Chronic Pain and Mindfulness-based Art Activities

by Meg Neufeld | Oct 31, 2017 | Chronic Illness

What is chronic pain?

Most of us have felt physical pain before: we’ve pulled a muscle, had a headache or bumped our funny bone (which really isn’t very funny at all!). The pain we experience is our body telling us something is wrong and after a period of rest and healing (up to three months), we can typically go back to normal activities. Chronic pain is when our brain is in an ongoing state pain and heightened sensitivity that persists longer than 3-6 months. Despite common understandings of pain as being a purely physical reaction, pain is actually directly linked to our brain and nervous system. This video highlights the complexities of our brain and nervous system and identifies the ways in which medication, exercise, diet, medical procedures and emotional processing can help retrain the brain and improve the quality of life for those who suffer from chronic pain.

Whether persistent pain takes the form of back pain, migraines, arthritis, fibromyalgia, endometriosis, lupus, other invisible illnesses, the chronic pain experience affects the body, mind, and soul. While each person’s experience with pain is different, there is a range of common threads:

• Everyone has their own definition of a good day and a bad day. Simple tasks may be manageable one day and not the other.
• In order to “self-manage” daily symptoms, there is a constant need to balance or carefully plan periods of rest, work, exercise, social activities, diet, sleep, and spiritual connectedness.
• It is challenging to talk to family and friends about our pain. The impact on family and friends can be devastating as roles, expectations, and relationships change because of the pain.
• Pain is challenging to treat. The constant rotation of medical appointments, medications and medical procedures can be exhausting and what may work for one person, may not for another.
• Chronic pain goes hand-in-hand with mental health and evokes strong emotions as attempts are made to cope with a loss of purpose, former abilities and relationships.

How can we tackle chronic pain?

The chronic pain experience is riddled with complexities; it has both physiological and psychological components, making a holistic approach in tackling chronic pain the most effective way to approach treatment planning. This video highlights the importance of a multi-disciplinary approach. As a result, we need to find ways to reboot our nervous system, learn productive skills to manage our symptoms, help educate others on chronic pain experiences, and strive to have a better quality of life.

HOW MINDFULNESS-BASED ART ACTIVITIES CAN HELP PEOPLE WITH CHRONIC PAIN

“Art gives a face to the ambiguity of chronic pain …

it gives a visual expression to something that is often elusive.”

–Dr. Steve Feinberg, American Chronic Pain Association

What are the overall health benefits of making art?

Using art for its health benefits is widely becoming a critical component of healthcare. Art helps us explore, practice and develop our creativity as a means to promote health and well-being. Making art has several benefits in key areas:

• Mental Health: Making art reduces stress, protects against depression and anxiety, can improve self-confidence[i] and encourages positive self-care. Doing something creative in a supportive and safe environment encourages experimentation and risk-taking, two essential qualities of the art-making process.[ii]
• Social Health: Those that participate in creative activities are more likely to have wider social networks with people from different backgrounds, have a sense of belonging, and are less likely to be socially isolated and lonely.
• Brain Health: Art making is an effective preventative tool in managing symptoms of diseases such as Dementia, Alzheimer’s disease, and other chronic conditions. It also improves memory processing, problem solving, and helps to maintain neuro-spatial functions as we age.
• Emotional Health: Creative engagement can provide a healthy outlet or path to healing for those who have suffered trauma, abuse, or significant life changes. Doing something creative can act as a distraction tool and is another way to preserve self-identity and move forward.

Using Mindfulness-Based Art Therapy (MBAT) techniques to tackle chronic conditions

According to Jon Kabat-Zinn, a leading researcher on mindfulness-based programs, mindfulness is, “the ability to become fully present in this moment, in a particular way, with a non-judgmental attitude.” [iii] Combining mindfulness skills while making art can be an effective way to manage symptoms of depression and anxiety, improve pain tolerance, and elevate the quality of life of people with chronic pain [iv] [v]  and illness,[vi] including those with arthritis[vii], Dementia and Alzheimer’s disease[viii], and cancer.[ix]

Why does MBAT work for chronic pain management?

