meditation and pain

Catherine Kerr on the Science of Meditation

Alex Knapp, Forbes: Dr. Kerr received her BA in American Studies from Amherst College and her PhD in History and Social Theory from the Johns Hopkins University, but in 2006 received a K Award from the National Institutes of Health to be retrained as a neuroscientist. Since then, her research primarily focused on the effects of meditation the brain.

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Recently, I wrote up a paper that had some interesting results regarding the mechanisms through which the practice of meditation might lead to pain relief. Namely, the results suggested that meditation can lead to changes in alpha wave behavior, which in turn may lead to the pain relief through the inhibition communication in the brain. Since that time, I’ve had a chance to communicate with Catherine Kerr, formerly the Lab Director at the Neuroscience of Meditation, Healing and Sense of Touch Lab at the Osher Research Center at Harvard, and who is now associated with Brown University. Dr. Kerr received her BA in American Studies from Amherst College and her PhD in History and Social Theory from the Johns Hopkins University, but in 2006 received a K Award from the National Institutes of Health to be retrained as a neuroscientist. Since then, her research primarily focused on the effects of meditation the brain.

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Tell me about your background. What got you interested in studying meditation?

The route that I took on the way towards my study looking at the effects of meditation training on alpha rhythms in somatosensory cortex has been circuitous.

My interest arose out of my early work on the placebo effect in chronic pain. It’s sort of a long story that has to do with a specific theoretical interest that I developed. It began in 2001 with my earliest research, in which I investigated placebo effects, working closely with Ted Kaptchuk at Harvard Medical School. I helped Ted design and implement several large cutting-edge clinical trials that investigated placebo effects (published in BMJ in 2006 and 2008).

What we learned from these studies was that healing is more likely to come about when there is a tactile or somatic “body-based” placebo (like a tactile-sham needle) administered by a warm, confident practitioner. What these placebo studies suggested to me was that there might be a common factor – something like body-based attention — that was being manipulated by confident healers in many different modalities such as acupuncture, light touch massage and other ritual treatments.

Interestingly, body based attention to touch sensations, and more generally the sense of touch, are disordered in chronic pain and IBS. And the disorder seems to be mediated by a cortical mechanism. So, what I intuited from my work on placebo was that many therapies may elicit healing by using the sense of touch, or more generally the manipulation of somatic attention in order to address a disordered somatic-attention system. One way of thinking about somatic attention is to think of it as a biasing system – in chronic pain patients, attention becomes biased towards the chronic pain percept so that the sensation intrudes on and interferes with everyday life. What acupuncture and other therapies may actually do is to help erase or undo some of these biases so that the sensation, while it might not disappear, is less intrusive and has less of an effect on daily activities.

How did you develop your brain-based approach to meditation?

Although my initial intuition about body-based attention and healing was interesting and promising, it was not framed as a scientific question at the level of brain mechanism. To reframe this idea as a testable brain science question, I was very lucky to work with an incredibly creative, brilliant brain scientist named Christopher Moore at MIT’s McGovern Institute. It turned out Chris had formed some of the same ideas, especially based on his experiences with acupuncture and light-touch massage, except that unlike me, Chris is (1) a sophisticated thinker about the brain and (2) a brilliant experimentalist who is deeply knowledgable about the somatosensory system in animals and humans.

Chris Moore, working with his colleague Steph Jones at Massachusetts General Hospital, helped me reframe my interest in the somatosensory attentional system as a problem in brain dynamics and brain rhythms: how does the brain constantly adjust its “biases” (ie, the likelihood of neurons to fire) in response to new situations? And, how might somatic-attention focused therapies help the brain respond more adaptively to new situations and shed pre-existing, maladaptive biases like those seen in chronic pain?

It turns out that alpha rhythms in the cortex may serve as a useful index for understanding how attentional biases are maintained—many studies have shown that alpha rhythms can be controlled in a precise “map-like” way by attention. That is, alpha rhythms can help to suppress or amplify sensory inputs in a specific location, for example, in your visual field when I cue you about a location where a stimulus is likely to appear.

What aspects of meditation has your research focused on and why did you choose that focus?

