Pain

Reduce Pain by Accepting it Mindfully

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By John M. de Castro, Ph.D.

 

“They were able to have a sense of personal control over their migraines. It really makes us wonder if an intervention like meditation can change the way people interpret their pain.” – Rebecca Erwin Wells

 

Headaches are the most common disorders of the nervous system. It has been estimated that 47% of the adult population have a headache at least once during the last year. The most common type of headache is the tension headache with 80 to 90 percent of the population suffering from tension headaches at least some time in their lives. The second most common type of headache is the migraine headache. Around 16 to 17 percent of the population complains of migraines. It is the 8th most disabling illness in the world with more than 90% of sufferers unable to work or function normally during their migraine. American employers lose more than $13 billion each year as a result of 113 million lost work days due to migraine.

 

There are a wide variety of drugs that are prescribed for chronic headache pain with varying success. Most tension headaches can be helped by taking pain relievers such as aspirin, naproxen, acetaminophen, or ibuprofen. A number of medications can help treat and prevent migraines and tension headaches, including ergotamine, blood pressure drugs such as propranolol, verapamil, antidepressants, antiseizure drugs, and muscle relaxants. Drugs, however, can have some problematic side effects particularly when used regularly and are ineffective for many sufferers. So, almost all practitioners consider lifestyle changes that help control stress and promote regular exercise to be an important part of headache treatment and prevention. Avoiding situations that trigger headaches is also vital.

 

Mindfulness training has been shown to be an effective treatment for headache pain. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing can reduce headache pain. In addition, mindfulness improves self-efficacy, the belief that the individual can adapt to and handle headache pain. In addition, mindfulness training also has been shown to alter not only what is thought, but also how thoughts are processed. Central to this cognitive change is mindfulness and acceptance. By mindfully viewing pain as a present moment experience it can be experienced just as it is and by accepting it, the individual stops fighting against the pain which can amplify the pain.

 

It is not known whether it is the changes in the what or how, or both, of thoughts that is responsible for mindfulness training’s efficacy in treating headache pain. In today’s Research News article “The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache.” See:

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or see below

Day and Thorn investigate this question. They randomly assigned headache patients to receive either 8-weeks of Mindfulness Based Cognitive Therapy (MBCT) or treatment as usual as a wait-list control condition. Before and again after treatment measurements were obtained of pain, pain acceptance, pain catastrophizing, and pain self-efficacy.

 

They found, as has previously been shown, that the MBCT training significantly reduced the level of pain and pain catastrophizing, and increased the levels of pain self-efficacy and pain acceptance. Day and Thorn then went on to use a sophisticated statistical technique to assess whether the change in pain produced by mindfulness training was due to the changes in the what or how about thinking. They found that only the how aspect of thought, pain acceptance, significantly mediated the effect. Neither of the what aspects of thought, pain catastrophizing nor pain self-efficacy, were significantly related to the mindfulness training effects on pain.

 

These results are very interesting and potentially important. They suggest that mindfulness training reduces headache pain by altering how pain is thought about, increasing acceptance of the pain. Acceptance is defined as the “conscious willingness to stay in direct contact with experience.” This may operate by reducing the individual’s attempts to counteract the pain. Since, fighting against the pain can actually increase the level of pain, accepting the pain interferes with this amplifying process, thus lowering the pain level experienced. It is interesting that neither the pain catastrophizing nor pain self-efficacy were significant mediators as they have long been thought to be important mechanisms of mindfulness’ effectiveness for pain management. But, it is clear that how pain is thought about, in particular, the acceptance of pain, is the key.

 

So, reduce pain by accepting it mindfully.

 

“Awareness transforms emotional pain just as it transforms the pain that we attribute more to the domain of body sensations. When we are immersed in emotional pain, if we pay close attention, we will notice that there is always an overlay of thoughts and a plethora of different feelings about the pain we are in, so here too the entire constellation of what we think of as emotional pain can be welcomed in and held in awareness.” – Jon Kabat-Zinn

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

 

Day MA, Thorn BE. The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache. Complement Ther Med. 2016 Apr;25:51-4. doi: 10.1016/j.ctim.2016.01.002. Epub 2016 Jan 13.

 

Highlights

  • Pain acceptance was a significant mediator of the MBCT-pain interference relation.
  • Specifically, activity engagement emerged as the critical component of acceptance.
  • Pain catastrophizing and self-efficacy did not meet criteria for mediation.
  • This is the first study to show acceptance is a key mediator of MBCT for headache.

Abstract

Objectives: This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy).

Design: A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N = 24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted.

Results: Pain acceptance emerged as a significant mediator of the group-interference relation (p < .05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p < .05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference.

Conclusions: Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache.

 

Mitigate Pain with Mindfulness

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Meditation pain Meize-Grochowski

By John M. de Castro, Ph.D.

