Living with chronic illness or pain
Nakulapitā came to the Buddha old and sick and was told to train so that a sick body need not mean a sick mind — which is an instruction, not a demand, and the suttas are frank that the first arrow lands on everyone. The passages here are about the second: the aversion to the pain, the story of what it has taken, the fear of what comes next. They describe attending to painful feeling without adding to it, in the same texts that describe the Buddha lying down with a stone splinter in his foot. They do not say the pain is in your head and they do not replace medicine. The right person for the pain itself, and for the fear of what it means, is your doctor, who can tell you what it is and what can be done; tell them if it changes or gets worse. How to sit with pain, and whether to, is a conversation for a teacher who knows your body.
What the suttas say
For this body is ailing, swaddled in its shell. If anyone dragging around this body claimed to be healthy even for an hour, what is that but foolishness? So you should train like this: ‘Though my body is ailing, my mind will be healthy.’ That’s how you should train.
Nakulapitā, old and ill — the training the Buddha gives him.
SN 22.1:3.2–3.6 · Nakula’s Father
Āturo hāyaṁ, gahapati, kāyo aṇḍabhūto pariyonaddho. Yo hi, gahapati, imaṁ kāyaṁ pariharanto muhuttampi ārogyaṁ paṭijāneyya, kimaññatra bālyā? Tasmātiha te, gahapati, evaṁ sikkhitabbaṁ: ‘āturakāyassa me sato cittaṁ anāturaṁ bhavissatī’ti. Evañhi te, gahapati, sikkhitabbanti.
When an unlearned ordinary person experiences painful physical feelings they sorrow and wail and lament, beating their breast and falling into confusion. They experience two feelings: physical and mental. It’s like a person who is struck with an arrow, only to be struck with a second arrow. That person experiences the feeling of two arrows. In the same way, when an unlearned ordinary person experiences painful physical feelings they sorrow and wail and lament, beating their breast and falling into confusion. They experience two feelings: physical and mental.
The distinction between the pain and the reaction to the pain.
Where this stops: The sutta grants that the first arrow lands on everyone, including the awakened.
SN 36.6:1.5–1.13 · An Arrow
assutavā, bhikkhave, puthujjano dukkhāya vedanāya phuṭṭho samāno socati kilamati paridevati urattāḷiṁ kandati sammohaṁ āpajjati. So dve vedanā vedayati— kāyikañca, cetasikañca. Seyyathāpi, bhikkhave, purisaṁ sallena vijjheyya. Tamenaṁ dutiyena sallena anuvedhaṁ vijjheyya. Evañhi so, bhikkhave, puriso dvisallena vedanaṁ vedayati. Evameva kho, bhikkhave, assutavā puthujjano dukkhāya vedanāya phuṭṭho samāno socati kilamati paridevati urattāḷiṁ kandati sammohaṁ āpajjati. So dve vedanā vedayati— kāyikañca, cetasikañca.
Now at that time the Buddha’s foot had been cut by a wooden splinter. The Buddha was stricken by harrowing pains; physical feelings that were painful, sharp, severe, acute, unpleasant, and disagreeable. But he endured unbothered, with mindfulness and situational awareness.
The Buddha in physical pain — the canon does not exempt him from the first arrow, and shows what enduring it looks like.
Where this stops: A description, not a standard to measure oneself against; bearing pain untroubled is the fruit of a long training, not an instruction to the person in pain today.
SN 1.38:1.3–1.5 · A Splinter
Tena kho pana samayena bhagavato pādo sakalikāya khato hoti. Bhusā sudaṁ bhagavato vedanā vattanti sārīrikā vedanā dukkhā tibbā kharā kaṭukā asātā amanāpā; tā sudaṁ bhagavā sato sampajāno adhivāseti avihaññamāno.