We chose mindfulness meditation because, it turns out that mindfulness meditation is not the same as napping or relaxing: instead, the practice actually involves a very strong attentional focus on the breath and body sensations—the cultivation of somatically focused attention is the critical factor for training the attentional system in the earty stages of practice. This is even spelled out in an early Buddhist sutra (which talks about “mindfulness of the body”) although I did not know this when we assembled our hypotheses.

In our brain experiment, we actually looked at what happens in the “body map” in the somatosensory cortex when you are asked to pay attention to your hand versus when you are asked to pay attention to your foot. We tested the effects of a specific, standardized form of mindfulness meditation called mindfulness based stress reduction. Our hypothesis was that after meditation training, meditators would have more attentional control over their brain rhythms in the brain’s map of the hand—meditators would be able to adjust their alpha rhythms more precisely depending on whether they were attending towards or away from the finger. Our hypothesis was proven correct as meditators demonstrated a higher ability to control their brain rhythms than nonmeditators and they were faster (after a cue) in exerting this control.

It’s important to mention that our study had a small sample size (given this size, it’s surprising how strong the statistical significance of the effect was), so this study should be viewed as a “proof of principle” that needs to be replicated in a larger study.

What about meditation research has surprised you the most?

Two things have surprised me and I think they are a little bit related.

First, I was surprised by my experience of the actual practice of mindfulness meditation. My experience came about because I felt that it was important, as a scientist, to actually undergo the same type of training as my subjects.

So after all of my subjects were done with the course, out of curiosity, I actually enrolled in the same 8-week standardized mindfulness course and, on a subjective level, I found it to be very transforming—this surprised me. The course involved daily sitting meditation practice, the core of which involved an attentional focus on the breath and body-related sensations for 20-30 mins per day. This attentional focus was more difficult than I thought it would be. The difficulty wasn’t so much in the beginning. Rather, it was about half way through the 8-week class, I found that the meditation practice actually brought up some charged unresolved emotions from different past experiences. What I found was that, at first these unresolved emotions were difficult but as I continued in the course, they actually became much more easy to deal with – and in general, I just felt more at ease, even in difficult or stressful situations.

But my experience was so complex: were these effects captureable through the brain imaging paradigm that I designed? Having more control over the cortical dynamics of attention should lead to having more ability to regulate cognition, including cognitions related to emotionally charged issues. But, of course, I did not directly test this question.

One reason I tell this story is to emphasize there is always going to be a gap between the subjective effects that people report experiencing during meditation and the putative objective brain mechanisms that are put forth to explain the effects. Skeptics deal with this gap by simply dismissing the subjective experience as “woo.” I understand why they do this – but I think this dismissal is actually quite unscientific since one of the things that’s so fascinating about a practice like mindfulness meditation is the fact that it seems to reliably induce these complex, transformational subjective experiences. In their exit interviews, my subjects spontaneously offered different accounts of personal transformation). Isn’t that interesting?

Of course, the flip-side of this impulse to reject subjective experience that you see in the skeptic community can be seen in meditation enthusiasts and their uncritical embrace of neuroscience—this embrace has been my second surprise.

There has been a kind of mania or madness surrounding the brain and meditation that I see most strongly in studies reporting on brain plasticity. Take the wonderful work (on which I am a coauthor), led by Sara Lazar at MGH, on structural changes in the brain that are correlated with meditative practice. This research is fascinating and very promising but it is also fraught with uncertainty.

When we see differences between experienced meditators and controls on structural MRI images we don’t actually know what is causing that difference. It could be changes in vasculature or in dendritic arborisation. And these differences matter a lot as we consider how structural changes might relate to any possible changes in how the brain processes information. For instance, since these brain changes are not correlated with any measure of function, we don’t know if the reported changes in brain structure are a good thing, since there can be pathological increases in brain structure which have been observed in some diseases!

Yet people take this idea that “meditation grows your brain” (which we never claimed in our early report and which Sara Lazar still approaches cautiously although she has published new data on this question) and run with it, to the point of absurdity—the idea that meditation might change brain structure appears to exert some kind of magnetic power (for an example of this, check out the coverage of Sara Lazar’s recent study in Gawker or a recent Huffpo piece that I flagged on Twitter). Some of the ways in which our 2005 study have been summarized point to a shocking lack of scientific literacy about brain imaging and a poor understanding of what a correlational brain study in experienced meditators can actually tell us.

