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Pain Management with Mindfulness… while passing a kidney stone!

Posted Feb 21 2012 9:28pm

This article explores pain management with mindfulness including an exercise in sensation surfing for pain management to help anyone in need. I’ve also included an account of my own experience using this exercise in the midst of a kidney stone attack.

The full sensation surfing exercise is located at the end of this article though in summary a mindful approach to an experience that is causing pain, is to continuously bring yourself into inquiry and application of the following:

“Tune in, Relax, Accept, Relax, Allow, Relax, Breathe, Be”

Tune in; what am I feeling, thinking?
Relax; where am I experiencing tightness and bracing in my body and can I disengage or relax these muscles?
Accept; where is the sensation of my breath strongest and how long can I keep it there to accept and allow what I’m going through?
Relax; can I relax my tense or bracing muscles even more?
Allow; what are the unique experiences of this pain that I’m going through and how long can I ride the sensations for?
Relax; it’s overwhelming, where am I experiencing tightness and bracing and can I disengage or relax these muscles again?
Breathe; can I come back to the sensation, temperature, and cadence of my breath?
Be; how can I have fun right now? How can I make myself laugh? Which friends can I call to offload my experience?”

After a day of coaching at the office of Myplanet Digital, I suddenly felt a rising pressure on my left flank. A wave of recognition swept over me as I realized that my second kidney stone had shifted and it wasn’t going to be pretty. Remembering the trials and tribulations passing the last kidney stone I put my mind training to action and I thought I would share with you my experience in pain management using mindfulness in this article.

Passing a kidney stone is regarded as one of the most painful experiences a human can have and therefore is a great example to illustrate how a meditative mind can surpass even the most trying of times – quoting my Grandmother “I will never forget the pain of passing a kidney stone, I have already forgotten the pain of giving birth to your father.” Ouch…. But does it have to be? Really, is it possible to experience pain as just another impermanent event in one’s life and not a deep element of suffering? In my experience… it is.

The evening slowly progressed, as I sat having dinner with my close friends discussing our coming trip to India the pressure began spreading across my left side, slight waves of nausea swept over me.

My mind wanted to race; “what if this stone causes kidney failure? What impact would this have on my trip to India the next week? What would happen if the attack happened right here right now in the restaurant?” …. Pause, Breathe, Relax and Accept… I repeated a mantra I developed during my last attack to stimulate mindfulness of what is happening to me “Tune In, Relax the Body, Accept, Relax the Body, Allow, Relax, Breathe, Be”, luckily the full attack didn’t strike in the restaurant… but it was inevitable.

When 5am rolled around I continued to toss and turn in bed, treating it like a meditative exercise I locked my full awareness in on the ebb and flow of sensations washing over my body as the attack slowly surfaced – my kidney and all the muscles surrounding it pulsing and contracting trying to force this stone out – If only they knew that it is 1.2cm and too big to pass! I was rushed to the hospital, luckily with my training I was well equipped to handle this oncoming onslaught of pain… in moments of greatest pain and suffering is when you derive greatest benefit from meditation training; the ability to experience pain (or any sensation for that matter) with an equanimous mind, is liberating beyond what we can conventionally desire. Equanimity is the unique state that you practice while meditating, a state of `non-interference` with what is happening in the moment, allowing you to call on a greater state of resilience at times of need.

Heat, pulsing spasms, stinging, expansion, contraction sensations in all their unique beauty flowed in fluid disarray through my left side – my body danced on the stretcher not able to be still. According to the tears rolling down my cheeks and the Emergency Room pain scale I was pinging at 10+ points on a ten point scale. Code Blue is called and I’m rushed in.

When the doctor rushed in on the emergency call, I told him about the intricacies of my experience and of course he immediately called for an IV, Anti-Inflammatory and Morphine. I declined the Morphine illustrating that it will cloud my attention of the pain and all of its subtleties, viewing it almost as if watching a film and not one of the characters going through the pain, as simply another experience. I told him Morphine will bring me into a state of sticky thoughts where I would start overanalyzing the pain increasing my suffering – he looked at me in awe and walked away.

The 10+ pain lasted for over 10 hours within which I visited specialists, received x-rays, ultrasounds and through fear mongering that I would be discharged from the hospital because I didn’t allow them to help me (as in giving me pain medication, not really treating the pain) I obliged to 4 heavy doses of morphine.

As the doctor injected the morphine directly into my IV vein I guided them through a step by step description of the experience – slight pressure and coolness in my vein, a smell of tin washing through my nostrils as the chemicals engaged neuronal recognition of something that shouldn’t be in body, warmth spreading through my right hand, tingling sensations in my fingertips, the warmth rises up my arm and spreads throughout my chest, my lymph nodes swelling, nausea, lightness, my attention becomes heavily clouded, the warmth spreads over my body in deep waves of numbness…this last escape from pain provided by doctors did not address the pain, but simply attempted to numb all my senses, I felt sick and sad to have brought such a deadly opiate into my body. Three morphine doses later I was discharged from the hospital with the verdict – my 1.2cm kidney stone is blocking my ureter not allowing my kidney to flush toxins out of it, the waiting game for my surgery begins.

