chronic pain

Pain relief with mindfulness meditation

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Study findings published in the Journal of Neuroscience provide “novel evidence demonstrating that mindfulness meditation produces greater pain relief and employs distinct neural mechanisms than placebo cream and sham mindfulness meditation,” according to the authors.

Led by Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center, the study team found that mindfulness meditation—unlike other cognitive-based approaches to reduce pain, such as hypnosis, acupuncture, distraction, and even the placebo effect—does not appear to utilize the endogenous opioid system to reduce pain.

“Our finding was surprising and could be important for the millions of chronic pain sufferers who are seeking a fast-acting, non-opiate-based therapy to alleviate their pain,” said Zeidan. The finding is all the more important considering that the approximately 100 million Americans who suffer from chronic pain—according to estimates from the Institute of Medicine—spend more than $600 billion annually on treatment. The finding could also provide much-needed relief to the increasing problem of opioid addiction from prescription medications to heroin, which the CDC has labeled an epidemic.

Although mindfulness meditation had been shown in previous research to reduce pain in experimental and clinical settings, whether it engaged pain-relieving mechanisms other than those associated with the placebo effect (eg, conditioning, psychological context, beliefs) had yet to be defined.

To determine if the analgesic mechanisms of mindfulness meditation are different from placebo or use the body’s opioids, the researchers injected participants with naloxone to block the pain-reducing effects of opioids and then randomly assigned 75 healthy volunteers to 4 days (20 minutes per day) of the following:

  • Mindfulness meditation plus naloxone
  • Non-meditation control plus naloxone
  • Meditation plus saline placebo
  • Non-meditation control plus saline placebo

The study teamed used a thermal probe to heat a small area of participants’ skin to 120.2 degrees, a heat most people find very painful. Participants rated their pain on a sliding scale. Patients in the meditation plus naloxone group experienced a 24% reduction from baseline in pain ratings.

According to Zeidan, this finding shows that even when opioid receptors are chemically blocked, meditation appears to be able to significantly reduce pain by using a different pathway. The mediation plus placebo-saline injection group also experienced a reduction in paint ratings, down 21% from baseline. However, participants in both non-meditation control groups—either with naloxone or placebo-saline injection—actually reported increases in pain.

“Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain,” said Zeidan. “And now this study shows that meditation doesn’t work through the body’s opioid system. This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain. These findings are especially significant to those who have built up a tolerance to opiate-based drugs and are looking for a non-addictive way to reduce their pain.”

In a follow-up study, the investigators hope to determine if and how mindfulness meditation can affect a number of various chronic pain conditions.

“At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without it producing the addictive side effects and other consequences that may arise from opiate drugs,” said Zeidan.

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Mindfulness meditation improves chronic low back pain

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Thomas G. Ciccone, Practical Pain Management: Mindfulness meditation may offer the drug-free key to pain-free living for patients aged 65 and older, according to the results of new research. The study, recently published in JAMA,1 found when patients meditated for 90 minutes a week over the course of 8 weeks, their pain symptoms, including their most severe pain, decreased significantly—a robust trend that continued for up to 6 months.

“Preserving physical function with aging is critical to maintaining independence, because loss of independence is arguably one of the most feared consequences of aging,” the authors wrote.

The primary aim of the study was to determine the effectiveness of the mind-body program at increasing function and reducing pain in adults 65 years or older with chronic LBP.”

Mindfulness meditation is a relatively popular alternative form of medicine in the U.S. Some 18 million Americans tried meditation in 2012, alone.² A recent meta-analysis has found the practice can have moderate benefits for a number of symptoms, including pain, anxiety, and depression.³ However, up to this point, it appeared meditation’s pain-relieving benefits related to an analgesic effect on visceral pain, not necessarily musculoskeletal—a notion that could be challenged, now.

The Study

In the study, 282 community-dwelling adult patients (mean [SD] age, 74.5 [6.6] years), who were recruited from the metropolitan Pittsburgh area, either enrolled in a mindfulness meditation program (n=140) or an education program on healthy aging (n=142).

Patients in the meditation group convened for weekly sessions modeled on the Mindfulness-Based Stress Reduction Program (MBSR),⁴ which is designed to cultivate a better awareness of the body and mind in order to reduce stress, recognize negative cognitions, and positively influence autonomic physiological processes, including blood pressure and overall reactivity.⁵

The control group of patients instead received an education course on the “10 Keys” to Healthy Ageing, a prevention program on key health topics like hypertension management.⁶ Interestingly, one particular chair exercise introduced in the control group also was utilized in the meditation program. However, the control group’s program did not include information on pain management.