Stepping back a little bit to meditation in general, it seems to attract a lot of pseudoscience to it. How much do we really know about meditation right now, and what needs to be studied?

I think my two surprises are related to one central problem: because subjective experiences like those felt in meditation practice can be very powerful, there is a strong impulse to try to capture or “bottle” these experiences in a brain image. While I think brain imaging will be and has already been very informative about these practices, it’s important to understand that (1) brain imaging cannot do away with the basic gap between subjective experience and objective measurement (2) complex subjective experiences like those felt in meditation are likely made up of a complex array of brain mechanisms that cannot be captured by the simple sets of hypotheses that can be tested in a single brain experiment.

That being said, I do think that we can draw some conclusions about how mindfulness meditation practice might affect brain processes related to attention and emotion regulation. Work by our group on attention regulation and somatosensory brain dynamics comes in addition to fine work by Amishi Jha showing that mindfulness meditation appears to exert specific effects on well-defined attentional dynamics related to basic sensory processes. Work by Philipe Goldin and coauthors suggests that mindfulness practice may exert effects on the reactivity of the amygdala to emotional challenge. And, work by Sara Lazar and others (including her subsequent study) in replication of her brave initial effort, suggest meditation causes changes in brain structure. I think the most important idea underlying all of these studies, that is now well-established is that the standardized form 8-week format of mindfulness meditation training called MBSR that we and others have studied (which is reported to reduce distress in many patient groups) involves an active process of attentional training and is not the same as relaxing or napping. Although some skeptics might wish this was not true.

What kinds of claims about meditation do you see in your work that don’t seem to be backed by science?

My experience with media coverage of my alpha meditation study has been a little different from that which I observed in coverage of the Lazar meditation-brain-structure study. The mechanism and the paradigm used to test the mechanism are both complex. While the implications of my study are far-reaching (especially the notion that meditators exert more precise attentional control over the “volume knobs” in sensory neurons in the brain) , many media outlets have had trouble understanding really basic aspects of the experiment (what we tested, who were our subjects, etc). There is not much I can do about this.

As a scientist, how do you respond to people who use your research to bolster non-scientific claims?

I don’t respond since response would involve me in endless distraction and since I know that whoever has misunderstood my study has probably been triggered by the current brain-meditation mania rather than the specific details of my own work.

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Your Brain on Meditation: Researchers study how ­meditating helps improve focus and minimize pain

Studies have shown that ­meditating regularly can help relieve chronic pain, but the neural mechanisms ­underlying the relief were unclear. Now, ­researchers from MIT, Harvard, and Massachusetts General ­Hospital have found a possible explanation.

In a recent study published in the journal Brain Research Bulletin, the researchers found that people trained to meditate over an eight-week period were better able to control a specific type of brain waves, called alpha rhythms.

“These activity patterns are thought to minimize distractions, to diminish the likelihood stimuli will grab your attention,” says Christopher Moore, PhD…

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Thinking away the pain: Meditation as cheap, self-administered morphine

Pain is a huge medical problem. According to a new report from the Institute of Medicine, chronic pain costs the U.S. more than $600 billion every year in medical bills and lost productivity. Back pain alone consumes nearly $90 billion in health-care expenses, roughly equivalent to what’s spent on cancer.

Despite the increasing prevalence of chronic pain—nearly one in three Americans suffers from it—medical progress has been slow and halting. This is an epidemic we don’t know how to treat. For the most part, doctors still rely on over-the-counter medications and opioid drugs, such as OxyContin and…

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Meditation instead of morphine — not so fast

Marissa Cevallos: Meditation appears to be a powerful way to take away pain — just a short session is more potent than even morphine, if we’re to believe the headlines — but let’s take a closer look.

In a new study published in the Journal of Neuroscience, meditation rookies reported feeling less pain after meditation training than they had felt before the training.

The novice yogis weren’t simply being polite — scans of their brains backed up their “less-hurt” claims.

