18 April 2011

Reading How to be Sick: Pain Management III

This is the tenth in a series of posts about Toni Bernhard's book, How To Be Sick - A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers.

When we live with chronic pain, we go through stages - as in most of life - of learning how to live with it, struggling against it, wishing or praying it would go away, and, hopefully, a kind of creative acceptance of what is.  For the past several weeks, the migraines have been particularly unrelenting except for a couple of blessedly low-pain days last week, and so I have had to come to a new level of understanding my pain and how to cope with it.  There is a chapter in Toni's book that is good for me to read and review at this time, entitled "What to Do When (It Seems) You Can't Do Anything."  (pp. 121-125)

I include this post as part of the pain management series because, while I practice and espouse many different methods for pain management (PM), another and just as important aspect of PM is about relieving the mental/emotional/spiritual suffering that goes along with physical pain.  Again, Toni's explanation of Buddhism and a certain practice have made a difference in my ability to learn to live with these migraines.

"... we need to look at another practice on the Eightfold Path - wise action - because it has a lot to teach the chronically ill [and I would add, those chronically in pain] about how to take care of themselves.  Simply stated, actions that lead to the cessation of suffering are to be cultivated and actions that enhance or amplify suffering are to be avoided.  Wise inaction can thus be thought of as simply not engaging in those actions that make our condition worse."  p 121

I am reminded of the 12-Step understanding of powerlessness - that accepting and naming we are powerless over some aspect of our lives or personalities is the first step to healing. 

We accepted that we were powerless over our addictions [in this case, our pain] - that our lives had become unmanageable.  (Step One)

Similarly, Toni's chapter on wise action/inaction is built upon the concepts of acceptance and equanimity, by way of powerlessness:

"I'd been getting despondent when a treatment didn't work and becoming angry when a doctor didn't live up to my expectations.  I was trying to control the uncontrollable."   p 81

I just love the synchronicity of the world's religions and philosophies: here is a very 20th-century phenomenon, The 12-Step Program with its foundational concept of powerlessness, echoing and redefining in our time the ancient wisdom of the Buddha.  (Not to mention the wonderfully surprising discovery of my 30-day retreat on the Spiritual Exercises of St. Ignatius, which reminded me at every turn of the wisdom, challenge and comfort of the 12-Steps.)

Acceptance.  Powerlessness.  Equanimity.  To a 21st-century Western adult living in a culture of just-do-it accomplishment, these concepts can seem like giving up.  But as Toni, Buddha, St. Ignatius and Bill W. (one of the founders of the 12-step Program) knew, there is great courage and wisdom in the acceptance of life as it is, in understanding our powerlessness to change most of it, and in thus coming to a place of creative action/inaction that ends the futile fight to change the unchangeable.

So it is with pain.  Our understanding of our powerlessness and our subsequent equanimity clear the way for a kind of creative inaction.  With pain as the backdrop - not denying or arguing with it but simply accepting that we cannot change it - we move gracefully into a renewed ability to choose wisely what is to be done or not done in every moment.  For me, this state - when I allow it - gives me freedom to choose among the many tools I have for pain management, none of which come freely to mind when I am un-accepting pain's presence.

The paradox that freedom can come from admitting powerlessness, from accepting what is, is a marvelous help when we are living with pain.  It leads me to remember all of the many ways I have developed over the years for managing my pain and suffering, allowing me to choose which is best in the moment.  I can:

- conduct a body scan and deep muscle relaxation
- stretch my beleaguered body a bit
- make a cup of tea
- take pain medication
- meditate and/or pray
- practice deep breathing and breath-focus
- take a warm, comforting bath
- lie down with my blindfold and a cool compress
- play one of my favorite DVDs - Seinfeld or Golden Girls 
- listen to NPR, especially Car Talk (I know nothing about cars, but just love Click and Clack)
-  listen to audio books, usually non-fiction or inspirational (Eckhart Tolle, Pema Chodron, Jack Kornfield)
- if the pain is not too bad, knit
- if the pain is not too bad, walk my dog and throw the Kong for her in the back yard.

The point is that the peaceful state of my mind and being when I have accepted my powerlessness over the pain and come to equanimity allows me to access this list of comforts which would likely otherwise be hidden beneath the layering of denial, anger, fear, or physical pain.  In a previous post, I talked about all of this in another context - "there is pain here, but I am not in pain": reviewing that post makes me realize again how much of pain management is in our spirits. 

In my next post I want to write about acupuncture and pain management.  In the meanwhile, may all persons who read this post allow peace to flood their hearts and spirits.

I would love to hear from you.  You can use the Comment link, below, or email me at carold.marsh@gmail.com.


  1. Thank you so much for another post about my book. It has so much wisdom from your own experience in it. I love your list of "what you can do" and laughed when I got to Car Talk. In that very chapter of the book, I had several examples of what you can do when it appears you can't do anything and one of them was "listen to Car Talk" even though I know nothing about cars." My editor thought the chapter was better without all my examples and I went with his judgment. I just wanted to share that!

    I do talk about pain in the book but the focus is on chronic illness since that's my major difficulty although I do also suffer from pain at times. Alll of the tools and practices can be applied to those whose major symptom is pain.


  2. I am sure that the Car Talk guys have no idea their show is on the list of pain- and illness-management! I can just hear the guffaws.

    Thanks again for your book, Toni -