Mindful Based Pain Management: Interview with Vidyamala Burch


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Vidyamala Burch has been practising meditation for 35 years and lived with a spinal injury for 45 years. Her experience of living with chronic pain led to an interest in meditation and mindfulness which later to led to the development of Mindful Based Pain Management (MBPM) to help others with chronic pain issues.

In 2001 she set up Breathworks in Manchester to provide mindful based pain management courses to suffers of chronic pain. In 2004 this was expanded to include long term health conditions and stress.

Vidyamala is the author of three books on mindfulness including, Mindfulness For Health: A Practical Guide to Relieving Pain, Reducing Stress And Restoring WellBeing which she co-authored with Dr. Danny Penman. It won first Prize in Popular Medicine in the British Medical Association Books Awards in 2014. In 2018 the British Pain Society awarded Vidyamala an honorary membership in recognition of her contribution to the field of pain management with her development of Mindful Based Pain Management.

Currently, NICE acknowledges that pain is a common symptom in people with ME/CFS and is particularly intense in people with severe or very severe ME/CFS. People with ME who seek relief from pain often get prescribed painkillers and anti-depressants by their GP’s or local pain clinic. A few even get physiotherapy and CBT to help with their chronic pain. After these courses of action are exhausted, then pw ME are basically told they just have to learn to live with their chronic pain. Is there another approach for dealing with chronic pain?

Pain is obviously highly unpleasant and if it is acute, for example as a response to an injury, then pain medications may well be a very good solution. You take the pain killers, rest the injury, healing takes place, and the pain resolves.

When living with chronic pain the situation is much more complicated. Chronic or persistent pain is defined as pain that has lasted on a daily basis for three months or more. In this situation there will be many factors at play. Modern neuroscience shows that on-going pain can lead to a sensitisation of the nervous system and brain, so that pain perception is enhanced. A good analogy is a burglar alarm. At a normal setting it will go off when a burglar breaks into your house, but if it is set to a sensitive setting it will go off when a moth flies by. Pain perception can undergo a similar sensitisation when pain becomes chronic. A little bit of input into the system can create a lot of pain experience.

This means that one of the crucial ways to help manage pain is to find ways to calm the nervous system and to reduce the sensitivity to the pain experience. This involves working across quite a broad front – cultivating relaxation, eating regular meals, staying as fit and flexible as possible (within the limits of your health condition), pacing activities to get out of ‘boom’ and ‘bust’ patterns and learning how to manage stress as well as possible in your life. Gradually, your nervous system will become calmer and, although you may still have pain, it will not feel so intense and intrusive.

As for medication: relying on heavy doses of pain killers comes at quite a price as I am sure many readers will know. We become groggy and, over time, the medication loses its efficacy. It can be a horrible and sapping quality of life.

However, I think there can sometimes still be a place for the lowest level of medication possible to take the edge off the pain if it is in the service of bringing about the changes to calm the nervous system. For example, I take some medication to ease nerve pain as otherwise I’d get very little sleep, be exhausted during the day and find it hard to work creatively with my life. But I take a much lower dose than I used to and a fairly minimal level for someone with my injury. It has been a relief to be able to lower my dose over the years as a consequence of my whole life becoming more balanced and my nervous system losing some of its hyper-sensitivity.

In 1979 Professor Jon Kabat Zinn set up the Mindfulness Based Stress Reduction clinic at the University of Massachusetts Medical Centre to offer an 8 week course for helping people with their chronic pain issues. Numerous medical studies in the 1980s and in the decades since have confirmed that striking reductions in the suffering that accompanies chronic pain can be achieved by mindfulness based pain management. This new approach to chronic pain comes under the rubric of a new field called Integrative or Mind-Body medicine. Can you tell us something about the science behind mindfulness based pain management?

Mindfulness-based Pain Management (MBPM) is the approach I pioneered over the past 20 years. It is delivered via the Breathworks ‘Mindfulness for Health’ programme. We have been asking participants to fill out health questionnaires ever since the first courses and now have quite a large body of evidence. You can read more at www.breathworks-mindfulness.org.uk/research

All the areas that we measure showed improvement such as: ‘Pain Severity’, ‘Pain Interference’, ‘Pain Acceptance’, ‘Pain Catastrophising’, ‘Quality of Life’, ‘Emotional Distress’, ‘Self-Compassion’ and ‘Level of Mindfulness’.

Studies have generally found mindfulness meditation to benefit a great variety of health conditions. Some of the key benefits are:

  • Improving mood and quality of life in chronic pain conditions, for example reducing levels of depression and anxiety.
  • Reducing physical pain and the emotional reaction to it, allowing individuals to change their relationship with their condition by living in harmony with their pain rather than trying to fight it.
  • Improving social functioning by strengthening relationships, improving sleep quality and decreasing the level of interference that pain has on daily activities
  • Re-establishing a sense of control by learning coping mechanisms and feeling empowered in knowing that individuals have a choice in response to pain and discomfort.

