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Posts from the ‘Pain Relief’ Category

A Major Cause Of Mental Ill-Health Has Been Discovered And So Has A Powerful New Treatment

In the Matrix movies, there are those who famously opt to take the ‘red-pill’ and discover that they are living inside a computer simulation of the world, while those who take the ‘blue-pill’ continue to live in blissful ignorance. Hollywood hyperbole aside, could the Matrix really contain a glimmer of truth? In recent years, neuroscientists have started to believe that we do indeed live inside a simulation, albeit one created by the brain rather than an alien computer. And this has profound implications for our understanding of the origins of thoughts, feelings and emotions but also for many mental health problems too.  

The New Psychology of the Mind: Predictive Processing

It takes an enormous amount of mental energy to become con­scious of the present moment. This is because of the vast amount of information flowing in from our senses, all of it needing to be co-ordinated and integrated so that we can become not only conscious of the world but also make decisions and act upon them – in real time – in the present moment. Given the complex­ity of the task, you would expect this to make everything – from walking along a crowded street to such simple things as catching a ball – extremely difficult. But nature has got around the problem by giving us a brain that predicts the future. It constructs a ‘simplified’ model of the world that is constantly updated and enriched by information from our senses. What we regard as the present moment is actually a stunningly realistic illusion created by the mind. An illusion so compelling that we mistake it for reality. It is called a simulation and the process it relies upon is known as ‘predictive process­ing’[i].

Predictive processing works by constantly ‘guessing’ what information the senses are about to send to the brain. We do not truly see the world; we see what our minds think the world is about to look like. Nor do we truly hear, but instead experience the sounds that the mind believes are about to hit our ears. And the same is true for our other senses, too. The mind predicts what we are about to taste, feel and smell. And in practice, it is this prediction – or simulation – that we experience, rather than the ‘real’ world.

As you can imagine, this is a fantastically complex process, but a simple analogy helps: if you are talking about politics in the UK and someone mentions the Houses of P . . . you can guess what’s coming next (the word ‘Parliament’). Because you have predicted the word, you don’t need to listen to the word itself. You can instead use that moment to capture the meaning of the whole sentence. Such predictions make perception and responses more fluent because the world is normally predict­able. As explained above, we don’t create a prediction for one single sense but for all of them. Simultaneously. We construct a global model that incorporates sights, sounds, smells, tastes and sensations. This model is constantly updated, moment by moment, and incorporates any deviations from the real external ‘reality’; we move through the world creating and updating – pre­dicting and checking – it. And if our checks show that we have made an error (like when we approach a door and pull on the large handle rather than pushing on it), we simply begin to pay more attention to the actual stream of data arriving from our senses. Any necessary corrections are then built into the model.

The brain also stores core experiences ready for re-use in the simulation. Imagine you are walking through your local park on a lovely sunny day. You have been to the park countless times before, and know it in detail. You have seen the sun filtering through the leaves of the trees many times; you know how the grass looks and smells, the sounds made by the children on the swings, the dogs barking and the traffic in the distance. You know everything you need to know about the park in order to reconstruct a highly accurate simulation of it in your mind. And if there are a few gaps – well, the mind is perfectly capable of filling them in and constructing a seamless experience.

States of Distress Are Also Ones of Hope

It’s not just visits to a lovely park that are recalled from memory to prime your simulation. Distressing thoughts, feelings and emotions are, too. In fact, troublesome states of mind are the easiest to recall. This is because the mind tends to store the most salient experiences on a hair-trigger (along with your most potent thoughts, feel­ings and emotions). So in practice, the things most likely to be re-experienced in your simulation are the most negative ones. Such dark and amorphous emotions as anxiety, stress, anger and unhappiness are held at the front of the queue.

None of this means that your distress is exaggerated or untrue. If you feel sad, then you are sad. If you feel anxious, stressed, exhausted or angry, then you truly are experiencing such distress. Your predictions are true for you. Simulation is reality.

Painful though they are, these states of distress are also ones of hope. For they are not solid, real and unchanging. Your simulation can be ‘re-calibrated’ to better reflect reality. And you can do this using an ancient type of mindfulness known as vedana or feeling tone meditation (See Deeper Mindfulness: The New Way to Rediscover Calm in a Chaotic World). In these meditations, you are asked to still the mind with a simple breath or body meditation and then to focus, in a very specific way, on the feelings and sensations that arise in the moment that the unconscious mind crystallises into the conscious one. In this way, your simulation is progressively recalibrated and brought into closer alignment with reality. So you learn to experience the world as it truly is rather than one recreated from your darkest memories or deepest fears. Feeling Tone meditations progressively release the grip that such distressing states of mind hold over you. You come to realise that yes, sometimes life can be painful, but at other times it is glorious, too. So you come to experience life as an ever-flowing series of pleasant and unpleasant moments. Moments of keen reality. And it is in such moments, that you can genuinely start to live again.

And research is beginning to show that an eight week program based on these feeling tone meditations can be a highly effective treatment for anxiety, stress, and depression while also enhancing overall wellbeing.[ii] It might not be necessary to take a Red Pill to break free of a distressing simulation. Feeling tone meditations may be enough.

You can download/stream some Feeling Tone meditations HERE.

Buy Deeper Mindfulness: The New Way to Rediscover Calm in a Chaotic World from Amazon UK

Buy Deeper Mindfulness from Amazon US

Download Chapter One for free (the US & UK versions are the same apart from the cover)

[i] For a review of this approach, see Andy Clark, Surfing Uncertainty: Prediction, Action and the Embodied Mind (Oxford University Press, 2016), Lawrence Barsalou (2008), ‘Grounded cognition’, Annual Review of Psychology, 59, pp. 617–45 and Lisa Feldman Barrett, How Emotions Are Made: The Secret Life of the Brain (Pan Books, 2017) and Manjaly, Z. M. & Iglesias, S. (2020), ‘A computational theory of mindfulness based cognitive therapy from the “Bayesian brain” perspective’, Frontiers in Psychiatry, 11, p. 404.

[ii] Williams, J.M.G., Baer, R., Batchelor, M. et al. What Next After MBSR/MBCT? An Open Trial of an 8-Week Follow-on Program Exploring Mindfulness of Feeling Tone (vedanā). Mindfulness 13, 1931–1944 (2022).

Deeper Mindfulness: The New Way to Rediscover Calm in a Chaotic World – Book Extract

This is a little taste of our new book Deeper Mindfulness. It’s the companion to Mindfulness: Finding Peace in a Frantic World (which has now sold two million copies and been translated into 34 languages).

‘This book walks you gently through the beautiful, messy process of being human, and teaches you how and why all can be well’ Sir Kenneth Branagh.

Chapter One: That Was My Life … But I Must Have Missed It

Every morning, a man walked his four dogs in the park. Three of them always darted about, barking happily, tails wagging with delight. The fourth seemed happy enough but would only ever run around in tight little circles (albeit covering quite a distance), staying close to the man as he walked. Day after day, the park keeper watched the dog’s strange behaviour. After a while, the keeper plucked up the courage to ask the man why his dog was behaving so oddly.1

‘Ah,’ the man replied. ‘She’s a rescue dog. She was locked up for most of her life. That was the size of her cage.’

How often have you behaved like that dog? Free, but constantly running around in little mental circles. Free to be happy, yet caged by the same dark, repetitive thoughts. Free to be at peace with yourself and the world, while remaining trapped and entangled by anxiety, stress, unhappiness and exhaustion.

Free as a dog in a cage.

So much of life is needlessly marred by little tragedies such as these. Deep down, we all know that we are capable of living happy and fulfilling lives, and yet something always stops us from doing so. Just as life seems to be within our grasp, it slips through our fingers. Although such periods of distress seem to appear from nowhere, they actually arise from deeply buried psychological forces. Neuroscientists have begun to understand how these processes guide our thoughts, feelings and emotions; but more importantly, they have discovered why they occasionally go wrong and leave our lives as shadows of their true potential. These new discoveries also show why mindfulness is so effective at relieving distress, but crucially, they also open the door to subtly different methods that can be even more effective. Mindfulness has not been superseded; rather, it can be expanded to include an extra dimension that transforms it.

Our new book Deeper Mindfulness: The New Way to Rediscover Calm in a Chaotic World harnesses these developments. It will help you to step aside from your worries and give you the tools necessary to deal with anxiety, stress, unhappiness, exhaustion and even depression. And when these unpleasant emotions evaporate, you will rediscover a calm space inside from which you can rebuild your life.

We can help you to do this because we – and our colleagues at Oxford University and other institutions around the world – have spent many years developing treatments for anxiety, stress, depression and exhaustion. We co-developed Mindfulness-based Cognitive Therapy (MBCT), which has been clinically proven to be one of the most effective treatments for depression so far developed. Out of this work arose our book Mindfulness: Finding Peace in a Frantic World. That book, and the mindfulness programme within it, has been proven in clinical trials at Cambridge University and elsewhere to be a highly effective treatment for anxiety, stress and depression. So much so, that it is prescribed by doctors and psychiatrists around the world to help people cope with a wide range of mental health conditions, as well as generalised unhappiness and dissatisfaction with life.

But the practices revealed in Mindfulness, and similar skills taught on courses such as Mindfulness-based Stress Reduction (MBSR), are only the first steps on a longer and more fruitful road. Although they form the foundations for a happier and more fulfilling life, and have proven transformative for many, a lot of people have asked us whether there is anything more they could do to enhance their practice and resolve their remaining issues.

