By John M. de Castro, Ph.D.
“If you move into pure awareness in the midst of pain, even for the tiniest moment, your relationship with your pain is going to shift right in that very moment. It is impossible for it not to change because the gesture of holding it, even if not sustained for long, even for a second or two, already reveals its larger dimensionality.” – Jon Kabat-Zinn
We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. For many, however, pain is a constant in their lives. Chronic pain affects a wide swath of humanity. At least 100 million adult Americans have common chronic pain conditions. It affects more Americans than diabetes, heart disease and cancer combined. Chronic pain accompanies a number of conditions. The most common form is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.
The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. Fortunately, there are alternative treatments. Mindfulness and Yoga have been shown to specifically improve back pain and mind-body practices in general have been shown to reduce the gene expressions that underlie the inflammatory response which contribute to arthritis. So, it would seem reasonable to look further into the effectiveness of alternative and complementary practices in treating chronic pain.
In today’s Research News article “Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis.” See:
https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1296780620345861/?type=3&theateror see summary below or view the full text of the study at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439829/
Bawa and colleagues review the published research literature on the use of mindfulness training to treat chronic pain. Most of the studies reviewed used either Mindfulness-based Stress Reduction (MBSR) or Mindfulness-based Cognitive Therapy (MBCT) programs. They found that the published literature reported that mindfulness practices in general produced a small but significant reduction in pain, depression, and anxiety and an increase in sleep quality. They also found moderate significant improvements in physical functioning, physical and psychological quality of life. Large significant effects of mindfulness training were reported for pain acceptance and perceived pain. Hence, the published literature reports many beneficial effects of mindfulness training for chronic pain. The largest effects were for the psychological aspects of pain, but, also for the physical aspects of pain, albeit smaller effects.
There are a number of effects of mindfulness training that might underlie these improvements in chronic pain. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to reduce stress responses and anxiety, and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable that mindfulness practices would be helpful in pain management. In addition, pain is accompanied by, and frequently caused by, inflammation and mindfulness training has been shown to reduce the inflammatory response. This may account for the mindfulness’ effects on the physical aspects of chronic pain.
These are exciting findings that non-drug treatments can be effective for chronic pain. They are effective and importantly, safe. So, reduce chronic pain with mindfulness.
“a regular meditation practice is the best ongoing foundation for working with pain. Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”).” – Christiane Wolf
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Bawa, F. L. M., Mercer, S. W., Atherton, R. J., Clague, F., Keen, A., Scott, N. W., & Bond, C. M. (2015). Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. The British Journal of General Practice, 65(635), e387–e400. http://doi.org/10.3399/bjgp15X685297
Abstract
Background: Chronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique.
Aim: To assess the effectiveness of mindfulness-based interventions for patients with chronic pain.
Design and setting: Systematic review and meta-analysis including randomised controlled trials of mindfulness-based interventions for chronic pain. There was no restriction to study site or setting.
Method: The databases MEDLINE®, Embase, AMED, CINAHL, PsycINFO, and Index to Theses were searched. Titles, abstracts, and full texts were screened iteratively against inclusion criteria of: randomised controlled trials of mindfulness-based intervention; patients with non-malignant chronic pain; and economic, clinical, or humanistic outcome reported. Included studies were assessed with the Yates Quality Rating Scale. Meta-analysis was conducted.
Results: Eleven studies were included. Chronic pain conditions included: fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome, and mixed aetiology. Papers were of mixed methodological quality. Main outcomes reported were pain intensity, depression, physical functioning, quality of life, pain acceptance, and mindfulness. Economic outcomes were rarely reported. Meta-analysis effect sizes for clinical outcomes ranged from 0.12 (95% confidence interval [CI] = −0.05 to 0.30) (depression) to 1.32 (95% CI = −1.19 to 3.82) (sleep quality), and for humanistic outcomes 0.03 (95% CI = −0.66 to 0.72) (mindfulness) to 1.58 (95% CI = −0.57 to 3.74) (pain acceptance). Studies with active, compared with inactive, control groups showed smaller effects.
Conclusion: There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.