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founded by S. N. Goenka in the tradition of Sayagyi U Ba Khin






Vipassana Meditation and the Treatment of Chronic Pain

-By Dr. George Poland

(George Poland is a senior assistant teacher and a medical doctor practicing in Quebec, Canada.)

The purpose of Vipassana meditation is to liberate the mind, not to cure physical disease. Nevertheless, meditation shares a common goal with the practice of medicine: the alleviation of suffering. In medicine there are many ways of approaching this goal, each with its own system of treatment. The basic procedure, however, remains the same: we must discover the cause of the suffering and eradicate this cause. Then suffering will naturally come to an end.

In treating acute illness, a doctor usually tries to strike at the root cause of the malady in order to restore the patient to health. At the same time, various methods may be used to reduce the patient’s suffering. While the process of healing is going on, for example, a patient with a throat infection may be given antibiotics to eradicate the invading bacteria, as well as painkillers to reduce discomfort.

However, patients suffering from chronic pain may receive quite different treatment. Such cases usually involve an incurable condition, causing constant or recurrent pain. Since the underlying disease is incurable, attacking its cause will not alleviate the suffering. Hence, another approach must be taken.

To grasp that approach, we must distinguish between pain and suffering. Pain is unpleasant physical sensation of varying intensity. Suffering is the mental reaction to this sensation. Another way of looking at it is to define suffering as the difference between what we are actually experiencing, from moment to moment, and what we would like to be experiencing. An experience is, yet for various reasons we want it to be something else; hence we suffer. The reaction, or suffering, only adds to the painful experience. The physical pain becomes a mental pain, and a vicious circle of suffering is created.

In the usual attempts to alleviate pain, drugs are prescribed to dull the patient’s awareness. However, this approach is not advisable for chronic pain, because painkilling medications have side-effects if taken for long periods. Further, their efficacy gradually diminishes, necessitating ever larger dosages that can lead to addiction and worse side-effects. It makes more sense to attack the mental side of suffering rather than only the physical pain. To eradicate the suffering, the patient must learn to observe the pain objectively without reacting to it, accepting it as it is, by coming to understand its inherent nature of impermanence. By gradually developing equanimity toward the pain, one can break the old habit pattern of reacting and thus emerge from suffering. This is obviously easier said than done. However, I have found that with proper instruction and constant encouragement, patients can learn to ‘live in the present moment.’ As they learn to keep bringing their awareness back to physical sensations and to develop even a little equanimity, they find their ability to deal with chronic pain has improved.

In my practice, I deal almost exclusively with sufferers from chronic pain caused by such conditions as arthritis, migraine headache, or lower back pain. Most have already tried various treatments to alleviate their symptoms, yet the pain remains. The treatment which they receive at our clinic is a combination of acupuncture, physiotherapy and meditation (both Anapana and a gross form of Vipassana, as I will explain later). Acupuncture itself alleviates pain without producing any side-effects. However, here I wish to concentrate on the effects of meditation. All the patients are taught the practice of Anapana (awareness of the natural breathing), so as to train their minds to stay in the present moment. This exercise prevents the mind from wandering into the past or future—in other words, from worrying about their disease. Such worries only multiply tension and stress, adding to the suffering. Thus mindfulness of respiration by itself decreases stress and suffering.

In addition, we use a form of physiotherapy known as Transcutaneous Electrical Nerve Stimulation (T.E.N.S.). Small rubber electrodes are placed on the surface of the skin in the area of pain, and a vibrating electrical stimulation is applied at an intensity which the patient can easily feel, and yet which is not unpleasant. These vibrations remove the apparent solidity of the pain. During the procedure, which lasts twenty to thirty minutes, the patient is instructed to relax and remain motionless, either lying down or sitting. The patient is also asked to keep bringing awareness back to either respiration or the sensations of the vibrating T.E.N.S., whenever the mind wanders away.

In this way the patient practices either Anapana or a very gross form of Vipassana (awareness of bodily sensation), gradually developing equanimity toward the vibrations and pain, and slowly coming out of the old habit pattern of reacting with negativity to unpleasant sensations. After some time patients can continue treatment at home with their own T.E.N.S. machines and, of course, meditation. I have found this combined approach to the treatment of chronic pain to be very effective. The vast majority of patients report a decrease in the pain, less stress and nervousness, less depression and better sleep patterns. Although acupuncture certainly is responsible for some of this improvement, I consider that the main benefit arises from the patients' development of awareness and equanimity regarding their pain. This mental change, in turn, strikes at the root cause of their suffering. The effect is all the more evident in patients who continue home treatment of T.E.N.S. and meditation without any acupuncture.

Of course Vipassana meditation is not intended for curing or treating any physical ailment. Still, it was with good reason that the Buddha was known as the Great Physician. For the Buddha, all beings were suffering from an apparently incurable disease known as existence, which invariably was associated with chronic pain and suffering. His prescription of Dhamma, given twenty-five hundred years ago, is still valid today. Anyone who practices Vipassana meditation properly will surely strike at the root cause of misery and will gradually emerge from suffering.

(Courtesy: International Vipassana Newsletter, Vol. 17, No. 2, June 1990)