Natasha Doran's article on Breathworks for Talkback Magazine.
Talkback is a magazine produced by Backcare – the Charity for Healthier Backs.
I first discovered the Breathworks Mindfulness-based Self-Management Pain Group (SMPG) in 2002 when I was in the first year of my PhD looking at back pain in the Northwest of England. The pain management courses had been set up the previous year by Vidyamala Burch - a practicing Buddhist in her forties - with the aim of exploring a multi-facetted approach to pain management. Having suffered a lifting accident when she was 17, followed by a series of surgical operations, Vidyamala had to adapt her life and her outlook in order to manage what became constant back pain. This led her to develop a method - based on her own personal experience as well as the mindfulness- based teachings of Jon Kabat-Zinn - which she hoped could be adapted and shared more widely to help others living with pain.
So one spring morning there I was, a first year student walking down a street in the heart of Manchester’s old town - known as the Northern Quarter – when the familiar intrusion of severe sciatic pain shooting down my leg caused me to stop and rest in the nearest café. Here I picked up a leaflet, while waiting for a ride home, and saw that on the next street, courses were being run in pain management. By this time I had been living with back pain for eleven years following a spinal fusion operation, so I decided to join the course as I was keen to explore new ways to manage and cope with my pain.
I attended several of the courses as part of my fieldwork research, but it was the first one I recall most vividly, for it was the first time I had attended any form of self-help or support group. I remember one woman looking around the room at each of us before saying: ‘You all look normal to me, none of us look ill, yet we are all in pain…’ While another man, stood in the corner because of his pain, started to talk about the awkwardness he felt having to stand when others were sitting and the embarrassment this caused him having to constantly explain himself and his unseen pain.
The day was centred around alternating activities such as relaxation and discussion in order to incorporate and reflect the value of ‘pacing’, a key feature and central message of the pain management course. As each person entered the room, they would take up a mat, cushion or chair and settle into a guided meditative relaxation practice known as the ‘body scan’. This involved focusing one’s mind on different parts of the body in order to let go of habitual tension. Following the relaxation session everyone would take a moment to stretch or walk before moving to the back of the room where a clip board for discussion was standing on a tripod. Here key themes would be introduced such as goal setting and methods of coping with pain and experiences would be shared amongst the group. During one of these discussions, we talked about warning signs which could precede an episode of back pain - including shallow breathing; feelings of increased tiredness; blurring of vision; and decreased attention to external stimuli. From this we learnt that if we could become more aware of these early warning signs, if we could slow down, stop, change activity or position in response, rather than in reaction to the pain, then we would be better able to ward off a flare up or at least lessen the effects. By keeping weekly diaries we were able to learn the difference between being tense or being relaxed in the pain. We could then see for ourselves that if we ignored the early signs, the pain signals would get louder. For example tiredness would lead to exhaustion, shallow breathing would become shortness of breath, stress and tension would lead to tight muscles or muscular spasm which could in turn result in increased pain. As one woman who had been living with back pain for seven years commented: “I’ve learnt that much of my tension is unconscious…it’s been an unconscious response to my pain.” While one man who had been living with his pain for twelve years told me: "It’s only now that I'm actually learning to breathe into the pain rather than tighten around it…living with pain means learning this difference."
While the course does not promise to remove the pain, what it does offer is a means and a way of living with it. As one women observed: "It's part of a process and we’ll go on learning lessons from pain after this course has finished…it can’t take away our pain but it can increase our awareness to learn these lessons quicker and better…through pacing, through managing the tension." Drawing on a broader experience-led perspective, the course teaches that: "you are more than your pain" and that "pain is forever changing not fixed." Many found this to be comforting, having experienced their pain to be all consuming.
Reflecting on my own experience, over the next three years my health slowly improved. Where in the past my daily life was ruled by back pain - to the extent where a trip to town could end in my having to lie down in numerous awkward and inconvenient places including a public toilet with a baby changing cubical; behind a clothes rack in a department store; a flowerbed in a large roundabout; park benches or the back seat of a taxi which I would have to call when unable to stand or walk any further – yet today I am able to sit for fifty minutes instead of five, walk for one or two miles and my pain is no longer constant but activity specific.
By combining treatments such as cranial osteopathy and applying methods such as relaxation and pacing, I am able to engage in far more activities and enjoy a quality of life which I had lost for fourteen years. For the first time I can talk about my back pain in the past tense – whereas before it was in the forefront controlling all activities, decisions and future choices, now, despite daily bouts of pain, I no longer see myself as a ‘back pain sufferer’ the back is very much back where it belongs, behind me!