 

“It turns out, the human mind does not simply feel pain, it also processes the information that it contains. It teases apart all of the different sensations to try to find their underlying causes so that you can avoid further pain or damage to the body. In effect, the mind zooms in on your pain for a closer look as it tries to find a solution to your suffering. This ‘zooming-in’ amplifies pain.” – Danny Penman

 

Postherpetic neuralgia is a complication of shingles, which is caused by the chickenpox virus, a form of herpes virus. It affects between 10%-20% of shingles sufferers. It affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. It produces pain that has been described as burning, sharp and jabbing, or deep and aching, that lasts for over 3 months. Patients report extreme sensitivity to touch such that even the feel of clothing is very uncomfortable. Sometimes it is also accompanied with itching or numbness. Postherpetic neuralgia pain is difficult to cope with and can thus lead to depression, fatigue, sleep problems, loss of appetite, and difficulty with concentration. The risk of acquiring postherpetic neuralgia increase with age and primarily afflict people over 60. There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time. But, it is an extremely uncomfortable and disruptive disorder and new and better treatments are needed.

 

Mindfulness training has been shown to effectively reduce pain from a number of different conditions. So, it is reasonable to explore whether mindfulness training could be an effective treatment for postherpetic neuralgia. In today’s Research News article “Mindfulness meditation in older adults with postherpetic neuralgia: a randomized controlled pilot study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1218626534827937/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488325/

Meize-Grochowski and colleagues randomly assigned elderly patients (55-90 years of age) with postherpetic neuralgia to either a 6-weeks of 20-minute daily meditation or to a wait-list control condition. They found that at the end of the 6-weeks the meditation group had a significant decrease in neuropathic pain, total pain, and affective pain and improved physical functioning compared to baseline and control participants.

 

These results are encouraging. But, it should be recognized that this was a very small pilot study and needs to be replicated in a much larger clinical trial. Regardless, the results suggest that meditation may be a safe and effective treatment for postherpetic neuralgia, decreasing pain and improving functioning in life. This adds to the growing list of pain conditions that respond positively to mindfulness techniques. It suggests that mindfulness training may be a universally effective treatment for chronic pain.

 

Mindfulness training may be effective for pain by focusing attention on the present moment and thereby reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing should reduce pain. In addition, negative emotions are associated with pain and amplify it. Mindfulness may ne effective for pain because it increases positive emotions and decreases negative ones. Finally, mindfulness has been shown to change how pain is processed in the brain reducing the intensity of pain signals in the nervous system.

 

Regardless of the mechanism, it is clear that meditation is a safe and effective treatment for postherpetic neuralgia. So, mitigate pain with mindfulness.

 

“What we want to do as best as we can is to engage with the pain just as it is. It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently.” – Elisha Goldstein

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Study Summary

Meize-Grochowski, R., Shuster, G., Boursaw, B., DuVal, M., Murray-Krezan, C., Schrader, R., … Prasad, A. (2015). Mindfulness meditation in older adults with postherpetic neuralgia: a randomized controlled pilot study. Geriatric Nursing (New York, N.Y.), 36(2), 154–160. http://doi.org/10.1016/j.gerinurse.2015.02.012

Abstract

This parallel-group, randomized controlled pilot study examined daily meditation in a diverse sample of older adults with postherpetic neuralgia. Block randomization was used to allocate participants to a treatment group (n = 13) or control group (n = 14). In addition to usual care, the treatment group practiced daily meditation for six weeks. All participants completed questionnaires at enrollment in the study, two weeks later, and six weeks after that, at the study’s end. Participants recorded daily pain and fatigue levels in a diary, and treatment participants also noted meditation practice. Results at the .10 level indicated improvement in neuropathic, affective, and total pain scores for the treatment group, whereas affective pain worsened for the control group. Participants were able to adhere to the daily diary and meditation requirements in this feasibility pilot study.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488325/

Improve Surgery Recovery with Yoga

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Yoga Surgery2 Khan

Improve Surgery Recovery with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga is a holistic approach to wellness. We already know the many benefits of yoga. Apart from yoga, even intensive stretching may improve chronic lower back pain and reduce your dependence on medication drugs. Patients have shown to benefit immensely from yoga after their back surgery. Research shows that 12 weeks of yoga can actually improve back function and reduce symptoms in people with chronic back pain.” – Jasmine Bilimoria

 

Yoga practice has been shown to have a myriad of beneficial effects on physical and psychological well-being and it can help the individual heal from physical or mental illness or injury. In India, it is a common and acceptable practice to include yoga and other ayurvedic practices along with modern medical techniques in treating patients. This provides an opportunity to investigate the effects of these alternative practices on healing and recovery after a large array of medical interventions.

 

In today’s Research News article “From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756240/

Khan and colleagues investigate the effects of a package of alternative treatments including yoga, yogic breathing techniques, and massage on patients’ recovery after modern minimally invasive robotic thoracic surgery for a variety of conditions. They compared groups who received the additional treatments to those who did not. Yoga practices commenced shortly after surgery and were taught for as long as they were in the hospital (mean stay of 2.1 days). The patients were encouraged to continue practice at home after release from the hospital.

 

They found that the yoga practices group reported high satisfaction with the practices, less pain and use pain killing medications, less wound drainage, and less lung collapse. Hence, the yoga practices were effective in reducing pain and promoting recovery. These are interesting findings that these practices can improve recovery after surgery. This can have positive benefits for the patients and reduce hospital stays and overall treatment costs, making it attractive to the medical professions.