The study, from Wake Forest Baptist Medical Center, echoes other research that suggests clearing your mind can reduce pain, but it’s far too early to recommend that chronic pain sufferers toss out their pain-killers.

In the study, an instructor taught 15 volunteers a technique called focused attention, in which one lets go of distracting thoughts and focuses on breathing. Subjects attended four 20-minute classes.

Before and after meditation training, the participants were subjected…

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to five minutes and 55 seconds of pain – relative pain, anyway. Researchers heated a small patch of skin on the subjects’ right legs to 120 degrees Fahrenheit, and the subjects used a 6-inch plastic sliding scale to report their level of discomfort.

After the training sessions, the volunteers reported a 40% reduction in pain intensity and a 57% drop in pain unpleasantness. Morphine typically reduces pain ratings by 25%, the researchers said.

MRI scans of the volunteers before meditation training showed a flurry of activity in a pain center of the brain, the primary somatosensory cortex, that all but disappeared after meditation training.

Now for the caveats. Every subject had some pain relief by meditating, but there was wide variability among participants — between 11% and 93%. Further, it’s difficult to draw conclusions from 15 people (18 were recruited, but one was excluded for not being sensitive enough to the heat, one was too sensitive and another fell asleep in meditation).

And the pain the researchers inflicted — a burning sensation for a few minutes — doesn’t compare to what many people, such as cancer patients, must endure.

Overall, such studies add to a growing body of research suggesting that even short meditation sessions can have measurable pain-relieving benefits. That’s important to folks who must struggle with the aches and pains of daily life and who don’t want to pop painkillers for every twinge. And for sure, daily meditation has clear medical benefits.

But meditate, for a few seconds, on the thought of undergoing even a small surgery without painkillers.

Maybe it’s too early to pass on morphine.

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Even beginners can curb pain with meditation

Adam Cole, NPR: Meditation has long been touted as a holistic approach to pain relief. And studies show that long-time meditators can tolerate quite a bit of pain.

Now researchers at Wake Forest Baptist Medical Center have found you don’t have to be a lifelong Buddhist monk to pull it off. Novices were able to tame pain after just a few training sessions.

Sounds a bit mystical, we know, but researchers using a special type of brain imaging were also able to see changes in the brain activity of newbies. Their conclusion? “A little over an hour of meditation training can dramatically reduce both the experience of pain and pain-related brain activation,” Fadel Zeidan, a neuroscientist and the study’s lead author, tells Shots. That finding’s a first, Zeidan says.

In the study, a small group of healthy medical students attended…

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four 20-minute training sessions on “mindfulness meditation” — a technique adapted from a Tibetan Buddhist form of meditation called samatha. It’s all about acknowledging and letting go of distraction.”You are trying to sustain attention in the present moment — everything is momentary so you don’t need to react,” Zeidan explains. “What that does healthwise is it reduces the stress response. The feeling of pain is a very blatant distraction.”

So how did the researchers gauge the effect? They administered a very distracting bit of pain: A small, thermal stimulator heated to 120 degrees was applied to the back of each volunteer’s right calf. The subjects reported both the intensity and unpleasantness of the pain. If pain were music, intensity would be volume. Unpleasantness would have more of an emotional component, kind of like how much you love or hate a song.

After meditation training, the subjects reported a 40 percent decrease in pain intensity and a 57 percent reduction in pain unpleasantness. And it wasn’t just their perception of pain that changed. Brain activity changed too.

Every part of the body is mapped to a specific part of the brain called the primary somatosensory cortex. “If I touch you on your left hand right above your left knuckle, there is an area in the brain that corresponds to that specific area in your hand that will be activated,” Zeidan explains. “When you are in pain it is much more activated — more intense and more widespread.”

This activation shows up on MRI brain scans. When subjects experienced the heat stimulus under normal conditions, the “right calf” part of the primary somatosensory cortex lit up. But after the subjects were trained in meditation, the activity in this region was not even detectable.

Brain images also show that meditation increased activation in areas of the brain related to cognitive control and emotion — areas where the experience of pain is built. What’s more, better meditators (those who scored higher on a standard scale of mindfulness) tended to have more activation in these areas and a lower experience of pain.

