Meditations on Transforming the Suffering of Pain

by Joan Halifax Roshi

Part 1 : Being with Pain

Pain is part of our experience of life in a human body. There is no way to escape from feeling pain sooner or later. We often fear pain and feel victimized by it. Being in pain now we may remember pain of the past or anticipate more pain in the future. And pain can remind us that our life span is finite, our connection to life fragile, and beings everywhere experience pain in one way or another.

Sometimes we feel trapped by small as well as great pains. A toothache can take over our whole life. The point of a needle pressed into our skin can fill us with anxiety. A tumor pressing against nerves in the abdomen can consume us with fire and fear. And the pain of a phantom limb or womb can rob us of sleep and peace. We often look on pain as an enemy, and we will do anything to get away from pain. In a way, our culture is very wrapped up in its escape from pain, whether through addiction or our unwholesome, self-referential and fearful obsession with pain.

For many people, one of the most dreaded aspects of dying is the anticipation or experience of pain. Indeed, pain is an  experience that many of us will not be able to avoid when we are dying. Yet pain is a teacher, whether we like it or not. We  can use our experience of pain now to help us to prepare for the pain that might be present as our bodies are dying.  Exploring pain gives us many lessons that bring our life into greater focus and meaning, teaching us strength and patience, and giving us compassion and humility, ways of being that can make a difference in our dying.

Sometimes, it is skillful for us to take ourselves away from pain. Perhaps the pain is not worth getting involved with. We should just let it go or ignore it. Giving it too much attention might increase it and make an unnecessary problem of it. At other times, we might not have the mental or energetic resources to deal with it. We are too sensitive, too tired, or very afraid. Then we can focus our attention on something else, something that is healing, engaging or pleasant.

When we feel stronger, have the right kind of support, or have mental buoyancy, commitment, and resilience, we may have earned the strength to deal with pain directly. If this is the case, we may want to experience our pain fully. Being there for our pain may decrease the negative experience of pain as we learn about it and observe it change, and as the emotions intensifying the experience of pain withdraw. Being there can also teach us that the experience of pain is impermanent and train our mind to not be overwhelmed by pain in the future.

Many of us know that working with our pain directly is one of the ways that we have strengthened our spiritual development. Maybe we have discovered the truth of impermanence by noticing that pain is always changing in one way or another. Perhaps we have come to a place where we don’t feel so heavy, cornered, or tragic when we are in pain, because we have dropped the story around the pain and have let go of any sense of outcome. Maybe our pain has nourished compassion within us as we realize that many others have pain like ours.

Our pain can teach us patience, give us the strength to endure, make us more mindful, and be our road to boundlessness as we increase the horizon of our experience of it. We might even look on it as a gift, as have many dying people who have realized that their pain and suffering drove them into practice and made their life and relationships more valuable and helped them to reorder their priorities.

The question then is what do we do when we are in pain. Are we afraid of pain? Do we try to escape it in unhealthy ways? Do we make a big deal of it? Are we likely to become anxious when faced with pain? Do we find ourselves caught in the past, remembering all of our ancient pains, or anticipating a pain-filled future? Do we accept our pain, making a

friend of it? Do we use pain as a way to increase our resilience, our strength? Do we take the opportunity, when in pain, to open our feelings to others who feel pain like us? Are we able to live with our pain with equanimity? Can we make our pain a teaching on impermanence and a basis for strength and compassion?

Of course we do not want to live a life of pain. We want to learn to work effectively with mental and physical pain, so that pain does not dominate us. Yet sometimes we cannot transform pain through practice or psychological strategies. This is just the way it is, and we need to be realistic and face the truth that pain might be an obstacle to our practice and to our life.

In this regard, I once asked His Holiness the Dalai Lama about this subject, and he was emphatic that we should always do the best we can to help relieve pain, whether with modern pharmacology or with meditation and understanding. This was just compassionate, he stated. I asked him if he thought that the mind was at risk if certain strong drugs were used to help relieve severe pain. He said that even if the medications fog the mind, such things do not affect the mind ground. He explained that the mind ground, which is not touched by conditioning or chemicals, is liberated at the moment of death. If the deceased has had a strong practice in life, then the way is clear, the conditioning present, for becoming one with the nature of mind at the moment of death.