Meditation Provides Short-term Pain Benefits

Patients that practiced meditation significantly improved their current and most severe Numeric Pain Rating Scale (NRS) scores, showing additional -1.8 and -1.0 improvements over the control group, respectively. A noticeably higher percentage of patients doing meditation (56.8%) were able to achieve a 2.5-point clinically significant improvement after the 8-week course, compared to the control group (44.9%).

In fact, compared to the control group, noticeably more patients in the MBSR program were able to achieve a clinically meaningful 30% improvement both in NRS pain scores for current (54 of 132 [40.9%] vs 34 of 138 [24.6%]; P = 0.004) and most severe pain (48 of 132 [36.4%] vs 30 of 138 [21.7%]; P = 0.008). Even when evaluating patients for a more stringent 50% improvement, the meditation group also outperformed the control group for average (21 of 132 [15.9%] vs 14 of 138 [10.1%]; P = 0.16), current (43 of 132 [32.6%] vs 22 of 138 [15.9%]; P = 0.001), and most severe (21 of 132 [15.9%] vs 12 of 138 [8.7%]; P = 0.07) pain.

Caveats to Consider

However, other outcome measurements did not show robust differences between the groups, particularly at the 6-month follow-up. Pain self-efficacy, pain catastrophizing, depressive symptoms, quality of life, and even self-reported mindfulness—while any noticeable benefits for the meditation group were recorded at the 8-week mark, they were nullified after 6 months. Furthermore, significant differences in functional improvements were not sustained at 6 months, either.

This suggests the meditation, while not a game-changer in functional improvements over a longer period, may have significantly helped patients perceive improvements in their pain. Regardless of unremarkable differences in self-efficacy or catastrophizing scores, meditation patients reported more improvement in their back pain symptoms than control participants (P < .001), with a majority (80.3%) of meditation patients reporting at least minimal improvement at 8 weeks compared to the control group (37.0%).

Not only did this difference persist up to the 6-month mark, but a greater number of patients in the control group began reporting worsening symptoms, by contrast.

Limitations to Consider

The improvements in pain that mindfulness meditation appeared to offer patients was consistent with a patient-centered view of successful pain relief,⁷ something that other therapies are not able to achieve, the authors noted. The short term benefits of increased self-efficacy also can help decrease impairment, distress, pain severity for patients in pain,⁸ and while the difference in self-efficacy improvement between the study groups was not maintained at 6 months, there may be some limitations of the study to consider.

At baseline, patients already showed robust psychological profiles, with low occurrence of depressive symptoms. This could be explained by the fact the researchers excluded patients that had reported moderate to severe depressive symptoms in the past. Past studies have shown meditation to improve psychological disorders, like depression and anxiety.³

And even though the researchers excluded patients who were familiar with mindfulness meditation programs, baseline mindfulness scores for all participating subjects noticeably were strong. So despite the fact that qualitative reports showed patients experience increased mindfulness upon learning how to meditate, the quantitative scores did not reflect this. Also, participation rates were not very high for the 6 monthly booster sessions following the initial 8-week course, which may have dulled the measurements, as well.

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Mindfulness meditation trumps placebo in pain reduction

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Press release, Wake Forest Baptist Medical Center: Scientists at Wake Forest Baptist Medical Center have found new evidence that mindfulness meditation reduces pain more effectively than placebo.

This is significant because placebo-controlled trials are the recognized standard for demonstrating the efficacy of clinical and pharmacological treatments.

The research, published in the Nov. 18 issue of the Journal of Neuroscience, showed that study participants who practiced mindfulness meditation reported greater pain relief than placebo. Significantly, brain scans showed that mindfulness meditation produced very different patterns of activity than those produced by placebo to reduce pain.

“We were completely surprised by the findings,” said Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy at Wake Forest Baptist and lead investigator of the study. “While we thought that there would be some overlap in brain regions between meditation and placebo, the findings from this study provide novel and objective evidence that mindfulness meditation reduces pain in a unique fashion.”

The study used a two-pronged approach – pain ratings and brain imaging – to determine whether mindfulness meditation is merely a placebo effect. Seventy-five healthy, pain-free participants were randomly assigned to one of four groups: mindfulness meditation, placebo meditation (“sham” meditation), placebo analgesic cream (petroleum jelly) or control.

Pain was induced by using a thermal probe to heat a small area of the participants’ skin to 49 degrees Centigrade (120.2 degrees Fahrenheit), a level of heat most people find very painful. Study participants then rated pain intensity (physical sensation) and pain unpleasantness (emotional response). The participants’ brains were scanned with arterial spin labeling magnetic resonance imaging (ASL MRI) before and after their respective four-day group interventions.