But can you achieve similar results by just approximating meditation, or believing you are in control of your pain tolerance? Zeidan says probably not. In this study, subjects who paid attention to their breathing to mimic meditation saw no significant change in pain. And, in a previous study, subjects given fake training failed to see meditation’s effects, even though they believed they were actually performing mindfulness meditation.

Zeidan says he will run some more studies to get at how meditation relieves pain. He hopes meditation can soon be applied clinically, perhaps to help patients cope with pain after surgery or chemotherapy.

“You might not need extensive training to realize pain-relief benefits,” Zeidan says. “Most people don’t have time to spend months in a monastery.”

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Meditation has the power to make dramatic changes in your physical and psychological health

Many people see meditation as an exotic form of daydreaming, or a quick fix for a stressed-out mind. My advice to them is, try it.

Meditation is difficult, at least to begin with. On my first attempt, instead of concentrating on my breathing and letting go of anything that came to mind, as instructed by my cheery Tibetan teacher, I got distracted by a string of troubled thoughts, then fell asleep. Apparently, this is normal for first-timers. Experienced meditators will assure you that it is worth persisting, however.

“Training allows us to transform the mind, to overcome destructive emotions and to dispel suffering,” says Buddhist monk Matthieu Ricard. “The numerous and profound methods that Buddhism has developed over the centuries can be used and incorporated by anyone. What is needed is enthusiasm and perseverance.”

It all sounds very rewarding, but what does science have to say on the subject?

Stories abound in the media about the transformative potential of meditative practice, but it is only in recent years empirical evidence has emerged. In the past…

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decade, researchers have used functional magnetic-resonance imaging (fMRI) to look at the brains of experienced meditators, such as Ricard, as well as beginners, and tested the effects of different meditative practices on cognition, behavior, physical and emotional health and brain plasticity.

A real scientific picture of meditation is now coming together. It suggests meditation can indeed change aspects of your psychology, temperament and physical health in dramatic ways. The studies are even starting to throw light on how meditation works.