Today, more and more often, spiritual and psychological approaches to pain management are used with pain medicine to enhance the effect of the drugs and to help dying people to relax and let go of fear and of life. Fortunately, there are many medications that make it possible to manage pain without diminishing awareness. This can give a dying person the time to strengthen practice and be with others and not have pain or an unclear mind be an obstacle.

I am mentioning this since I have encountered people with a spiritual background who withhold pain medication from their relatives because they thought that the pain was a purification process, the medication would cloud the mind of the dying person, or they were concerned about issues of addiction. My approach is pretty practical and supports bringing together the gifts of modern medicine as well as the skillful strategies of psychology and spirituality.

It is helpful if we have a practical perspective on our relationship toward pain. From the point of view of Buddhism, for example, we are taught that our pain and suffering are not bad or wrong. They are simply other aspects of life. Being thus, we are encouraged to recognize our pain and accept it. We learn to see our pain as an experience that brings us to practice and can teach us more acceptance and resilience as we work with it.

Our practice gives us room to cry and to share our suffering with others. It also encourages us to give ourselves more space so that pain and suffering do not take over our lives. In practice, we explore our pain and discover it is not who we really are. Moreover, our practice can help us separate pain from suffering. Pain is the sensation; the story around pain is the stuff of suffering. The arrow of pain doesn’t necessarily have to be followed by the arrow of suffering, when you make the distinction between the sensation of pain and the story surrounding and amplifying pain. What I often say to myself when I am in pain is: “I am in pain, but I am not suffering.” I say this to remind myself not to amplify the pain by building a story around it.

We also need to let go of our expectations of a good or bad outcome regarding pain. Sometimes something can be done to alleviate our pain. Sometimes there is nothing to be done about pain, except to experience it. So be it. Our expectations of being pain-free can fill us with anxiety and disappointment. Our practice is to learn to accept pain, bear witness to it, and remember that it will change for better or for worse. Pain then reminds us to open to Not-knowing.

We can also discover that dwelling on the negative aspects of pain will not help the pain at all. We need to find fresh ways of looking at and experiencing pain that make pain an ally not an enemy. Become a friend to your pain, the teachers say. Reach out to it. See what it needs. You may not know what to do, but your pain might. Give your pain space. Don’t irritate it. And see what it wants to teach you. Or use the experience of your pain to develop compassion as you contemplate the lives of others who have pain like you.

Here is a Buddhist phrase that gives us a feeling for this: “May my pain be a ransom to relieve the suffering of all motherly beings.” Perhaps you will contemplate this phrase with commitment when you are in pain. Ten years ago, I was very sick and in a lot of pain. I was worried and discouraged because my body was not healthy. Fortunately I had good friends who would walk with me in the nearby mountains. Even though it was a stretch for me to do this, I gave myself that little extra push, because the mountains were an inspiration to me. In this way, I would spend time away from the worry about my body, giving my heart and mind some space in the vastness of the wilderness.

The mountains were the physical and spiritual nourishment that made it possible for me to work with my suffering, my story, and to take care of what needed to be taken care of. With more energy, I began to explore the fact that many women were sick like me. I opened my heart to them and began to practice for them, not just for me alone. My pain and suffering slowly became a ransom to help others. Then with my heart more open I could give myself more internal room for the pain in my body to just be. And slowly I got the courage and had the energy to have the necessary surgery.

Years later, I realized that I could have easily dwelled in my misery. A little justifiable and a little self-centered. My obsession with my situation could have led to a kind of paralysis keeping me from being cured and from healing. In Zen, we call this tightness “being tied up without a rope.” I needed to change my attitude toward my situation. That is, I needed to put more room around my difficulties, as I was getting claustrophobic in my concern with my illness. I needed to consider the suffering of others and offer them my support. I needed to do positive and healing things to give my heart a chance to heal from worry. I needed to relax and let go. I also needed to accept my sickness and ask for help.

