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Bhikkhu Bodhi on the stern but eloquent teachings of chronic pain.

When I write about living with pain, I don’t have to use my imagination. Since 1976 I have been afflicted with chronic head pain that has grown worse over the decades. This condition has thrown a granite boulder across the tracks of my meditation practice. Pain often wipes a day and night off my calendar, and sometimes more at a stretch. The condition has cost me a total of several years of productive activity. Because intense head pain makes reading difficult, it has at times even threatened my vocation as a scholar and translator of Buddhist texts.

In search of a cure, I have consulted not only practitioners of Western medicine but also herbal physicians in remote Sri Lankan villages. I’ve been pierced countless times by acupuncture needles. I’ve subjected my body to the hands of a Chinese massage therapist in Singapore, consumed Tibetan medicine pills in Dharamsala, and sought help from exorcists and chakra healers in Bali. With only moderate success, I currently depend on several medications to keep the pain under control. They cannot extricate it by the root.

I know firsthand that chronic bodily pain can eat deeply into the entrails of the spirit. It can cast dark shadows over the chambers of the heart and pull one down into moods of dejection and despair. I cannot claim to have triumphed over pain, but in the course of our long relationship, I’ve discovered some guidelines that have helped me to endure the experience.

First of all, it is useful to recognize the distinction between physical pain and the mental reaction to it. Although body and mind are closely intertwined, the mind does not have to share the same fate as the body. When the body feels pain, the mind can stand back from it. Instead of allowing itself to be dragged down, the mind can simply observe the pain. Indeed, the mind can even turn the pain around and transform it into a means of inner growth.

The Buddha compares being afflicted with bodily pain to being struck by an arrow. Adding mental pain (aversion, displeasure, depression, or self-pity) to physical pain is like being hit by a second arrow. The wise person stops with the first arrow. Simply by calling the pain by its true name, one can keep it from extending beyond the physical, and thereby stop it from inflicting deep and penetrating wounds upon the spirit.

Pain can be regarded as a teacher—a stern one that can also be eloquent. My head pain has often felt like a built-in buddha who constantly reminds me of the first noble truth. With such a teacher, I hardly need to consult the sermon in Deer Park at Benares. In order to hear the reverberations of the Buddha’s voice declaring that whatever is felt is included in suffering, all I have to do is attend to the sensations in my head.

As a follower of the dharma, I place complete trust in the law of karma. Therefore, I accept this painful condition as a present-life reflection of some unwholesome karma I created in the past. Not that I would advise someone who develops a painful illness to immediately resign themselves to it. Although it may be the inevitable fruit of some past karma, it might also be the result of a present cause that can be effectively eliminated by proper medical treatment. However, when various types of treatment fail to help with an obstinate and defiant condition, one can be pretty sure there is a karmic factor. Personally, I don’t lose sleep trying to figure out what this past karma might have been, and I would advise others against succumbing to such obsessive concerns. They can easily lead to self-deluding fantasies and superstitious practices. In any case, by trusting the law of karma, one can understand that the key to future good health lies in one’s hands. It is a reminder to refrain from harmful deeds motivated by ill will and to engage in deeds aimed at promoting the welfare and happiness of others.

Chronic pain can be an incentive for developing qualities that give greater depth and strength to one’s character. In this way, it can be seen as a blessing rather than as a burden, though of course we shouldn’t abandon the effort to discover a remedy for it. My own effort to deal with chronic pain has helped me to develop patience, courage, determination, equanimity, and compassion. At times, when the pain has almost incapacitated me, I’ve been tempted to cast off all responsibilities and just submit passively to this fate. But I’ve found that when I put aside the worries connected with the pain and simply bear it patiently, it eventually subsides to a more tolerable level. From there I can make more realistic decisions and function effectively.

The experience of chronic pain has enabled me to understand how inseparable pain is from the human condition. This is something that we in America, habituated as we are to comfort and convenience, tend to forget. Chronic pain has helped me to empathize with the billions living daily with the gnawing pain of hunger; with the millions of women walking miles each day to fetch water for their families; with those in Third World countries who lie on beds in poorly equipped, understaffed hospitals, staring blankly at the wall.

Even during the most unremitting pain—when reading, writing, and speaking are difficult—I try not to let it ruffle my spirits and to maintain my vows, especially my vow to follow the monastic path until this life is over. When pain breaks over my head and down my shoulders, I use contemplation to examine the feelings. This helps me see them as mere impersonal events, as processes that occur at gross and subtle levels through the force of conditions, as sensations with their own distinct tones, textures, and flavors.