Mindfulness is a frame of mind; a decision is made to intentionally pay attention to the present moment when doing an activity. It is an effective way for the brain to concentrate on surrounding senses other than the pain itself. It involves resting the physical body (doing body scans) and the psychological mind. Art therapist and facilitator Margaret Jones Callahan describes mindfulness-based art therapy (MBAT) as the “appreciative inquiry mindfully applied to the empty page or the open space. The practice of holding one’s awake attention fully in the present moment, non-judgmentally, while in the act of creating and expressing,[x] acknowledges the presence of pain and helps to get through it, moment by moment. While mindfulness is the lens in which to approach a particular moment, making art is the vehicle with which you experience it. Mindfulness-based art therapy:

• Promotes both the healing and rehabilitation process and is a way for chronic pain sufferers to “’lose themselves’ in the moment,”[xi] (also known as “being in the flow”) giving the nervous system a break.
• Provides temporary respite from physical symptoms of pain (headache, nausea)
• Is an effective method of distraction and promotes positive self-management skills to filter emotions and is a way to express suffering.
• Can build social alliances, companionship, and social affirmation, creating a wider support system with family, friends, and peers. Making art with others lends another way to talk about or communicate with others about pain experiences.
• Allows space to be self-reflective and helps monitor growth and progress in a visual manor.
• Affirms a sense of control over surroundings in the decision-making process of selecting colour, shape, and images.

At its core, MBAT, strives to create a peaceful environment where one can be completely absorbed in the moment while immersed in the process of creation. Along with healthy changes to our diet, sleep, and exercise regimes and with attentiveness on empathy, intentionally putting time aside to do something creative (read, write, paint, knit, sing, do yoga[xii], or dance) can help lower stress levels, give our nervous system a rest, and helps to promote self-care habits. By using a variety of creative processes, health difficulties can be better expressed, understood, accepted, and transformed.[xiii]

If you’d like to experience how MBAT can help you manage your chronic condition, please feel free to give me a call, or email, or come to our Open Studio Sessions where we go through many of these techniques! Give art a try!

[i] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 40. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.

[ii] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 41. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.

[iii] Jon Kabat-Zinn. http://www.mindfulnesscds.com

[iv] Ann Behav Med. Eds. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis.2017 Apr;51(2):199-213. https://www.ncbi.nlm.nih.gov/pubmed/27658913

[v] Kabat-Zinn, J., Lipworth, L. & Burney, R. J The clinical use of mindfulness meditation for the self-regulation of chronic pain. Behav Med (1985) 8: 163.

[vi] “The Art of Pain Management.” American Chronic Pain Association: https://theacpa.org/uploads/Art_and_Music_final.pdf

[vii] Reynolds, Frances and Sara Prior. Strategies of Adapting and Replacing Artistic Leisure Occupations to Maintain Participation and Identity: A Qualitative Study of Women with Arthritis. Journal of Activities and Adaption and Aging, March 2011. http://www.tandfonline.com/doi/abs/10.1080/01924788.2010.545970?journalCode=waaa20

[viii] Quintana Hernández DJ et all. The effects of a neuropsychology program based on mindfulness on Alzheimer’s disease: randomized double-blind clinical study. Revista Espanola de Geriatria y Gerontologia [2014, 49(4):165-172]

[ix] Monti, Daniel W., Caroline Peterson, et al. A Randomized, Controlled Trial of Mindfulness-based Art Therapy (MBAT) for Women with Cancer. Thomas Jefferson University, Philadelphia, PA, Psycho-Oncology 15:363–373 (2006)

[x] Callahan, Margaret Jones. Mindfulness Based Art: The Sparks Guide for Educators and Counselors. Friesen Press. 2016.