The Tibetan teacher Tulku Thondup uses a wonderful image to describe how we are when we have transformed the  claustrophobia of being in the grip of pain and suffering. He compares our freedom from this state to a skydiver who is dancing in the sky as he is falling to earth. He says the trick is to relax and let go. This means that we must have the courage to let go into our pain, which might seem really scary. We might be afraid of being overwhelmed by pain. But we also might be so desperate to deal with our pain that we generate the courage to really get into it. Then we have the chance to find pain’s true nature: that pain is made of non-pain elements. It is composed of sensation, duration, intensity, and cadence. It has no inherent goodness or badness. It is not unchanging. And, most importantly, it is not who we really are.

When a dying person is in the early stages of pain, it is often helpful to work with relaxation techniques, mindful breathing, music, visualizations, giving pain attention and observing its qualities, or breathing into the pain. If possible, I teach people Mindfulness Practice, the Body Scan, Tonglen, and Metta Practices as meditation strategies that can be helpful for pain. The best situation is when a person in pain already has a practice. Then my job is simply to support her practice. I have also developed some simple practices that are specific for working with the suffering of pain. Often these practices are helpful compliments to conventional pain management with drugs.

People often discover strategies that can be used to prevent the pain from reaching such an intensity that it has to be attended to with conventional medicine. One friend painted out her pain. Another set his pain to music. A third friend had had such a vivid experience of the truth of impermanence that he could objectify his pain and not be dominated by it. Yet if pain has reached a certain threshold, pharmaceuticals can be life giving and profoundly supportive of a gentle death. Good medical pain management with spiritual and psychological support can make it possible for an individual to turn to spiritual practice in the experience of active dying with fewer obstacles to the mind.

There is another important point to consider as we experience pain or work with those who are in pain. As a caregiver and a person who has had her share of pain, I try to remember the Buddhist teachings on the interdependence of the relative and absolute. This means that I try to be sensitive to the details of pain and suffering, and at the same time be aware of one’s true nature.

When I sit with a dying person, I try to do whatever I can to help relieve pain and suffering. Sometimes there is something that can be done: kind words, medication, meditation, physical touch, or simply bearing witness and being present. But maybe there is nothing but suffering and misery. I need to respect this experience of being trapped in misery. At the same time I know that suffering and pain are transitory, and if I look deeply enough, I see that beneath the misery is an unconditioned realm that is free of ill-being.

I try to open to both suffering and freedom from suffering. If I see only suffering, then I am caught in the relative nature of existence: we are nothing but suffering. If I see only the pure and vast heart, then I am denying the truth of our human  experience. I also need to let go of my expectations of a good outcome, even though they may give inspiration and energy to my practice. I have learned that my attachment to a pain-free outcome can cause more pain and suffering. At the same time, I do the best I can to help. Imagine sitting with a dying person, someone in intractable pain. Imagine feeling his pain and suffering with compassion and kindness. Now look through the pain and suffering to the very ground of this one’s being, that unshakable heart, where all categories, dualities, cravings, delusions, and dislikes have never been. See her true nature, free from all ill-being, and at the same time, see the truth of this one’s suffering.

For many of us, our pain has brought meaning and depth to our lives, and guided us to our spiritual practice. Our  willingness to be with pain and suffering and at the same time see the dying person’s or our own true nature is one of the most important capacities of a caregiver. This is why you are encouraged to explore your own pain and suffering as a way to uncover the unmoving truth within your own being. This may lead you to see in a pure way the basic goodness that is the true heart of all beings, that which connects us in the spirit of non-duality. You will see the truth of suffering and the truth of well-being–and the truth of their interdependence. Your own willingness and practice foster your ability to look through the pain deeply, with stability. So please become a good friend to your pain and try not to reject it.