The answer is yes. There is a way of taking mindfulness to the next level, of going deeper and unleashing more of your potential, by exploring another frontier of mindfulness known as vedana or feeling tone. And, importantly, you don’t need to have extensive meditation experience to benefit from these practices. Research is showing that novice meditators can gain just as much from them as those who have practised for many years.

Although it is an often overlooked aspect of meditation, feeling tone is, in fact, one of the four original foundations of mindfulness. These are: mindfulness of the body and breath; mindfulness of feelings and sensations (or vedana); mindfulness of the mind or consciousness; and mindfulness of the ever- changing nature of the world and what helps and hinders your journey through it. Each aspect is cultivated using a different set of practices that, together, bring about profoundly different effects on mind and body. Mindfulness courses generally focus on the first layer of each of these four foundations. This book uses new meditations on feeling tone as a gateway into the deeper layers of the same four aspects of mindfulness. These take you closer to the source of your ‘spirit’; closer to any difficulties you may be having; nearer still to their resolution.

There is no satisfactory translation of the ancient Sanskrit word vedana.

It is a quality of awareness that can only be experienced, not pinned down with precision. It is the feeling, almost a background ‘colour’, that tinges our experience of the world – of mindfulness itself. For this reason, vedana is often translated as feeling tone. Although we will use both terms interchangeably, it will always pay to remember that we are referring to a flavour of awareness, and not a rigid concept that can be hedged in by words and definitions. Feeling tone is something that you feel in mind, body and ‘spirit’, but its true quality will always remain slightly ineffable. Sometimes annoyingly so.

A typical feeling tone meditation consists of stilling the mind with a simple breath or body meditation and then paying attention to your experiences in a manner that is subtly different to what other meditations request. It asks you to focus in a very specific way on the feelings and sensations that arise in the moment when the unconscious mind crystallises into the conscious one. Such moments, though fleeting, are often the most important ones in your life. This is because vedana is the balance point in your mind that sets the tone for the sequence of thoughts, feelings and emotions that follow. It is often subtle, but if you pay attention to it, you can feel it in your mind, body and spirit – right through to your bones. The feeling tone is of profound importance because it guides the trajectory of your subsequent thoughts, feelings and emotions. If it is ‘pleasant’, you will tend to feel positive, dynamic and in control of your life (at least for a while). If it is ‘unpleasant’, you will likely feel slightly gloomy, deflated and powerless. Feeling tone meditations teach you to see, or more precisely, to feel the way that your life is pushed and pulled around by forces you are barely conscious of. Sometimes these forces act in your best interests, sometimes not – but the important thing is that they are not under your immediate control. Under their influence, your life is not your own.

To help these ideas settle into your mind, you might like to try this little practice to get a sense of your feeling tones: if it is convenient, take a few moments to look around you; the room, the window, the interior of your train or bus, or perhaps the street, field or forest before you. As your eyes alight on different things, or different sounds come to your ears, see if you can register the subtle sense of whether each one feels pleasant, unpleasant or neutral. If you are at home, your eye might alight on a card, gift or memento from a much-loved friend. You might feel the instant warm glow of a pleasant feeling tone in response. Or you might see a dirty dish that you’ve been meaning to tidy away, or something you’ve borrowed from someone and had intended to return, and then you might notice an unpleasant feeling tone. If you are outside, you may notice the sun streaming through the leaves of a tree, or a piece of dirty plastic rubbish flapping around. If you can catch the moment, you might sense ripples of pleasant or unpleasant feeling tones. But it is not just the external world that has such an impact. You may also become aware of sensations inside your body, such as aches and pains, or perhaps a sense of relaxed calm. These, too, register on the same dimension of pleasant, unpleasant or neutral. And sooner or later, you may notice thoughts or emotions arising and passing away soon after the feeling tones.

You don’t need to know how you know these feeling tones – you just know. Somehow there is a ‘read-out’ in body and mind on the dimension of pleasant to unpleasant. It’s like a gut feeling. It’s not a matter of thinking hard about it, or hunting for it, it’s more like the taste of something; you just know it when you taste it. Like tasting milk that’s gone sour, you know it’s unpleasant without having to think about it.

Feeling tones can be hugely significant. Cast your mind back to the last time you were sitting in a café and suddenly felt unhappy for no apparent reason. If you could rewind the clock and observe what was happening – frame by frame – as your unhappiness arose, you would have noticed that the emotion was preceded by a momentary pause. It was as if your mind was poised on a knife-edge, a moment when it was sensing whether the evolving situation was pleasant, unpleasant or neutral. A moment of vedana.

So vedana is often a tipping point in your mind that affects how you experience the world in the moments that follow. Good, bad, indifferent. But it is what happens next that is of paramount importance – we call it ‘the reactivity pulse’. It works like this: if a pleasant feeling tone arises in the mind, then it is entirely natural to want to grasp it, keep hold of it and be a little fearful that it will fade away or slip through your fingers. If the tone is unpleasant, then it is natural to want to get rid of it, to push it away, fearing that it will stick around for ever and never leave. Neutral sensations often feel boring, so you feel like tuning out and finding something more interesting to do. These feeling tones are primal and can quickly trigger a cascade of reactions in the mind and body. These are felt as emotions and cravings that compel you to try to keep hold of pleasant feeling tones, push away unpleasant ones and distract yourself from neutral ones. So, the reactivity pulse is the mind’s knee-jerk reaction to feeling tone. If a feeling tone sets the scene, then the reactivity pulse casts the actors, selects the costumes and writes the script for what happens next. And it can write a script and direct a scene that can easily ruin your whole day and sometimes far, far, longer.

Virtually all of the emotional difficulties that many of us experience begin with the mind’s reaction to our feeling tones – our reactivity pulse. But it’s not even the pulse itself that is the problem, but our ignorance of its existence and underlying nature. We are often not aware that it has occurred, oblivious of the feeling tone that triggered it and unaware of its tendency to fade away, all by itself, if only we would allow it to do so. All we are aware of is the cascade of thoughts, feelings and emotions that follow in its wake.

Learning to sense the feeling tone – bringing it into the light – teaches you to recognise your underlying state of mind and helps you make allowances for your sensitivities and entirely natural biases and reactions. It gives you the space to respond rather than react. It helps you to compassionately accept that although you might be anxious, stressed, angry or depressed in this moment, this is not the totality of your life with only one depressing future ahead of you. You can change course. Alternative futures are available to you.

And tapping into an alternative future is as simple as sensing the underlying flow of feeling tones. Noticing the reactivity pulses. Realising that the craving for things to be different is the problem. Craving an end to unpleasantness. Craving for pleasantness to remain. Craving an end to boredom. This idea is common to many ancient traditions. And now, neuroscience agrees.


Our previous book, Mindfulness: Finding Peace in a Frantic World, became the ‘go-to’ book for so many people because it helped them find freedom from their emotional and physical suffering. Throughout the book, we were honest about the benefits of mindfulness, and also warned readers that their journey would not be quick or particularly easy. We asked them to be certain that they were at the right moment in their life to begin, and highlighted that they would need to set aside the necessary time each day to actually do the practices. Despite these caveats, hundreds of thousands of people – perhaps millions – completed the programme in the book (or mindfulness courses based upon it). Many of these people became so intrigued by the effects of meditation on their lives that they wanted to broaden and deepen their practice. Perhaps you are one of them. If you, like them, would like to go beyond the eight-week programme taught in Mindfulness, or on your meditation, MBCT or MBSR course, and extend your practice to embed its benefits, this book is a good place for you to begin.

Alternatively, you may have found Mindfulness, or a course, helpful but it did not go far enough to completely dissolve your remaining negative or self-destructive habits. Perhaps you caught a glimpse of freedom but then lost it once again in your rush through life and now want to renew your acquaintance with it. Or, maybe, the mindfulness skills you learned on courses or through books didn’t quite ‘gel’ with you and you now want to try a different approach. If any of these is true for you, then this book will likely help you.

In Deeper Mindfulness, and the accompanying meditation downloads, we reveal the Feeling Tone programme. This is not simply a sequel to our original book, or to other meditation courses and classes; rather, it is one that will take your practice in a new and even more fruitful direction. And if you don’t have any meditation experience, there is no reason to be put off. The programme has been found to be equally helpful for both novice and experienced meditators, especially for those seeking a practice that combines scientific rigour with millennia-old wisdom.

We wish you well on your journey.

Buy Deeper Mindfulness: The New Way to Rediscover Calm in a Chaotic World from Amazon UK

Buy Deeper Mindfulness from Amazon US

Why cultivate awareness of the feeling tone of your thoughts, memories and emotions?

Your thoughts, feelings, memories and emotions are not the problem, no matter how unpleasantly real and visceral they might feel. As an example, emotions are signals that something important needs our attention:

  • We feel sad if we’ve lost something or someone important.
  • We feel fear when a threat appears on the horizon.
  • We feel angry when a goal is thwarted.
  • We are preoccupied when a long-term project needs our problem-solving skills.

In many ways, the real problem is the reactivity pulse, triggered by fluctuations in the underlying feeling tone. This creates a narrative so compelling that we can get stuck inside our thoughts, feelings, emotions and memories and can’t escape.

Learning to sense the feeling tone that precedes this reactivity pulse gives you extra information. It signals to you the very moment when your thoughts, feelings, emotions or memories are likely to seize control, become entangled and spiral out of control. This programme teaches you how to recognise these moments so you can step in and dissolve your old, destructive habits. It will help you rediscover the calm, vigour and joy that lie at the core of your being.

1) Adapted from Into the Silent Land by Martin Laird.

