Chronic Pain
September 10, 2019

When the Buddha has us reflect that illness is unavoidable, it doesn’t mean that we shouldn’t treat our illnesses. After all, the Buddha himself used medicine, and the Vinaya, the collection of the monks’ rules, is full of information on different medicines for treating different illnesses. In fact, it was through the Vinaya that a lot of Indian ways of doing medicine spread throughout Asia.

As he said, there are some illnesses that respond to medicine, others that will go away whether you take medicine or not, and others that won’t go away even with medicine. It’s because of that first type of illness that he recommended treatment for all illnesses, because you never know ahead of time where your illness falls under those three categories. But you do have to accept the fact that illness will come. It’s part of having a body. You can think of it as the fine print on the contract when we’re born. And because there are some illnesses that just don’t go away, and because death is inevitable, we have to train the mind.

In other words, we do what we can to treat the body, but we have to remember the body has its limitations, its potential for health has its limitations, so we really have to treat the mind. Look into its relationship to pain and see how we’re creating extra pain on top of the pain. The Buddha gives the image of a man who’s been shot by an arrow, and then he shoots himself with more arrows. In other words, the physical pain is the first arrow, and the mental pain is the whole quiver of arrows with which he then shoots himself. The first arrow is something that we can sometimes do something about and sometimes not. But that second set of arrows is totally unnecessary. Although you may have to accept the fact of pain in the body, you don’t have to accept the pain in the mind. You don’t view it with equanimity.

As the Buddha said, he taught suffering and the end of suffering, and he offered the end of suffering as something you would want. It’s okay to want to put an end to suffering, but you have to do it wisely. You have to attack the problem at the cause. We’d like to get rid of the pain that we have in the mind, but the Buddha said you can’t get rid of it unless you see the cause and abandon the cause.

So how do we sort these things out—the pain in the body, the pain in the mind? Ajaan Lee recommends using the breath to start with. Use the breath energy in the body to try to create a place that allows you to take a stance in the present moment and not feel threatened by the pain. If, say, the pain is in the left side of the body, focus on the right. If it’s in the back, focus in the front, or anyplace in the body where you can have a sense of well-being as the breath energy flows, anyplace that can be nurtured by the in-and-out breath. For the time being, resist any temptation to get involved in the parts of the body that are in pain.

Ajaan Lee’s image is of a mango. Some of the spots in the mango are wormy, so you cut out the wormy spots and you eat just the remaining part of the mango. But that’s just the beginning step.

The next step is to think of the good breath energy in the more comfortable part of the body spreading from there and going through the pained parts. You keep your focus focused on the comfortable parts, but you expand your range of awareness and you think of the breath not just going up to the pain but going through it. That way, it helps to dissolve any bands of tension you may have built around the pain. You’re testing to see exactly how much of the pain is a result of your unskillful breathing, what the Buddha calls kayasankhara—bodily fabrication. After all, the fact that there’s pain in the body is problem enough, but you don’t want to be adding to it by the way you breathe. And you want to see if the way you breathe can actually help.

When I had malaria, I found that simply breathing became laborious. I realized that because I was using certain muscles in the body over and over and over again to do the breathing. They were being starved of oxygen, so they were wearing out quickly. So I held in mind an image of the breath coming in not through the nose but through the middle of the forehead or from the top of the head, from the back of the head. Thinking of the breath coming in those places required that I use a different sets of muscles, so that the first set of muscles got to rest and then another set of muscles got into action for a while. Then when they got tired, I could visualize the breath coming in someplace else, and another set of muscles would pick up the burden.

Another time, when I was having heart problems, I discovered that thinking of the breath energy coming in from the left side of the body seemed to help a lot. So you never know where the breath energy is going to be helpful. You try out different things and you use your imagination to think of the breath energy coming in and out different places. That will change the mechanics of the breathing, and you can give rise to a sense of a safe place in the body—and a sense that you’re not simply on the receiving end of the pain. When you’re more proactive like this, you’re less and less of the victim of the pain. You don’t just stay in the line of fire. You’re not an easy target, because you’re moving around, asking questions, trying this, trying that.