And how does a mendicant meditate observing an aspect of feelings? It’s when a mendicant who feels a pleasant feeling knows: ‘I feel a pleasant feeling.’ When they feel a painful feeling, they know: ‘I feel a painful feeling.’ When they feel a neutral feeling, they know: ‘I feel a neutral feeling.’ When they feel a pleasant feeling of the flesh, they know: ‘I feel a pleasant feeling of the flesh.’ When they feel a pleasant feeling not of the flesh, they know: ‘I feel a pleasant feeling not of the flesh.’ When they feel a painful feeling of the flesh, they know: ‘I feel a painful feeling of the flesh.’ When they feel a painful feeling not of the flesh, they know: ‘I feel a painful feeling not of the flesh.’ When they feel a neutral feeling of the flesh, they know: ‘I feel a neutral feeling of the flesh.’ When they feel a neutral feeling not of the flesh, they know: ‘I feel a neutral feeling not of the flesh.’
The canon's way of attending to feeling, the pleasant, painful or neutral tone of whatever is felt, each simply known while it is present.
Where this stops: About knowing a feeling while it is felt, not about producing pleasant states or holding out against pain; pain that persists or worsens is a matter for a doctor.
MN 10:32.1–32.10 · Mindfulness Meditation
Kathañca, bhikkhave, bhikkhu vedanāsu vedanānupassī viharati? Idha, bhikkhave, bhikkhu sukhaṁ vā vedanaṁ vedayamāno ‘sukhaṁ vedanaṁ vedayāmī’ti pajānāti. Dukkhaṁ vā vedanaṁ vedayamāno ‘dukkhaṁ vedanaṁ vedayāmī’ti pajānāti. Adukkhamasukhaṁ vā vedanaṁ vedayamāno ‘adukkhamasukhaṁ vedanaṁ vedayāmī’ti pajānāti. Sāmisaṁ vā sukhaṁ vedanaṁ vedayamāno ‘sāmisaṁ sukhaṁ vedanaṁ vedayāmī’ti pajānāti. Nirāmisaṁ vā sukhaṁ vedanaṁ vedayamāno ‘nirāmisaṁ sukhaṁ vedanaṁ vedayāmī’ti pajānāti. Sāmisaṁ vā dukkhaṁ vedanaṁ vedayamāno ‘sāmisaṁ dukkhaṁ vedanaṁ vedayāmī’ti pajānāti. Nirāmisaṁ vā dukkhaṁ vedanaṁ vedayamāno ‘nirāmisaṁ dukkhaṁ vedanaṁ vedayāmī’ti pajānāti. Sāmisaṁ vā adukkhamasukhaṁ vedanaṁ vedayamāno ‘sāmisaṁ adukkhamasukhaṁ vedanaṁ vedayāmī’ti pajānāti. Nirāmisaṁ vā adukkhamasukhaṁ vedanaṁ vedayamāno ‘nirāmisaṁ adukkhamasukhaṁ vedanaṁ vedayāmī’ti pajānāti.
Ānanda, if you were to recite to the mendicant Girimānanda these ten perceptions, it’s possible that after hearing them his illness will die down on the spot. What ten? The perceptions of impermanence, not-self, ugliness, drawbacks, giving up, fading away, cessation, dissatisfaction with the whole world, impermanence of all conditions, and mindfulness of breathing.
The Buddha's own instruction to a sick monk.
Where this stops: Long and technical; use a short excerpt.
AN 10.60:2.3–3.2 · With Girimānanda
Sace kho tvaṁ, ānanda, girimānandassa bhikkhuno dasa saññā bhāseyyāsi, ṭhānaṁ kho panetaṁ vijjati yaṁ girimānandassa bhikkhuno dasa saññā sutvā so ābādho ṭhānaso paṭippassambheyya. Katamā dasa? Aniccasaññā, anattasaññā, asubhasaññā, ādīnavasaññā, pahānasaññā, virāgasaññā, nirodhasaññā, sabbaloke anabhiratasaññā, sabbasaṅkhāresu anicchāsaññā, ānāpānassati.