Mindfulness is a powerful painkiller that can dramatically enhance quality of life in chronic pain sufferers – latest research

Mindfulness is a powerful painkiller that can dramatically enhance quality of life in chronic pain sufferers, suggests new research. The findings add weight to previous studies which discovered that mindfulness can reduce pain severity by around 50 percent.

This new meta-analysis, published in the peer-reviewed journal Evidence Based Mental Health, analysed the evidence from 21 previous studies involving 2,000 chronic pain sufferers. It was designed to assess whether mindfulness was as effective as Cognitive Behavioural Therapy (CBT) for relieving chronic pain and its associated distress. CBT can be effective and has none of the side-effects of traditional painkillers such as lethargy and addiction. But, crucially, not everyone benefits from CBT.

Most of the participants in this new analysis were women aged between 35 and 65 and suffered largely from musculoskeletal pain. In nearly 40 percent of the studies, participants had endured their pain for more than a decade.

This new analysis suggests that mindfulness is just as effective as CBT when it comes to improving ‘physical functioning’. And both mindfulness and CBT were equally good at reducing pain and its associated conditions such as depression.

Dr Wei Cheng, lead researcher on the study carried out at the Ottawa Hospital, Ontario, Canada, said: “While CBT is considered to be the preferred psychological intervention for chronic pain, not all patients experience a clinically significant treatment response.

‘Although a number of recommendations have been proposed to improve CBT for patients with chronic pain, an additional solution may be to offer patients Mindfulness-Based Stress Reduction since it shows promise in improving pain severity and reducing pain interference and psychological distress.’

Previous work has shown that mindfulness meditation is highly effective at directly relieving chronic pain and also reducing the distress it causes. For example, work carried out by Fadel Zeidan at the Wake Forest Baptist Medical Centre in North Carolina discovered that mindfulness can reduce chronic pain by 57 percent. Accomplished meditators can reduce it by over 90 percent.

Dr Zeidan said: ‘Meditation produced a greater reduction in pain than even morphine or other pain-relieving drugs.’

As I explain in our book Mindfulness: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing, which is recommended by the British Medical Association, meditation achieves these remarkable results because it turns down the ‘volume’ control on pain. (Our book is published in the US as You Are Not Your Pain).

A typical meditation involves focusing on different parts of the body and simply observing with the mind’s eye what you find. This allows you to see your mind and body in action, to observe painful sensations as they rise and fall, and to let go of struggling with them. And when you do this, something remarkable happens: your suffering begins to melt away of its own accord. It also creates a relaxed state of mind that reduces the level of stress hormones in the body. Such deep relaxation enhances healing and boosts mental and physical health.

Imaging studies show that mindfulness soothes the brain patterns underlying pain and, over time, these changes take root and alter the structure of the brain itself, so that patients no longer feel pain with the same intensity. Many say that they barely notice it at all.

For these reasons, hospital pain clinics now prescribe mindfulness meditation to help patients cope with the suffering arising from a wide range of diseases such as cancer (and the side effects of chemotherapy), heart disease, diabetes and arthritis. It is also used for back problems, migraine, fibromyalgia, coeliac disease, chronic fatigue, irritable bowel syndrome and even multiple sclerosis.

You can download free meditations from You Are Not Your Pain/Mindfulness: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeingfrom here.

What is Mindfulness?

What it can do for you

Frantic World Home

The Art Of Breathing: The Secret To Living Mindfully, by Dr Danny Penman, is published in the US by Conari Press

Buy the Art of Breathing from Amazon US.

Buy it from Amazon UK.



Can Mindfulness Help Relieve Tinnitus?

One in seven people will suffer from tinnitus at some point in their lives and yet its causes are unknown and treatments are only partially effective. A new clinical trial highlights the remarkable promise offered to sufferers by Mindfulness-Based Cognitive Therapy.


If you have ever suffered from tinnitus, you will understand what a surprisingly distressing condition it can be. It can lead to anxiety, stress, depression, insomnia and impaired hearing and concentration. Its medical definition of ‘the sensation of hearing sounds in the absence of any external sound’ barely reflects the impact it has on day to day life.

I suffered from tinnitus for several years and it still returns from time to time. I managed to control the condition using Cognitive Behavioural Therapy (CBT) and mindfulness. I was taught CBT at hospital where it was called Tinnitus Retraining Therapy and I used my own mindfulness sessions to enhance its effect. And I found it surprisingly effective. The tinnitus in my right ear disappeared completely. Some ringing returns to my left ear from time to time, but it no longer bothers me.

Nor is my experience an isolated case. New research shows that mindfulness can have a big impact on tinnitus. Dr Laurence McKenna of University College London Hospitals NHS Foundation Trust and Dr Liz Marks of the Department of Psychology at the University of Bath, have found that Mindfulness-Based Cognitive Therapy (MBCT) can help sufferers far more effectively than the relaxation-based treatments currently taught by many tinnitus clinics.

Dr Marks’ team compared MBCT to relaxation therapy, the normal treatment for people with chronic tinnitus, to determine if MBCT was a better option.

“In total, 75 patients took part in the trial at UCLH’s Royal National Throat, Nose and Ear hospital receiving either MBCT or relaxation therapy. The study found that both treatments led to a reduction in tinnitus severity, psychological distress, anxiety and depression for patients,” said Dr Marks.

“The MBCT treatment led to significantly greater reductions in tinnitus severity, and this improvement lasted for longer. In addition, 182 patients who completed MBCT routinely in our clinic showed a similar level of improvement.”

MBCT teaches patients to pay purposeful, present-moment attention to experiences, rather than trying to suppress them. In the case of tinnitus, patients were encouraged to meditate on sounds, including that of the tinnitus, and to follow how it rose and fell, how its pitch and timbre changed, and also to place it in the context of the wider ‘soundscape’. This cultivated a more helpful way of responding to tinnitus. People learnt how to allow and accept tinnitus rather than trying to fight or suppress it. Even though this mindful approach did not aim to change the nature of the tinnitus, it led to it becoming less intrusive to the point where it was no longer a problem. In many cases, it disappeared completely.

Dr Marks added: “MBCT turns traditional tinnitus treatment on its head – so rather than trying to avoid or mask the noise, it teaches people to stop the battle with tinnitus.

“The mindfulness approach is radically different from what most tinnitus sufferers have tried before, and it may not be right for everyone. We are confident, however, that the growing research base has demonstrated how it can offer an exciting new treatment to people who may have found that traditional treatment has not been able to help them yet. We hope the results of our research will be one of the first steps to MBCT becoming more widely adopted.”

So how does MBCT, and mindfulness in general, have this effect?

To answer this question, its first necessary to understand the true nature of tinnitus. While its cause is unknown, it is clear that tinnitus is not a disease or an illness in the normal sense. Rather, according to the British Tinnitus Association, it results from some type of change that can be either mental or physical and may be unrelated to hearing. It is probably akin to neuropathic pain, except patients hear non-existent sounds rather than feel the sensations of pain.

Neuropathic pain occurs in the nervous system and often normal investigations fail to discover a clear cause. It might result from damage to the nerves, spinal cord, or brain. But sometimes pain is felt even when there is no damage, or when healing seems to have completed at the site of an illness or injury.  Such neuropathic pain can also take the form of unusual sensations, such as burning or electric shocks, and can even ‘occur’ in amputated limbs. Or it can take the form of tinnitus.

It is believed that tinnitus arises when background electrical or ‘white noise’ in the sound processing systems of the ear and brain become unduly amplified. The auditory system is highly sensitive and the nervous system is naturally ‘noisy’. Normally, the auditory system screens out this background electrical noise. However, if the background electrical noise rises above this auditory threshold – or the threshold is lowered – then you will hear the hissing sound of white noise, or tinnitus. What happens next is crucial to the progress of the condition. In some people, the noise is perceived as alarming and the body’s fight or flight system is activated. This ensures that the brain begins to actively search for the sounds of tinnitus because they are seen as a threat that needs to be avoided. The brain and nervous system then responds by increasing its capacity to process the noisy tinnitus signals – rather as a computer devotes extra memory and circuits to an important task. So the brain begins to act like an amplifier that’s stuck on ‘high’.

How you then react to tinnitus determines whether it is amplified further or fades away of its own accord. If you learn to accept the condition by paying conscious attention to the sounds by, for example, mindfully following how it rises and falls, and its changes in pitch and timbre, then you begin to accept the background noise. You can begin relaxing into it. The brain then no longer sees the noise as alarming and begins to naturally screen it out once again. Mindfulness also reduces anxiety and stress, which probably reduces the level of ‘white noise’ in the nervous system. In addition, lowering anxiety and stress can take you off a hair-trigger, and, in effect, lowers the brain’s sound amplifiers still further.

The Sounds and Thoughts meditation seems to be particularly effective for tinnitus although the whole MBCT programme reinforces the benefits.

The researchers in London and Bath now hope to extend their research to see whether it can help with tinnitus related insomnia. Given that mindfulness is an effective treatment for insomnia in its own right, the chances for success are high.

You can try some shortened MBCT meditations here. These are taken from my bestselling book Mindfulness: Finding Peace in a Frantic World co-written with Professor Mark Williams, co-developer of MBCT.

You can also try some free meditations from my book Mindfulness for Health (published in US as You Are Not Your Pain) here.

Please seek medical guidance before you try incorporating mindfulness into your own tinnitus treatment.

Find out more about the condition from the British Tinnitus Association.

You can read the original research papers here and here.


Buy Mindfulness: Finding Peace in a Frantic World from

Buy from Amazon UK

Buy Mindfulness for Health now from Amazon UK

Buy now from Amazon US (Sold as You are Not Your Pain)


What is Mindfulness?

What it can do for you

Frantic World Home

Can you really find peace in a messy world simply by taking the time to breathe correctly?