[xi] Dr. Daniel Potts. How art therapy enhances the life for Dementia Patients. 2014  http://www.alzheimers.net/2014-04-29/art-therapy-for-alzheimers/ Accessed September 15^th, 2016

[xii] Ward et.al. Yoga for functional ability, pain and psychosocial outcomes in musculoskeletal conditions: a systematic review and meta-analysis. Musculoskeletal Care. 2013 Dec;11(4):203-17. doi: 10.1002/msc.1042. Epub 2013 Jan 9. https://www.ncbi.nlm.nih.gov/pubmed/23300142 Ward L¹, Stebbings S, Cherkin D, Baxter GD.

[xiii] McNiff, Shaun. Chapter 2: The Role of Witnessing and Immersion in the Moment of Arts Therapy Experience. P. 40. In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 38-50.

My Life with Chronic Pain

by Meg Neufeld | Sep 28, 2017 | Chronic Illness

Just because you have a hard life, it doesn’t mean you have to have a bad life.
With challenges or disabilities, you can still have a great life.
– Ava Neufeld, age 9

When my husband Andrew and I began to conceptualize Alongside You, we wanted to serve the needs of our communities in different ways. While it was our goal to build an interdisciplinary clinic, we sought to create a place where I could use some of my skills as an artist and anthropologist to design an environment where I could work at my own pace. You see, 6 years ago, a car accident on a raining day left me with daily chronic pain.

It’s not something I like to bring up, but because it affects my daily life, I am learning to talk about it more as well as raise awareness of invisible chronic conditions. Just like mental health issues, chronic pain is an invisible illness. I don’t have any visible scars, a cast, a cane, or even a service dog to alert others about my condition. In the last six years, I have struggled with constant and never ceasing pain. Every. Single. Day. For me and so many others with chronic illness and pain, persistent pain makes normal activities excruciatingly difficult. For some, every movement or breath takes effort and every day choices are made based on a delicate balance between periods of rest and activity. Every day begins with the struggle to keep up with those around us.

At the Beginning:

The past 6 years have been a blur. At first, migraines where so intense that they would last 24-36 hours every few days. While life continued beyond my bedroom door, I spent my time with ice packed all over my head, heat on my back, with earplugs in and eye patches on, to rid me of all things sensory. Balance issues, cognitive impairment and physical mobility were so strained that I was in bed for months and months on end, rising only for short periods of time. Impaired cognitive functions such as critical thinking, organizing, memory, emotion regulation, and reasoning made simple tasks such as making lunches or setting the table, impossible. When I was not in bed, I focused on rehabilitation that consisted of physiotherapy, acupuncture, massage, trigger point injections, Botox treatments, and inner ear and concussion testing. I was prescribed neurological medication to treat acute neck, head, and ulnar nerve pain, but each had their own side-effects. After a year of being unable to drive and relying on our friends and family to take care of our children, we came to the realization that things were not going to drastically improve, so we hired a nanny who took over all the childcare while I rested and went to rehab.

It was a couple of years before I felt strong enough to manage the kids on my own. Having been and “absent parent,” for the last few years, taking back the reins of parenthood presented challenges of its own. My children no longer saw me as an authority figure and sought comfort from others. As I got a bit stronger and with a series of medication changes, new and ongoing surgical procedures (nerve blockers, trigger point injections, medial branch cauterizations and Botox injections) I have slowly been able to reclaim my role. I would be in a very different place today if it weren’t for the help of supportive family, friends and rehab therapists and counsellors.

Matters of the Heart

Though my body is adjusting to this new state of pain, my spirit is still trying to digest a complex set of emotions as a result of the motor vehicle accident. Feelings of stress, anger, isolation, disappointment, anxiety, depression, and hopelessness go hand in hand in the journey of someone who lives with chronic pain. There’s anger over lost time with family; grief over the career you once had; frustration with daily physical pain and low energy that prevents the beginning of new ventures; disappointment with not being able to be consistent with family, work and friends; guilt over the burden you place on others with no hope of returning the favour, and so much more.