Sometimes sitting with people who are in pain and suffering is pretty hard to take. We want so much to do something; we may feel helpless, heartbroken, and even angry. What can we offer? The treasure that many of us forget is our  compassionate and equanimous presence. This presence also exists within the one who is suffering. Often there is nothing to do but be present for pain and suffering just as it is. Our ability to be present for suffering can help the sufferer also be present. Remembering our strong back and soft front, we can offer equanimity and compassion and perhaps inspire the same for the one who is suffering.


In that which follows, I offer three simple practices for working with pain. Always begin your practice by letting the body settle. You can lie down, or sit on a chair or meditation cushion. Then remember why you are practicing. Let yourself cultivate an open and tender heart. Recall the suffering of others. Remember that there are many who are also experiencing pain like you are and pray that they can transform their experience and be free of pain and suffering. Then begin the practice. Someone can guide you through the meditation by reading it, or you can read a section, and then practice the “feeling” of it. At the end of your practice session, dedicate any goodness that has arisen in the course of your practice to the well-being of others. Then rest for a time with the atmosphere of the practice within you, letting the presence of the practice continue to nourish you.

Part 2 : Meditation: Transforming Pain Through Awareness

Remember why you are practicing: to help others and yourself.

Let your heart open to this aspiration.

Gently bring your attention to your breath.

Let the breath settle and become even and regular.

Take as much time as you need to settle the breath.

Now bring your breath deep within your body.

When you breathe in, the belly rises.

Breathing out, the belly falls.

Gently merge your awareness with your breath,

as your body relaxes.

Let the breath be deep in your body.

Give yourself time to bring together your attention and your breath.

Do this for ten breaths.

When you breathe in, let the breath nourish you.

When you breathe out,

softly say the sound “ah” as though you are sighing.

Let the body relax as you practice.

Continue this for at least ten breaths.

Gently bring your attention to your pain.

Let yourself soften to your pain.

Try to accept it without judging or fearing it.

Aware of your pain, breathe into it.

On the out-breath, have the feeling of fully accepting your pain.

Now merge your breath with your pain.

Breathe into your pain and out from it.

Breathing into your pain, be in touch with your pain.

Breathing out, let go into whatever you are experiencing.

Continue this for at least ten breaths.

Now, with your mind, explore the sensation of pain.

Is it sharp or dull, pulsating or penetrating?

Is it focused or does it spread out from its source?

Let yourself explore the sensation, intensity and quality of the pain.

Feel objective about your exploration of pain,

not judging or fearing it, if possible.

Give yourself time to really explore your pain.

On the in-breath, bring warmth to your pain.

On the out-breath, soften to your pain, accepting your pain.

As you do this, be aware of any change in the pain sensation.

Do this for at least ten breaths.

Now gently bring your awareness to your whole body.

Moving out from your pain, let your awareness fill your whole body.

Bring your breath and attention to entire body.

Be open to how your body is feeling.

Notice if there is resistance or fear.

Accept your feelings as you accept whatever your body feels like.

Take time to be with your body.

Let your awareness flow out to your surroundings.

Gently accept whatever your experience might be.

Rest for a while with this expansive awareness.

Breathe in the world around you.

Breathe out into the world around you.

Let a feeling of boundlessness arise within you as you breathe.

When you are ready to complete the practice,

send whatever good that has arisen to others.

Part : Meditation: Transforming Pain Through Practicing the Boundless Abodes

Find a phrase or phrases that are appropriate to your situation and practice them with the

breath or simply let them carry you along. You can do this practice sitting or laying down.

Begin by letting the body and breath settle. Remember why you are practicing and cultivate

an altruistic aspiration. Do the practice simply and gently.


May I turn to my pain with kindness.

May I be filled with compassion and lovingkindness

for others and myself.

May the power of lovingkindness sustain me.

May love and kindness fill and heal my pain.

May I relax and send warmth and ease to my pain.

May this experience in some way be a blessing for me.

May lovingkindness heal my body and mind.