Breathing is so ordinary, so mundane, that its true significance can easily pass us by. For thousands of years, people have used simple breathing exercises to relieve anxiety, stress, depression, and even chronic pain.

Some even claim they lead to spiritual enlightenment.

But I am as spiritual as a housebrick, so instead I use them to stay positive, focused and appreciative in a crazy world.

I first discovered the art of breathing as part of my research into mindfulness meditation, about which I have written three books, including the million-selling Mindfulness: Finding Peace in a Frantic World.

Mindfulness has been clinically proven to beat depression and enhance happiness, clarity of thought, and even decision-making and creativity. And correct breathing is its cornerstone.

My latest book, The Art Of Breathing, gathers a range of mindful breathing techniques into one little volume that allows anyone to incorporate some mindfulness into their life.

These techniques work because of the way your breath reflects and amplifies your emotions.

Incorrect breathing can cause anxiety, stress and even depression. It works like this: momentary stress causes the body to tense and you begin to breathe a little more shallowly. A shallow breath lowers oxygen levels in the blood, which the brain senses as stress.

Breathing then becomes a little faster and shallower. Oxygen levels fall a little more. The heart begins to race. The brain feels a little more stressed…

It is a vicious circle.

But there is an alternative.

A gently rising and falling breath stimulates the parts of the brain and nervous system responsible for creating a sense of calm tranquillity. Soothing hormones flow through the body, calming negative thoughts. You begin to relax and breathe even more slowly and deeply…

It’s a virtuous circle.

To gain a sense of its power for yourself, try this simple exercise:

  • Lie flat on the ground with a cushion under your head. Close your eyes.
  • Place your hands on your stomach. Feel them rise and fall as you breathe in, and out.
  • Submit to the natural rhythm of the breath. Feel the air as it flows in and out of your body. Relax into the breath’s fluidity.
  • Within a few breaths your heart will begin to slow and beat more effectively. Your breath will start to become deeper and more rhythmic. You will begin to relax and think more clearly.

Most of us breathe incorrectly, especially when we’re sitting slumped at desks all day long. This interferes with the natural motion of the lungs, chest and shoulders.

Breathing relies on the big, powerful muscles of the diaphragm, the abdomen and the intercostal muscles between the ribs. It is helped along by the smaller secondary muscles of the neck, shoulders and upper ribs.

When you are upset, anxious or stressed, or spend too much time sitting in one position, the abdomen tenses and prevents the big primary muscles from working, leaving the secondary muscles to do all the work.

But the secondary muscles are designed to shoulder only 20 per cent of the burden, so they become stressed. If this continues, it can lead to chronic tension in the shoulders and neck, to headaches and fatigue, and to increasingly shallower breathing.

You can counteract such tension by using a simple breath-based meditation. All you need is a chair, your body, some air, your mind – and that’s it.

Here’s how:

Sit erect in a straight-backed chair with your hands in your lap. Close your eyes.

  • Focus your attention on your breath as it flows in and out. Stay in touch with the sensations of each in-breath and out-breath.
  • When your mind wanders, bring your attention back to the sensations of breathing. In. Out.
  • The moment you realise your mind has wandered away from the breath is the meditation. It is a moment of mindfulness.
  • After a few minutes, or longer if you can manage, open your eyes and soak up your surroundings.

After spending a few minutes practicing this meditation, you’ll feel less anxious, stressed and unhappy. You’ll have gained a bit of mental clarity and started to realise that your breath is one of your greatest assets. It is naturally meditative and always with you. And peace is only ever a single breath away.


The Art Of Breathing: The Secret To Living Mindfully, by Dr Danny Penman, is published in the US by Conari Press

Buy the Art of Breathing from Amazon US.

Buy it from Amazon UK.



What is Mindfulness?

What it can do for you

Frantic World Home

How to breathe yourself happier: This week doctors claimed meditation can beat pain and depression. I’m living proof…

  • William Bankes-Jones had horrific para-gliding accident in Norfolk
  • Was in terrible pain for weeks afterwards – until he tried meditation
  • His suffering reduced by around 90 per cent after only 20 minutes
  • Meditation gaining recognition as a way of treating pain and depression

William Bankes-Jones had spent the entire morning para-gliding above the Norfolk countryside. At one point he’d reached 1,000ft, held aloft by nothing more than powerful currents of rising air, but now he was sinking slowly back to earth. Anxious to fly for a little longer, he tried to catch a thermal rising from a nearby field, hoping it would lift him back towards  the clouds. But as William turned towards it, he noticed a line of tall trees blocking his path. Too late. He smashed into the tallest tree, hung in mid-air for a few agonising moments, then plummeted to earth.

‘The pain was excruciating,’ says William. ‘It was so intense that I blacked out. Every time I regained consciousness, the pain would knock me out again. It was horrific.’

Doctors soon discovered that William had broken his back in three places and one of his vertebrae had burst wide open. But this was just the start of the 55-year-old’s ordeal.

‘In the weeks that followed, I was highly stressed and in severe pain. I was facing the possibility of paralysis,’ he recalls. ‘I couldn’t feed myself or go to the toilet without help. I knew I was going to spend the rest of my days in constant pain and my career as an NHS physiotherapist was probably over. It felt like my life was in ruins.

‘The hospital had given me a morphine drip to help me cope with the intense pain, but it had unpleasant side-effects, so I decided to try what’s called mindfulness meditation instead. I’d learned how to meditate many years before, but never expected to use it under such extreme circumstances.

‘After I started, within a few minutes the pain had reduced by about half. After about 20  minutes, it had reduced by around 90 per cent.’

Treating pain with meditation may seem like a desperate — and unlikely — measure but it is gaining widespread acceptance. A study published online this week in the prestigious online medical journal JAMA Internal Medicine claimed meditation can indeed be a powerful painkiller. Not only that, it also said that practising mindfulness for just half an hour a day can offer people with depression as much relief as popping a pill. This review of previous studies found regular meditation could alleviate symptoms of depression as well as conventional anti-depressants.

The same study also highlighted its power to help people cope with the after-effects of cancer treatment, such as exhaustion, nausea and systemic pain. It does this by dissolving anxiety and stress while also boosting the immune system.

Dr Madhav Goyal, of Johns Hopkins University in Baltimore, who led the team carrying out the research, says: ‘It was surprising to see that with so little training we were still seeing consistent effects.’

Another study published recently in the journal Neuroscience suggests mindfulness can reduce the ‘unpleasantness’ of pain by around 60 per cent. Experienced meditators can reduce it by 90 percent.

Dr Fadel Zeidan, lead researcher of the study, carried out at Wake Forest Baptist Medical Centre in North Carolina, says: ‘Meditation produced a greater reduction in pain than even morphine or other pain-relieving drugs.’

A typical meditation used in the studies involved focusing on the  sensations the breath makes as it flows into and out of the body. This allows you to ‘see’ your mind in action, to observe difficult thoughts and painful sensations as they arise, and to let go of your struggles with them. This creates a relaxed state of mind that reduces the levels of stress hormones in the body. Such deep relaxation enhances healing and boosts mental and physical health. In the case of pain, it encourages the brain to turn down the  ‘volume’ control on its suffering.

Don’t believe it? I can personally vouch for its effectiveness as a pain and stress reliever. Seven years ago, I also had a  terrible paragliding accident that shattered my right leg. The impact drove the lower half of my leg up through the knee and into my thigh. I needed three major operations and intensive physiotherapy to repair the damage.

Throughout my ordeal, I used mindfulness to help me cope with the intense pain and stress, which was accompanied by more than a little anxiety. And it worked to an astonishing degree. My pain gradually subsided and I was able to reduce my intake of painkillers by two-thirds. I also developed a more contented outlook, seeing my injuries as temporary problems that would gradually subside, rather than as limb-threatening ones that might confine me to a wheelchair. Equally, it gave me the mental  stamina and clarity of purpose to persevere with the more conventional treatments such as physiotherapy.

Mindfulness meditation is, I’m convinced, why I recovered in double-quick time. My leg actually healed in six months rather than the predicted 18. I became so convinced by the power of the technique that I began to train as a meditation teacher, and then  co-wrote the bestselling book  Mindfulness, with Professor Mark Williams of Oxford University.

This has now sold almost 200,000 copies in 19 languages and is  currently America’s bestselling meditation book. One of the reasons for the book’s popularity is, I believe, because of its focus on sound science and medicine, rather than spirituality. Although mindfulness meditation has its origins in ancient Buddhism, it is now an entirely secular practice. It is no more religious than yoga. This allows people of all faiths, and atheists, to follow the simple practices with a clear conscience.

This secular approach was begun in the late Seventies by Dr Jon Kabat-Zinn of the University of Massachusetts Medical Centre. He saw the potential healing power of meditation and was determined to bring it into the medical mainstream. Professor Williams, and his colleagues in Cambridge and Toronto, then turned it into a powerful  treatment for depression known as Mindfulness-Based Cognitive  Therapy (MBCT). This is at least as effective as drugs or counselling for severe depression. It is so powerful that it’s now one of the preferred treatments recommended by the National Institute for Health and Clinical Excellence.

Professor Williams says: ‘Scientific studies have now shown that mindfulness not only prevents depression, but that it also positively affects the brain patterns underlying day-to-day anxiety, stress, depression and irritability. This means that when distressing thoughts arise, they dissolve away again more easily.

‘Other studies have shown that regular meditators see their doctors less often and spend fewer days in hospital. Memory improves,  creativity increases and reaction times become faster.’

