more. Included with the book is a CD with guided meditation to get you started.

Wherever you go there you are – Jon Kabat-Zinn

Jon Kabat Zin is the Massachusetts based scientist and researcher who is largely credited with introducing mindfulness to Western Medicine.

Mindfulness on the go – Padraic O’Morain (Padraic’s Website, with details of courses and an excellent blog also worth a look)


Headspace (Paid app after 10 days free). This is a really user friendly app (iPhone and Android) with great video animations which help explain mindfulness. Not specifically for chronic pain but excellent modules on stress and anxiety. I use this one myself daily.

Insight timer Free app for iPhone and Android with a variety of different meditation teachers and styles of meditation and a handy meditation timer. In-app purchases available


There is a great article written by Galway (NUI Galway) psychologist Michael Hogan describing the research on the use of mindfulness in pain management. Michael and his team have done some research on the effectiveness of a Web based pain management programme using mindfulness. Links to the audio files used as part of the course are also online.

This is the organisation who run the courses on which the Mindfulness for Health book are based. Great resource (mainly UK)


“All of humanity’s problems stem from man’s inability to sit quietly in a room alone”.

So said Blaise Pascal way back in the sixteen hundreds.

Last month, to the great amusement of some of my surgical colleagues, I attended a meditation workshop at the Royal College of Physicians of Ireland. It was delivered by Brother Laurence Freeman, a Benedictine monk and world leader in the practice of meditation.

Left to themselves, our minds tend to wander, continually reminiscing and ruminating about the past, anticipating and planning thefuture. When moments present themselves where we might have the opportunity to pause, there are now almost infinite ways of distracting ourselves using new technologies. The net result is that the present moment tends to get squeezed out. Therefore we tend to live in a state, Brother Freeman describes, of imperceptible disconnectedness. This lack of situational awareness may even lead to medical errors – one of the reasons that the “art of paying attention” is receiving so much attention in medical quality and safety circles.

Read the Rest at the Medical independent 

This year my wife and I decided to compile a list of all of the holidays we’ve had since we had kids. Its a nice list and we’re lucky to have travelled as well as we have.

I always get excited about going. There’s the anticipation of down-time away from work (and other peoples’ problems), time for relaxation, sleeping, eating, reading, and some quality time with my family. Life is just going to be better on holidays. I just know it is going to be. Of course it is.

But as Robert Louis Stephenson said , ‘It is better to travel hopefully than to arrive’.

A few days after my arrival, I eventually ‘land’. My initial holiday euphoria is fairly predictably replaced by a familiar funk of low mood, anhedonia, irritability and impatience. I am, as my wife often reminds me (usually after the event – I am usually far too irritable to receive criticism at that stage) ‘difficult to be around’. Although the mood inevitably lifts, it has spoilt a few otherwise perfectly good family holidays.

A few of my friends have confided similar experiences. A spouse of one of them even suggested that we all (‘the miserables’) all go a way for a few days and be fed up together instead of inflicting ourselves on our respective families.

Whereas it is well recognised that those prone to low moods in the darker months don’t like Christmas Holidays much but there is very little written about why middle aged men get depressed in up market resorts in Portugal.

I have come to the conclusion that we doctors are a bit like actors and other performers; we thrive well in an environment of high drama where there’s adulation on offer and can become quite dependant on it. Without the warm balm of that appreciative audience (families can find it hard to sustain adulation for anything more than a few days), a certain emptiness can take hold and whatever the ‘emotional dust’ we may have swept under the carpet between holidays tends to become visible.

Over the last few years though I have developed some tricks to reduce the feeling and to cope better with it when it comes. I think I’ve got it cracked.

1. Don’t expect you holidays to make you happy. Live your life as it happens, seeking enjoyment and relaxation on a day to day basis and don’t save it up for a few weeks in the Sun every August. It sounds trite but its true.I’ve found meditation great in this regard. It allows you take a holiday from yourself, every day.

2. Adjusting to a high pressure environment of work to the low pressure environment of holidays should be done gradually – like a diver resurfacing trying to avoid the bends. Although its hard, try not to overdo it work wise in the week before you go. If possible spend a few days at home before you jump on a plane or pack the car up.

3. Avoid the temptation to overbook the first few days after you come back. Adjusting from high pressure to low pressure can be hard but the reverse is even harder. The anticipation of knowing that you’re about to return to a crazy schedule can spoil the end of your holiday.

4. Disconnect from all forms of communication. I either bring a disposable ‘pay as you go’ phone or set my phone up to only receive calls from family members. No email, no social media, no internet browsing. Read some fiction and avoid all forms of reading that will return your mind to the workplace. This allows the problem solving side of your brain a chance to recover.

5. Try and take it easy on the booze – you may feel like rewarding yourself with a few extra drinks (especially on the first few evenings) but this only worsens the land when it comes.

6. Try and give yourself a daily holiday routine as doctors (and other workaholics) don’t do well with unstructured time. For me it involves getting up early and having some time to myself before the family wakes, a light breakfast followed by some exercise. Knowing that you will have some protected time for yourself will also can help you cope with the demands of the childcare later. Which you’ll definitely get asked to do if you’ve done all of the above.

7. If you begin to feel low, don’t panic. For those of us who have experienced clinical depression the feeling can be particularly frightening as it may be reminiscent of previous episodes. Let yourself fall and reassure yourself that the feeling is likely to be temporary. It will pass (all the usual advice about attending your own doctor applies if it doesn’t).

If you already enjoy your holidays and cannot identify with any of the above, I’m happy for you. But spare a thought for the sad looking guy at the pool bar. And tell him to take it easy on the booze…

 “All of humanity’s problems stem from man’s inability to sit quietly in a room alone.” (Pascal) 

So this week I spent an hour of my time listening to a recording of silence.