The most powerful tool I’ve found for mitigating pain’s impact is a short meditative formula repeated many times in the Buddha’s discourses: "Whatever feelings there may be—past, present, or future—all feeling is not mine, not I, not my self." Benefiting from this technique does not require deep samadhi or a breakthrough to profound insight. Even using this formula during periods of reflective contemplation helps to create a distance between oneself and one’s experience of pain.

Such contemplation deprives the pain of its power to create nodes of personal identification within the mind, and thus builds equanimity and fortitude. Although the technique takes time and effort, when the three terms of contemplation—"not mine, not I, not my self"—gain momentum, pain loses its sting and cracks opens the door to the end of pain, the door to ultimate freedom.

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BHIKKHU BODHI, an American Buddhist monk, was ordained in Sri Lanka in 1972. He has translated several important works from the Pali Canon, including the Sumyatta Nikaya (The Connected Discourses of the Buddha, Wisdom Publications). He currently lives at Bodhi Monastery in Lafayette, New Jersey.

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When I became crippled by rheumatoid arthritis, I was completely overcome by unremitting pain, terror, and despair. Unable to walk, too weak to lift a phone, I thought bitterly of how much time I had wasted pursuing everlasting peace of mind. For seven years, over thousands of hours of zazen and maybe thirty sesshins, I had sat on a black cushion pursuing enlightenment in order to cope with just such an occasion—all to no avail. But I was wrong about the failure of practice, and within months of being struck by the condition, I knew it.

First of all, though ravaged by pain and disease, my body was deeply settled. While my mind had been plotting my rise to power at the San Francisco Zen Center, my body had been developing the tremendous stability associated with regular sitting practice. So even though I was overwhelmed and consumed by the pain, I was able to surrender completely to the physicality of my existence, moment after moment. Left alone to explore my consciousness without distraction, I discovered that wherever I looked, there were experiences other than pain waiting to be noticed: here is bending, here is breath, here is sun warming, here is unbearable fire, here is tightness. All these perceptions were fresh and fascinating.

The consciousness that sitting practice cultivates is open to many kinds of experience, not all of them necessarily pleasant. If at any given moment I am aware of ten different elements—my bottom on the chair, the sound of cars passing outside, the thought of the laundry I have to do, the hum of the air-conditioner, an unpleasant stab of sharp knee pain, cool air entering my nostrils, warm air going out—and one of them is pain, that pain will dominate my life. But if I am aware of a hundred elements, those ten plus more subtle sensations—the animal presence of other people sitting quietly in the room, the shadow of the lamp against the wall, the brush of my hair against my ear, the pressure of my clothes against my skin—then pain is merely one of many elements of my consciousness, and that is pain I can live with.

With such a mind, life becomes richly textured. Consciously putting a cup on a table and feeling the flat surfaces meet becomes a rare, satisfying, "just-right" kind of experience. Washing dishes is not just about getting the dishes clean; it’s also about feeling the warm, soapy water soothing my arthritic fingers. Doing laundry, I can smell its cleanness and luxuriate in the simple movements of folding, a counterpoint to my complex life.

For people in pain, tapping into this wisdom beyond wisdom is simply how to survive. When we have nothing left to hold on to, we must find comfort and support in the mundane details of our everyday lives, which are less than mundane when they’re the reason we’re willing to stay alive. This is the upside of impermanence: the shining uniqueness of beings and objects when we begin to notice their comforting presence. When preferences for a particular experience fade, the myriad things come forward to play, shimmering with suchness. Obviously, flowers and trees do this, but so do beer cans and microwaves. They’re all waiting for our embrace. It is enormously empowering to inhabit a world so vibrant with singularity.

Thirty years after first being devastated by pain, I never enter a room without noticing what sources of comfort and ease will sustain me: not only the recliner and the pillow but also the light streaming in from the window, the handmade vase on the table, even the muffled drone of the air-conditioner—all of it created for the pleasure of human beings. By bringing into my conscious life objects that offer their kind companionship—my toothbrush and my dishes, my spoon and my car—I feel their tangible support as well as their sometimes charming idiosyncrasies. Awareness of this support can be simultaneous with resistance to my pain and the search for ways to stop it. These tracks don’t hinder each other; they are both active, engaged encounters.