“Time spent earnestly investigating the nature of your mind is bound to be helpful,” says Clifford Saron at the Center for Mind and Brain at the University of California, Davis. And you don’t need a Buddhist or spiritualist worldview to profit from meditation. “One can be an empiricist (in meditation), just by working with the nature of your experience.” Saron should know. He’s leading the Shamatha project, one of the most comprehensive scientific studies of meditation ever.
In 2007, Saron and a team of neuroscientists and psychologists followed 60 experienced meditators over an intensive three-month meditation retreat in the Colorado Rockies, watching for changes in their mental abilities, psychological health and physiology. Participants practiced for at least five hours a day using a method known as focused attention meditation, which involves directing attention on the tactile sensation of breathing. The first paper from the project was published in June 2010 (Psychological Science).
Headed by Katherine MacLean at Johns Hopkins University School of Medicine, Baltimore, Md., the study measured the volunteers’ attention skills by showing them a succession of vertical lines flashed up on a computer screen. They then had to indicate, by clicking a mouse, whenever there was a line shorter than the rest. As the retreat progressed, MacLean and her colleagues found that as the volunteers became progressively more accurate and increasingly easy to stay focused on the task for long periods.
Other researchers have also linked meditation with improved attention. Last year, a team led by Antoine Lutz at the Waisman Laboratory for Brain Imaging and Behavior, which is part of the University of Wisconsin-Madison, reported that after three months of training in focused attention meditation, volunteers were quicker at picking out different tones among a succession of similar ones, implying their powers of sustained concentration had improved (Journal of Neuroscience).
In 2007, Lutz’s colleague Heleen Slagter, now at the University of Amsterdam, published results from a study involving a combination of focused attention and “open monitoring” or mindfulness meditation, which involves the constant monitoring of moment-by-moment experience. After three months of meditation for between 10 and 12 hours a day her subjects showed a decreased “attentional blink,” the cognitive processing delay, usually lasting about half a second, that causes people to miss a stimulus such as a number on a screen when it follows rapidly after another (PLoS Biology).
The suggestion that meditation can improve attention is worth considering, given that focus is crucial to so much in life, from the learning and application of skills to everyday judgment and decision-making, or simply concentrating on your computer screen at work without thinking about what you will be eating for dinner. But how does dwelling on your breath for a period each day lead to such a pronounced cognitive change?
One possibility is it involves working memory, the capacity to hold in the mind information needed for short-term reasoning and comprehension. The link with meditation was established recently by Amishi Jha at the University of Miami-Coral Gables. She trained a group of American marines to focus their attention using mindfulness meditation and found that this increased their working memory (Emotion).
Feeling better
Along with enhancing cognitive performance, meditation seems to have an effect on emotional well-being. A second study from researchers with the Shamatha project concluded that meditation improves general social and emotional functioning, making study participants less anxious, and more aware of and better able to manage their emotions.
The ability to manage one’s emotions could also be key to why meditation can improve physical health. Studies have shown it to be an effective treatment for eating disorders, substance abuse, psoriasis and in particular for recurrent depression and chronic pain.
Last year, psychologist Fadel Zeidan, at Wake Forest University School of Medicine in Winston-Salem, reported that his volunteers noticed a decreased sensitivity to pain after just a few sessions of mindfulness meditation (Journal of Pain). He believes meditation doesn’t remove the sensation of pain so much as teach sufferers to control their emotional reaction to it and reduce the stress response. He is now using fMRI in an attempt to understand why that helps.
“There’s something very empowering about knowing you can alleviate some of these things yourself,” he says.
A gym for your mind
The suggestion people can become more empathic and compassionate through meditation practice has prompted psychologist Paul Ekman and Alan Wallace, a Buddhist teacher and president of the Santa Barbara Institute for Consciousness Studies, to float the idea of mental training “gymnasiums.” Like physical exercise gyms, but for the mind, these would allow people to drop in and learn to improve their emotional balance, develop their capacity for compassion and even measure their stress levels.
Others have suggested meditation could become an alternative to medication. Although this seems like a good idea, Saron is dubious. He worries thinking of meditation as a quick fix will smother some of the subtleties integral to successful practice. “When you are returning your mind to the object in hand, you have to do it with a sense of gentleness and authority, rather than develop a sense of failure when your mind wanders.”
Anyone can do it
The great thing about meditation is anyone can practice it anywhere. What’s more, you don’t have to be an expert or spend five hours a day at it to reap the benefits. The novices in Zeidan’s pain experiment reported improvements after meditating for just 20 minutes a day for three days. In a second experiment he found that similarly brief sessions can improve cognitive performance on tasks that demand continuous attention, such as remembering and reciting a series of digits (Consciousness and Cognition).
“It is possible to produce substantial changes in brain function through short-term practice of meditation,” says Richard Davidson, director of the Waisman Laboratory. He says data from a new unpublished study by his lab shows “demonstrable changes in brain function” in novice meditators after just two weeks of training for 30 minutes a day. “Even small amounts of practice can make a discernible difference.”
Tribune Media Services
How to meditate
You needn’t be an expert to reap the benefits of meditation.
There are numerous meditation styles, but the two most commonly studied by researchers are focused-attention meditation, in which the aim is to stay focused on a chosen thing such as an icon, a mantra or the breath, and mindfulness or open-monitoring meditation, where practitioners try to become aware of everything that comes into their moment-by-moment experience without reacting to it.
n For focused-attention meditation, start by sitting on a cushion or chair with your back straight and your hands in your lap and eyes closed. Then concentrate your mind on your chosen object – say your breathing, or more particularly the sensation of your breath leaving your mouth or nostrils. Try to keep it there. Probably your mind will quickly wander away, to an itch on your leg, perhaps, or to thoughts of what you will be doing later. Keep bringing it back to the breath. In time this will train the mind in three essential skills: to watch out for distractions, to “let go” of them once the mind has wandered, and to re-engage with the object of meditation. With practice, you should find it becomes increasingly easy to stay focused.
n In mindfulness meditation the aim is to monitor all the various experiences of your mind – thoughts, emotions, bodily sensations – and simply observe them, rather than trying to focus on any one of them. Instead of grasping at whatever comes to mind, which is what most of us do most of the time, the idea is to maintain a detached awareness. Those who develop this skill find it easier to manage emotions in day-to-day life.