Traditional, mainly pharmacological, approaches to pain relief are guided by an approach that sees the patient as a passive recipient of medication/advice. Mindfulness based pain management take a different approach to the chronic pain experienced by a person. It acknowledges that the pain and distress that you actually feel is a fusion of primary and secondary pain. Can you explain what primary and secondary pain are? How does this insight, that the pain you feel is a fusion of primary and secondary pain, offer a path away from suffering?

Cultivating a sense of agency in relation to one’s experience of pain can be very empowering and helpful. Learning ways to self-manage and feel a sense of imitative in relation to health is especially important when living with a long-term or chronic condition.

Central to MBPM is learning how to divide the experience of pain into what we call Primary and Secondary suffering. The Primary pain is the actual experience of unpleasant sensations in the body in any given moment. We can’t do anything about these sensations as they have already arrived in the present, so the wisest response is a kindly acceptance – being gentle and kind towards how we respond to these sensations.

But when we are not aware, mindful or accepting, the common reaction is to automatically resist and resent the painful sensations which quickly layers on more suffering. For example, we might hold the breath and tense against the pain which just makes the pain worse. We might catastrophise with our thoughts which will make the overall suffering more intense. Or we might get anxious or depressed.

All these reactions are understandable and it’s important we don’t judge ourselves when we find ourselves caught up in these secondary layers of suffering. But, with mindfulness practice, we can learn to notice much more clearly what is going on. We can learn to accept the painful sensations – the primary suffering or pain - and to reduce or overcome the secondary reactions by learning how to soften resistance. This is key. You’ll find that it isn’t the pain that is ruining your life, it is the resistance to the pain that is creating lots of extra suffering and you can do something about that. It’s a very hopeful message and approach whilst also highly pragmatic.

There are many peer reviewed scientific papers which show that mindfulness meditation reduces pain and enhances mental and physical well being. Besides this, it helps people deal with the stresses and strains of daily life. Can you tell us about some of the main findings regarding the health benefits of mindfulness meditation?

There is an organisation called the Mindfulness Initiative that grew out of an All Party Parliamentary Group (APPG) investigating the benefits of mindfulness in healthcare, education, the workplace and criminal justice system back in 2015.

You can find lots of great information on their website and especially a recent briefing paper on mindfulness for health and well-being https://www.themindfulnessinitiative.org/briefing-paper-on-health-wellbeing-and-mindfulness

Doctors and specialist pain clinics refer their patients to the Breathworks centre in Manchester that you founded. The Breathworks centre uses a mindfulness based pain management (MBPM) programme to help patients with their chronic pain issues.

What motivated you to develop the MBPM programme?

I injured my spine 46 years ago when I was just 17 years old. I was left with chronic pain. For many years I didn’t cope at all well, but when I was 25 I learned to meditate. This was when I was in hospital after a major crisis with my back and I found it profoundly helpful. I realised I could train my awareness to help me manage my physical difficulties. It wasn’t ‘mind over matter’ in a naïve sense; more ‘mind with matter’ in a highly practical and effective sense.

I went on to spend many decades training in mindfulness and compassion meditation and gradually my life improved beyond all recognition. It was a very long, slow path and eventually I felt I had learned enough to have something useful to offer to others facing similar crises in their lives. I remembered myself as a young woman in a hospital bed all those years ago who wasn’t offered much in the way of guidance and I didn’t want others to have to plough the same long, lonely furrow. If I could be a companion offering practical, effective tools to help people manage ill-health and disability with a little more ease, then I knew I would find that rewarding.

Initially I just ran a few courses back in 2001 and could never have imagined that Breathworks would emerge out of that and become internationally successful helping many thousands of people around the world.

My aim in the start was a real wish to help people and that remains my simple and over-riding motivation.

If anyone is interested in finding out more about mindful based pain management where should they start?

Please contact Breathworks on www.breathworks-mindfulness.org.uk

You can find out more about Mindfulness for Health at https://www.breathworks-mindfulness.org.uk/mindfulness-for-health. There are options to complete our gold standard eight-week course in the context on a supportive online group. Bursaries are available for thos on low income.

You can buy my book which contains the 8-week mindfulness for course health at https://www.breathworks-mindfulness.org.uk/shop/mindfulness-for-health-book

There are a range of interviews on my personal website: www.vidyamala-burch.com

You can access my guided meditations on the Breathworks youtube channel or Insight Timer meditation app http://insig.ht/breathworksvidyamalaburch

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