Working with Pain Handout

Working With Pain in Meditation and Daily Life:

Handout and Resources from:
A 3-week workshop with Ines Freedman 1/12 to 1/26/10


mp3’s of the following meditations can be downloaded here: Working with Pain

In mindfulness meditation we use the breath as the center of our attention, but if something else becomes compelling, we turn our attention to it until it’s no longer compelling, then we return to the breath.  What arises are either physical sensations, emotions and/or thoughts.  The meditations below help develop our awareness of each of these areas.

One way of working with these meditations is to spend the first 10 minutes of each session on Mindfulness of Breathing, and the second part with one of the other methods.  Continue with the same method for several weeks, until you have an ease with it, before moving on to another method.

If pain dominates your life, it might be helpful to meditate at least twice a day.  In that case, feel free to work with one meditation at one session, and a different one later in the day.

After you’ve become comfortable with these various methods, you can use Mindfulness of Breathing as your core practice, allowing these methods to be tools in your “toolbox”, and using them as needed. 

1.  Mindfulness of Breathing: Begin the first 10 minutes or so with Mindfulness of Breathing

  • Take a few deep breaths; relaxing a little more with each exhale.
  • Let your attention settle on the sensations of breathing, wherever it’s easiest and most relaxing for you to feel it: maybe the nostrils, the chest, or the belly…  Let that be your “anchor”, your “home”.
  • If it’s helpful, silently whisper in your mind: in-out or rising-falling with each breath.
  • Let your attention rest on the sensations of breathing.  If the attention wanders off, bring it back gently.
  • Keep the attention continuous throughout the entire breath, including any spaces between the breaths.
  • Let any concerns or issues that want your attention stay in the background, no need to push them away, it’s okay for them to be there, just keep returning to the breath, to the rhythm of breathing in and out.

2. Free Floating Within the Discomfort: After about 10 minutes of mindfulness of breathing, turn your attention to any discomfort or pain; if there isn’t any, return to mindfulness of breathing.

  • Let the awareness be pulled to wherever the discomfort or pain arises in your body.  Mentally label the location.  Hand…face…low back… Fully focus there for a few seconds, and then move on to the next sensation – do this at a leisurely pace.
  • If pulled to the same area over and over again, let your awareness freely-float within that area and label the smaller movements in that area:  upper right… center, lower left, overall… shifting your attention to a new part of that area every few seconds.
  • Continue to let the awareness freely float within the body, going from one area to the next, but now look more deeply at the different flavors of sensations and label them: burning, aching, shooting, itching, pressure, expanding, contracting, tingling, vibrating, shooting, pounding, dull aching, oscillating …
  • Now, let go of the labeling.  Bring your awareness to the entire area of discomfort all at once, and penetrate it with your awareness.  Notice its size and shape, the outline, the edges.  Is it long? Round?  Flat?  Deep?  Are its borders sharp or diffuse?  Is it uniform, or does it have areas of greater or lesser intensity within it?  Is it changing?  Stay open and accepting of the sensations.

3. Emotional Reaction to Pain or Discomfort:

  • Notice how you feel in your body and emotions.  Second by second you may have an emotional reaction or you may be neutral.  The emotional reaction might be to pain or to other things; it doesn’t matter.
  • If you find that you have an emotional reaction, mentally, like a whisper in the mind, silently label it.  It could be anger, dislike, fear, sadness, impatience, and so forth. Label it with the simplest word or phrase that seems appropriate; don’t worry about being exact. If you have a reaction to the physical discomfort but can’t pin down what it is, just label it as “emotion”.
  • If you have no emotional reaction at a given instant, and find that it is restful or peaceful, then label that “peace” or “calm”.
  • If an emotion persists, repeat the label at a steady pace.  It might sound like this, “sadness…sadness… irritation…irritation…calm… calm… dislike… tension…calm…. gratitude… fear…fear…. etc…”
  • If an emotion is strong and persistent, keep labeling it, but notice how it feels in the body.
  • Moment by moment, there is either an emotional reaction or you’re emotionally resting.  Either is fine.  Greet these reactions with gentle matter-of-factness.  When there are no reactions, consciously enjoy the restfulness.
  • Place some of your awareness on the discomfort, but keep noticing your emotions as they come and go.   Have a friendly interested attitude towards them.  Notice the difference between the physical sensations and the emotional reaction.
  • End with a couple of minutes of Mindfulness Of Breathing.

4. Local Intensity and Global Spread:

Primary Area: The area where the pain is very strong.  This may include one or several areas.

Secondary Areas: The areas where there are no discomfort or pain, or the discomfort is not very strong; everything outside the primary area.

  • Keep your attention only in the secondary areas, moving from place to place at a leisurely pace.
  • Every time your attention lands on a new place, label it, and intimately sense it, before moving on.
    • For example: label cheek and then feel what your cheek feels like.
    • Then just go on to another area where there is no pain or where the discomfort is mild.
  • Try not to be pulled into the primary area.
  • If the pain spreads beyond the primary area, focus your attention to where it has spread. But still only one small area at a time.  Label the area and feel it. 
    • Discomfort that spreads from the primary area is usually much milder, so you may be able to notice it and experience the spread with more equanimity and acceptance.
  • Last few minutes: 
    • Get a sense of your body as a whole.
    • Place some attention in the primary area, but still maintain an awareness of your body as a whole.
    • Each time there’s a change in the intensity or shape of the primary area, notice any global spread.
    • Let your attention go back and forth between the whole body awareness and the primary area.  Keep watching any interplay between your primary pain and the secondary areas of the body.
    • It’s like a pond where there’s a local splash, and a ripple spreads throughout the whole pond releasing the pressure and the energy.  See if you can get into that rhythm.  Local splash… global spread, and then let it release throughout the body in all directions.