The mindfulness meditation group reported that pain intensity was reduced by 27 percent and by 44 percent for the emotional aspect of pain. In contrast, the placebo cream reduced the sensation of pain by 11 percent and emotional aspect of pain by 13 percent.

“The MRI scans showed for the first time that mindfulness meditation produced patterns of brain activity that are different than those produced by the placebo cream,” Zeidan said.

Mindfulness meditation reduced pain by activating brain regions (orbitofrontal and anterior cingulate cortex) associated with the self-control of pain while the placebo cream lowered pain by reducing brain activity in pain-processing areas (secondary somatosensory cortex).

Another brain region, the thalamus, was deactivated during mindfulness meditation, but was activated during all other conditions. This brain region serves as a gateway that determines if sensory information is allowed to reach higher brain centers. By deactivating this area, mindfulness meditation may have caused signals about pain to simply fade away, Zeidan said.

Mindfulness meditation also was significantly better at reducing pain intensity and pain unpleasantness than the placebo meditation. The placebo-meditation group had relatively small decreases in pain intensity (9 percent) and pain unpleasantness (24 percent). The study findings suggest that placebo meditation may have reduced pain through a relaxation effect that was associated with slower breathing.

“This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation,” Zeidan said.

“Based on our findings, we believe that as little as four 20-minute daily sessions of mindfulness meditation could enhance pain treatment in a clinical setting. However, given that the present study examined healthy, pain-free volunteers, we cannot generalize our findings to chronic pain patients at this time.”

###

This work was supported by the National Center for Complementary and Integrative Health, R21-AT007247, F32-AT006949 and K99-AT008238; the National Institute of Neurological Disorders and Stroke, NS239426; the Mind and Life Institute Francisco J. Varela Award; and the Wake Forest Center for Integrative Medicine.

Co-authors are: Nichole M. Emerson, B.S., Suzan R. Farris, B.S., John G. McHaffie, Ph.D., and Youngkyoo Jung, Ph.D., of Wake Forest Baptist; Jenna N. Ray, Ph.D., of the University of North Carolina, Charlotte; and Robert C. Coghill, Ph.D., of Cincinnati Children’s Hospital Medical Center.

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How can mindfulness help with chronic pain?

wildmind meditation newsStephanie Weaver, Huffington Post: More than 100 million adults in the U.S. deal with chronic pain. After reading an article by Dr. Christiane Wolf, I reached out to her to learn more.

You say that chronic pain is a malfunctioning side of evolution. What do you mean by that?

This is my theory as I’ve considered chronic pain. Acute pain is important; it alerts the brain that there is danger. But for chronic pain, there is no separate system. It continually alerts the brain that there is something wrong, and yet it doesn’t stop. There is no way to calm it down.

Does mindfulness …

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Mindfulness and chronic pain: every moment is a new chance

Pain always seems worse at night. Something about the silence amplifies the suffering. Even after you’ve taken the maximum dose of painkillers, the aching soon returns with a vengeance. You want to do something, anything, to stop the pain, but whatever you try seems to fail. Moving hurts. Doing nothing hurts. Ignoring it hurts. But it’s not just the pain that hurts; your mind can start to suffer as you desperately try to find a way of escaping. Pointed and bitter questions can begin nagging at your soul: What will happen if I don’t recover? What if it gets worse? I can’t cope with this. Please, I just want it to stop. . . .

You Are Not Your Pain Vidyamala BurchWe wrote this book to help you cope with pain, illness, and stress in times such as these. It will teach you how to reduce your suffering progressively, so that you can begin living life to the fullest once again. It may not completely eliminate your suffering, but it will ensure that it no longer dominates your life. You’ll discover that it is possible to be at peace, even if illness and pain are unavoidable, and to enjoy a fulfilling life.

We know this to be true because we have both experienced terrible injuries and used an ancient form of meditation known as mindfulness to ease our suffering. The techniques in this book have been proven to work by doctors and scientists in universities around the world. Mindfulness is so effective that doctors and specialist pain clinics now refer their patients to our Breathworks center in Manchester, UK, and to courses run by our affiliated trainers around the world. Every day we help people find peace amid their suffering.

This book and the accompanying CD reveal a series of simple practices that you can incorporate into daily life to significantly reduce your pain, anguish, and stress. They are built on Mindfulness-Based Pain Management (MBPM), which has its roots in the groundbreaking work of Dr. Jon  Kabat- Zinn of the University of Massachusetts Medical Center. The MBPM program itself was developed by Vidyamala Burch (coauthor of this book) as a means of coping with the after effects of two serious accidents. Although originally designed to reduce physical pain and suffering, it has proven to be an effective stress-reduction technique as well. The core mindfulness meditation techniques have been shown in many clinical trials to be at least as effective as drugs or counseling for relieving anxiety, stress, and depression.