May my suffering show me the way to compassion.

May I receive other’s love and compassion.

May I experience my pain with compassion.

May I be open to feel my pain.

May I be free from pain and suffering.

May I connect with all those who have pain like I am experiencing.

Although I am in pain, so are many others.

May those with pain like mine be free of their suffering.

May I receive and transform the pain of all those who suffer like me.

Sympathetic Joy

May beings everywhere be free of pain.

May peace and goodness be present for all beings.

May your wellbeing continue.

May all beings be happy.


May I observe my pain with equanimity.

May I be present for my pain and suffering.

May I accept things as they are.

May I have the strength to face my situation.

May I accept my pain, knowing that I am not my pain,

not my body, not my illness.

Even though I am in pain, I can be present for it.

May I realize that this pain is not permanent.

Acceptance and Surrender

May I accept my pain,

knowing that it does not make me bad or wrong.

May I be open to my pain and let go into it.

May I let go of the fear around my pain.

May accept my pain, knowing that my heart is not limited by it.

May I be peaceful and let go of expectations.

May I be open with others and myself about my experience.

May this experience open me to the true nature of life.

May I be open to the true nature of life.

May I find the inner resources to be present for my pain.

May I be peaceful with this experience of pain.

May I let go of my struggle.

May I be peaceful and let go of my expectations around my pain.

May I breathe into my pain, surrendering to it,

knowing it will change.


Meditation: Transforming Pain Through the Elements

You can read this practice and rest in the atmosphere of each section, or a guide can read

it to you.

Bring your attention to your whole body and let the body settle.

Accept whatever your experience might be.

Be with your body as you inhale and exhale.

Bring your breath deep into your body.

Fill your whole body with the in-breath.

Gently bring your attention to your whole body on the in-breath.

Let go as you breathe out, letting the breath sweep the body.

Now consider that your body is composed

of earth, water, fire, air, and space.

In the practice that follows,

consider the elements that constitute the body.

Invite yourself to use the elements

as a way to transform your experience of pain.

Contemplate the element of earth.

Feel earth’s solidity and strength.

Now feel the solidness of your body,

and the element of earth in your body.

Feel your bones, your tissue.

Your body is your temporary home.

Feel welcomed by your body.

Invite your mind to feel at home in your body.

Remember that when you die,

the earth element of your body will return to the earth.

Contemplate the element of water.

Feel water’s fluidity and power to accept anything and to purify.

Feel the water element of your body:

blood, urine, mucous, and lymphatic fluid.

Feel the sense of flow in your body.

Feel your body’s power to purify.

Let your mind and body settle like a still pool.

Remember that when you die,

the water element of your body will return to water.

Contemplate the element of fire.

Feel fire’s energy to give warmth, light, mature, and heal.

Feel fire’s power to transform.

Feel the element of fire in your body.

Be in touch with your body’s warmth and its capacity to digest.

Let the element of fire open up the mind to its own luminosity.

Remember that when you die,

the fire element of your body will return to fire.

Contemplate the element of air.

Feel the power of wind in your breath.

Be aware of any movement in your body.

Feel the element of air in your body as your breathe in and out.

Be aware of the lightness and the strength of wind in your body.

Let the element of wind bring clarity to your mind

and openness to your body.

Remember that when you die,

the air element of your body will return to air.

Contemplate the element of space.

See if you can feel your body as boundless,

both vast and at one with all beings and things.

Let yourself experience the openness of your own nature.

Give yourself room to experience space without limits.

Let the element of space give you room for peace.

Remember that when you die, you will be boundless.

Now bring your attention to your pain.

Breathe into and out of your pain.

Give yourself time with each of the elements

in relation to your experience of pain.

Let the element of earth give you tolerance for your pain.

Let the element of water absorb your pain.

Let the element of fire burn through your pain.

Let the element of air release your pain.

Let the element of space give room for your pain.

Rest in openness

as the elements do their natural work on your behalf.

When you are ready,

dedicate the merit of your practice to the well-being of others.