medicine

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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Medical matters: should doctors prescribe a course in mindfulness?

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Muiris Houston, The Irish Times: Mindfulness has become quite a buzzword of late. An ancient Buddhist practice, it is seen as being especially relevant to our modern frenetic lives. Jon Kabat- Zinn, an author and mindfulness teacher, who has played a central role in broadening the appeal and use of mindfulness, describes it as “simply the art of conscious living”.

It is a “systematic process of self-observation, self-inquiry and mindful action . . . the overall tenor of mindfulness practice is gentle, appreciative and nurturing”, he writes.

With the “coming” of mindfulness there has been an explosion of interest in its potential uses. Inevitably, the corporate world …

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Dalai Lama’s American doctor wants more compassion in medicine

wildmind meditation newsPBS Newshour: Before he was a personal physician to the Dalai Lama, Dr. Barry Kerzin never imagined that a professional trip to Tibet would lead him down a decades-long path studying Buddhism and meditation. Special correspondent Fred de Sam Lazaro talks to Kerzin in India about his feeling that compassion and empathy are essential to medical training.

Sixty-eight-year-old California native Barry Kerzin began his career as a professor of family medicine at the University of Washington. He never dreamed it would lead to a pro bono house calls thousands of miles away in Tibet.

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Mind Over Matter

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Maggie Flynn. Philly.com: Stressed out? Think it out.

Mind over matter is a difficult state to achieve, but according to a new study, meditation might provide some help in getting there.

Research from Johns Hopkins University, Baltimore, suggests that 30 minutes of daily meditation may help alleviate the symptoms of anxiety, pain and depression.

This six-month study, led by Johns Hopkins assistant professor Dr. Madhav Goyal, found that those suffering symptoms of anxiety and depression saw “a small but consistent benefit” after an eight-week week training program in mindfulness meditation.

The research found that this type of meditation, which focuses precise attention to the present moment, had a tangible effect on symptoms of anxiety and depression, especially those associated with a clinical medical condition.

Dr. Goyal explained that while the study focused on the effect of meditation, it also examined the effectiveness of the meditation on symptoms of anxiety and depression. “We compared it to what other studies have found in similar populations using antidepressants, and the effect is about the same,” he says.

The beneficial results of meditation were consistent even when the study allowed for the placebo effect, wherein patients feel better because they perceive they are getting help. However more studies will be needed to determine just how powerful the effects of meditation are for those suffering from anxiety and depression.

Goyal says that one of the benefits of using meditation for medical therapy is that there are no side effects. For people who are already on a medical regimen, this opens up the possibility of treatment – as long as they have the time to learn and the willingness to practice.

Dr. Goyal stressed the importance of having a good instructor who can teach the appropriate techniques, and cautioned that while “historically in the eastern traditions from which these programs have evolved, meditation was not seen as a therapy for health problems – it was a means to gain an insight into one’s life.”

But patients from the study’s 47 clinical trials showed consistent improvement over the course of six months. From those results, meditation presents an intriguing option for those dealing with anxiety symptoms. And it’s open to almost everyone.

“I think future studies are needed to determine which patients would respond and which might not,” Dr. Goyal says. “But for the time being, I think anyone who is interested can try it out.”

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We need to take meditation more seriously as medicine

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Jacoba Urist, Time: To be fair, I’m not sure how I would have responded had my surgeon suggested I meditate before or after surgery to ease my anxiety or post-operative pain. My guess is, like many women, I would have been skeptical: what exactly did sitting in half-lotus pose or breathing deeply have to do with the tumor in my right breast? And why was a doctor— whose job and training and every measure of success is rooted in science and clinical outcomes— prescribing a spiritual or religious method of therapy?

But a new review study, published last week in the Journal of the American Medical Association (JAMA) Internal Medicine, suggests that the ancient Eastern practice of mindful meditation can offer real help for patients with depression, anxiety, and pain. And researchers are increasingly demonstrating the measurable influence of meditation on the brain, proving that mindfulness programs can make us feel happier, have greater emotional resilience and take fewer sick days.

The problem? Many of us conflate meditation with yoga or other types of complementary medicine, overestimate the time it takes to meditate effectively, and discount the neurological evidence that mindful focus improves…

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Could an awareness of the heartbeat be a vital component of empathy?

Heart shape drawn in condensation on a window. Outside it is dark and we see out-of-focus lights in white, yellow, and red.

An awareness of the heart (the physical organ, not the metaphorical seat of emotion) and its role in empathy. Noticing the heart concerns a process called interoceptive awareness (IA), which is just a fancy term for how we monitor the body’s internal state. There’s evidence that interoceptive awareness is important for social cognition, including empathy.