Nor do you need to meditate for hours each day to gain these  benefits. According to Professor Williams: ‘Just 10 to 20 minutes per day of mindfulness meditation can have a significant benefit on overall mental health and wellbeing.’

Perhaps the most surprising thing about these benefits is that you can actually see them taking root in the brain. Imaging studies show that the brain lays down extra connections and tissue in areas associated with attention, memory and empathy in proportion to the hours of meditation practised. You can also see stress reactions in the brain dissolve once people begin to meditate.

Variants of MBCT are proving to be effective for treating a wide range of other mental and physical health problems. Hospitals have now started prescribing it to help patients cope with the suffering arising from a wide range of diseases such as cancer (and the side-effects of chemotherapy), heart disease, diabetes and arthritis.

It is also now used for back  problems, migraine, chronic fatigue, irritable bowel syndrome and even multiple sclerosis. Mindfulness appears to help IBS sufferers by reducing inflammation. With MS, meditation seems to promote healing while reducing such distressing symptoms as pain, pins and needles, balance problems, anxiety and depression.

Professor Lance McCraken, clinical psychologist at King’s College, London, says: ‘It has now become a vital part of our treatment  programme at Guy’s and St Thomas’ Hospitals. Mindfulness infuses everything we do.

‘Our patients tend to become very keen on it. When they have a little taste of mindfulness, and see how it can transform their lives for the better, they become very committed to meditation.’

It’s not just beneficial to adults; when applied in schools, mindfulness increases both children’s self-esteem and performance in class. This is largely because it reduces stress and enhances clarity of thought.

With all of these benefits, it’s hardly surprising that many businesses have begun offering in-house mindfulness classes. Apple and Google are the most prominent. Apple’s co-founder the late Steve Jobs was a Zen Buddhist who encouraged his employees to take up meditation.

Google offers its employees a mindfulness-based training programme called Search Inside Yourself, that aims to enhance kindness, integrity and compassion. And it’s not all about the individual: the programme’s founder says these qualities are also beneficial to the corporate bottom line.

William Bankes-Jones has experienced  all of these benefits first hand. He made a surprisingly good recovery from his 2010 para-gliding accident. When he returned to work, he began to teach mindfulness to his physiotherapy patients.

‘It can help them heal faster,’ he says simply. ‘The more at ease you are within yourself the better you heal.’


 Meditation can be simple and does not require any special equipment. This meditation demonstrates the basic technique and takes just a few minutes. It should leave you profoundly relaxed.

1 – Sit erect but relaxed in a straight-backed chair with your feet flat on the floor. Or you can lie on a mat or blanket on the floor, or on your bed. Allow your arms and hands to be as relaxed as possible.

2 – Gently close your eyes and focus your awareness on the breath as it flows into and out of your body. Feel the sensations the air makes as it flows through your mouth or nose, down your throat and into your lungs. Feel the expansion and subsiding of your chest and belly as you breathe. Focus your awareness on where the sensations are strongest. Stay in contact with each in-breath and out-breath. Observe them without trying to alter them in any way or expecting anything special to happen.

3 – When your mind wanders, gently shepherd it back to the breath. Try not to criticise yourself. Minds wander. It’s what they do. The act of realising that your mind has wandered — and encouraging it to return to focus on the breath — is central to the practice of mindfulness.

4 – Your mind may or may not become calm. If it does, this may only be short-lived. It may become filled with thoughts or powerful emotions such as fear, anger, stress or love. These may also be fleeting. Whatever happens, observe without reacting or trying to change anything. Gently return your awareness back to the sensations of the breath again and again.

5 – After a few minutes, or longer if you prefer, gently open your eyes and take in your surroundings.

You can download or listen to this and other free meditations at

Dr Danny Penman’s book Mindfulness for Health: A Practical Guide To Relieving Pain, Reducing Stress And Restoring Wellbeing is published by Piatkus.

Buy now from Amazon US (Sold as You are Not Your Pain)


Relieve Pain, Reduce Stress and Restore Wellbeing With Week Three of Our Mindfulness Meditation Course

Pain, illness and stress walk hand in hand together. They feed off each other in a vicious cycle that leads to ever greater suffering and disability.

Nothing creates stress with such brutal efficiency as the feeling of being trapped by illness. Painful questions can begin nagging at your soul: Is it getting worse? Maybe they’ve missed something? Perhaps it’s terminal and they won’t tell me…

Such negative thoughts are incredibly powerful and almost impossible to stop. One thought triggers the next, and the next, in a vicious cycle that can leave you burnt-out and broken.

But it’s often far worse than this because such thoughts create tension in the body, aggravating illnesses and injuries. Stress also dampens the immune system and shuts down the body’s self-repair mechanisms. Stress isn’t just a miserable experience, it erodes physical health too.

Although it’s impossible to prevent stress from arising, you can change what happens next. You can stop the spiral from feeding off itself and triggering the cycle of negative thoughts that makes suffering far worse.

Mindfulness helps you step outside such vicious cycles by teaching you a different way of dealing with stress. With practice you come to realise that stress (like pain) is a ‘message’ that tends to melt away of its own accord once it has been ‘delivered’, or felt with full mindful awareness. When this occurs, an extraordinary thing can happen: a profound sense of happiness and peace fills the void.

Such bone-deep contentment isn’t just pleasant, it also boosts the immune system and restarts the body’s self-repair mechanisms. Even if you have an incurable condition, it will substantially improve your quality of life.

In previous weeks I taught you how to reduce pain using the Body Scan and Mindful Movement meditations. These were taken from our book Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing. This week you will learn to reduce stress with the Tension Release Meditation. Follow the instructions opposite or download the audio track from

You’ll find Week One of the course HERE.

And Week Two of the course is HERE.


Tension Release Meditation

The aim of this meditation is to move your awareness around the body, paying special attention to areas of tension and discomfort, and then to gently breathe ‘into’ them.

If sitting, choose a straight-backed chair and adopt an erect but relaxed posture. If lying, allow your legs to gently fall away from each other, arms at your sides.

Close your eyes. Allow your shoulders, neck, back, and face to soften. Feel the points of contact between your body and the floor or chair.

Gather your awareness around the sensations of breathing. Can you feel it in the chest, the stomach, the back? Feel the whole body expand and contract as you breathe.

Guide your awareness to the first area of tension. Allow the breath to soothe and massage it for a few minutes. Saturate the breath with kindness. If it feels too intense, broaden your awareness to include the whole body.

Focus your awareness on the next area of tension. Follow your breath into it for a few minutes… Then focus on the next area…

Open your eyes and gently move your body.

Mindfulness Meditation Can Reduce Physical Pain by 90 Percent, Week Two of Our Course Shows You How

Three American psychologists once asked a group of students to watch cartoons and rate how funny they were.

Some were asked to hold a pencil between their lips, forcing them to mimic a scowl. Others watched the cartoons with the pencil between their teeth, simulating a smile. The results were striking: those forced to smile found the cartoons funnier than those compelled to frown. Smiling had actually made them happier.

The process works in reverse too. Frowning makes you unhappy. And a tense neck, back, or shoulders can trigger anxiety and stress. But it’s not just emotions that are driven by such vicious cycles. Pain is too.

Pain creates tension in the body, which feeds back into the brain, which responds by turning up the ‘volume’ on its pain amplifiers, creating even more suffering.

As I explain in our book Mindfulness: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing, meditation is a powerful way of halting such vicious cycles. Clinical trials show that it can reduce pain by around 90 percent. With practice, you can watch as your pain and suffering evaporate like the mist on a spring morning.

Last week’s Body Scan meditation began this process but you also need to work with the body on a more physical level too. Your body needs to ‘unlearn’ its tension and this is what you’ll begin this week with the Mindful Movement meditation.

This meditation should be carried out once per day. Follow the instructions opposite, or download the audio track (which contains extra exercises) from It’s best if you also continue with last week’s Body Scan.

You’ll find Week One of the course HERE.

Dr Danny Penman is the co-author of the bestselling Mindfulness. His latest book Mindfulness: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing is published by Piatkus.

Mindful Movement Meditation
The aim of this meditation is to ‘tune into’ your body and breath as you move. This will help release any pent up tension.

Wrist rotations
Relax the shoulders and breathe as naturally as you can. Gently hold and support your right elbow with your left hand. Smoothly rotate your right hand around the wrist in a circle for 30 seconds. Keep the breath soft and even. Turn your wrist in the other direction for another 30 seconds. Relax your arms.

Notice the effects of the movement on your right hand and arm. Does this side feel different from the left? More alive, perhaps?

Repeat the movements for the other hand. Then relax your arms so they hang loosely at your sides. Close your eyes. Gently shake your hands and arms. What sensations do you feel?

Warm, hugging arms
Start with your arms hanging loosely at the sides of your body. Tune into the breath for a few moments.

On the in-breath, extend both arms outwards to shoulder level, palms facing forwards. As you breathe out, very gently draw both arms across your chest, cross the arms and give yourself a light hug. As you do so, feel the upper back broadening and opening. Imagine the hug is saturated with warmth and kindness.

On the in-breath, open your arms until they are fully extended. As they open, feel a corresponding opening in the chest, with the shoulder blades gently drawing together.
Repeat this movement for one minute (or for as long as you feel able). Let the hands hang loosely at your sides and give them a little shake. Feel the breath in your whole body and the sensations of being alive.

You’ll find more mindful movement exercises at

Can Mindfulness Meditation Really Reduce Pain and Suffering by 90 percent? This Three Week Course Shows You How To Begin.

Living with chronic pain and illness can be intolerable. Even after taking the maximum dose of painkillers, the aching soon returns with a vengeance. You want to do something, anything, to stop the pain, but whatever you try seems to fail. Moving hurts. Doing nothing hurts. Ignoring it hurts.