What keeps me going? My faith. It has sustained me and has played a huge role in my day to day functioning. It has provided me with guidance and has uplifted me in the ways I needed the most. I have also been regaining my sense of self by journaling daily. Reading back over previous entries reminds me of where just how far I’ve actually come. My abilities as a wife, a mother, daughter, twin, and friend have forever been altered. My job not only consists of taking care of my children and home and building Alongside You, it now includes spending time trying to prevent headaches and acute back pain by diligently trying to balance daily rest and activity. This includes a careful regime of exercise, daily rotation of heat and ice, visits to rehabilitation therapists, and has even led us to renovate areas of our house to make them more ergonomically sound. Chronic pain follows me wherever I go and dictates the extent of our plans, where we go, and what we do.

What I’m Learning About Living with Chronic Pain

1. The importance of approaching everyone with empathy

I have learned that because chronic pain is an invisible illness, others around me may be going through physical or mental health issues that are not immediately apparent.  Would I turn back the clock to before my accident? Yes…and no. Of course, I would have liked being spared the pain and suffering caused by our accident, but it is because of it that I have learned so much about the human spirit and how to have more empathy for those with visible and invisible pain and have sensitivity when planning activities that are accessible to all.

“Be Kind. For everyone you meet is fighting a battle you know nothing about. –Toby Mack

This has literally changed how I interact with everyone I encounter.

2. Try to make peace with your situation

This is the hardest thing I’ve had to learn. With chronic pain, there is no end in sight. You yearn for what you once were able to do and you grieve the things you have not yet done. With good and bad days, your pain is out of your control and there is no real light at the end of the tunnel. This can easily lead you to feel depressed and hopeless. What you can do, however, is to make quality choices. You can make a choice every day of whether or not you are going to let the pain take over or to do something constructive with your time and effort. You can make choices (however small) of the things that give you joy or help you cope with your pain. We will all choose things that are different – for some it could be a pedicure to avoid bending down, for others it may be a soak in the tub, coffee with a friend, or a skill you want to learn. It’s all about managing your symptoms and creating a better quality of life for yourself. It’s about having a life worth living.

“You either get bitter or you get better. It’s that simple. You either take what has been dealt to you and allow it to make you a better person, or you allow it to tear you down. The choice does not belong to fate, it belongs to you.”  – Josh Shipp

3. The need to educate others

Because chronic pain is invisible, it is sometimes difficult for others to understand what your life is like. Your husband, children, family and friends may have expectations of you that do not align with your abilities. It can be hard to let them know of the kinds of activities you are able to do or not to do, how long you can be active, and when you need to rest. Without people being able to gauge your abilities and tolerances, those around you may have unreasonable expectations of you. Those of us with unseen disabilities such as chronic pain, cancer, endometriosis, fibromyalgia, diabetes and more, know how much effort it takes to walk down the hall or the huge strain it is to complete simple tasks. Share your story with family, friends, and professionals. Describe your struggles. Your willingness to speak about your weakness can make yourself and others stronger. Adjust expectations. Remind your loved ones that some days you may be able to do a certain task, but the next day, you won’t. It may take some time for others to learn about your specific abilities and needs. Be gracious. Look up. Religious teachings or connection to your spiritual side can help us to reflect on our purpose, explore our spiritual existence, and meet like-minded folks who have the potential to be a group of caring people to add your support network.

