Ascellus Blog

Be ‘Mindful’ of Pain to Reduce It

September 20, 2017


You’ve probably heard of athletes being ‘in the zone;’ having a profound sense of heightened awareness in which they are playing at peak performance. Artists, writers and others feel it too. It’s a state of being focused solely on what is happening in that exact moment. Those who experience it describe it as a sense of vibrant aliveness, connectedness and peace. There’s even research saying it’s a way to attain true happiness.

All of us are capable of achieving this state. Mindful meditation, or mindfulness is a technique that helps people experience transformations — including a reduction of chronic pain. It is one of the primary and most effective strategies we use to help injured workers.

What is Mindfulness

Mindfulness, a derivative of the ancient practice of meditation, is described as ‘the state of being conscious or aware of something.’ Another definition says ‘it is a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique.’  A third says ‘it is the practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis.’

It involves intentionally paying attention to something. In the case of chronic pain, it means focusing on it in a way that, at first, may seem to be counterintuitive.

Our typical reaction to pain is to view it negatively. We are actually judging the pain as something that is bad. Thoughts such as, ‘this is awful,’ or ‘I hate this,’ dominate our minds.

This negative thinking may lead to negative emotions such as depression and anxiety, which increase the pain sensation. This thinking also creates expectations, and if you expect the pain to go away and it doesn’t, it generates even more negative thoughts. What we need to do when confronted by chronic pain is change our thinking to avoid the negativities.  

Pain starts when the affected body part sends a signal to the brain. It creates a stress arousal response which causes the fight/flight/freeze response. The pain creates a pain map in the brain which can expand over time.

Mindfulness can regulate the pain that goes to the brain, which helps control it. The injured worker becomes a detached witness to the pain sensations, rather than being attached and responding with the primal brain.  

This allows the injured worker to control the physiological effects to his pain; the stress response stands down and then has a positive effect on what we call the ‘action brain’ to take other actions that are thoughtful and will shrink the pain map and normalize the injured worker’s movements back again. It allows the patient to regulate the pain signal that goes from the brain back to the injured body area.

Studies of the brain shows mindfulness changes the structure of the brain. Injured worker we treat say mindfulness helps reduce and even alleviate their pain.


Mindfulness, along with biofeedback and meditation are the main cognitive behavioral therapy techniques we use to help injured workers take control of their health and wellness. These can help, for example, to decrease muscle discomfort; so recovering workers are able to go for walks and do other forms of exercise that help the process.

One of the biggest barriers to recovery from pain is the injured worker’s locus of control, when he feels the pain is happening to him and he has no ability to change it. Mindfulness helps shift the locus of control from outside influences to inside the person, so he feels he has a choice and is able to manage and cope with his pain.

Mindfulness helps the injured worker let go of his negative thoughts and be fully engaged in the present moment — much like the athlete who is in the zone. It releases the tension of expectations and allows him to accept the present moment as it is, so he can experience the pain not as an enemy or something bad, but something simply to be aware of.

How to Do It

Deep breathing is a great way to help achieve mindfulness. There are a couple of ways to use breathing to help reduce negative thinking.

Some people start by taking a deep breath through the nostrils, for about 3 seconds; holding their breath for 2 seconds; then exhaling slowly through the mouth for about 4 seconds. Other people just observe their breathing and do not try to control it.

At this point, the injured worker should relax and notice sensations in different parts of his body, the connection with the chair or floor, and any other stimuli — all the while feeling and being aware of the natural flow of his breath. The idea is to pay attention to the ‘now,’ what is happening at this very moment without casting judgment or engaging in negative thoughts.

Often the beginner finds his mind starts to wander. That is very normal and OK; the injured worker just needs to redirect his attention back to his breathing.

The analogy I give to patients is to imagine sitting beside a river, watching the river flow by.  If after a storm, debris such as tree branches and logs float past us we would mindfully perceive them, but we would not reach out and grab onto that debris, we would let it go. If we actually did wrestle with the debris we would build up more and more pressure, instead of relaxing with our perceptions.  Then I draw the analogy to patients’ pain perceptions as ‘logs floating down the river of consciousness’.  Instead of wrestling with the pain perceptions, just perceive them and let it go. However, most people have not been trained in how to ‘let it go’. Mindfulness training is just that, training in how to be detached from perceptions and ‘let it go’.


It takes practice to become skilled at mindfulness, but the benefits to injured workers in chronic pain can be astounding.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at The Ascellus Group, or visit our website  Please join our LinkedIn group, at COPE with Pain.

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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.