But it’s not just the pain that hurts; your mind can start to suffer as you desperately try to find a way of escaping. Pointed and bitter questions can begin nagging at your soul: What will happen if I don’t recover? What if it gets worse? I can’t cope with this . . . Please, I just want it to stop …

It’s only natural to want to fight back against pain and illness in times such as these, but what if this struggle actually made your suffering worse? What if it was more effective to explore the sensations of pain and illness as they rose and fell in your body? This may seem like the worst thing imaginable, but the latest medical advances show that it can be more powerful than the most commonly prescribed painkillers.

Such an approach forms the core of a new treatment for chronic pain and illness that is based on an ancient form of meditation known as ‘mindfulness’. Mindfulness meditation has been shown in clinical trials to reduce chronic pain by 57 percent. Accomplished meditators can reduce it by over 90 percent.

Imaging studies show that mindfulness soothes the brain patterns underlying pain and, over time, these changes take root and alter the structure of the brain itself, so that patients no longer feel pain with the same intensity. Many say that they barely notice it at all.

Hospital pain clinics now prescribe mindfulness meditation to help patients cope with the suffering arising from a wide range of diseases such as cancer (and the side effects of chemotherapy), heart disease, diabetes and arthritis. It is also used for back problems, migraine, fibromyalgia, coeliac disease, chronic fatigue, irritable bowel syndrome and even multiple sclerosis.

As I explain in our book Mindfulness: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing, meditation achieves these remarkable results because it turns down the ‘volume’ control on pain.

A typical meditation involves focusing on different parts of the body and simply observing with the mind’s eye what you find (see box below). This allows you to see your mind and body in action, to observe painful sensations as they arise, and to let go of struggling with them. When you do this, something remarkable happens: your suffering begins to melt away of its own accord.

After a while you come to the profound realisation that pain comes in two forms: Primary and Secondary. Each of these has very different causes – and understanding this gives you far greater control over your suffering.

Primary pain arises from illness, injury or damage to the body or nervous system. You could see it as the raw information sent by the body to the brain. Secondary pain is the mind’s reaction to Primary pain but is often far more intense and long lasting. Crucially, it is controlled by an ‘amplifier’ in the brain that governs the overall intensity of suffering.

In recent years, scientists have begun to work out how the mind’s pain amplifier is controlled, but more importantly they have discovered ways of turning down the ‘volume’ control on suffering.

It turns out, the human mind does not simply feel pain, it also processes the information that it contains. It teases apart all of the different sensations to try to find their underlying causes so that you can avoid further pain or damage to the body. In effect, the mind zooms in on your pain for a closer look as it tries to find a solution to your suffering. This ‘zooming-in’ amplifies pain.

As your mind analyses the pain, it also sifts through memories for occasions when you have suffered similarly in the past. It is searching for a pattern, some clues, that will lead to a solution. Trouble is, if you have suffered from pain or illness for months or years, then the mind will have a rich tapestry of painful memories on which to draw – but very few solutions.

So before you know it, your mind can become flooded with unsettling memories. You can become enmeshed in thoughts about your suffering. It can seem as if you’ve always been ill and in pain, that you’ve never found a solution and that you never will. You can end up being consumed by future anxieties, stresses and worries as well as physical pain: What will happen if I can’t stop this pain? Am I going to spend my life suffering like this? Is it going to keep on getting worse?

This process happens in an instant, before you’re consciously aware of it. Each thought builds on the last and quickly turns into a vicious cycle that ends up further amplifying your pain. And it can be worse than this because such stresses and fears feed back into the body to create even more tension and stress. This can aggravate illnesses and injuries, leading to even more pain. It also dampens down the immune system, so impairing healing. So you can all too easily become trapped in a vicious downward spiral that leads to ever greater suffering.

But even worse, such negative spirals can begin wearing tracks in the mind so that you become primed to suffer. Your brain begins fine-tuning itself to sense pain more quickly – and with greater intensity – in a futile bid to try to avoid the worst of it.

Over time, the brain actually becomes better at sensing pain. Brain scans confirm that people who suffer from chronic pain have more brain tissue dedicated to feeling the conscious sensations of pain. It’s almost as if the brain has turned up the volume to maximum and doesn’t know how to turn it down again.

It’s important to emphasise that Secondary pain is real. You do genuinely feel it. It’s only called Secondary pain because it is the mind’s reaction to Primary pain and has been heavily processed before you consciously feel it. But this same processing also offers a way out; it means you can learn to gain control over pain.

It is possible to learn to step aside from suffering and begin to handle pain very differently indeed. In effect, mindfulness hands back to you the volume control for your pain.

Brain scans confirm this. Mindfulness soothes the circuits that amplify Secondary pain and you can see this process happening in a brain scanner. In effect, mindfulness teaches you how to turn down the volume control on your pain. And as you do so, any anxiety, stress and depression that you may be feeling begins to melt away too. Your body can then relax and begin to heal.

On top of these benefits, hundreds of scientific trials have now shown that mindfulness meditation is extremely good at relieving anxiety, stress, depression, exhaustion and irritability. Memory improves, reaction times become faster and mental and physical stamina increase. In short, regular meditators are happier and more contented than average, while being far less likely to suffer from psychological distress.

Over the next three weeks I’ll lead you through three meditations from our book Mindfulness: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing. They are based on solid science as well as our own experience.

I used mindfulness to cope with the extreme pain of a paragliding accident. Seven years ago I fell 30 feet onto a rocky hillside. The resulting impact drove the lower half of my right leg several inches through the knee and into my thigh. The injury required three major operations and two years of physiotherapy to correct. I found mindfulness to be an extremely powerul painkiller and I’m convinced it also accelerated my healing.

The aftermath of Danny’s paragliding accident.

The programme in the book was developed by my co-author Vidyamala Burch following two serious spinal injuries that left her in continuous pain. This programme has helped tens of thousands of people worldwide cope with pain, suffering and stress.

This week I will lead you through the ten minute Body Scan meditation. Carry it out twice each day. Follow the instructions below, or preferably download the free audio track from

Next week I will lead you through another pain reduction exercise. The following week I will teach you a meditation to dissolve stress and speed recovery.

Dr Danny Penman is the co-author of the bestselling Mindfulness. His latest book Mindfulness: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing is published by Piatkus.

Body Scan Meditation
This is best carried out in quiet surroundings. The idea is to hold each region of the body in the mind’s eye, observe – or ‘feel’ – what you find, and then move on to the next area.

You will realise that your mind repeatedly wanders. It’s what mind’s do, so try not to criticise yourself. When it happens, simply bring your awareness back to the region of the body from where it wandered. Try not to judge what you find. Simply observe. Or perhaps smile inwardly to yourself.

The Scan
Lie on the floor and allow your legs to gently fall away from each other. Place your hands loosely on your stomach. Close your eyes. Sink into the floor. Focus on the natural breath as it flows in and out of the body. Is it deep or shallow? Smooth or ‘ragged’? Spend a few minutes feeling the rhythm of the breath in as much detail as you can.

Does the breath ‘echo’ in the groin? The lower back? What do you find in these regions? Are they warm or cold? Do they ache? Is it sharp or tingly pain? Gently probe the edges, then move closer. Spend a couple of minutes exploring the rhythm of the breath. Do you notice that discomfort is more ‘fluid’ than you thought? Does it feel more distant and less ‘personal’ than you expected?

Move your awareness to the middle back and observe what you find for a minute… Then the upper back…

Observe the whole back as one for a few minutes… And the shoulders… The neck… The face… The arms… hands.

Move your awareness through your legs and ‘feel’ what you find. Do your hips ache? Is it sharp or dull? Gently probe the edges and move inwards. If it begins to feel too intense, gently broaden the focus of your awareness so that you hold the discomfort in a wider space. Does that make it less intense?

And finally, spend a couple of minutes observing the whole body breathing as one.

Gently open your eyes and soak in the world around you. Can you carry this flavour awareness with you as you continue with your day?

You can download the free audio track of this meditation from


Chronic Pain, Chronic Pain, Chronic Pain, Meditation, Mindfulness, Sleep, The Third Metric, Anxiety, Depression, Irritability, Irritable Bowel Syndrome, Stress, Wellbeing, UK Lifestyle News

Can Mindfulness Meditation Really Reduce Pain and Suffering by 90 percent?

Claire stared at the computer screen before cocking her head slightly to one side. She winced as a sharp pain angled its way through her neck and down her left arm. Her fingers went numb and then began to throb. Claire’s youthful good looks dissolved and she suddenly looked twenty years older. She stretched her arm and slowly began rubbing her neck to loosen the muscles. Her shoulders and neck had cramped up, making her whole upper body look tense and contorted. She reached for a glass of water and gulped down two more painkillers.

Why won’t this pain just stop? Why won’t these blasted painkillers work any more? They’re useless. I’m so sick and tired of this.

Three years previously Claire had been injured in a car crash and suffered two broken ribs, a fractured wrist and whiplash. Her ribs and wrist had healed completely within three months, but the after-effects of her whiplash refused to go away. The doctors were puzzled by her pain. Several scans had shown that her neck had completely healed, but the pain stubbornly remained. It was worse if she stayed in one place for too long. After twenty minutes, sharp jagged pains would arc up and down her neck. When she finally did move, she would feel stiff and achy all over.

