Primary and secondary suffering can help us understand how to better manage our pain.
As some of us know too well, living with a chronic illness involves a lot of pain and suffering, sometimes with no end in sight. There is no medication or magic bullet that can disappear your pain.
I talk a lot about how yoga, meditation, and mindfulness helped me recover from chronic fatigue syndrome. Yet ‘recover’ and ‘cure’ are still words I feel uncomfortable using. I don’t see yoga and meditation as ‘cures’ or ‘treatments’ for illnesses. Yoga and meditation help reduce the amount of pain and energy your create around your illness, which can help you live better with illness, and potentially lead to recovery down the line. To better understand this concept, we need to talk about primary and secondary suffering.
What is primary suffering?
Primary suffering is physical pain that you experience as a result of illness, injury, and fatigue. Depending on your condition, there may or may not be anything you can do about this pain. This pain can be seen as the base level of pain in your body at this time.
What is secondary suffering?
Secondary suffering is the emotional and sometimes physical pain we have as a reaction to primary suffering. If you feel (rightfully) angry, sad, depressed, anxious, or hopeless because of your illness, this is secondary suffering. Most people aren’t able to help these feelings of secondary suffering. It’s an instinctual reaction to being in constant pain.
The pain you end up feeling on a daily basis, is a combination of both primary and secondary suffering. To get a better understanding of primary and secondary pain, you can watch this video from the Breathworks Mindfulness organisation, where they explain how primary and secondary suffering work with a short exercise.
What yoga and meditation help us to do, is to reduce the amount of secondary suffering present in our bodies. Reducing secondary suffering can lower your overall amount of pain, making managing from day to day, and making it easier to care for yourself.
How to reduce secondary suffering
“You can’t control the wind, but you can adjust the sails” is one of my favourite proverbs. You’ve probably also heard the saying, “you can’t control other peoples actions, only your reactions”.
Managing pain in your body, is similar to managing the external pains of dealing with difficult people or situations in your life. You can’t make the pain go away, but you can choose how you react and respond to it. If you can separate the two types of suffering within you, this is a crucial step in dissolving secondary suffering.
It’s important to acknowledge that although the suffering is created by the mind, your pain is still real. You really do feel it. It exists and it can be genuinely overwhelming. But once you understand the underlying mechanisms of this secondary pain, you can begin to release it.
Here are some steps you may find helpful in understanding and managing secondary pain. These steps may seem counter-intuitive to how you should treat your pain, but many people have found (myself included) that these mindful methods can help you better manage your chronic pain.
Steps to reduce secondary suffering
1. Begin by cultivating a sense of kindness and compassion towards your pain. Treat your pain the way you would treat your child or best friend if they were sick and injured. And just allow the pain to be in your body, as it is, rather than trying to force it away.
2. Move towards the pain. By this I mean acknowledge that the pain is there, and notice if you have any resistance to fully feeling the pain. Do you try to avoid the pain by distracting yourself with other activities or thoughts? If so, see if you can gently begin to remove these barriers to the pain.
3. Embrace impermanence. Once you start to really feel your pain, you will probably notice that it is not consistent. One moment you may feel an intense burst of pain, the next moment it may be a duller pain, and the next none at all. You’ve probably already noticed how chronic illness can be unpredictable. But when we realise that all sensations lack permanence it’s easier to move away from catastrophic thinking which can cause a great deal of secondary suffering.
(Catastrophic thinking is thoughts like: I’ll always be in pain, I’ll never get better, I’ll be sick forever, etc.)
Research on primary and secondary suffering
This study from Oxford University further elaborates on the effects of secondary suffering on the overall pain we feel, and how meditation can play a key role in reducing that suffering. Researchers measured the impact that even low levels of anxiety can have on pain. In the study, researchers induced low-level anxiety for one group of volunteers before burning the back of their hand.
Another group of volunteers were prompted to meditate before receiving the burn. The volunteers who were given the anxious stimulus before being burned had significantly higher levels of pain than those who got no prompt, or a relaxing stimulus before the burn. Even more interesting, is that experienced meditators tended to experience even less pain than the new meditators in the group.
Can mindfulness and meditation really reduce pain?
When in pain, it’s a very normal response to want to fight and resist this pain. Phrases like “we can beat this” are common amongst patient groups and charities. I find the terminology used very interesting. It feels like we’re going to a championship sports match and want to win, not working with our bodies which we love and cherish. What if the fighting approach, while a natural response, is the wrong way to go about things. What if this response is actually creating more pain rather than eliminating it?
A final note- mindfulness and acceptance of your pain, is not resignation. It is simply accepting the situation as it is at this moment. It is allowing yourself to stop struggling and fighting against yourself and allowing peace and kindness to take its place. Once you can make this transition, secondary suffering will begin to diminish. It is sometimes the case that your primary pain will also start to decrease once you allow it the space to do so.
I go into more detail about how yoga and meditation can help reduce secondary (and primary) suffering in the second week of Chronically Kind Yoga. This course is a great resource for anyone who wants to get deep into the effects of primary and secondary suffering.