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Buddhist Teachings for Pain Management

This is the sixth and final post in a series exploring the topics covered in the book You Are Not Your Pain*. See You Are Not Your Pain: An Introduction to learn more.

Mindfulness-based stress reduction is a secular approach that applies the Buddhist principle of mindfulness to pain, illness, and stress. The more I learned about mindfulness, the more curious I became about Buddhism. Many Buddhist practices can help with managing pain and illness. Vidyamala talks about the ones that she employs regularly. (If you want even more, How to Be Sick* by Toni Bernhard is a treasure trove.)

Kerrie Smyres: What other Buddhist teachings do you find helpful in managing chronic pain?

Vidyamala Burch: Along with mindfulness, loving kindness and compassion are other qualities that come from Buddhist teachings. Both mindfulness and loving kindness are integral to how I manage my pain and to all of Breathworks’ pain management programmes in “You Are Not Your Pain.”

Through Breathworks’ pain management programmes, we guide people very, very gently and with loving kindness – metaphorically holding someone’s hand – to help them move closer to what is actually happening in their bodies.

Loving kindness is about having a response to yourself that you would naturally have to a loved one who is hurting, so for example if your child fell over it’s completely instinctive to scoop that child up to comfort with love and tenderness. So, try and turn that instinctive emotional response back on to yourself; it is basically gentleness and tenderness and acknowledgement of the feeling of sorrow of what it’s like to live in a body that hurts. It’s not an easy thing. I often think one of the most heroic things that you can do in life is to inhabit a body that hurts.

In Buddhism mindfulness and loving kindness are articulated in some key Buddhist texts. The main one on mindfulness is the Satipatthana Sutta and this provides a theoretical basis for what we teach. The Brahma Viharas is a key teaching on loving kindness. The Salattha Sutta describes primary and secondary suffering very well. So all these are implicit in my approach to living with pain and illness.

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Mindfulness: An Amazing Tool for Coping With Migraine

“[T]echniques based on the Buddhist teaching of mindfulness have reliably been the most effective, helpful coping strategies I’ve used in my 25 years with chronic migraine. While plenty of people approach Buddhism as a religion, I think of it more as psychology; a collection of wise insights to help people live their fullest lives.”

Migraine & Mindfulness — “Bruce Almighty,” my favorite of the posts I’ve written for Migraine and Headache Awareness Month is now up on Migraine.com. No matter what your religious or spiritual bent is, mindfulness is an amazing tool, not only for coping with migraine, but with all of life’s stresses. To make this wonderful technique accessible to everyone, I focus on a secular approach to mindfulness in the beginning of the post, then include links to other incredible leaders who are more religious in their teachings.

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Gratitude

Having just drafted a post on gratitude for Migraine.com, the topic was fresh in my mind when I couldn’t sleep the other night. Instead of obsessing over why I was tossing and turning, I mulled over things I am thankful for. Each day I list three things I am grateful for as part of my strategy to keep chronic migraine from overwhelming me; this is more of a global list. As I feel like I’ve been a complainer on here lately, I wanted to share it with you all so you see that I’m not miserable and depressed! And to share how rich a life can be even with chronic illness.