Claire felt increasingly trapped and broken. Her doctor had prescribed several courses of physiotherapy without any long-term success. Now she was forced to continually take painkillers and anti-inflammatory drugs. They worked, more or less, but often left her feeling washed out and jaded. They were OK for stubborn ‘achiness’, but did nothing for the frequent sharp twinges of pain. Lately, her doctor had begun suggesting antide- pressants to lift her mood. Her response was always the same: ‘I’m not depressed,’ she’d snap. ‘I’m angry because that man who drove into me has taken my life away. I used to dance all night. Now I can barely walk!’

Experiences like Claire’s are not confined to injuries such as whiplash, but are common across a range of diseases. Conditions such as ‘bad back’, migraine, chronic fatigue syndrome and fibromyalgia can all cause pain long after the original injuries have healed or without any obvious cause that shows up on scans or tests. And even when there is a clear physical cause, as with illnesses like arthritis, heart disease or cancer, the pain often comes and goes without any apparent rhyme or reason. Doctors then feel forced to prescribe long-term courses of painkillers, but these can have side effects such as memory loss, lethargy and even addiction.

Claire and millions of others exist in a world of suffering; a place where even the simplest of tasks can amplify their pain. This often leads to anxiety, stress, depression and exhaustion, each of which serves to further enhance suffering in a downward spiral. Such vicious cycles are driven by newly discovered psychological forces that underlie the perception of pain. And crucially, this discovery offers a wholly new approach to the management of pain and illness that has the potential to transform suffering.



The commonsense view of pain is that it arises from damage to the body. This attitude was formalised in the seventeenth century by the French philosopher René Descartes with his ‘rope-pull’ model of pain: just as pulling a rope in a church steeple rings a bell, Descartes thought that damage to the body is a tug that causes the awareness of pain in the brain. For centuries after Descartes, doctors regarded pain in a similar light. The intensity of pain was thought to be directly proportional to the degree of damage to the body, which would mean that if different people had the same injury they would experience the same amount of pain. If no obvious physical cause was found, the patient would be regarded as malingering or making it up.

Since the 1960s, science has come to accept another model of pain known as the ‘Gate Theory’ developed by Ronald Melzack and Patrick Wall.1 They suggest that there are ‘gates’ in the brain and nervous system that, when open, allow you to experience pain. In a sense, the body sends a continuous low-level ‘chatter’ of pain signals to the brain, but it is only when the gates are opened that the signals reach your conscious mind. These gates can also close, which is what happens when your pain lessens or fades away. Opening and closing these pain gates is a phenomenally complex process. Although the details are still being worked out, it is clear that pain is far more subtle and complex than the traditional idea of damage signals being sent to the brain which are then passively felt. Pain is a sensation, which means that it is an interpretation made by the brain before it is consciously felt. To make this interpretation, the brain fuses together information from the mind as well as the body. In practice, this means that the thoughts and emotions flowing through your mind, both conscious and unconscious, have a dramatic effect on the intensity of your suffering. Not without reason did the ancient Greek philosophers consider pain to be an emotion.



Suffering occurs on two levels. Firstly, there are the actual unpleasant sensations felt in the body – this is known as ‘Primary Suffering’. This can be seen as the ‘raw data’ that is sent to the brain from, say, an injury, an ongoing illness or changes to the nervous system itself (this is believed to lie, at least partly, behind such conditions as chronic pain syndrome and phantom limb syndrome). Overlaid on top of this is ‘Secondary Suffering’, which is made up of all the thoughts, feelings, emotions and memories associated with the pain. These might include anxiety, stress, worry, depression and feelings of hopelessness and exhaustion. The pain and distress that you actually feel is a fusion of both Primary and Secondary Suffering.

This insight is crucial because it reveals a path away from suffering. For if you can learn to tease apart the two flavours of suffering, you can greatly reduce – or even eliminate – your pain and distress. This is because Secondary Suffering tends to dissolve when you observe it with the mind’s compassionate eye. Mindfulness allows you to see the different elements of pain laid out in front of you. And when you see this vista, something remarkable begins to happen: your suffering gradually begins to subside and evaporate like the mist on a summer’s morning.

It’s important to understand that although the sensation of pain is created by the mind, your suffering is still real. You really do feel it. It exists and it can be genuinely overwhelming. But once you understand the underlying mechanisms of pain, you can begin to temper its power and the hold it has over you.

To go back to Claire, had she been asked to look inside herself a little more closely she would have realised that there was not one single ‘thing’ that she could label as an ‘ache’ or as a ‘pain’. Both were ‘bundles’ of different feelings that were constantly changing; becoming either more or less intense. There was the underlying unpleasant ‘tightness’ of the muscles and tendons in her neck, which were twisting her vertebrae slightly out of alignment and creating the most pronounced of her painful feelings. There were also twinges of outright pain – which felt like sharp spikes of electricity running through her muscles and down into her arm. And then there were patches of ‘numbness’ in her left arm and hand. These would alternate with pins and needles. Those were the obvious sensations of pain. This was her Primary Suffering.

But there were other feelings too – powerful emotions and disturbing thoughts that would frequently sweep across her mind, often with no apparent rhyme or reason. Stress, worry and exhaustion had become a way of life. Troubling thoughts constantly nagged at her soul: Why won’t this just stop? The doctors must have missed something, surely? Maybe I’m going to end up a cripple, or even dead. Are they too afraid to tell me? Such thoughts and emotions were constantly bubbling away in the background. And while they were often less obvious than the nagging feelings of pain, ultimately they were far more significant because they were central to the way that her mind interpreted and felt the raw feelings of pain. In a sense, they controlled the intensity or ‘volume’ of her pain. This was Secondary Suffering; and Claire had it in spades.

Claire’s Secondary Suffering had its roots in the five days she spent in hospital after her accident. They were the worst of her life. She was in considerable pain and on a morphine drip for the first twenty-four hours. She could cope with the physical pain – just. Far worse, however, were her turbulent emotions: her fears and worries for herself and the future. Neither she nor the doctors could predict the outcome of her neck injuries. Would she be partially paralysed? Would she be in pain for the rest of her life? There was also a sense of anger mixed with bitterness. The man who crashed into her didn’t appear to care. He just walked away from the accident with no cuts or bruises at all. He’d been drinking, but was just inside the legal drink–drive limit. Was he insured? It turned out he wasn’t. Every time she thought about it, Claire’s anger boiled over. Such thoughts and overwhelming emotions constantly washed across her mind. It was mental pain and just as real and tormenting as her physical injuries.

She lay in her hospital bed at night crying quietly to herself. She was wracked with fears and worries for the future, and ‘what ifs’ filled her mind. If only she had left home a minute or two later, then none of it would have happened. She’d had a feeling something was wrong before she had left home. Why hadn’t she waited just a few minutes longer?

After the accident and the subsequent months of physiotherapy, a new emotion was added to the list: depression. Claire refused to believe that she was depressed, but it was there none the less, gnawing away at her in the background. It wasn’t an all- consuming depression. It simply drained her of all energy and enthusiasm for life. Such powerful emotions as anxiety, fear, anger, worry and depression can feed into the mind’s perception of pain. Other feelings, too, can have an incredibly strong effect. Feeling tired and overwhelmed, fragile and broken, stressed and anxious, can all magnify suffering and tip you into a downward spiral. How often has the intensity of your suffering increased when you felt anxious, stressed, exhausted or sad? These emotions act like amplifiers in the mind’s pain circuits. They can open the floodgates of suffering.

The effect of such emotions can be observed with a brain scanner. Work at Oxford University,7 for example, shows the significant impact that even mild levels of anxiety can have on pain. Scientists at the university’s Department of Clinical Neurology induced low-level anxiety in a group of volunteers before burning the back of their left hand with a hot probe. As anxiety built, you could see the waves of emotion sweeping through the volunteers’ brains. This primed areas of the brain that collectively make up the ‘pain matrix’. It was almost as if the volunteers’ minds were turning up the volume on their pain amplifiers ready to ‘hear’ its first ‘notes’, so that they could take action to protect themselves. This meant that when the skin of the anxious volunteers was actually burned, they experienced far more pain and suffering than the ‘non-anxious’ volunteers. You could see this extra pain represented in the brain scans too. As the Oxford neuroscientists noted, anxiety primes the ‘behavioural responses that are adaptive to the worst possible outcome’. In other words, anxiety and other powerful ‘negative’ emotions prepare the body to sense pain quickly and with great intensity.

The reverse is also true. Reducing anxiety, stress, depression and exhaustion can lower the perception of pain and even eliminate it completely. This is one of the main routes by which mindfulness helps reduce suffering. Mindfulness soothes the mind’s perception of pain – essentially Secondary Suffering – by replacing it with a sense of peace and wholeness.

Neuroscientist Fadel Zeidan and his team at Wake Forest University School of Medicine in America decided to investigate this effect using scanners to map activity in different parts of the brain.8 They did this by exploiting a curious quirk of brain anatomy. Every part of the body is reflected in a specific part of the brain known as the primary somatosensory cortex. So if the sole of your left foot is brushed with a feather, an area of the primary somatosensory cortex lights up; if you feel a pain in your lower back, a different part becomes active. Neurosurgeon Wilder Penfield charted this brain region and produced a ‘map’ that reflects the human body overlaid on the brain (see illustration below). It was termed the cortical ‘homunculus’.

Homunculus Graphic from Chap 2 v2

Fadel Zeidan and his team reasoned that if mindfulness affected the perception of pain, then this should be visibly reflected in the level of activity in the corresponding regions of the primary somatosensory cortex. To test this, Zeidan studied the perception of pain in a group of students. The students first had the back of their right calf burned with a piece of hot metal while their brain was scanned with the latest functional Magnetic Resonance Imaging (fMRI) scanner. Each was then asked to rate both the intensity and unpleasantness of the pain. If pain was music, ‘intensity’ would be the volume and ‘unpleasantness’ would be the level of emotion it aroused. As expected, when the students’ legs were burned the ‘right calf’ region of their primary somatosensory cortex lit up as the pain swept over them.