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In pain? Try meditation

You don’t have to be a Buddhist monk to experience the health benefits of meditation. According to a new study, even a brief crash course in meditative techniques can sharply reduce a person’s sensitivity to pain.

In the study, researchers mildly burned 15 men and women in a lab on two separate occasions, before and after the volunteers attended four 20-minute meditation training sessions over the course of four days. During the second go-round, when the participants were instructed to meditate, they rated the exact same pain stimulus — a 120-degree heat on their calves — as being 57 percent less unpleasant and 40 percent less intense, on average.

“That’s pretty dramatic,” says Fadel Zeidan, Ph.D., the lead author of the study and a postdoctoral researcher at the Wake Forest University School of Medicine, in Winston-Salem, North Carolina. The reduction in pain ratings was substantially greater than those seen in similar studies involving placebo pills, hypnosis, and even morphine and other painkilling drugs, he adds.

The findings, which appear in the April 6 issue of the Journal of Neuroscience, aren’t entirely surprising. Past research has found that Buddhist-style…

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meditation — also known as mindfulness meditation — can help people cope with pain, anxiety, and a number of other physical and mental health problems. But in most cases the training takes weeks, not days.

The fact that Zeidan and his colleagues achieved these results after just 80 minutes of training is “spectacular,” says Robert Bonakdar, M.D., the director of pain management at the Scripps Center for Integrative Medicine, in San Diego.

“Although the full benefits of meditation can be realized after long-term training, our study suggests that some of the effects can be realized just for your average Joe,” Zeidan says.

The type of meditation used in the study is known as Shamatha, or “focused attention.” Like other forms of mindfulness meditation, it entails learning how to observe what’s going on in one’s mind and body without judging, and while maintaining focus on one’s breathing or a chanted mantra.

Brain scans conducted during the pain experiments showed that this technique appeared to cause a number of changes in how the participants’ brains responded to pain.

The researchers looked, for instance, at a part of the brain called the somatosensory cortex, which contains a kind of map of the body. Before meditation training, the area corresponding to the right calf was quite active when the heat was applied to the volunteers. But there was little activity in this region when they were meditating, which suggests that “meditation reduces pain by reducing the actual sensation,” Zeidan says.

Areas of the brain responsible for maintaining focus and processing emotions were also more active during meditation, and the activity was highest in the volunteers who reported the greatest reductions in pain. “There’s not just one thing happening,” Zeidan says. “Mindfulness meditation incorporates multiple mechanisms, multiple avenues for pain relief.”

The conventional wisdom has been that meditation relieves pain not by diminishing sensation but by helping people consciously control their perception of pain, says Katharine MacLean, Ph.D., a meditation researcher and postdoctoral fellow in psychology at Johns Hopkins University, in Baltimore.

However, she says, the brain scans make it clear that both processes take place: Meditation changes the nature of pain before it’s perceived and also allows people to better handle it. “Meditation is really kind of retuning your brain,” MacLean says.

An important question raised by the study is whether meditation might have the same effect on “real-life pain,” Bonakdar says. Pain — especially chronic pain — is much more complex in the real world than in a laboratory, he points out, and it can involve trauma, depression, and other physical and mental processes.

“Sometimes pain is more about suffering than it is about pain,” he says. “Sometimes that’s the hardest part of pain to treat. Maybe mindfulness meditation is just the right medicine for that problem.”

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Meditation with the Financial Times: Tim Parks

bookWhat actually is meditation? That thought occasionally crossed my mind in the many years during which I disparaged the practice. I had no idea. The cross-legged statuesqueness of it and the beatific Buddha-smile were enough to put me off. Whatever it was, it stank of prayer. Having escaped my parents’ evangelism, their exorcisms and speaking in tongues, I was more than happy to live as an adult in a world emptied of all things esoteric.

I got busy and used my head and studied and wrote. Life presented itself as a task to which I felt I was just about equal, assuming I gave it absolutely all I had. There was no time for sloppy, slithery, New Age nonsense.