  • A husband who understands how debilitating a migraine attack is and often has a better grasp on how I feel than I do.
  • My family for being loving, caring and messy in the way only family can be.
  • Migraine friends who truly get what my days are like and non-migraine friends who try.
  • The people I get to connect with through this blog. I’m not able to be as connected as I’d like, but everyone who reaches out to me touches my heart and is in my thoughts.
  • Old friends who wait patiently while I burrow in my self-imposed migraine nest of rarely communicating with anyone.
  • My sister, who keeps calling, texting and playing Words With Friends with me even when I retreat into migraine solitude.
  • The amazing team of doctors that I kind of stumbled upon when I moved back here.
  • People who knew me before the chronic migraine became too severe to take Advil and ignore — the ones who are so understanding because they remember me as vivacious.
  • My nieces and nephew, with whom I was fortunate to see often when they were young. I’ve missed them so much the last five years, but am so proud of the teenagers they have become.
  • COBRA and pre-existing condition health care coverage, which allow my husband to pursue his dream of starting his own business.
  • Jack Kornfield’s guided meditations, which showed me how to heal, particularly Guided Meditations for Self-Healing.
  • Tara Brach, whose guided meditations and podcast talks have taught me how to experience emotions without being carried away by them. (She has also published a great book, but my favorite resources are those on her website, all of which are free!)
  • How to Be Sick, a book by Toni Bernhard that applies principles of Buddhism to life with chronic illness in a straightforward, non-preachy manner.
  • The Anatomy of Hopeby Jerome Groopman, which taught me that hope is not a blind wish, but the belief that one can live a good life against all odds.
  • Anne Lamott’s writing, especially in the writing guide Bird by Bird and her willingness to share imperfect, thought-provoking and hilarious missives on Facebook.
  • That I was able to attend some of the American Headache Society symposium and felt like my engaged, intelligent self while there. And for the dedicated, compassionate, caring physicians, psychologists and researchers I met there.
  • That Excedrin Migraine changed their ad in response to the outcry of The Daily Headache readers.
  • Getting into the groove of writing and that feeling when I get a sentence or phrase just right.
  • The friends who are so supportive of my writing.
  • Being able to read books again. Proof that chronic migraine can improve and we can get back the things we lost.
  • Doctors who pursue unlikely avenues of inquiry.
  • That I’m a natural optimist.
  • Pinterest for migraine distractions. Facebook for keeping me somewhat connected to the world even when I’m hibernating. And Words With Friends for giving me a chance to play with loved ones I rarely see.
  • Friends who don’t mind if I sit on their couch like a zombie because I’ve had a migraine for a week and need new scenery. Even when I smell like a zombie, too.
  • That I know what the basic structure of my book will be. No idea when I’ll have the energy and mental wherewithal to write it, but it will be a tool to help people with chronic illness live happy, rewarding lives.
  • Baking. Nothing I bake is safe for my severely restricted migraine diet, but the process of baking brings me so much joy.
  • Fall weather in Phoenix.
  • My adorable yellow house in Central Phoenix.
  • Oven roasted Brussels sprouts with garlic added. Really.
  • That sleep is usually easy.
  • The quirky, funny, unconditionally loving pets I’ve been so fortunate to live with. A pet is too much work for my life right now, but memories of Cricket, Kayla and Cleo keep me smiling.
  • That the 2012 presidential election is over.
  • My fantastic neighborhood yoga studio.
  • A year-round farmers’ market that’s indoors in summer.
  • The smell of rain in the desert.
  • My perfectly sized and shaped bathtub.

Yesterday I dreamed that a doctor told me I was all out of treatment possibilities and that suicide was my only option. I kept telling him that I wanted to live and he wanted to know why since I had such terrible and frequent migraines. I said, “Don’t you see, I have a great life? Of course the migraines are awful, but they aren’t the sum of my life. I have so much to live for.” I was so grateful to wake up and know that doctor was totally wrong. There is never an end to treatment options. It has been almost a year since I first felt the joy of finding a treatment that helps and I’m thankful for every day of improvement since then (even if I grumble about it sometimes).

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Bad Migraine Spells Don’t Last Forever — Neither Do the Good Ones

“This too shall pass” is a phrase people rely on to help them through tough times. It is one I often employ when a severe migraine spell lasts so long that I cannot see a way out. As I’ve learned through mindfulness meditation, it also describes the concept Buddhism calls “impermanence.” The trick is that it doesn’t only apply to difficult situations — every moment, good or bad, passes, whether we want to hold onto it or not.

And this, folks, is today’s lesson in chronic migraine.

Whenever I have a good week I expect it to last. I’ve reigned in that same need to assume one good day is a sign of more to come, but string a few good days together and I’m a goner. No, actually, I’m lying. No matter how hard I try to temper the anticipation, there’s always at least a little part of me that latches onto that glimmer of better days and believes I’m on the upswing.

I’m still clinging to the bliss that was the last full week of September, the week before my birthday. Well, bliss in the view of a chronic migraineur. Migraines still came on every night, but the postdrome (migraine hangover) lifted by 2 or 3 each afternoon, giving me many engaged, productive hours each day. I really thought every week of my life was going to be like that. I knew there’d be setbacks, but that week, in my mind, was the result of taking cyproheptadine and magnesium, as well as correcting vitamin D and B12 deficiencies. Not only were the migraines not too painful, I had energy.

Then came a setback, which didn’t concern me much. I totally overdid the birthday celebrating and pushed myself into a week of migraine attacks. It was the price I (mostly) expected to pay for pushing too hard. But the migraines continued to be debilitating the following week. This week started off with the worst migraine I’ve had in two months, followed by persistent level 5 or 6 pain.