Now, sometimes working with the breath will help alleviate the pain; sometimes it won’t make any difference, but at the very least you’ve checked that possibility and checked it off. But the fact that you have your safe place allows you to be a little bit more daring in trying to figure out the pain, because after all, the real problem is not so much the pain. It’s the fact that the mind latches on to the pain and then stabs itself with the pain. That’s a matter of perception—the images of the pain that you hold in mind, the images of your relationship to the body that you hold in mind. You want to see these three things as separate—your awareness, the body, and the pain—so you have to watch out for any perceptions that glom them all together.

First you ask yourself: Is the pain the same thing as the body? The body is made out of the four elements or the four properties of solidity, liquidity, warmth, and energy—and the pain is none of those. The pain is something else. Even though it may seem to be in the same place, it’s as if it’s on a different frequency. Then you can ask yourself: Is the pain the same thing as the mind? The pain doesn’t know anything. The mind is aware. The pain is not aware. The mind has intentions. The pain has no intentions. Learn to see these three things as separate—the body, the pain, and the mind—and that way, the mind can be there at the same time that there’s pain there, but it’s not pulling it in.

The challenge is trying to figure out exactly what perceptions are pulling it in, and you’ll find that these will change from time to time. You may have figured out one perception today and then you try to correct that. Your approach may work today, but then tomorrow you’ve got another perception, so you have to keep probing around, keep asking questions, because the ability to separate the mind out from the pain, even though it’s based on concentration, is an activity of discernment. You have to figure out: “What is it that I’m doing that’s making the pain pain the mind?”

If you’re willing to sit with the pain, and the pain is not overwhelming, then you get to see a lot of the mind’s conversations around the pain—what the Buddha calls verbal fabrication and mental fabrication. The pain will become the center for all kinds of complaints, and you get to see a lot of the mind’s assumptions written into the complaints. It’s a really good place to get to know the mind.

You can think of it as a water hole in the savannah. Suppose you want to make a documentary about the animals in the savannah. You don’t go running around the whole savannah chasing them down. You just wait by the water hole, and in the course of twenty-four hours, they’re all going to come. In the same way, if you want to learn about your clingings and cravings and all the other unskillful things going on in the mind, find some way to hang out around the pain by giving yourself a good comfortable place to stay right next to it. Again, it’s like staying in the savannah. You’ll want to have some protection from the sun, protection from the heat. Otherwise you won’t be able to make it for the whole twenty-four hours. And there are times when you have to rest. You don’t spend all your time fighting with the pain. When it gets overwhelming, you take the medicine.

Ajaan Fuang talks about being with Ajaan Mun and getting a little perplexed about the way Ajaan Mun treated the issue of medicine. There were times when some monks would be sick, and he’d go and give them a Dhamma talk, saying, “What do you want medicine for? Here’s your chance to learn the Dhamma from the pain.” There were other cases, though, when there was medicine and the monks would refuse to take it, and Ajaan Mun would scold them for being difficult to care for. Ajaan Fuang came away with the lesson that if there’s medicine, you use it. If there’s no medicine, you have to face the pain, but you don’t face it simply by sitting with it. You learn to use your discernment. We don’t gain awakening simply through patience and equanimity. As Ajaan Chah once said, if those two qualities were enough to gain awakening and understanding, then chickens would have all gone to nibbana a long time ago, long before human beings.

Getting past the pain requires that you be interested and probing, trying to understand: “What is this pain? Why does it have such an influence over the mind? And why does the mind grab on to it? What are its perceptions that grab on to it?” When you probe and question like this, you come to a lot of understanding—and even before you come to the understanding, the fact that you’re willing to question means that you’re not just sitting there as an easy target.

So try to provide yourself with a safe place to stay. Find which parts of the body you can make comfortable through the way you breathe and protect them. Look after them. Value them. They’ll give you the strength you need in order to deal with this issue that keeps eating away at the heart and mind, the issue of why it wants suffering. It tells itself it wants happiness, but it goes and wants things that make it suffer. Why does it do that? What we really want is an end to suffering—and that desire is okay. It’s simply a matter of learning how to focus your efforts and your attention in the right way, in the right place. In that way, you give yourself a chance.