“Behind every chronic illness is just a person trying to find their way in the world. We want to find love and be loved and be happy just like you. We want to be successful and do something that matters. We’re just dealing with unwanted limitations in our hero’s journey.” – Glenn Schweitzer

4. Knowing it’s okay to ask for help

Let’s face it, it’s hard to ask for help, especially if you need help frequently. For so many of us, asking for help indicates defeat, stresses helplessness and highlights our deficiencies. Sometimes, people don’t know how to help those with chronic pain. Reaching out to family, friends, and professionals, however, can change your quality of life in a positive way! Do regular check-ins with your doctor or rehabilitation practitioners who can help you at different stages of managing your pain. They are there to help you find strategies and ways to cope. This will not only help you track your progress, it’s a great way to network with other local people and services that can help you in your journey. Stressing about things we can’t control does not help the healing process but hinders it (physically and psychologically). Make choices by asking yourself, “If I do this activity, is it going to add to me in a positive way or can I have someone else do it?” Handing over control may make you feel vulnerable, but get to know your limits so that you can participate in other things.

“At any given moment, you have the power to say this is not how my story is going to end.” – Unknown

5. To live in the moment and celebrate small victories

“Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.” – Mary Anne Radmacher

Mindfulness, or having a heightened sense of awareness to the present moment, can be a tool to use with the management of chronic conditions. Practicing mindfulness has been proven to help decrease stress and anxiety[1], aid in pain management[2], increase quality of life in cancer[3] and Alzheimer patients[4] and ease symptoms among those suffering from persistent mental illness.[5] As we refocus our brain to be aware of the sounds, textures, smells, and what we see, we are actually giving our brain time to rest from being focused on pain. When we become more aware of our surroundings we tend to notice details and take pleasure in them. Something as simple as watching leaves fall, the wind blow, kids playing at the park, the crunch of fall leaves underneath you, can help you put your pain on the back burner for a period of time. Even that short amount of time can be restorative. As you relish in these daily experiences and are more mindful of how your body feels, there is an opportunity to take little steps forward. Take note of these small victories. These are little gold nuggets, ones you can look back on and remember them as stepping stones. It could be that you have been able to accomplish tasks that you haven’t been able to do in a long time: ride your bike, follows recipes, taking a new class, walk to the end of your block. Each of those little triumphs are golden nugget moments. Take time to breath, moment by moment, hour by hour, day by day. When you just can’t keep up, remember your small victories…they can reap huge benefits!

“The reason why people give up so fast is because they tend to look at how far they still have to go, instead of how far they have gotten.” – Unknown

I rolled my eyes at Andrew and others who suggested mindfulness to me because it’s not something that I knew about before, but it is something that has radically changed my wellbeing and I encourage you to try it. I did training in Mindfulness Based Art Therapy (MBAT) techniques as a way to use art in my own journey and now I use it with people in our art studio where I am the creative arts facilitator. I would love to have you at our Open Studio Sessions on Mondays or Wednesdays if you’re interested. Art is a great way of being mindful, and the research shows how effective it can be in our recovery. As an art facilitator, I hope to bring people together so that they can make meaningful connections with others.

Thank you for witnessing a part of my journey in reading this post and I hope it has been helpful for you in your own journey. Join us next week when we will share more posts about chronic illness.

If I, or anyone at Alongside You can be of any help please don’t hesitate to get in touch.

[1] Jon Kabat-Zinn. http://www.mindfulnesscds.com
[2] Kabat-Zinn, J., Lipworth, L. & Burney, R. J The clinical use of mindfulness meditation for the self-regulation of chronic pain. Behav Med (1985) 8: 163.
[3] Monti, Daniel W., Caroline Peterson, et al. A  Randomized, Controlled Trial of Mindfulness-based Art Therapy (MBAT) for Women with Cancer.
[4] Quintana Hernández DJ et all. The affects of a neuropsychology program based on mindfulness on Alzheimer’s disease: randomized double-blind clinical study. Revista Espanola de Geriatria y Gerontologia [2014, 49(4):165-172]
[5] Herring, Daniel. Mindfulness-Based Expressive Therapy for People with Severe and Persisitent Mental Ilness. P.172. In In Mindfulness and the Arts Therapies: Theory and Practice. Laury Rappaport ed. Jessica Kingsley Publishers. 2014: 168-179.