 

Since, this study was performed in India, where these practices are highly acceptable to the population, it remains to be demonstrated if they would be similarly effective in western countries. In addition, the yoga practices included a package of practices including postures, breathing, and massage. As a result, it cannot be determined which of these components, or which combinations of components, were required for effectiveness. Finally, since another active treatment or placebo control was not included in the study, it is impossible to determine if the effectiveness on recovery from surgery was due to the yogic practices or to a variety of contaminants including subject expectancy effects, demand characteristics, or experimenter bias. It remains for future research to verify the results under more controlled circumstances.

 

Regardless, the results are encouraging and provide the rationale to continue investigating the use of yogic practices to promote recovery after surgery.

 

“Yoga can be a great way to heal from surgery. However, as with any exercise after surgery, make sure you take it slow and do not push yourself. The best yoga for after surgery is Hatha yoga, which is very gentle and can be done very slowly. Hatha yoga focuses on a series of asanas done slowly and with deep breathing. If done properly, it is unlikely that it will do you any harm after the surgery.” – YogaWiz

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

Khan, A. Z., & Pillai, G. G. (2016). From 200 BC to 2015 AD: an integration of robotic surgery and Ayurveda/Yoga. Journal of Thoracic Disease, 8(Suppl 1), S84–S92. http://doi.org/10.3978/j.issn.2072-1439.2016.01.74

 

Abstract

BACKGROUND: Among the traditional systems of medicine practiced all over the world, Ayurveda and Yoga has a documented history dating back to beyond 200 BC. Robotic and video assisted thoracic surgery (VATS) is an invention of the 21(st) century. We aim to quantify the effects of integration of Ayurveda and Yoga on patients undergoing minimally invasive robotic and VATS.

METHODS: Four hundred and fifty-four patients undergoing VATS and robotic thoracic surgery were introduced to a pre and postoperative protocol ofYoga therapy, mediation and oil massages. Yoga exercises included Pranayam, Anulom Vilom, and Oil Massages included Urotarpan. Preoperative and postoperative respiratory functions were recorded. Patient satisfaction questionnaire were noted. Statistical comparison was made to control group undergoing minimally invasive thoracic surgery without integrative medicine. Only one patient refused to undergo Ayurveda therapy and was deleted from the group.

RESULTS: Acceptability was high among all patients. Preoperative training led to implementation as early as 6 hours post surgery. Pulmonary function test showed significant improvement. All patients suggested an improvement in satisfaction score. Pain score were less in study patients. Quicker mobilization led to early discharge and drain removal. Chronic pain was prevented in patients having oil massages over the healed wound sites.

CONCLUSIONS: Integration of Ayurveda, Yoga and minimally invasive robotic and VATS is acceptable to Indian patients and gives better clinical results and higher patient satisfaction.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756240/

Improve Tension Headaches with Mindfulness

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MBSR stress2 Omidi

By John M. de Castro, Ph.D.

 

“Stress is a known trigger for headaches, and mindfulness is a known combatant against stress. Several studies have shown that mindfulness meditation can curb stress responses” – Mandy Oaklander

 

The most common medical ailment is headaches. They affect about 16.5% of the population of the U.S., approximately 45 million Americans each year. Over eight million seek out medical attention for headaches each year. The most common type of headache is the tension headache. It is estimated that 80 to 90 percent of the population suffer from tension headaches at least some time in their lives, about 69% of males and 88% of females. They come in two categories. Episodic headaches appear occasionally, while chronic headaches occur more than 15 times per month. Headaches are associated with personal and societal burdens of pain, disability, damaged quality of life and financial cost.

 

Tension headaches are generally treated with over the counter analgesics. Opiates, or narcotics, are rarely used because of their side effects and potential for dependency. To prevent tension headaches antidepressants or muscle relaxers are sometimes prescribed. Some individuals learn to employ a non-drug method to prevent or reduce tension headaches by learning what causes the headaches and trying to avoid those triggers. Finally, recently it has been shown that mindfulness techniques are generally helpful with coping with pain and specifically can be effective for headache relief. These include Mindfulness Based Stress Reduction (MBSR). Hence, it makes sense to further investigate the relationship of MBSR with stress reduction and tension headache relief.

 

In today’s Research News article “Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755092/

Omidi and colleagues randomly assigned tension headache sufferers to either a treatment as usual (TAU) group, treated with antidepressant medication and clinical management, or an MBSR group which received TAU plus 8-weeks of Mindfulness Based Stress Reduction. They found that the MBSR group had significantly lower headache pain and increased mindfulness, while the treatment as usual group had no significant change in either.

 

These results are impressive and demonstrate that MBSR training may be an effective treatment for tension headache when combined with treatment as usual. Because MBSR contains three primary components; body scan, meditation, and yoga, it is not possible to discern which component or which combination of components were responsible for the improvement in headache pain. It is also not possible to discern if MBSR might be effective alone without the associated treatment as usual.