5. Mindfulness of Thinking:

  • Bring your attention to the thinking process. 
  • When a thought arises, if it’s dialogue, words or phrases, label it THINKING.
  • If it’s an image, label it SEEING.  (It can be clear and vision-like or vague.)
  • As the mind quiets, the grosser thoughts may calm down or even go away.  But there can still be a sense of movement in the mind.  This is the pre-conscious area from which thoughts arise.
    • In this subtler level, there are no clear words or images, yet you know you are thinking.
    • It’s too subtle to notice the content, but we can observe the movement, the energy of this subtle thinking.  If it’s helpful, label this process by how you experience it: maybe calm or movement.
    • You may go back and forth from the pre-conscious area to words and images.  It doesn’t matter.
    • If the mind drifts, notice it, and gently, non-judgmentally bring it back to paying attention to thoughts.  If you have judgmental thoughts, such as “I blew it again…,” you can label it JUDGMENT.

6. Metta or Lovingkindness Meditation: for more resources see www.audiodharma.org/talks-metta.html

  • Lovingkindness practice is connecting with the intention of wishing happiness for yourself and others.  It’s practiced first toward oneself, as we often have difficulty loving others without first loving ourselves.
  • Mentally repeat, slowly and steadily, the following or similar 3 to 4 phrases.  These are suggestions only, feel free to use other phrases that you resonate with instead.

May I be happy… May I be peaceful… May I feel safe… May I be at ease…

  • We connect with the intention of wishing ourselves happiness. Whatever feelings arise are fine.
  • Optional: For some people, involving more of the senses can help deepen the concentration.  Such as:
    • When repeating “May I be happy”, not only hear the words in your mind, but you can also visualize a smile, or the felt-sense of your lips with a slight smile.
    • “May I be peaceful”, feel the relaxation of your forehead, and visualize a peaceful face.
  • With significant pain: you can shift your focus and direct the phrases towards the area of pain, switching to “May you be happy… may you be peaceful…”

7. Body Scan: (This can be done lying or sitting.) There are a number of variations of this meditation, any of them are fine; the order of what you pay attention to is not critical. 

  • Begin with a few deep breaths, relaxing more with each exhale.
  • With some awareness on the breath, direct your attention to the toes of the left foot, feeling them without moving them. You might imagine the breath flowing to the area where you’re directing your attention. 
  • At a gradual pace, systematically move your focus to the sole of the left foot, then the top of the foot, continuing in this way to the ankle, calf, knee, thigh and hip.
  • Move on to the right toes, continuing in the same way to the foot, ankle, calf, knee, thigh and hip.
  • Become aware of the pelvis and buttocks, continue to the lower back, mid back, upper back, notice the ribs around the spine.
  • Shift the attention to the stomach, continuing to the solar plexus, the chest.
  • Focus on the fingers of both hands, palms, back of hands, wrists, forearms, elbow, upper arms, and shoulders.
  • Focus the attention onto the neck, throat, face, jaw, eyes, forehead, the entire face.
  • Focus on the back of the skull, to the top of the skull, the entire skull.
  • Focus at the top of the head, an area the size of a quarter, breathing in and out of that spot.
  • Become aware of your entire body breathing.

8. Walking Meditation is a practice that complements Sitting Meditation.

  • Find a pathway about 20-30 feet long.
  • Use a pace that gives you a sense of ease as you walk.
  • Let your attention settle on your feet and lower legs.
  • Feel what it’s like for the legs and feet to contract as you lift the leg, and feel the movement of the leg as it swings through the air. Feel the contact with the ground.
  • If helpful, silently label movements corresponding with your speed:
    • If fast pace: step… step
    • If moderate pace: lifting … placing
    • If very slow place: lifting … moving … placing
    • At the end of the path, come to a full stop. Slowly and mindfully turn around, and set your intention to be mindful during the next pass.  Begin again.
    • Keep a soft gaze, eyes slightly downward without looking at anything in particular. Don’t look at your feet, but feel the sensations of movement and contact from within.  


1. 8 Breath Meditation: Do this several times throughout the day.  Commit to times that are easy to remember.  Take 8 deep breaths.  Remember to have a kind and accepting attitude towards yourself as you do this.  After each deep inhale:

  • Exhale 1:  Relax your face, jaw, scalp and smile.
  • Exhale 2:  Relax your neck, shoulders, arms and hands
  • Exhale 3:  Relax your entire back, upper, middle and lower
  • Exhale 4:  Relax your chest and abdomen
  • Exhale 5:  Relax your thighs and legs and feet.
  • Exhale 6, 7, and 8:  Maintain awareness of your entire body, relaxing as much as you are able to.

2. Relaxation Response: Breathe, Relax and Open (BRO). Frequently throughout the day use a single breath to trigger a relaxation response.


  • Break Through Pain, A step-by-Step Mindfulness Meditation Program for Transforming Chronic and Acute Pain by Shinzen Young – a concise book with accompanying CD with detailed guided meditations
  • Full Catastrophe Living by Jon Kabat Zinn
  • Guided Mindfulness Meditation (Guided Mindfulness) AUDIOBOOK, by Jon Kabat Zinn.  Guided meditations that include a body scan and guided yoga.
  • Arthritis, Stop Suffering, Start Moving and Turning Suffering Inside Out by Darlene Cohen.  Other resources can be found on her website:   www.darlenecohen.net/


The following guided meditations can be downloaded from the audiodharma website:

  • Walking Meditation 4/3/03
  • Guided Body Scan, by Gil Fronsdal  7/17/03
  • Guided Metta Or Lovingkindness Meditation, by Gil Fronsdal   9/6/01
  • World of Thoughts, by Gil Fronsdal 8/29/04

*For information on future courses and recordings, send an email to:  wwp@audiodharmacourse.org