Reduce Pain with Mindfulness
By John M. de Castro, Ph.D.
“Meditation (which is the ‘formal’ practice of mindfulness) actually changes the way the mind perceives pain (2) so that it’s more bearable. It is a natural and effective way to ease physical pain.” – Melli O’Brien
We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. 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.
Hospital inpatients frequently are in pain and the management of that pain is important to the patients and to the amount of hospitalization time. It is not known whether mindfulness training is effective for the relief of acute pain in hospitalized patients. In today’s Research News article “Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602767/ ), Garland and colleagues examined the effectiveness of mindfulness training in comparison to hypnotic suggestion and psychoeducation for the relief of inpatient acute pain.
They recruited hospital inpatients who reported intolerable pain that was not adequately managed. They were randomly assigned to receive either mindfulness training in a “single, scripted 15-min training session in focused attention on breathing and body sensations, with concomitant metacognitive monitoring and acceptance of discursive thoughts, negative emotions, and pain”, or a hypnotic suggestion in a “single, scripted 15-min self-hypnosis session which invited patients to roll their eyes upward, close their eyes, and breathe deeply, focus on sensations of floating, and imagine the visual, auditory, olfactory, and tactile details of a pleasant scene of their choosing”, or a psychoeducation session of a “single 15-min session in which a social worker provided empathic responses to the patient and then attempted to increase perception of pain control by reviewing common behavioral pain coping strategies (e.g., stretching, using hot and cold compresses).” They were measured before and after the training for pain intensity, pain unpleasantness, anxiety, relaxation, pleasant body sensations, and desire for opioids.
They found that both the mindfulness and the hypnotic suggestion groups but not the psychoeducation group had significant decreases in pain intensity and pain unpleasantness. The mindfulness group also reported significantly higher relaxation and pleasant body sensations after training than the psychoeducation group while the hypnotic suggestion group reported significantly lower desire for opioids after training than the psychoeducation group. All three groups showed a reduction in anxiety.
Hence, a brief mindfulness training or hypnotic suggestion in hospital patients significantly improved their pain and psychological state. These are interesting results that suggest that these trainings may be useful for the relief of acute pain in hospital patients. But this trial was very brief. It remains for future research to establish the duration of effectiveness and the ability of continued training to potentiate the effectiveness and its duration.
So, reduce pain with mindfulness.
“When we’re in pain, we want it to go away. Immediately. And that’s understandable. Chronic pain is frustrating and debilitating. . . The last thing we want to do is pay more attention to our pain. But that’s the premise behind mindfulness, a highly effective practice for chronic pain.” – Margarita Tartakovsky
CMCS – Center for Mindfulness and Contemplative Studies
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Garland, E. L., Baker, A. K., Larsen, P., Riquino, M. R., Priddy, S. E., Thomas, E., Hanley, A. W., Galbraith, P., Wanner, N., … Nakamura, Y. (2017). Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. Journal of general internal medicine, 32(10), 1106-1113.
Medical management of acute pain among hospital inpatients may be enhanced by mind-body interventions.
We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly reduce acute pain intensity and unpleasantness compared to a psychoeducation pain coping control. We also hypothesized that mindfulness and suggestion would produce significant improvements in secondary outcomes including relaxation, pleasant body sensations, anxiety, and desire for opioids, compared to the control condition.
This three-arm, parallel-group randomized controlled trial conducted at a university-based hospital examined the acute effects of 15-min psychosocial interventions (mindfulness, hypnotic suggestion, psychoeducation) on adult inpatients reporting “intolerable pain” or “inadequate pain control.” Participants (N = 244) were assigned to one of three intervention conditions: mindfulness (n = 86), suggestion (n = 73), or psychoeducation (n = 85).
Participants in the mind-body interventions reported significantly lower baseline-adjusted pain intensity post-intervention than those assigned to psychoeducation (p < 0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%), and lower baseline-adjusted pain unpleasantness (p < 0.001). Intervention conditions differed significantly with regard to relaxation (p < 0.001), pleasurable body sensations (p = 0.001), and desire for opioids (p = 0.015), but all three interventions were associated with a significant reduction in anxiety (p < 0.001).
Brief, single-session mind-body interventions delivered by hospital social workers led to clinically significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management.