For instance, I have difficulty dressing. My arthritic shoulders, elbows, and fingers flinch from the stretching, tugging, and tying required to dress myself. Velcro might solve my problem, but it’s out of the question; I’m not and never have been a utilitarian dresser. Rather, I’m the sort who is thrilled by the fine art of asymmetrical hems, darts, double-stitched denim seams, linings in jackets, and bias-cut skirts. My throat catches at a flutter of silk in the breeze. My underwear is adorned with lace and embroidered flowers. Instead of hurrying to dress and becoming frustrated by how difficult it is to pull up socks, put on shoes, and button blouses, I make it a well-loved morning ritual: I lay out all the clothes on the couch and sit in the warmth of the morning sun as I put on each lovely article one at a time, noting the temperature change associated with covering my body, admiring the darts and seams and insets that search out its topography.

Most of my physical tasks have taken on this ceremonial quality. If we can’t be speedy and productive, if something as simple as putting on clothes takes all of our attention and focus, we must find our home in the activity itself as its goal recedes into the future. The practice of doing each thing for its own sake, the staple of Zen training, had mostly eluded me as a Zen student striving for enlightenment and better housing at Green Gulch Farm. But now, as I live in the vibrancy of the sensual present, clearly seeing each moment as my most viable source of solace and delight, I prefer to stay right here. I have lost any sense that there is something special or tragic about my circumstances. Day in and day out, they are just my life.

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DARLENE COHEN, a longtime member of the San Francisco Zen Center, was ordained a Zen priest in 1999. She is the author of Turning Suffering Inside Out: A Zen Approach to Living with Physical and Emotional Pain (Shambhala Publications).

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Is there something we can do with pain besides cope through distraction, denial, wishful thinking, or numbing anesthetics? Is there a universal strategy that can be applied to all pains, regardless of their type, intensity, or causes? Is there a psychologically healthy way of making pain meaningful, a simple, systematic way to harness its energy in the service of life?

If there is, this would be very good news. We could then use the unavoidable discomforts of day-to-day life to foster personal growth. It would certainly be comforting and empowering to know that if we encounter major pain that cannot be relieved by any of the standard methods, there is another option available. Meditation represents such an option.

In order to understand the nature of pain and its relationship to the spiritual path, we must first discuss pleasure. Any pleasure we have can be experienced completely or not. When it is experienced completely, it yields satisfaction. Completeness has nothing to do with the intensity, type, or duration of the pleasure. Completeness requires just two elements: an unbroken contact with the pleasure and the absence of interference with it.

Absence of interference means that the pleasure is not mixed with grasping, either conscious or subconscious. Grasping is a tension or viscosity that impedes the natural flow of the pleasure. It’s a kind of tightening around pleasure’s arising and passing. To experience pleasure without grasping is to experience it with equanimity—not aloof withdrawal but radical self-permission to feel the pleasure. Pleasure not mixed with grasping could be called pure pleasure. Pure pleasure purifies consciousness and permanently raises our base level of appreciation for life.

The situation with pain is perfectly parallel to that of pleasure. Any given pain can be experienced either completely or incompletely. When it is experienced completely, it is not experienced as suffering; it does not become a problem. Does it hurt? Yes. Does that eclipse the perfection of the moment? No. Complete pain means pure pain, pain not mixed with resistance, either at the conscious or subconscious level of neural processing. Resistance is inner friction that interferes with the natural flow of pain. Not resisting pain is to have equanimity with the pain, radical self-permission to feel the pain. Pure pain purifies. The "matter" of the pain becomes converted into energy that massages and softens the very substance of the soul.

Let’s try to make this process more tangible. In the undistracted meditative state, if pain arises, you can clearly observe the interaction of the pain and your resistance to it. For example, an uncomfortable sensation may arise in your knee as you’re meditating. At the same time, you may observe that in reaction to the pain, you are clenching and tightening other parts of your body, while in your mind a stream of judgments and aversive thoughts are erupting.

The sensation in your knee is the pain. The tension is your bodily resistance. The judgments are mental resistance. The resistance can be distinguished clearly from the pain itself. As you consciously relax the tension and drop the judgments, even though the pain level is the same, it seems to be less of a problem. Later, when the resistance returns, you notice that the pain has again become a problem. So once again you drop the judgments and stop the clenching, and the sense of suffering diminishes, even if only slightly. But you are making your first steps in learning how to experience pain skillfully.