Neuroscientists think we detect our own heart-beats via two routes. One is “somatosensory” — that is, we feel the movement of the heart’s beat through our sense of touch. The other route is via the vagus nerve, which runs from the brain down to the heart and beyond, and which carries electrical impulses in both directions.

The British Psychological Society reports that researchers Blas Couto and Agustin Ibanez and their colleagues, at the University of Cambridge and INECO (Instituto de Neurologia Cognitiva, in Argentina), studied a man who is awaiting a heart transplant and who has a kind of “artificial heart” to support the function of his failing left ventricle. This assistive device beats out of sync with he man’s natural heart, and when asked to tap in time with his heartbeat the man would tap in time with the device, not with his own heartbeat.

An EEG showed that brain activity associated with interoceptive awareness was reduced in the man’s brain compared with control subjects. He seemed to have lost touch with his own heart, presumably because the sensory input from the artificial heart was much stronger in comparison.

The interesting thing, though, is that this subject’s empathy was impaired in comparison with control subjects. He also had greater difficulty understanding other people’s mental states) and with decision-making. These impairments are consistent with past research showing how interoceptive awareness is important for social and emotional cognition.

Now of course a sample of one patient is not necessarily representative, but it would be an interesting practice to pay more attention to your heartbeat — both during meditation and in other activities — and to see whether this brings about any changes in your level of empathy. There’s lots of scope for subjectivity here — how exactly do we measure our own empathy — but subjective evaluations are an inherent part of meditation experience.

I’d suggest just noticing the beating of the heart, and seeing what, if anything, happens.

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Meditation reduces PTSD symptoms in nurses

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Practicing a form of meditation and stretching can help relieve symptoms of post-traumatic stress disorder and normalize stress hormone levels, according to a study of nurses.

More than 7 million adults nationwide are diagnosed with PTSD in a typical year, according to background information for the study, which is scheduled for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

PTSD patients have high levels of corticotrophin-releasing hormone and unusually low levels of cortisol, both of which regulate the body’s response to stress. Although levels of cortisol typically rise in response to pressure, PTSD patients have abnormally low levels of cortisol and benefit when these levels increase. The study found cortisol levels responded favorably in subjects who participated in mind-body exercises for an eight week-period.

“Mind-body exercise offers a low-cost approach that could be used as a complement to traditional psychotherapy or drug treatments,” the study’s lead author, Sang H. Kim, PhD, of the National Institutes of Health, said in a news release. “These self-directed practices give PTSD patients control over their own treatment and have few side effects.”

The randomized controlled clinical trial studied the impact of mind-body practices in nurses, a group the authors noted is at high-risk of developing PTSD due to repeated exposure to extreme stressors. A study cohort of 28 nurses from the University of New Mexico Hospital, including 22 experiencing PTSD symptoms, was divided into two groups. One group took 60-minute mindfulness sessions twice a week in which participants performed stretching, balancing and deep breathing exercises while focusing on awareness of their body’s movements, sensations and surroundings.

The predominantly female participants underwent blood tests to measure their stress hormone levels and completed the government’s PTSD checklist for civilians. Among those who were enrolled in the mind-body course, cortisol levels in the blood rose 67% and PTSD checklist scores decreased by 41%, indicating the individuals were displaying fewer PTSD symptoms. In comparison, the control group had a nearly 4% decline in checklist scores and a 17% increase in blood cortisol levels during the same period.

“Participants in the mind-body intervention reported that not only did the mind-body exercises reduce the impact of stress on their daily lives, but they also slept better, felt calmer and were motivated to resume hobbies and other enjoyable activities they had dropped,” Kim said. “This is a promising PTSD intervention worthy of further study to determine its long-term effects.”

The article — “PTSD Symptom Reduction with Mindfulness-Based Stretching and Deep Breathing Exercise: Randomized Controlled Clinical Trial of Efficacy” — will appear in the July issue of JCEM.

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Meditation gets thumbs-up for pain, more muted support for stress

Melissa Healy, Los Angeles Times: Meditation this week won the scientific stamp of approval from a federal panel as a means of reducing the severity of chronic and acute pain. The influential committee also concluded the practice of mindfulness has demonstrated effectiveness in reducing stress and anxiety, but it found the scientific evidence for that claim weaker and more inconsistent.

As a therapy to promote positive feelings, induce weight loss and improve attention and sleep, the Agency for Healthcare Research and Quality was less impressed with meditation. The group concluded there is currently an insufficient body of scientific evidence to conclude meditation is …

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Meditation helps doctors deal with the emotional flood

The woman was terminally ill with advanced cancer, and the oncologist who had been treating her for three years thought the next step might be to deliver chemotherapy directly to her brain. It was a risky treatment that he knew would not, could not, help her.

When Dr. Diane Meier asked what he thought the futile therapy would accomplish, the oncologist replied, “I don’t want Judy to think I’m abandoning her.”

