Mindfulness is Associated with Reduced Pain by Improving the Capacity for Pleasure
By John M. de Castro, Ph.D.
“It felt good to realize [through mindfulness] that I can co-exist with my pain. Being mindful helped me realize that in my angry reaction to my back pain, I was neglecting my whole body. I saw my body only through my pain, which caused me to hate my body over time. I can now see myself outside of my body, and am working day by day with my meditation to become a happier person living with chronic pain.” – Natalia Morone
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. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s 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. 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 how these practices effect chronic pain.
In today’s Research News article “Mindfulness Is Associated with Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5235319/ ), Thomas and Garland recruited chronic pain patients who were being treated with opioids. They were measured for mindfulness, hedonic (pleasure) capacity, pain severity, pain interference, and depression. The relationships among these variables was explored with regression analysis.
They found that for the higher the levels of mindfulness for these chronic pain patients the higher their ability to experience pleasure (hedonic capacity) and the less that pain interfered with their daily lives (pain interference). This was also true for the mindfulness facets of observing inner experience, non-judgment, and acting with awareness. A mediation analysis demonstrated that the association of mindfulness with less pain interference in daily living resulted from mindfulness’ association with higher levels of hedonic capacity that in turn was associated with lower pain interference. So, the higher levels of ability to experience pleasure associated with mindfulness was the mediator of mindfulness’ association with lower ability of pain to interfere with living.
It needs to be kept in mind that this study was correlational and causation cannot be determined. But, the results suggest that being mindful predicts a greater ability to experience pleasure and, in turn, less interference in daily life produced by pain. This makes sense as pleasure occurs in the present moment and the ability of mindfulness to focus attention on the present moment would heighten the appreciation of this pleasure. In turn, it makes sense that being able to experience the good things in life would interfere with the ability of pain to interfere with living. So, being mindful may heighten the appreciation of pleasure and lower the difficulties in daily living produced by chronic pain.
“The current state of chronic pain and opioid use in the United States may indeed be daunting and require a multifaceted approach; yet, there is promise for our Veterans and the more than 100 million Americans1 who suffer from chronic pain in the age-old and now richly evidence-based practice of mindfulness meditation.” – Dawn Bazarko
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Thomas, E. A., & Garland, E. L. (2017). Mindfulness Is Associated with Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy. The Clinical Journal of Pain, 33(2), 166–173. http://doi.org/10.1097/AJP.0000000000000379
Abstract
Objectives
Chronic pain and long-term opioid use may lead to a persistent deficit in hedonic capacity, characterized by increased sensitivity to aversive states and insensitivity to natural rewards. Dispositional mindfulness has been linked with improved emotion regulation and pain coping. The aim of the current study was to examine associations between dispositional mindfulness, hedonic capacity, and pain-related interference in an opioid-using chronic pain sample.
Methods
Data were obtained from a sample of 115 chronic pain patients on long-term opioid therapy (68% females, M age=48.3, SD=13.6) who completed the Five Facet Mindfulness Questionnaire (FFMQ), the Snaith Hamilton Anhedonia and Pleasure Scale (SHAPS), the Brief Pain Inventory (BPI), and a psychiatric assessment of major depression. Bivariate correlations, hierarchical multiple regression, and path analysis were used to determine if dispositional mindfulness scores (FFMQ) predicted variance in hedonic capacity (SHAPS), and if hedonic capacity mediated the association between mindfulness and pain interference.
Results
We observed a significant positive correlation between dispositional mindfulness and hedonic capacity scores, r=.33, p<.001. Hierarchical regression indicated that after controlling for pain interference and major depressive disorder diagnosis, dispositional mindfulness explained a significant portion of variance in hedonic capacity (Beta = .30, p< .01). The association between dispositional mindfulness and pain interference was mediated by hedonic capacity (b = −.011, SE=.005, 95% C.I. = −.004 to −.024, full model R2=.39).
Discussion
Findings indicate that dispositional mindfulness was associated with hedonic capacity among this chronic pain sample. In light of this association, it is plausible that interventions that increase mindfulness may reduce pain-related impairment among opioid-using patients by enhancing hedonic capacity.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5235319/
New Definition of Mindfulness and Pleasure from Affective Neuroscience
Presented below is a new definition and procedure for mindfulness and increasing positive affect from affective neuroscience. (Thankfully, its easily falsifiable). A different perspective that comes to your same conclusion.
My work is largely based on the latest iteration of incentive or discrepancy-based models of motivation representative of the work of Dr. Kent Berridge of the University of Michigan. Berridge is a renowned bio-behaviorist and affective neuroscientist and was kind to vet and endorse the little book I have linked below. My explanation and argument are tiered into three parts, for a lay audience (pp.7-52), an expanded academic version (pp.53-86), and a formal journal article published on the topic in the International Journal of Stress Management. The procedure is a variant of mindfulness practice but entails a new definition of mindfulness based on contemporary neurologically grounded models of learning.
A brief summary of my argument
In discrepancy models of motivation (or bio-behaviorism), affect is schedule dependent. VR (variable-ratio) schedules of reinforcement or reward (gaming, gambling, creative behavior) are characterized by moment to moment positive act-outcome discrepancy or uncertainty between what is expected and what actually happens, which parallels the release of the neuro-modulator dopamine that is felt a state of attentive arousal, but not pleasure.
However, heightened pleasurable affect as well as heightened attentive arousal is also reported while performing under VR schedules, but only when the musculature is in a state of inactivity or relaxation. Relaxation induces the activity of mid-brain opioid systems and is felt as pleasure. Because dopamine and opioid systems can co-activate each other, concurrent contingencies which induce relaxation (mindfulness protocols) and attentive arousal (purposive or meaningful behavior) will result in a significant spike in affective tone as both dopaminergic and opioid activity will be much higher due to their synergistic effects. The result is the ability to be mindful and relaxed almost constantly, and to significantly increase felt levels of ‘pleasure’ and ‘energy’.
The procedure to do this, outlined on pp. 47-52, has several important characteristics.
Behavioral- no appeal to events outside of objective behavior.
Simple – explained in five minutes, and refutable as quickly.
Validates Mindfulness – but from the novel perspective of modern learning theory.
Also, as a layman (though academically trained in behavioral psychology, I am an executive for a tech company in New Orleans), I am most curious to see if this procedure is effective. Formal test is not at first necessary, but informal exposure is since the procedure is simple and innocuous and its predictions significant and clear.
But again, I may be wrong. So, it pays not to quite your day job!
https://www.scribd.com/doc/284056765/The-Book-of-Rest-The-Odd-Psychology-of-Doing-Nothing
https://www.scribd.com/doc/121345732/Relaxation-and-Muscular-Tension-A-bio-behavioristic-explanation
And Holmes’ Article on Meditation and Rest from ‘The American Psychologist’
https://www.scribd.com/document/291558160/Holmes-Meditation-and-Rest-The-American-Psychologist
Being mindfulness would be a big help for you to keep in mind of something and able to focus. It would help you to think less on other things.