Subsequent steps involve letting go of progressively more subtle mind and body resistance, until the deep subconscious resistance begins to break up. At that point the pain starts to flow. It feels like you’re being massaged and nurtured. You experience the pain working on your consciousness at a very deep level. It is as though your consciousness were dough and the pain wave is kneading that dough, working out the lumps and kinks, transforming it at a molecular level into something soft, pliant, and malleable. With continued practice, this skill becomes internalized and integrated into your being. When you encounter discomforts in the course of daily life, you automatically let go into equanimity.

Is it necessary to experience discomfort in order to deepen one’s spiritual practice? Absolutely not! The skills that allow us to experience pleasure with heightened satisfaction are the same ones that allow us to experience pain with diminished suffering. Skill with pleasure leads to skill with pain, and vice versa, because what we’re really learning is how to feel. If discomfort arises during meditation, we can take measures to relieve it or we can explore it. The choice is ours. If we encounter pain in daily life that cannot be relieved, then we have no choice, since the only alternative to experiencing it skillfully is to experience it as abject suffering.

In this life we must sometimes spend time in purgatory, an uncomfortable place of spiritual purification. If we understand how to meditate, then the purgatory won’t turn into hell, a terrifying place of meaningless suffering. From the perspective of spiritual growth, there’s a big difference between hell and purgatory. Either way, the idea of voluntarily staying with pain may still seem a little radical. Please remember that we are talking about working with small, manageable doses of subjective discomfort that do not objectively harm the body. And yes, this is a radical thing to do. From Latin, "radical" means addressing an issue at the root, the most basic level.

When we sit and meditate, we may sometimes be subject to discomforts, aches and pains, sleepiness, body sensations of agitation and impatience, itches, and awkwardness from the posture. These discomforts are real but quite manageable. In the meditative state, we can experience them with more mindfulness and equanimity than we do in daily life. In meditation the mind and body go through a natural change, a deep learning process that affects the unconscious levels of neural processing. The deep mind learns a healthy way to deal with pain. As a result, when we encounter real pain in the real world, we discover that we are not suffering the way we used to. By not suffering, I mean that the pain does not obscure the perfection of the moment, does not distort our perception or behavior, does not alienate us from our spiritual source or from our fellow beings.

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SHINZEN YOUNG is a vipassana meditation teacher and the author of Break Through Pain: A Step-by-Step Mindfulness Meditation Program for Transforming Chronic and Acute Pain (Sounds True).

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The Mahamudra lineage of Vajrayana Buddhism in Tibet teaches us how to approach physical pain from within the context of ultimate awareness. This body of oral instructions begins with the direct pointing out of unborn mind, or ultimate awareness. The lineage holder’s transmission opens the practitioner to the unborn mind as a matter of his or her immediate, direct experience. Such awareness is empty of anything definite or solid, brilliantly illuminated like sun-drenched space, and pregnant with supercharged possibility.

Through meditating again and again on this natural state, we are able to let go into it for increasingly extended periods of time. It is from within this "ordinary mind," or rigpa, that we can begin to make a nonego-based relationship with our relative experience, including physical pain. It involves approaching pain just as unborn awareness itself would see and work with it. When we do this, we are able to discover the way in which physical pain, far from being any kind of problem, actually has the possibility to liberate us into the three enlightened bodies of the Buddha: dharmakaya, sambhogakaya, and nirmanakaya.

Physical Pain as Dharmakaya

When physical pain arises, we are instructed to rest within the natural state. Then we look directly into the physical pain. This is not "us" looking from ego’s dualistic, self-centered consciousness. Rather, it is us having surrendered our vantage point, letting awareness itself hold or reflect the physical pain that is arising. So it is a looking that occurs from within the primordial awareness.

Resting there, we ask ourselves, what is the essence of this physical pain? We are allowing the experience of pain to register within the field of awareness and checking to see what it is. Does physical pain have any substance, any heart, any essence that would mark it as "physical pain"? What we may discover is that what we thought of as pain—which from within dualistic consciousness seemed so real and problematic—actually has no defining feature at all. It is empty of anything that would mark it as physical pain. This is known as discovering physical pain as dharmakaya.

Lama Thubten Yeshe had a serious and painful heart ailment from which he eventually died. He used to comment that using the Mahamudra instruction to work with physical pain eliminated all the feeling of "problem" or even of "pain." He said, "You won’t ever have to go to the doctor to get pain medication." He wasn’t saying that we shouldn’t be treated for medical conditions, but that through these practices we eliminate the identity of pain itself, which causes us to be so closed down to it and so preoccupied by the "problem" it presents.