With pain we always have a choice, as in life, to dwell on the suffering we are going through, all the future possibilities that this suffering may cause, all past circumstances that have caused this suffering – or to view the experience as just another event in our life, full of sensation, full of awareness, full of a depth that is beyond the analyzing mind.

For example my mind came up with an infinitude of thoughts during this whole ordeal – usually it is in these states of deepest pain (emotional or physical) that our mind will go into its deepest state of thought creation, rumination, ideation. But I had a choice, to catch it, when it was going too far and skilfully bring my awareness away from these thoughts that do not serve me, back home to the experience, the sensations, rather than let it continue to ruminate hopelessly in my mind.

Ancient wisdom traditions illustrate a simple equation – pain is exponentially multiplied by our thoughts about it, causing suffering. The more thoughts you have, the more analysis, judgement, expectations – the greater the suffering. If you eliminate the thoughts and simply stay with the sensations, you have the potential to eliminate the suffering and experience the pain as just another experience.

Just as there are only a handful types of thoughts that one can have, there are a handful of sensational experiences that one can have to various degrees; temperature (heat, warmth, coolness), space (expansion, neutrality, contraction), feeling (pulsing, calm, pressure), sight, sound and smell. Your experience of pain is simply a varying collection of these experiences, no more, no less.

“It is a lack of attention and awareness which leads to greater suffering”

This is a rich subject in itself but in a nutshell a weak level of awareness leads to a greater chance of not realizing that you’ve entered into a destructive state of mind. A weak level of attention prohibits you from bringing yourself from this destructive state to a healthier one and staying there, centered and calm for as long as needed.

To reach the possibility of experiencing pain as just another impermanent experience lies in practicing the three primary elements of attention, mindfulness and equanimity:

Attention – develops the resilience to shift from magnifying your pain with thoughts and be able to stay within which ever state of awareness you chose
Mindfulness - develops the laser like awareness needed to seek out and explore the subtle nuances of sensations, emotions, thoughts and feelings
Equanimity - develops your ability to accept, allow and be appreciative of the experience you are going through without judgement or analysis of it

A regular practice is the key to effortlessly and effectively enter this attentive, aware and equanimous state. If you haven’t the chance for prolonged stretches here is a simple exercise to bring the mind home to the body in times of pain while training yourself to be in a more healthy responsive relationship with the pain, rather than lashing out in reactivity.

Because of the novelty of such a practice at first try it may be difficult, but try to approach it with an open mind, healthy scepticism and continuous application to get the most out of them.

This practice is great for mild to medium pain levels (if you are a regular meditation practitioner than you can use this in high levels). Essentially we are dropping in on the pain waves just as a surfer would, at which point we begin riding the pain with attention, allowance, acceptance and appreciation.

1. Swimming out – check in on where your mind is, ask yourself; what are my thoughts feelings and emotions? What have I been thinking about? Where are these thoughts taking me? Am I analyzing, judging or foreshadowing?
2. Breathe - for a few minutes take deep breaths to gather your self, put your hand on your abdominal wall if that helps and feel it expand and contract rhythmically; being curious with your awareness feel the pace of your breath, is it deep and rhythmic, or shallow and fast?
3. Getting on the board – shift your awareness to your body now and explore it for areas of tension or relaxation. If you are able you can deepen this exploration with a body scan starting from your toes or from the top of your head, searching for areas of tightness, bracing, tension, heat, warmth and see if you can diffuse it by disengaging tight muscles, relax and disengage your core, shoulders, back or any other part of the body that might be subtlety impacted by the pain.
4. Catch the wave – after you’ve eased the body and breath as best you can into a state of acceptance bring your awareness to the sensation of the pain and notice the quality of it; temperature (heat, warmth, coolness), space (expansion, neutrality, contraction), feeling (pulsing, calm, pressure), sight, sound and smell. Remembering that your experience of pain is simply a varying collection of these experiences, no more, no less. Ride the wave as long as you can.
5. What do we do when you fall down? We pick ourselves up and get back again. Repeat the process with intermittent breaks for healthy sensation rich snacks, music, friends, laughter and any other simple yet pleasurable and absorptive experience you can immerse yourself in. This is your life, we can choose to appreciate and enjoy the richness of anything and everything that surrounds us.

Please remember to use your discretion, if at any time the pain is too intense seek immediate medical treatment. At times the body or that particular body part may not be a safe haven for sensation surfing and exploring of sensations, in this case bring your awareness to another body part that is safe by applying a gentle pressure to it and observing sensations there, your breath is also always available and one of the most powerful tools to break free from a wandering mind.

If you are looking for further information on Mindfulness based interventions for pain and stress please visit Mindful.org  and the Centre for Mindfulness at the University of Massachusetts Medical School

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