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Does it hurt? Yes. Is that a problem? No.

Teeth clenched. Hands clenched and pressed tightly to my chest. This is what pain feels like, I think, as the doctor asks if I can feel anything in my foot. Yes, I say. This is a pain that feels like she’s poking me with a meat fork – or the Swiss Army knife that we’d joked about a few minutes ago as she’d checked to make sure she had the screwdriver she needed.

This is not the pain I’d noticed a week earlier in yoga class. That was tingly, like bumping your elbow. We were doing a squat, heels raised, to stretch tendons, and I noticed that my left foot had significantly less bend than my right. I felt the tingle when we moved into downward dog, then later noticed a bump near the top of my instep, right where a screw held the bones together. A screw that was now becoming unscrewed.

That pain was not particularly uncomfortable as a physical sensation. More painful was the disruption to my routine: I couldn’t sit comfortably in meditation, couldn’t walk barefoot without the tingling – and the fear that the screw was further unscrewing itself and would poke its way through the skin before the doctor could take it out. That was particularly annoying because I was planning to go to a weekend meditation retreat, and aside from the physical discomfort, there was my discomfort at the idea of not fitting in – not taking part in walking meditation, sitting through the yoga breaks, changing position a lot more than usual. The suffering of suffering.

Back to the suffering of pain in the doctor’s office. The plan was to make a small incision, unscrew the screw, then put in a couple of stitches. The doctor moved the head of my chair down and asked if I wanted a magazine to read while she worked. I tried that but then decided to observe sensations.

I’ve had enough experience with chronic physical pain to explore it as a practice. My teacher Matthew Brensilver of Against the Stream Buddhist Meditation Society is a student of Shinzen Young, a Buddhist teacher who wrote the book on pain (OK, a book on pain) "Break Through Pain." He breaks it down to a simple mathematical equation: Suffering is a function of pain and the degree to which the pain is being resisted. (S = P + R)

Pain is simply an energy, he says.

Resistance interferes with that energy wave, fights against it, tries to beat it back. Thus deep within our being there is a kind of violent conflict, a veritable civil war between two parts of the same system. This produces a pressure called suffering.

According to this view, resistance is a kind of internal friction; the system is grinding against itself. Such friction produces useless suffering and wastes physical and psychological energy.

Resistance occurs in both the body and the mind, and may be either conscious or unconscious. Conscious resistance in the mind takes the form of judgment, wishes, fearful projections, etc.: I hate the pain. I cant stand this pain. When is it going to stop?

Conscious resistance in the body takes the form of tension and holding. You have pain in the leg, but you may be tightening the jaw, tensing the breath, perhaps clenching throughout the whole body, not letting the pain spread and circulate. Opening to the painis the practice of dropping the conscious resistance by letting go of the judging thoughts and continually relaxing your whole body as much as possible.

Once I noticed myself clenching, physically and mentally, against the pain, I made an effort. I focused on breath. I relaxed. I flinched when she stuck me with the sharp thing until my foot was numb and I couldn’t feel it. I listened to the assorted sounds. At one point, I looked down and saw the doctor using what looked like a tire iron to unscrew the screw – which was not coming any farther out without encouragement. I laughed.

It was pretty funny.

Pain is sometimes necessary, Shinzen Young says, but suffering is not. He writes:

Pain informs and motivates; suffering drives and distorts. Pain experienced skillfully brings us closer to our spiritual source; suffering alienates us from our spiritual source and our fellow human beings. Suffering obscures the perfection of the moment; pain experienced skillfully is the perfection of the moment.

For most people the notion of pain which is not suffering may sound like a contradiction in terms. People have difficulty imagining what the experience of pain without suffering would be like. Does it hurt? Yes. Is that a problem? No.

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