 

MBSR is structured to reduce stress and has been empirically shown to significantly reduce both the physiological and psychological responses to stress. Since tension headaches are primarily produced by stress and migraine headaches are frequently triggered by stress, it would seem reasonable to conclude that the stress reduction contributed to the effectiveness of MBSR for chronic headaches. Mindfulness training, by focusing attention on the present moment has also been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing should reduce headache pain. In addition, negative emotions are associated with the onset of headaches. Mindfulness has been shown to increase positive emotions and decrease negative ones. Finally, mindfulness has been shown to change how pain is processed in the brain reducing the intensity of pain signals in the nervous system.

 

Regardless of the mechanism, it is clear that MBSR is a safe and effective treatment for tension headaches. So, improve tension headaches with mindfulness.

 

“In the pain studies, people with chronic pain such as headaches, back pain, neck pain and fibromyalgia who participated in the Mindfulness-Based Stress Reduction Clinic reported a dramatic reduction in the average level of pain during the eight-week training period and for at least four years following the treatment.” – Mindful Living

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

Omidi, A., & Zargar, F. (2015). Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 20(11), 1058–1063. http://doi.org/10.4103/1735-1995.172816

 

Abstract

Background: Programs for improving health status of patients with illness related to pain, such as headache, are often still in their infancy. Mindfulness-based stress reduction (MBSR) is a new psychotherapy that appears to be effective in treating chronic pain and stress. This study evaluated efficacy of MBSR in treatment of perceived stress and mental health of client who has tension headache.

Materials and Methods: This study is a randomized clinical trial. Sixty patients with tension type headache according to the International Headache Classification Subcommittee were randomly assigned to the Treatment As Usual (TAU) group or experimental group (MBSR). The MBSR group received eight weekly classmates with 12-min sessions. The sessions were based on MBSR protocol. The Brief Symptom Inventory (BSI) and Perceived Stress Scale (PSS) were administered in the pre- and posttreatment period and at 3 months follow-up for both the groups.

Results: The mean of total score of the BSI (global severity index; GSI) in MBSR group was 1.63 ± 0.56 before the intervention that was significantly reduced to 0.73 ± 0.46 and 0.93 ± 0.34 after the intervention and at the follow-up sessions, respectively (P < 0.001). In addition, the MBSR group showed lower scores in perceived stress in comparison with the control group at posttest evaluation. The mean of perceived stress before the intervention was 16.96 ± 2.53 and was changed to 12.7 ± 2.69 and 13.5 ± 2.33 after the intervention and at the follow-up sessions, respectively (P < 0.001). On the other hand, the mean of GSI in the TAU group was 1.77 ± 0.50 at pretest that was significantly reduced to 1.59 ± 0.52 and 1.78 ± 0.47 at posttest and follow-up, respectively (P < 0.001). Also, the mean of perceived stress in the TAU group at pretest was 15.9 ± 2.86 and that was changed to 16.13 ± 2.44 and 15.76 ± 2.22 at posttest and follow-up, respectively (P < 0.001).

Conclusion: MBSR could reduce stress and improve general mental health in patients with tension headache.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755092/

Improve Arthritis with Massage, Yoga, and Tai Chi

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By John M. de Castro, Ph.D.

 

“Osteoarthritis is a degenerative joint disease which can lead to pain and swelling of your joints. Yoga is a great complimentary practice to help overcome knee osteoarthritis relief, as you’re strengthening and loosening your joints, and improving your overall well being.” – Minakshi Welukar

 

Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. It is the leading cause of disability in the U.S., with about 43% of arthritis sufferers limited in mobility and about a third having limitations that affect their ability to perform their work. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Knee osteoarthritis is not localized to the cartilage alone but involves the whole joint, including articular cartilage, meniscus, ligament, and peri-articular muscle. It is painful and disabling. While age is a major risk factor for osteoarthritis of the knee, young people are not immune. It effects 5% of adults over 25 years of age and 12% of those over 65. Its causes are varied including, hereditary, injury including sports injuries, repetitive stress injuries, infection, or from being overweight.  There are no cures for knee osteoarthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers and anti-inflammatory drugs, corticosteroids, arthroscopic knee surgery, or even knee replacement.

 

Gentle movements of the joints with exercise appears to be helpful in the treatment of knee osteoarthritis. This suggests that alternative and complementary practices that involve gentle knee movements may be useful in for treatment. Indeed, yoga practice has been shown to be effective in treating arthritis 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 knee osteoarthritis.

 

In today’s Research News article “Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review”

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Tiffany Field reviews the literature on the application of three alternative and complementary practices, massage therapy, yoga, and tai chi, for the treatment of treating knee osteoarthritis. She reports that the literature finds fairly consistently that massage can help to relieve pain. It appears that pressure massage, involving skin displacement if more effective than light massage. She further reports that yoga practice has been routinely found to reduce pain and relieve accompanying depression and sleep problems in arthritis sufferers. Yoga practice appears to produce better results than simple light exercise. Finally, she reports that the ancient Chinese gentle slow movement practice of Tai Chi significantly decreased knee pain and improved movement characteristics including stride length, stride frequency and gait speed.

