Chronic Pain Care: Can Mindfulness Play a Role?

Meditation—and being “in the now”—can help take the focus off your pain

Mindful people seem to feel less pain, according to a recent study conducted at Wake Forest School of Medicine in Winston-Salem, North Carolina. As part of the research, just over 75 healthy volunteers used a clinical measurement to determine their baseline levels of mindfulness. Then, they underwent an MRI while painful heat stimulation was applied. Those volunteers with higher levels of mindfulness reported lesser levels of pain from the stimulation compared to those who were less mindful. Does this mean that if people with chronic pain practice mindfulness, they are likely to see a decrease in their pain?

MindfulnessPracticing mental health therapies like mindfulness may play an added role in your chronic pain management. (Source: 123RF)

Pain & the Mind: What the Experts Say

“Some research suggests this, others not so much,” says the study’s lead author, Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy at Wake Forest School of Medicine, which is part of Wake Forest Baptist Medical Center. “I think it depends on the pain condition but it’s impossible to tell until the clinical trials that are being performed by us and others are completed.”

Dr. Zeidan does believe, however, that mindfulness can very easily be taught and that it could be used as an adjunctive therapy to traditional chronic pain management.

Mindfulness involves paying attention to one’s experience in the present moment, according to the American Psychological Association. When practicing mindfulness, an individual is aware of thoughts and emotions from moment to moment but does not become caught up in them. Meditation is one way of being mindful, and if the person’s mind starts to wander, he or she simply returns to focusing on the present. This transition can be accomplished by paying attention to one’s breath or doing a simple yoga move.

David Rakel, MD, professor and chair of the Department of Family and Community Medicine at the University of New Mexico School of Medicine in Albuquerque, agrees. Mindfulness can help people avoid catastrophizing their pain, the latter of which can increase fear and severity, he says. “Mindfulness means being in the present moment and making a conscious choice not to judge,” explains Dr. Rakel, who is the author of The Compassionate Connection: The Healing Power of Empathy and Mindful Listening.  

When a person in pain tries to avoid or ignore pain, it often has a way of getting one’s attention by becoming more severe, notes Dr. Rakel. He adds, that, “Mindfulness helps give attention to the pain without judgment. Mindfulness training teaches one to turn toward suffering and in doing so, the severity of pain often softens. It is similar to dealing with a screaming child. Putting your hand over their mouth rarely works, but giving them your full attention does.”

Mindfulness Courses: ACT, MBSR & Meditation

Patricia Tsui, PhD, a clinical psychologist in the Stony Brook Center for Pain Management in New York, teaches mindfulness-based approaches to dealing with pain to patients who have chronic neck and back pain, migraine, fibromyalgia, and complex regional pain syndrome (CRPS/RSD). Both Acceptance Commitment Therapy (ACT) and mindfulness-based stress reduction (MBSR), two evidence-based psychological approaches that incorporate concepts of mindfulness, can help, she says.

ACT teaches patients to adapt and to be resilient in the face of pain, Dr. Tsui explains. “We learn to develop psychological flexibility,” she says. “You may cultivate mindfulness with a meditative practice that can be done seated or even while walking.” In either case, the individual may be instructed to focus on his or her breath, to be in the present moment, and to observe the experience in a non-judgmental way. People can learn to shift their attention away from pain, but this usually takes motivation and practice, she says.

Carol M. Greco, PhD, an associate professor of psychiatry at the University of Pittsburgh School of Medicine, is a certified Mindfulness Based Stress Reduction (MBSR) instructor. The course, which is taught all around the world, consists of eight weekly sessions, lasting 2.5 to 3 hours each. She explains mindfulness as “training your mind to pay attention and be okay with whatever arises without trying to get rid of the stuff we don’t like or trying to hang onto stuff. We have a lot of habits around getting away from anxiety and pain,” she explains. “If we can work with ourselves to be more accepting and allow what is there to be there, there is greater enjoyment and less suffering.”

There is no “right answer” for how long each day a person should meditate, Dr. Greco adds. “During the MBSR course, people are asked to practice mindfulness meditation for about 45 minutes per day. Recent research supports that those who commit more time, closer to that 45 minutes, typically see stronger health and well-being benefits. However, even if participants practice much less than that, they can still experience benefits,” she says. 

Once the course ends, Dr. Greco encourages people to continue to practice meditation daily or near daily, whatever amount they are able to do, whether it is 10 minutes or an hour. “But this is not a ‘should,’ ” she says. “The mindfulness meditation ongoing practice is a gift to themselves – a time in their day to connect with themselves, and to just be.”

For a patient in pain, just being with the sensations, and not adding all the emotional reactivity in terms of thoughts and attitudes, can reduce the experience of pain, Dr. Greco says.

For more information, visit https://www.umassmed.edu/cfm/mindfulness-based-programs/mbsr-courses/find-an-mbsr-program/. 

Practicing Mindfulness at Home

For those who may not be able to attend mindfulness training, mobile apps are available. Among the apps that Dr. Tsui recommends are Calm, which teaches meditation and mindfulness; Headspace, which offers guided meditations and mindfulness techniques; and Insight Timer, a free app that teaches meditation and offers free guided meditations, music tracks, talks, and courses.

Pain Warriors Find Peace through Mindfulness

One chronic pain patient who was able to find a way out of his suffering through mindfulness is Michael McGee, MD, who also serves as chief medical officer at The Haven at Pismo in Grover Beach, California, and is the author of The Joy of Recovery: The New 12 Step Guide to Recovery from Addiction. Dr. McGee has had chronic back pain for 30 years from a damaged lumbar disc, as well as neck pain due to a cervical spine injury. He says there is nothing to be done except physical therapy and medication. “I am in pain every day, but I practice mindfulness, which really puts the pain in its proper perspective,” he says. “I’ve learned through mindfulness that I can experience wonder and joy. I have an attitude of appreciation and gratitude.”

When he is feeling pain, for example, Dr. McGee focuses on the moment. “I feel the phone cradled by my neck, I hear my voice and the computer copier in the background,” he explains. “I’m able to say, look, I have pain. But I also have a job I love, I can see, and walk, and taste. I have family and friends who I love, and a wonderful wife. There is so much to be appreciated that it puts the pain in its proper perspective.”

Dr. McGee recommends meditation twice a day, morning and night. “The best thing is to link it to something you are already doing, like brushing your teeth, to make it easy. I recommend just starting with 5 minutes a day minimum. If people want to meditate more, great, but better to make it not overwhelming. I meditate for 30 minutes, twice a day,” he adds.

Another patient using mindfulness and meditation to overcome pain is David Dachinger of Scarsdale, New York, a two-time Grammy-nominated composer who was diagnosed with a Stage 4 cancer in 2014. Dachinger endured radiation and painful side effects that persisted even after he got a clean bill of health. Yet, he managed to stay focused with mindfulness and meditation, says his wife, Tamara Green. “He still has lingering problems and concerns, but he turns to the tools he used during treatment. We found that it’s helped us to get a better perspective.”

The couple now manages a company called Loving Meditations that features an app with audio/video content featuring soothing music and guided meditations. Says Dachinger: “It’s pretty dramatic to see how mindfulness and meditation can make such a difference.” 

Read more #PainWarriorWins and mindfulness tips from readers.

Updated on: 01/07/19
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Meditation: A Pathway to Pain Relief
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