In a recent interview, Meier said, “Most physicians have no other strategies, no other arrows in their quiver beyond administering tests and treatments.”

“To avoid feeling that they’ve abandoned their patients, doctors …

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Meditation, memory loss, Alzheimer’s and aging

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Gordon Richman, WASHINGTON, November 12, 2012 – Alzheimer’s is devastating and terrifying. Our grandparents are fighting it now, our parents preparing to fight it, and we know that we’re next. A recent bittersweet  NPR piece explained that in order for most currently-conceived Alzheimer’s drugs to work effectively, patients would have to start treatment early— up to 20 years early.

Most of us, as much as we fear Alzheimer’s, don’t want to take a cocktail of drugs for something that may or may not happen in 20 years. Although there are brilliant scientists and physicians working on helping people with Alzheimer’s (and those who might suffer from it in the future), most of this is theoretical. Fortunately, there are some fairly innocuous, easy and relatively inexpensive things older and middle aged people can do to fight memory loss. One of those things is the opposite of a modern miracle drug—it’s a health practice that’s over 5000 years old. That practice is meditation.

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Age

Earlier this year, the Thomas Jefferson University Hospital released a very interesting study. According to Medical News Today, the study showed that meditation can indeed help with memory loss. 15 older adults meditated for 12 minutes a day for 8 weeks, and the results were remarkable. Blood flow increased in key areas of the brain, and cognitive function improved as well. They were less depressed, less stressed and less confused. They were holding on to their memories.

Older people often become depressed and detached as their lives change, and as the world changes around them. Modern Western society is moving in unexpected directions, and it’s doing so at an alarming rate— a rate that some seniors have a hard time keeping up with. All of that stress, confusion and depression can add up to apathy and despair, which can lead to lack of mental engagement and activity. That engagement deficiency is unhealthy for several reasons, but it can also contribute to Alzheimer’s. Meditation is all about nurturing your mind and moving you away from negativity. It makes sense, then, that meditation can fight against Alzheimer’s and improve overall health.

In a Huffington Post piece from last year, Dr. Dharma Singh Khalsa put it succinctly, “…  This cutting-edge [neuroscience] research showed that stress, through the release in the body of a hormone called cortisol, could kill brain cells by the millions and lead to memory loss similar to Alzheimer’s disease. For me, this was an epiphany. I remember thinking that, if stress could cause memory loss, then why couldn’t anti-stress techniques, such as meditation, stop it from happening?”

Health

Some people, young, old or middle aged, refuse to try meditation. They think it’s a “new age” practice left to those who wear strange clothing and hold séances with their dogs. Meditation is actually good for just about everyone— it can help with stress, depression, anxiety, blood pressure and cholesterol. It’s free, it feels good and it doesn’t take much time out of the day. Those are huge selling points, especially for the suspicious. The biggest struggle in using meditation as a treatment for current and future Alzheimer’s patients might be getting them to actually try it. What sounds better, though—years of expensive pills or years of quiet, relaxed mindfulness?

If Dr. Khalsa and the Thomas Jefferson University Hospital are correct, it might only take minutes out of our day to fight a debilitating condition. The key, then, to utilizing meditation in the fight against memory loss is in building a daily routine.

Routine

The secret to successful meditation is to include it in a daily routine. Similarly, the key to successfully engaging your mind also lies in the realm of consistency. Older people, especially those who are retired, should have no problem adding meditation to their daily lives. Meditation, coupled with some regular social interaction, light exercise and other inexpensive, non-invasive techniques (such as Music for Memory are a gentle way to curb and reverse memory loss. They’re pleasant, productive and healthy—and they also don’t rely on expensive medications.

For middle aged people, finding a routine might be more difficult at first. The trick is finding about 15 minutes of uninterrupted time, preferably first thing in the morning, to sit down to meditate. There are many different meditation techniques available to suit any number of different personalities and preferences. The important thing is that it’s done daily.

Know that meditation is not for other people—it will work for you, and it can help you, especially if you’re worried about memory loss. It also doesn’t ask for anything in return. It’s there when you need it, and it will be ready when you are.

There will continue to be scientific breakthroughs in the realm of Alzheimer’s studies, but one surefire method has already been proven. Meditation might not be an instant cure-all, but it does help and it doesn’t pose any harmful side effects. Alzheimer’s is devastating, but it’s comforting to know that meditation works and that we don’t yet understand its full potential.

The Jefferson Myrna Brind Center of Integrative Medicine’s Dr. Andrew Newberg is extremely hopeful. Speaking with Medical News Today, he said, “This study is one of a growing body of neuroimaging studies to illustrate the neurological and biological impact of meditation, highlighting brain regions that regulate attention control, emotional states, and memory. It is a first step in understanding the neurophysiologic impact of this and similar meditative practices.”

We can take the first step anytime we’re ready.

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