 

The results of the reviewed studies are encouraging that massage therapy, and yoga and tai chi practices are effective in treating knee osteoarthritis. Yoga and tai chi have other characteristics that recommend them. They are both safe practices with very few, if any, adverse effects and importantly, they both can be practiced conveniently and inexpensively in groups or alone at home, thus allowing their widespread affordable application to sufferers. In addition, both yoga and tai chi practices have been shown to have a large number of other physical and psychological benefits. So, they would seem to be excellent alternative and complementary practices for the treatment of knee osteoarthritis.

 

So, improve arthritis with massage, yoga, and tai chi.

 

“Research suggests that a tailored yoga practice can help reduce pain and improve function in patients with knee osteoarthritis. Potential mechanisms include strengthening, improving flexibility, and altering gait biomechanics.” – Richa Mishra

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Study Summary

Field T. Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review. Complement Ther Clin Pract. 2016 Feb;22:87-92. doi: 10.1016/j.ctcp.2016.01.001. Epub 2016 Jan 14. Review.

 

Highlights

  • Massage therapy reduces knee osteoarthritis pain in the elderly.
  • Yoga reduces knee osteoarthritis pain in the elderly.
  • Tai chi reduces knee osteoarthritis pain in the elderly.

Abstract

Background and methods: This is a review of recently published research, both empirical studies and meta-analyses, on the effects of complementary therapies including massage therapy, yoga and tai chi on pain associated with knee osteoarthritis in the elderly.

Results: The massage therapy protocols have been effective in not only reducing pain but also in increasing range of motion, specifically when moderate pressure massage was used and when both the quadriceps and hamstrings were massaged. The yoga studies typically measured pain by the WOMAC. Most of those studies showed a clinically significant reduction in pain, especially the research that focused on poses (e.g. the Iyengar studies) as opposed to those that had integrated protocols (poses, breathing and meditation exercises). The tai chi studies also assessed pain by self-report on the WOMAC and showed significant reductions in pain. The tai chi studies were difficult to compare because of their highly variable protocols in terms of the frequency and duration of treatment.

Discussion: Larger, randomized control trials are needed on each of these therapies using more standardized protocols and more objective variables in addition to the self-reported WOMAC pain scale, for example, range-of-motion and observed range-of-motion pain. In addition, treatment comparison studies should be conducted so, for example, if the lower-cost yoga and tai chi were as effective as massage therapy, they might be used in combination with or as supplemental to massage therapy. Nonetheless, these therapies are at least reducing pain in knee osteoarthritis and they do not seem to have side effects.

Mindfully Control Back Pain

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By John M. de Castro, Ph.D.

 

“MBSR is a practice that can help you “turn the volume down” on the perception of back pain by teaching you to look into the pain, and being with the experience and not resisting it so much. Looking into our emotional reactivity to it. Focusing on the present, rather than being bitter about the past or worried about the future about your back pain, helps you take ownership of the situation (i.e., accept your pain), and ultimately, find creative solutions for pain relief. It trains you to be in control of your mind, not for your mind to control you.” – Mark Neenan
Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse and addiction. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.

 

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. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable to project that mindfulness practices would be helpful in pain management. Indeed, these practices have been shown to be safe and  beneficial in pain management in general and Yoga and mindfulness has been shown to specifically improve back pain. Mindfulness Based Stress Reductions (MBSR) programs contain both yoga and mindfulness practices. So, it would seem reasonable to project that MBSR practice would improve emotion regulation and thereby be beneficial for back pain.

 

In today’s Research News article “Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients”

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or see below.

Braden and colleagues investigate the effectiveness of a 4-week program of Mindfulness Based Stress Reductions (MBSR) for the treatment of low back pain. They randomly assigned patients with chronic low back pain to either an MBSR or reading control group. They found that only the MBSR group reported a significant decrease in low back pain and the somatic-affective aspects of depression following the MBSR training. In addition, they performed functional magnetic imaging of the brains of the patients, both before and after training, during a task designed to induce emotions. They found that after MBSR training there was increased activity in response to emotions in the subgenual Anterior Cingulate Cortex and the ventrolateral Prefrontal Cortex. Both of these areas have been associated with emotion regulation processing.

 

Hence the results suggest that a 4-week MBSR training program can be effective for the relief of low back pain and the improvement in emotions. The results suggest that the improvements may have been due to changes in brain processing of emotions produced by the MBSR training. Unfortunately, at a one year follow up the reductions in pain and depression were not maintained. This suggests that an abbreviated program of 4 weeks of MBSR (the standard program is 8-weeks) may be able to improve the patients but not sufficient to produce lasting effects. It remains to be shown if the standard 8-week program can produce more lasting effects. Regardless, the findings provide support for further research into the utility of MBSR training for the treatment of chronic low back pain.

 

So, mindfully control back pain.

