Improve Pain Responding in Adolescents with Mindfulness
By John M. de Castro, Ph.D.
“mindfulness was a significant predictor of both real-world and experimental pain outcomes. Adolescents who were more mindful tended to experience less interference in their day-to-day life as a result of pain. Additionally, . . . more mindful adolescents reported less intense pain and a higher level of pain tolerance.” – Mark Petter
We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. Sadly, about a quarter to a third of children experience chronic pain. It has to be kept in mind that pain is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s important that pain signals not be blocked or prevented. They need to be perceived. But, methods are needed to mitigate the psychological distress produced by chronic pain.
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. The use of drugs in adolescents is even more complicated and potentially directly harmful or could damage the developing brain. So, there is a great need to find safe and effective ways to lower the psychological distress and improve adolescents’ ability to cope with the pain.
Pain involves both physical and psychological issues. 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. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. These include meditation, yoga, tai chi, qigong, biofeedback, progressive muscle relaxation, guided imagery, hypnosis, acupuncture, and deep breathing exercises. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults. But there is very little systematic study of the application of these practices for the treatment of chronic pain in adolescents.
In today’s Research News article “I Learned to Let Go of My Pain”. The Effects of Mindfulness Meditation on Adolescents with Chronic Pain: An Analysis of Participants’ Treatment Experience.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742755/ ), Ruskin and colleagues recruited adolescents between the ages of 12 to 18 years who suffered from chronic pain. They provided the adolescents with an 8-week program or Mindfulness-Based Stress Reduction (MBSR) modified for adolescents, including meditation, yoga, and body scan, but with reduced expectation for home practice and shortened sessions. One week after the end of the program the youths were asked about their satisfaction with the program and participated in focus groups to provide feedback, evaluations, and suggestions regarding the program. The groups discussions were transcribed and a content analysis performed.
The participants rated their satisfaction program at 8.29 out of 10, suggesting a high degree of satisfaction. Ruskin and colleagues found that the “Qualitative analysis of focus group transcripts revealed six main themes: Mindfulness Skills, Supportive Environment, Group Exercises, Empowerment, Program Expectations, and Logistics.”
In terms of the mindfulness category the participants reported that the program improved their awareness of the present moment, their ability to let go of their pain, their ability to cope with the emotions produced by the pain, and increased their overall emotional well-being and happiness. In addition, they reported that the mindfulness skills transferred to other aspects of their life such as work, and became a part of how they normally viewed the world.
In terms of the supportive environment, the participants reported that the group developed a sense of openness and trust, provided emotional support and made them feel less alone. They also reported that being able to discuss their pain issues with others who were also suffering was very beneficial. In terms of the group exercises, the participants reported that the “weather report”, reporting on their current state with the group was very helpful, that focusing on the pain in meditation was helpful. In terms of empowerment, the participants felt that the program did not actually ease their pain but empowered them to take actions to cope with it and not let it interfere with their activities. In terms of the program expectations, they reported that they had great misconceptions of mindfulness at the beginning believing it to be uninteresting and dumb and some reported that they thought the program would actually lower their pain levels. Finally,
in terms of the logistics, the meeting room was too sterile and needed to be decorated in a more interesting fashion, there needed to be more meetings, and they liked working with other adolescents with chronic pain.
Hence, the participants viewed the program very positively as improving their ability to appreciate and stay in the present moment and better cope with the emotional and practical consequences of their pain. That the practice was conducted in a group of other adolescents with chronic pain was viewed as an important and helpful characteristic of the program. In other words, they were pleased and felt the program was helpful to them in dealing with their pain.
These results must be interpreted carefully. They should be viewed as constructive feedback on the program and nothing more. More empirical evidence is needed to reach firm conclusions regarding the programs efficacy. But, the results are suggestive that more systematic studies are warranted as mindfulness training may be very helpful to adolescents in coping with chronic pain.
“Mindful meditation can have profound effects for those who suffer from chronic pain. This simple practice seems to be able to change a patient’s perception of pain, making it less intense. . . . consistent meditation helped patients locate and turn down the “volume knob” on sensations. Often pain sufferers are unable to focus on anything but their pain, which increases their perception of it.” – Pain Doctor
CMCS – Center for Mindfulness and Contemplative Studies
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Danielle Ruskin, Lauren Harris, Jennifer Stinson, Sara Ahola Kohut, Kathryn Walker, Erinn McCarthy. I Learned to Let Go of My Pain”. The Effects of Mindfulness Meditation on Adolescents with Chronic Pain: An Analysis of Participants’ Treatment Experience. Children (Basel) 2017 Dec; 4(12): 110. Published online 2017 Dec 15. doi: 10.3390/children4120110
Chronic pain can lead to significant negative outcomes across many areas of life. Recently, mindfulness-based interventions (MBIs) have been identified as potentially effective tools for improved pain management among adolescents living with pain. This study aimed to explore the experience of adolescents who participated in an eight-week mindfulness group adapted for adolescents with chronic pain (MBI-A), and obtain their feedback and suggestions on group structure and content. A mixed method design was used employing qualitative data from focus groups and data from a satisfaction questionnaire. Focus group data were transcribed and analyzed using inductive simple descriptive content analysis. Of the total participants (n = 21), 90% (n = 19) provided feedback by completing satisfaction questionnaires and seventeen (n = 17) of those also participated across two focus groups. Analysis of the focus group transcripts uncovered six themes: mindfulness skills, supportive environment, group exercises (likes and dislikes), empowerment, program expectations, and logistics. Participants reported positive experiences in the MBI-A program, including support received from peers and mindfulness skills, including present moment awareness, pain acceptance, and emotion regulation. Group members suggested increasing the number of sessions and being clearer at outset regarding a focus on reduction of emotional suffering rather than physical pain.