That good week in September was not evidence of a general upswing in my health, but, apparently, a fluke. Fortunately, life is full of flukes. I will have more good weeks, though I can’t predict when they’ll be. I’ll have more bad weeks, too. In the bigger picture of my life with chronic migraine, even the bad weeks of the last couple months aren’t too bad, more like mediocre. I’m content with mediocrity in this case. Besides, it too shall pass.

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All Migraineurs Are Different — So Stop Judging Me!

I’ve been fortunate to receive very little negative feedback on this blog. Yesterday was one of the rare days that another migraineur left a rude comment. In response to the post Showing Others What a Migraine Attack is Really Like, Lynda wrote:

I think you should worry that you are clinging to your migraine to define you and that you wouldn’t know who you were if the pain went away, so it is helping you by not going away. I am a chronic migraneur as well, every week, I lose a night of sleep at least and two days to a horrible headache, but I have managed them for 2o years of work and supporting a family and myself. yes there are days I must come home. but oddly my headaches wait til friday night to take me down so I can perform my tasks. I question your will when I read your attitude. You are lucky to have your husband or you would die, or wake up.

There are so many possible responses to this. I can hear the universal mom’s voice telling me to ignore the meanie and not share her comment with you at all. That Lynda is just jealous and I’m giving her more attention than she deserves. Buddhist psychology would say she is lashing out from her own pain or fear and that her words have nothing to do with me. There’s the snide part of me pointing out that losing two days a week to migraine does not meet the clinical definition of chronic migraine, which is 15 or more migraine days a month15 headache days a month, at least eight of which are migraine. The martyr also rears her head — “I’m sorry you’re suffering so much. I hope lashing out at me has brought you some relief.”

Underneath all these possible responses swirling in my mind is the most puzzling part to me. Why? Why does one migraineur feel the need to judge another’s experience? Why do so many migraineurs assume that their migraine attacks are representative of everyone else’s?

Migraineurs and their migraine attacks are all so different. The definition of chronic migraine encompasses a vast range of pain levels and numerous possible symptoms. There are people who have 15 migraine attacks come on each month, but are able to abort them with triptans before the pain even begins. Then there are people who have level 8 or higher pain every single day. That’s right, one chronic migraineur can experience no pain at all while another has daily pain on par with childbirth, according to this excellent comparative pain scale from TIPNA.

As confused as I am about why people are so mean to each other, I also  feel the sting personally. I write this blog to help myself cope with and comprehend daily headaches and nearly daily migraine attacks in the hope that I can help others who face similar challenges. I share my most vulnerable thoughts and describe moments I would rather no one ever know. Only in the last year have I opened up completely, sharing what my days are really like and that the emotional cost of migraine is so high that I have considered suicide. A weak person would not open up in the way I have, though it has taken more than a decade for me to comprehend how strong I truly am. Yet I still fall prey to the internal voices that question the severity and validity of my illness. External voices are not welcome in the choir.

The havoc that migraine has wreaked on my life and my identity is immeasurable. I have accepted migraine as part of who I am, but the only way it defines me is in the tremendous resolve I employ to keep it from overtaking me. In no way do I cling to this illness for my sense of self. Instead, the opposite is true as the illness attempts to suffocate my personality. The moments in which migraine is not at the forefront are blissful. I had a few good hours last night, dancing and baking and laughing. My identity shines when I am not in the throes of migraine.

Just as I have not let a lifetime of migraine dominate my sense of self, I will not allow one person’s meanness bring me down. Thanks for the armchair psychological assessment, Lynda, but you are completely wrong. Well, not completely — I am incredibly lucky to have an emotionally supportive husband who is able to support both of us financially. It is quite a stretch since he lost his job last year and is starting his own business, but we are making do for now. Without him, I would be living with my mom and spending all of my low-migraine-pain time trying to earn money. Now I just spend most of my low-migraine-pain time trying to earn money; in the rest I can dance and bake and laugh. For this I am immensely grateful.

Plenty of weeks go by when I am too sick to even laugh, but the small bits of time I allow myself to do what I love keep me from withering away in bitterness and resentment. I hope you the same for you, Lynda, and for every reader of this blog. Seeking joy wherever you can find it is imperative in a life with migraine. Without it, misery becomes the disease.