The silence I listened to was from a 3 track CD called Anail (Anail – the Irish word for ‘breath’). It is a series of recordings of the type of silence that can be heard at the ruins of three ancient Irish churches in North Tipperary at dawn. Bear with me.

The recordings include the quiet sound of wind blowing, birds singing, the rustle of wings taking flight, sheep baahing quietly in the distance, periods of actual silence and (to prove that the recordings were made in Ireland) the sound of rain falling on leaves. It is beautiful to listen to, calming and not at all as boring as it sounds.

The Anail recording is part of a project which hopes to teach school children life coping skills and to enhance their mental well being through mindfulness and meditation. Mindfulness is initially learned by teaching us how to focus on the present moment (using our breathing as a central focus to anchor our minds) while meditating. It acknowledges the inevitability that thoughts will intrude but allows us to learn to simply allow them to come and go. These recordings are intended to act as an acoustic backdrop to that meditation – allowing those meditating something to focus on – but also protecting the listener from the sounds and distractions of world around them.

Although this all sounds a bit ‘new agey’ there is a growing evidence that mindfulness based techniques may be useful for our mental health. Mindfulness based approaches help reduce stress levels in healthy individuals, increase feelings of empathy towards others, and may even add to the effectiveness of medical treatments for depression and anxiety. There is also emerging evidence that mindfulness techniques may help prevent burnout in health care professionals. Doctors and Nurses take note.

Although I think it will take some effort to convince younger children (and even their parents) to sit and listen to a recording of silence, I think it is an important way of raising awareness of the need to step back from the hectic, ‘always on’ world around us and to learn how to notice and pay attention to the voices from within us.

“In my adult life, the time I have actually lived inside the present moment would have amount to no more than a single day; it would have thrown its light into all the others, like a brazier in a dark arcade. Instead I find my way by sparks, and what they briefly make visible” (Don Paterson, ‘The Book of Shadows’)

The Cd is available to purchase online here.

Useful links

Wherever you go. there you are
The Art of Travel, Alain de Boton


Like a lot of other social media addicts, I fear my brain may be changing.

Constantly feeding my brain with a diet of high calorie online information and ideas, I am finding it increasingly difficult to switch the darn thing off. Hyped up on the sorts of epiphanies presented through TED talks, I sometimes have difficulty concentrating on the less stimulating conversations that make up the bulk of every day life. Where I used to read a novel a week, I am struggling to read fiction of any length and have a general feeling that I am skimming along the surface of things without time to reflect and dig deep. 

Of late, I have been imposing some discipline on my exposure to the online world and using some tools to restore myself to my pre-Twitter state. Heres’ some tips that I hope those similarly afflicted will find helpful

1. Delete all social media apps and email from your phone

photoHaving access to the perfect distraction tool on a device that I carry everywhere means that I am never bored. Therein lies the problem. Being constantly exposed to other peoples’ amazing ideas online, I have no time to allow ideas of my own to bubble up from the deeper recesses of my subconscious in those quieter moments of inactivity. 3 months ago I deleted all social media apps from my phone. The temptation to constantly check your Twitter feed wanes very quickly once it is not immediately available to you. Although I still check my Twitter and RSS feeds regularly on my desktop, I’m not doing it while waiting for the kettle to boil or while sitting in traffic on the way home from work.

Once I deleted social media apps from my phone, I found myself checking and rechecking my phone for (and responding to) email messages. Although removing email from my phone seemed like the natural next step, I was afraid of missing something important. I therefore initially signed up to a service called Awayfind. Away find is an email filtering service that will alert you (by text message) if you have received an important email – without the need to have to open your email client. You can set it to let alert you if certain person has emailed you (I couldn’t really think of anyone who I needed to add to the list) or pre-specified topics you don’t want to miss (I couldn’t think of any). Once I realised that I was unlikely to miss anything important I relaxed. If you call checking your email a few times an hour on my desktop relaxed.


2. Buy a disposable phone for vacation use

Fans of the series ‘The Wire’ will be aware of the concept of ‘a burner’ phone. A ‘burner’ is a basic ‘pay as you go’ mobile phone purchased by drug dealers to be used only a couple of times and then to be disposed of. Difficult to trace, lacking even basic internet access, and with a keyboard small enough to make it almost impossible to send text messages. I have taken to using a ‘burner’ on vacation’ leaving my iPhone turned off, to limit (to zero) the number of calls I get from work and any temptation to reinstall social media apps or email. Not sure if Marlo Stanfield would be impressed, but it gives me some proper head space for a few weeks a year. 

3. Try

How often have I sat down to write a blog or prepare some slides for a presentation and found myself 30 minutes later on some Website that has nothing to do with what I’m writing about and not even realizing how I got there. There’s a nifty app called Freedom (Mac only) which allows you to disconnect your computer from the internet if you want to avoid being distracted when you have some real work to do.

 4. Get Some Headspace

It is ironic that the thing I have found the most use in calming my internet addled brain is an app I downloaded from the iTunes and which I run on my smartphone. Developed by an ex Buddhist monk, Andy Puddicombe its called Headspace and it allows you to meditate every day, without recourse the chanting of a mantra, the use of wind chimes, incense or the Andy’s physical presence in your sitting room. Its available to download, free of charge (for the first 10 days) from

Although, by most standards I am probably more connected online than most, putting some distance between myself and the the online world has allowed me a greater sense of control over my online activities, a bit more downtime and having stepped back made me realise quite how hectic it had got. I’m getting back into reading fiction (ok, some short stories) too and trying to reground myself in the real world. Thats where the really good content is….