 

“Mindfulness soothes the circuits that amplify secondary pain and you can see this process happening in a brain scanner. In effect, mindfulness teaches you how to turn down the volume control on your pain. And as you do so, any anxiety, stress and depression that you may be feeling begins to melt away too. Your body can then relax and begin to heal.” – Danny Penman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Study Summary

Braden BB, Pipe TB, Smith R, Glaspy TK, Deatherage BR, Baxter LC. Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients. Brain Behav. 2016 Feb 16:e00443. [Epub ahead of print]

 

Abstract

INTRODUCTION: Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment.

METHODS: Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group.

RESULTS: While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one’s emotional state.

CONCLUSIONS: An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.

 

Add Spirituality to Meditation and Improve Migraines

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“Migraine is a disorder of a hyper-excitable brain, and it makes sense for people with migraine to adopt a stress-reducing . . . One behavioral intervention that may be useful, not only for migraine, but also for life in general, is what is called mindfulness meditation.” – John Wendt

 

Migraine headaches are a torment far beyond the suffering of a common headache. It is an intense throbbing pain usually unilateral, focused on only one side of the head. They last from 4 hours to 3 days. They are actually a collection of neurological symptoms. Migraines often include: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Migraines are the 8th most disabling illness in the world. They disproportionately affect women with about 18% of American women and 6% of men suffering from migraine. In the U.S. they affect roughly 40 million men, women and children. While most sufferers experience attacks once or twice a month, 14 million people or about 4% have chronic daily headaches. Migraines are very disruptive to the sufferer’s personal and work lives as most people are unable to work or function normally when experiencing a migraine.

 

There is no known cure for migraine headaches. Treatments are targeted at managing the symptoms. Prescription and over-the-counter pain relievers are frequently used. There are a number of drug and drug combinations that appear to reduce the frequency of migraine attacks. These vary in effectiveness but unfortunately can have troubling side effects and some are addictive. Behaviorally, relaxation and sleep appear to help lower the frequency of migraines. Mindfulness practices have been shown to reduce stress and improve relaxation (see http://contemplative-studies.org/wp/index.php/category/research-news/stress/). So, they may be useful in preventing migraines. Indeed, it has been shown that Mindfulness Based Stress reduction (MBSR) practice can reduce tension headache pain (see http://contemplative-studies.org/wp/index.php/2015/09/07/headaches-are-a-headache-reduce-them-with-mindfulness/).

 

Wachholtz and colleagues have previously shown that adding a spiritual dimension to meditation can increase the effectiveness of meditation for increasing pain tolerance. In today’s Research News article “Effect of Different Meditation Types on Migraine Headache Medication Use”

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Wachholtz and colleagues randomly assigned migraine sufferers to four conditions, spiritual meditation, internal secular meditation, external secular meditation, and progressive muscle relaxation. The differences between the meditation groups was solely a phrase that the participants were asked to repeat a few times at the beginning of the meditation. The phrases were for spiritual meditation, “God is peace,” “God is joy,” God is good,” and “God is love,” or alternatively substituting the words “Mother Nature” for God; internal secular meditation, “I am content,” “I am joyful,” “I am good,” “I am happy;” and for external secular meditation, “Grass is green,” “Sand is soft,” “Cotton is fluffy,” “Cloth is smooth.” Practice continued 20 minutes once a day for 30 days.

 

They found that over the 30 days of practice all groups had a decrease in the frequency of migraines and the amounts of pain medications taken, but the spiritual meditation group had a significantly greater decrease in frequency and medication use than the other three groups. None of the treatments appeared to change the severity of the migraines. Hence, adding the spiritual dimension to the meditation enhanced its effectiveness with migraines. Unfortunately, once a migraine began, nothing altered its magnitude or duration.

 

There is evidence that meditation can reduce pain (see http://contemplative-studies.org/wp/index.php/category/research-news/pain/). But, it is not known how the addition of simple spiritual phrases at the beginning of the meditation might improve its effectiveness. It is possible that the spiritual phrases were more effective than the secular phrases in focusing attention for the meditation session and thereby making it more effective. It is also possible that the phrases increased the individual’s ability to let go of struggling by turning over responsibility to a higher power. But, these are pure speculations. It will take further research to clarify the mechanism of action. But, it is clear that adding a spiritual dimension to meditation increases its effectiveness against migraine headaches.

 

So, add spirituality to meditation and improve migraines.

 

“although mindfulness is often thought of as a method of spiritual enlightenment, the underlying principles for healing are based on science. In a nutshell, mindfulness is capable of changing our brain chemistry, which impacts each and every one of our systems and organs.” – Cynthia Perkins
CMCS – Center for Mindfulness and Contemplative Studies

 

Beat Pain with Mindfulness

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“A common but unfortunate saying is that the pain is in your head….this saying implies that it’s not real, but fabricated. This is not true. However, pain is located in your head, within your brain. When you have pain, the brain is very active processing it. How your brain processes it determines the pain you experience. So yes, your pain experience is in your head, but it’s real. It can be measured, and it can be changed for the better.” – Adriaan Louw

 

Mindfulness practices including meditation have been shown to reduce perceived pain (see http://contemplative-studies.org/wp/index.php/category/research-news/pain/). The studies that examined mindfulness and pain, however, did not include any control conditions to account for the effects of a placebo or participant expectations about the efficacy of the treatment. The placebo effect is powerful and can produce outcomes that are very similar to those produced by different forms of treatment including therapy and drugs. This effect is based upon the psychological tendency of people to produce outcomes that conform to their expectations. So, if the participant believes that a treatment will make him/her better, it will, regardless of whether the particular treatment is actually effective or not.