When it comes to pain, clinical trials show that mindfulness can be as effective as the most commonly prescribed painkillers, and some studies have shown it to be as powerful as morphine. Imaging studies show that it soothes the brain patterns underlying pain, and over time, these changes take root and alter the structure of the brain itself so that you no longer feel pain with the same intensity. And when it does arise, the pain no longer dominates your life. Many people report that their pain declines to such a degree that they barely notice it at all.

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Breathe away pain

wildmind meditation newsFerris Jabr, Psychology Today: While resisting pain only makes suffering worse, mindfulness meditation can help chronic pain sufferers.

Pain is necessary. It alerts us to threats, teaches us to avoid future risks, and makes sure we don’t forget to help ourselves heal. Our bodies have evolved instinctive reactions to pain and injury—accidentally brush your hand against a boiling kettle and your arm will retract reflexively before you even realize why. Our minds, too, respond to pain in a characteristic manner: ever notice how even a minor wound can dominate your thoughts?
But what if you could manipulate your natural response to pain in …

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Treating chronic pain with meditation

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Brian Steiner, The Atlantic: In some cases, the holistic practice could replace narcotics. Integrating meditation into regular treatment could significantly cut healthcare costs.

Sarah Kehoe tried Aleve for her back pain. She tried stretching. She tried yoga. She tried forgetting about it. She tried pain patches. She tried acupuncture. A shot of painkillers into her back. Prescription anti-inflammatory pain patches. Opiates. Surgery. Physical therapy. Heat and compresses. Ignoring it again. Steroids. More opiates. Acupuncture again. She couldn’t sit, stand up straight, lie down on her back. She was weak, had lost muscle tone. She fainted on the subway. Sarah Kehoe, an otherwise healthy …

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Mindful meditation is being used to help with a range of problems

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Sarah Matheson, Oxford Mail: Mindfulness meditation has gone viral.

With its adoption by the medical establishment, it is now considered one of the most effective treatments for a whole range of conditions from depression, anxiety and addiction to eating disorders and chronic pain.

Its success is widely documented with intriguing evidence of very particular patterns shown in the brain scans of meditators. But where did this practice originate?

Taught by the Buddha 2,600 years ago, the tradition has been kept alive in Buddhist monasteries throughout Asia. It has now spread amongst lay people throughout the world as its benefits have become increasingly widely recognised.

Mindfulness meditation is a technique for observing the mind in the present moment so that we can wake up to its true nature – this can often be a shocking revelation.

As we practise, we begin to see how we hurtle from one moment to the next in the pursuit of feeling better or seeking a refuge from pain.

We can also see how this …

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Yoga and meditation can work spinal wonders

The New Indian Express: Hospitals should house yoga and meditation centres as it gives strength to the body and mind, said T N Governor K Rosaiah at the inauguration of the Continuing Medical Education programme on Common Problems of Spine, on Sunday.

The governor further said that many medical problems can cause or contribute to back pain. He added that the causes of back pain were usually physical, and that it was important to know that emotional stress can play a role in how long the pain lasted. “Stress can affect the body in many ways, including causing back muscles to become tense and painful,” he said while addressing orthopaedicians and surgeons at the function organised by Spot Hospital as part of its ninth anniversary celebrations. He further advised that mediation will help develop a strong mind and a good physique, adding that yoga should be a part of daily routine.

Earlier, Dr R Selvaraj, President of Tamil Nadu Orthopaedic Association said during his speech that majority of spine problems were due to bad postures at work and that correcting them will solve most of them.

Dr Nalli R Uvaraj, President Elect, TNOA, Dr Ramesh Babu, Director, Spot Hospitals, were also present at the function where a book titled Care and Cure was released. Around 12 doctors were felicitated for their outstanding contribution to the field.

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Mindfulness: Week 3 – The amazing three-minute breathing space

John Alex Murphy, The Province: Week 3 has been a breakthrough week for me. When I started my eight-week mindfulness meditation course, I suspected that it would eventually help alleviate my chronic pain. However, I did not expect that help would come as soon as this, and in such a dramatic fashion.

First, a quick update on my ongoing struggle with scheduled daily meditation times. I have decided that it actually worked better for me to not have a schedule. This past week, I have been doing my daily meditations when the need arises and when time allows. It’s working fine so I will …

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