The students were then taught mindfulness meditation and the experiment was repeated. The results could not have been more different second time around. Activity in the ‘right calf’ region of the primary somatosensory cortex had diminished to such a degree that it had become undetectable. But not only that. Meditation increased activity in regions of the brain related to the processing of emotion and of cognitive control – areas where the sensations of pain are actually interpreted and ‘built’. These brain areas modulate the sensations of pain and give it ‘meaning’ before it is consciously felt. What’s more, experienced meditators (those who scored higher on a standard scale of mindfulness) tended to have enhanced activity in these regions and to experience less pain. That is, they tended to devote more brain power in this region to moderating the pain-related information – and to, in effect, turning down its ‘volume’.

Zeidan’s co-worker Dr Robert C. Coghill explains:

These areas all shape how the brain builds an experience of pain from nerve signals that are coming in from the body. Consistent with this function, the more that these areas were activated by meditation, the more that pain was reduced. One of the reasons that meditation may have been so effective in blocking pain was that it did not work at just one place in the brain, but instead reduced pain at multiple levels of processing.

And what of the students’ conscious experience of pain? On average they experienced a 40 per cent reduction in pain intensity and a 57 per cent lessening of pain ‘unpleasantness’. Perhaps the most surprising thing was the amount of practice required to achieve this level of pain relief: just four training sessions of twenty minutes each. Remarkable though these results were, they masked something even more intriguing. The more accomplished meditators suffered far less than these averages might suggest. They experienced a reduction in pain intensity of 70 per cent and its unpleasantness was reduced by 93 per cent. This meant that it could barely be felt and hardly bothered them at all. Overall, said Zeidan, mindfulness produced a greater reduction in pain than standard doses of morphine and other pain-relieving drugs.


Loosening the bonds of pain

Secondary Suffering can be seen as resistance to pain. It is entirely natural to struggle against and resist pain with all of your might. You want to eliminate it. Stamp on it. Do anything at all to get rid of it. This is absolutely understandable. But what if this was also precisely the wrong approach? What if, in your bid to eliminate pain, you were actually creating far more of it instead? This is the lesson from Zeidan’s research and from many other studies too. And this holds true not just for pain, but for many other disease symptoms as well. Stress, exhaustion and depression can all be made far worse through resistance.

But if the act of resisting pain can make it worse, the converse is also true. Acceptance of your pain can actually diminish it – and might even get rid of it completely. Allow us to explain this seemingly outrageous idea. Neuroscientists have a saying: ‘What we resist persists.’ In other words, if you resist the messages that your mind and body are sending you, those messages will keep on being dispatched (and felt) until you accept them. This holds true not only for messages of pain, but also for thoughts, feelings, emotions, memories and judgements. If you mindfully accept (or feel) these messages, they will have done their job and will tend to melt away of their own accord.

Mindfulness meditation creates a sense of safety, of space, in which you can begin to tentatively explore the raw sensations of pain and, as such, it is the vehicle through which you can begin to accept these messages. And when you do so, you will often find that pain waxes and wanes quite dramatically. There can be long moments of normality followed by flickers or spikes of pain. There are often different sensations too. Some are hot. Others cold. Some feel ‘tight’, others throb, while still others feel sharp or stabbing. Not all are completely unpleasant. The different sensations often rise and fall like the waves on the sea. They constantly change in character and intensity. By exploring each of these different sensations, moment by moment, you come to accept that they are like black clouds in the sky: you can watch as the sensations arise, drift past and disappear again. Your mind is like the sky and individual thoughts, feelings, emotions and sensations are like different types of cloud. So in a sense, mindfulness teaches you to observe the weather without becoming embroiled in it. And no matter what happens, the sky – your mind – remains untouched by it.

It is important to realise that mindful acceptance is not resignation to your fate. It is not the acceptance of the unacceptable. It is simply the acceptance of the situation as it is, for now, at least. It is a period of allowing, of letting be, of non-resistance, so that you cease to struggle. And when this struggle ceases, a sense of peace takes its place. Secondary Suffering then progressively diminishes. Often as not, Primary Suffering will begin to do so too.

We can explain this to you in minute detail. We can cite numerous scientific trials that prove the point. We could even show you scans of your own brain as it ‘builds’ the sensations of pain from all of your thoughts, feelings and emotions – but only when you have experienced the power of mindfulness for yourself will you truly believe it.

This is why it is called a practice. Accepting pain can be difficult. It’s just better than the alternative, which is to live in a state of perpetual suffering.

Countless participants on our Breathworks courses have discovered this for themselves. Claire was one. She found that when her neck began to hurt she was also assailed by fear, anger, stress, sorrow, hopelessness, despair and exhaustion. So not only did she feel the initial unpleasant sensations in her neck, but she was also swamped with yet more suffering. It was almost as if she was struck with an arrow, and when she reacted to it she was then hit by a second one. Now she had to bear the pain of two arrows – that from the second being caused by resistance to the first. It is an entirely natural response. In fact, in cases of acute, rather than chronic, pain, it might even be the best response because it’s a powerful driving force to take yourself out of danger. When it comes to chronic pain and illness, however, it is often precisely the wrong solution because it simply compounds your suffering. And, of course, it can then seem as if you’re pierced not by two arrows, but by many, many more.

Accepting the sensations of Primary Suffering allows the Secondary Suffering to take care of itself – and to progressively diminish. Claire discovered that she could resist pain for days or even weeks. She could distract herself with alcohol, cigarettes and food. She could squash the pain with powerful drugs. If those failed, she could ignore the pain – for a while, at least. But all this came at a cost: the rest of her life. She discovered that in ignoring and walling off the pain she had also isolated herself from all that is wonderful and precious about life. The world became increasingly wan and grey. Food lost its flavour and texture. She no longer laughed or cried. Her love life declined into irrelevance. All this meant that when she could no longer maintain the struggle, she simply crashed and burned. So not only did the pain return, but, with all of the things that normally sustained her love of life having evaporated, she was left feeling fragile and broken. No wonder her doctor wanted to prescribe her antidepressants.

After three years of struggling, Claire embraced mindfulness – not because she believed that it would work, but because she was desperate. And when she began to mindfully explore the sensations of pain, something remarkable and counter-intuitive began to happen. Not only did the pain begin to subside, but she began to experience all of the good things that had been squeezed out of her life too. It opened the door to a wealth of emotions such as happiness, love, compassion and empathy, as well as sadness. Claire realised that life is bittersweet, and when she let go of expecting it to be either wholly wonderful or truly distressing and to hold in an honest heart a delicate mixture of the two, she felt increasingly relaxed and open. Through facing up to and becoming sensitive to her own predicament, she became a happier and more centred person with greater empathy for others. She also began to heal.


Taken from our new book Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing by Dr Danny Penman and Vidyamala Burch

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‘A beautiful and compassionate book, Mindfulness for Health will put you back in touch with the extraordinary person you already are’ Professor Mark Williams, University of Oxford

‘This book provides an extremely effective and elegant mind-body approach to healing . . . Highly recommended’ Jon Kabat-Zinn, PhD, author of Full Catastrophe Living and Coming to Our Senses

‘In a world of much suffering this book is a gift of wisdom and practical help’ Professor Paul Gilbert, PhD, OBE, author of The Compassionate Mind



1. Wall, Patrick D. & Ronald Melzack, The Challenge of Pain (Penguin Books, 1982), p. 98; Melzack, R. Wall, p. D. (1965), ‘Pain Mechan- isms: a new theory, Science, 150(3699), pp. 371–9.

2. Cole, Frances, Macdonald, Helen, Carus, Catherine & Howden-Leach, Hazel, Overcoming Chronic Pain (Constable & Robinson, 2005), p. 37; Bond, M., Simpson, K., Pain: Its Nature and Treatment (Elsevier, 2006), p. 16, offers an alternative definition from the International Association for the Study of Pain as acute pain (lasting less than one month), sub-acute pain (lasting one to six months) and chronic pain (lasting six months or more).

3. ‘Health Survey for England 2011’, Health, social care and lifestyles, Chapter 9 Chronic Pain, The Health and Social Care Information Centre (NHS) 20 December 2012,

4. Gaskin, Darrell J. & Richard, Patrick (2012), ‘The Economic Costs of Pain in the United States’, Journal of Pain, 13(8), p. 715.

5. ‘Health Survey for England 2011’, Health, social care and lifestyles, Chapter 9 Chronic Pain, The Health and Social Care Information Centre (NHS) 20 December 2012,

6. NOP Pain Survey (2005), 23–25 September, on behalf of the British Pain Society.

7. Ploghaus, Alexander, Narain, Charvy, Beckmann, Christian F., Clare, Stuart, Bantick, Susanna, Wise, Richard, Matthews, Paul M., Nicholas, J., Rawlins, P. & Tracey, Irene (2001), ‘Exacerbation of Pain by Anxiety Is Associated with Activity in a Hippocampal Network’, Journal of Neuroscience, 21(24), pp. 9896–903.

8. Zeidan, Fadel, Martucci, Katherine T., Kraft, Robert A., Gordon, Nakia S., McHaffie, John G. & Coghill, Robert C. (2011), ‘Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation’, Journal of Neuroscience, 31(14), pp. 5540–48. See also the accompanying comments regarding morphine effectiveness by Fadel Zeidan of the Wake Forest University School of Medicine at