 

The placebo effect presents a difficult issue for treatment research and most studies do not include any mechanism for assessing the expectations of the participants. Thus many reported positive results may in fact be due to the placebo effect rather than an actual effect of the treatment. So, it is possible that the reported efficacy for mindfulness training to reduce perceived pain may in fact be due to a placebo effect. Even if a treatment is actually effective, the placebo effect may be so strong that the true effect cannot be distinguished from the placebo effect. It is very difficult to separate the two.

 

A potential method for examining whether an effect is due to a treatment or a placebo is to look at the neural mechanisms underlying the two.  In today’s Research News article “Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms than Placebo and Sham Mindfulness Meditation-Induced Analgesia”

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http://jn.sfn.org/press/November-18-2015-Issue/zns04615015307.pdf

Zeidan and colleagues implement this strategy and investigate the neural systems that respond to meditation vs. placebo for pain. They actually implement three control groups, placebo conditioning, sham mindfulness meditation, and book-listening for comparison with meditation and also record functional neuroimaging for each group while responding to an experimental pain condition. The placebo condition involved telling the participant that they were being administered a pain killing cream which was in actuality an inert petroleum jelly. The sham meditation condition only instructed the participant to close their eyes and breath and meditate but without specific instructions as to how to meditate. The experimental pain procedure involved the application of a non-damaging hot probe. During the application of the probe the participants rated their pain and also had their brains scanned with functional MRI.

 

They found that only the meditation group had an increase in mindfulness and that all groups except the book-listening control group had decreased pain intensity and pain unpleasantness ratings. The meditation group, however, had the largest decrease in perceived pain and pain unpleasantness. They also found that different neural structures were activated with the pain manipulation with the different conditions. Meditation produced a greater activation in brain regions associated with the cognitive processing of pain, including the orbitofrontal, subgenual anterior cingulate, and anterior insular cortex. While the placebo produced increased activity in the dorsolateral prefrontal cortex and deactivation of sensory processing regions. Sham meditation did not produce significant neural activity, but rather greater reductions in the respiration rate.

 

These results are interesting and important. They demonstrate that meditation is more effective than either a placebo or a sham meditation in reducing perceived pain and pain unpleasantness. In addition, they demonstrate that there were different neural mechanisms involved in the effects of each on pain. The fact that they work differently in the brain indicates that meditation’s effectiveness at relieving pain is not due to a placebo or subject expectancy effect or to the conditions of meditation. Hence, meditation is an effective treatment for pain.

 

So, meditate and beat pain.

 

“Your brain plays a major role in controlling your pain. How you are feeling or what you are thinking about your pain has a direct impact on what happens to the pain signal in the spinal cord, and thus has a huge effect on how much pain you feel.”- Charles Argoff

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Headaches are a Headache – Reduce them with Mindfulness 2

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“To diminish the suffering of pain, we need to make a crucial distinction between the pain of pain, and the pain we create by our thoughts about the pain. Fear, anger, guilt, loneliness and helplessness are all mental and emotional responses that can intensify pain.” ~Howard Cutler

 

Headaches are the most common disorders of the nervous system. It has been estimated that 47% of the adult population have a headache at least once during the last year. The most common type of headache is the tension headache with 80 to 90 percent of the population suffering from tension headaches at least some time in their lives. The second most common type of headache is the migraine headache. Around 16 to 17 percent of the population complains of migraines. It is the 8th most disabling illness in the world with more than 90% of sufferers unable to work or function normally during their migraine. American employers lose more than $13 billion each year as a result of 113 million lost work days due to migraine.

 

There are a wide variety of drugs that are prescribed for chronic headache pain with varying success. Most tension headaches can be helped by taking pain relievers such as aspirin, naproxen, acetaminophen, or ibuprofen. A number of medications can help treat and prevent migraines and tension headaches, including ergotamine, blood pressure drugs such as propranolol, verapamil, antidepressants, antiseizure drugs, and muscle relaxants. Drugs, however, can have some problematic side effects particularly when used regularly and are ineffective for many sufferers. So, almost all practitioners consider lifestyle changes that help control stress and promote regular exercise to be an important part of headache treatment and prevention. Avoiding situations that trigger headaches is also vital.