When His Holiness the Sixteenth Karmapa was dying of cancer in a hospital in Zion, Illinois, his deteriorating physical condition suggested to the attending medical staff that he should be in agonizing, incapacitating, absorbing physical pain. Yet all reports depicted him as fully present to others, concerned only about how everyone else was doing. I have often thought that he must have been embodying a high level of mastery, discovering physical pain as dharmakaya.

There is a Mahamudra exercise you can do in order to train in this approach to physical pain, even if you are not within its grip at the moment. Rest your mind in the natural state and then assume a posture—such as squatting slightly—that will shortly cause physical distress. As the discomfort builds, you will find yourself beginning to think about it. Then return to the natural state and, when you are resting there, check to see if there is anything you can locate and define as pain. If you are injured or ill, then you already have the physical pain that you need to do this practice. By doing this practice, you can use physical pain to experience the freedom and fulfillment of the dharmakaya.

Physical Pain as Sambhogakaya

Physical pain, seen from within the natural state, is not simply empty of any essence; it is also charged with unusual vividness and clarity. When there is nothing in particular going on in our relative experience and we rest our minds in the natural state, the field of awareness will be empty and open but it will not necessarily have much charge to it. However, if there is some strong relative experience going on with us, such as physical pain, when we return to the natural state we will find the awareness greatly heightened.

When our relative experience—in this case, physical pain—is very strong, we may find it more difficult to let go into the emptiness of the unborn mind. That’s because relative experience, particularly when it is especially intense, functions as an almost irresistibly seductive reference point. Whether that intensity is experienced as negative or positive is immaterial; it gives our ego-consciousness something strong to feed on and maintain itself. Given that situation, it can be more difficult for us to let go and release into the formlessness of our primordial mind.

But if we do let go when we are experiencing physical pain, we may discover that the intensity of our awareness is greatly heightened. It can feel strong and immovable, almost monolithic. We may find unique possibilities of letting go of any grasp on the boundaries of awareness, or even on awareness itself. It is as if the awareness can more easily burn through any possibilities of holding on that may arise. Discovering this intensity of awareness is known as discovering physical pain as the sambhogakaya.

Physical Pain as Nirmanakaya

One of the central discoveries made by Vajrayana practitioners is that nothing occurs in our life without rhyme or reason. In other words, any relative experience appears with complete timeliness, accuracy, and appropriateness to our immediate situation. Until we have attained the liberation that does not decline, we are caught somewhere each moment of our lives. Though we are not aware of it (if we were, we would cease to be caught), we are always hanging on to our reference points, to our limited self, in some way. We cannot free ourselves by ourselves; we need outside intervention.

According to the Vajrayana, what appears within our experience at such moments always provides the needed intervention. Whatever occurs is a catalyst of freedom; it exactly addresses our bondage as it exists right now. In a most apt and personal way, it cuts through the place where we are caught. This is the meaning of "sacred outlook" or "pure appearance" in Vajrayana: every phenomenal experience that arises exactly addresses our entrapment, cuts through it, and liberates us on the spot. The challenge, of course, is to recognize the liberation and surrender to it, instead of reconstituting our "I" unconsciously and immediately.

The appearance of physical pain is no exception. When we experience short- or long-term pain, it always addresses our particular situation. In this sense, it is truly a blessing. The arrival of pain cuts through the unique bondage of this moment, liberating us into dharmakaya. At the moment of freedom, we see just how much expectation we’ve been having, how much we’ve been identifying with some relative situation or experience. Being cut through in this way can be experienced as horrific, humorous, frightening, sad, inspiring, and so on. But in any case, it leaves us with an appreciation of the sacredness of the experience of pain as an incursion of supreme wisdom in our lives.

Open, Fearless, and Creative

Discovering pain as the dharmakaya and as the sambhogakaya are practices that are initially developed on the meditation cushion. After we have trained in these practices in formal meditation, we can then apply them anytime and anywhere. Discovering physical pain as the nirmanakaya is a practice that can be engaged directly in the post-meditative state simply by looking—again, from within nonconceptual mind—at the impact of the pain we may be feeling.

When we approach physical pain through these Mahamudra instructions, we find that far from being trapped and defeated, we are able to work with it in an increasingly open, fearless, and creative way. Finally, our growing familiarity with, and skill in relating to, our pain in Mahamudra practice can lead us into and through the process of dying.

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REGINALD A. RAY is a professor of Buddhist studies at Naropa University and the author of Secret of the Vajra World and In the Presence of Masters. He recently cofounded the Dharma Ocean Foundation in Crestone, California.

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