 

A Mindfulness Based Stress Reduction (MBSR) program has been shown to be an effective treatment for tension headache (see http://contemplative-studies.org/wp/index.php/2015/09/07/headaches-are-a-headache-reduce-them-with-mindfulness/). Unfortunately, migraine sufferers were not included in the study. In today’s Research News article “The Effectiveness of Mindfulness-Based Stress Reduction on Perceived Pain Intensity and Quality of Life in Patients with Chronic Headache”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1144418128915445/?type=3&theater

Bakhshani and colleagues examine the effectiveness of an 8-week Mindfulness Based Stress Reduction (MBSR) program compared to a treatment as usual (primarily drugs) control group for chronic headaches including tension and migraine headaches. They found that in comparison to the control group which primarily controlled pain with drugs the MBSR group had a clinically significant reduction in pain intensity with a moderate effect size. They also found that MBSR produced a significant improvement in quality of life including role limitation due to physical health, bodily pain, general health, energy and vitality, emotional health and physical and mental health. These results indicate that MBSR is a clinically meaningful effective treatment for both tension and migraine headaches, not only reducing pain but also improving the patients’ quality of life. Importantly, MBSR effects were superior to drug treatment.

 

MBSR is structured to reduce stress and has been empirically shown to significantly reduce both the physiological and psychological responses to stress (see http://contemplative-studies.org/wp/index.php/2015/07/29/get-your-calm-on/). Since tension headaches are primarily produced by stress and migraine headaches are frequently triggered by stress, it would seem reasonable to conclude that the stress reduction contributed to the effectiveness of MBSR for chronic headaches. Mindfulness training, by focusing attention on the present moment has also been shown to reduce worry and catastrophizing (see http://contemplative-studies.org/wp/index.php/category/research-news/worry/ and http://contemplative-studies.org/wp/index.php/2015/08/07/pain-is-a-pain-relieve-it-with-meditation/). Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing should reduce headache pain. In addition, negative emotions are associated with the onset of headaches. Mindfulness has been shown to increae positive emotions and decrease negative ones (see http://contemplative-studies.org/wp/index.php/2015/08/15/spiraling-up-with-mindfulness/). Finally, mindfulness has been shown to change how pain is processed in the brain reducing the intensity of pain signals in the nervous system.

 

Regardless of the mechanism, it is clear that MBSR is a safe and effective treatment that is more effective than drugs for chronic headaches. So, reduce headache pain and improve quality of life with mindfulness.

 

“The way to live in the present is to remember that ‘This too shall pass.’ When you experience joy, remembering that ‘This too shall pass’ helps you savor the here and now. When you experience pain and sorrow, remembering that ‘This too shall pass’ reminds you that grief, like joy, is only temporary.” ~Joey Green

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Stop Being Angry, Anxious, and Depressed over Fibromyalgia with Mindfulness

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Mindfulness fibromyalgia Amutio2

“Fibromyalgia is not a cookie-cutter illness. Each of us is different and unique. There is no cure or control over this, hence each day we must continuously adapt to our disease state.” – Dear Fibromyalgia

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

Many studies have linked fibromyalgia with depression. In fact, people with fibromyalgia are up to three times more likely to be depressed at the time of their diagnosis than someone without fibromyalgia. In addition, the stress from pain and fatigue can cause anxiety and social isolation. As a result, many patients experience intense anger regarding their situation. The emotions are understandable, but can act to amplify the pain. Hence, controlling the emotions may reduce the perceived pain.

 

Mindfulness practices have been shown to be effective in reducing pain from fibromyalgia (see http://contemplative-studies.org/wp/index.php/2015/10/05/reduce-fibromyalgia-pain-with-mindfulness/). This may occur directly or indirectly by reducing emotions or both. Since mindfulness has been shown to improve emotion regulation, it would seem reasonable that this could be a route of effectiveness. In today’s Research News article “Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1135018156522109/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290530/

Amutio and colleagues investigate the effects of a 7-week, 2-hour per week mindfulness practice on the heightened emotions that accompany fibromyalgia. Results were compared to those obtained from a wait-list control group. It was found that the mindfulness training significantly reduced anger, anxiety, and depression at the end of training and these improvements were maintained three months later.

 

These are exciting results and suggest that mindfulness training is effective for the heightened emotions associated with fibromyalgia. It is unfortunate that Amutio and colleagues did not measure levels of pain. So, it is impossible to ascertain whether the emotional reductions also produced pain reductions. But, even if the mindfulness program only affects emotions, that by itself would be a significant contribution to the patients’ well-being.

 

Mindfulness has been shown to improve emotion regulation (see http://contemplative-studies.org/wp/index.php/category/research-news/emotions/) which allows the individual to experience the emotions fully but to respond to them in a constructive, productive fashion, thus taking away the amplifying effect of the emotions on pain. Mindfulness training also improves the individual’s ability to focus on the present moment and this has been shown to reduce rumination and catastrophizing (see http://contemplative-studies.org/wp/index.php/2015/08/07/pain-is-a-pain-relieve-it-with-meditation/) which can produce anxiety and depression. These would also amplify the pain. Regardless of the mechanism it is clear the mindfulness training can be beneficial in controlling the emotional sequela of fibromyalgia pain.

 

So, stop being angry, anxious, and depressed over fibromyalgia with mindfulness.

“Pain is inevitable. Suffering is optional. Say you’re running and you think, ‘Man, this hurts, I can’t take it anymore. The ‘hurt’ part is an unavoidable reality, but whether or not you can stand anymore is up to the runner himself.” ― Haruki Murakami

CMCS – Center for Mindfulness and Contemplative Studies