Twenty books later, illness struck. Twenty books and as many years teaching and writing articles and translations, for I had changed language and moved to Italy. But now I couldn’t sit down to write. I had to stand with a laptop on a bookcase. The pains in my bladder were too fierce, the jab in the perineum, the electric shocks down the inside of the groin, a general dull awfulness down there which was an enlarged prostate, the urologist said, but then no it wasn’t that, nor stones, nor bladder cancer, nor any of the other nightmares they tested me for. Eventually the doctors gave up; I was alone, locked up in a life sentence of chronic pain without a diagnosis.

It was at this desperate point that a curious book, A Headache in the Pelvis, told me all I had to do was breathe…

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That prolonged fretfulness to achieve had atrophied my muscles deep inside and they were giving the nerves that criss-crossed them a hard time. It sounded feasible.

And I had nothing to lose.

The idea was to align the heartbeat with the breathing so that the pulse was a little faster on inhalation than exhalation. I couldn’t do it. Too spooky taking my pulse, too complicated timing my breathing. The other instruction was to empty the mind of words and focus on some tension in the body without trying to relax it. Maybe that was doable.

So, at 52, for the first time in my life, I lay still and shut my eyes for a full hour without meaning to sleep. Two discoveries I made that day are still deeply impressed on my mind.

First, I had about the same chance of stopping the babble of words in my head as of halting a river in flood.

Second, my body was a very different place from what I had imagined. I could have sworn it wasn’t tense at all. “Flex a muscle,” my book advised, “then un-flex, and focus on the afterglow”. I contracted and relaxed a thigh muscle. Suddenly, there it was: tension. And it was intensifying, expanding. The more I stayed still and focused on it the more ferocious it became. I was all ripples and throbs and weird pulses, nothing like the stuff they told you in biology lessons. At some point during my fourth or fifth attempt at this technique, the tension exploded and a great wave of relaxation broke over me. For a minute the pain was gone.

“What you’re doing is meditation,” someone said to me.

I was having none of it. Meditation was bearded loons handing you secret mantras; it was visualising bucolic scenes to achieve a better reincarnation.

“Try Vipassana,” my friend told me. “It’s just breathing and bodywork. It’s older than ancient.”

It took me about a year to accept that the exercise that was gradually curing me of my chronic pain was the same practice I had been mindlessly despising all my life. As the gate closed behind me for my first Vipassana retreat, I read the words: “Participants must not leave the grounds for the duration of their stay.”

It’s a prison and a school of pain. You take a vow of silence. You sit cross-legged nine hours a day, starting at 4.30am. For 10 days. You eat at 6.30am and 11.30am, then no more. For the first three days you do nothing but focus on the breath entering and leaving your nostrils. For the remaining seven you explore every inch of your body, observing all the sensations you come across and with just one imperative in mind: not to react either to pleasure or pain.

What do you learn in this school?

That the discomfort you feel sitting cross-legged is directly related to your mental activity which, deprived of all fresh input, reveals itself as an endless churn of self-regard, pointlessly rewriting the past, vainly scripting the future, stubbornly avoiding the present.

That the moment you truly focus on your breathing, thought subsides and everything relaxes, everything is easy.

That exploring the body with this intensity over so many days will change forever your perception of what it is and who you are.

At long last, when you do learn not to react to pain, pain itself is much diminished, even irrelevant, while pleasure is the more pleasurable when you learn not to hang on to it. The Buddhist context can be taken or left as you please. The meditation works fine without any belief.

On returning to reality after the 10 days it’s as if you are enjoying the opposite of a hangover, an extraordinary mental clarity, together with a new and strange benevolence, as though being part of the human race were not such a bad thing after all. You lose your temper less often.

Every morning since that first of a half-dozen retreats, I sit for an hour, eyes closed, in this once despised cross-legged position and simply observe whatever sensations the body throws at me. No thinking, no career narrative, just being here, breathing, the mind sinking into the flesh, the flesh becoming mind. It’s very quiet, very still, immensely calming.

Then breakfast. Kids to school. And back to work.

Tim Parks is the author of ‘Teach Us To Sit Still: A Sceptic’s Search for Health and Healing’ (Harvill Secker)

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Mindfulness therapy no help in fibromyalgia trial

A program aimed at easing stress with meditation and yoga may not be much help for people with the chronic-pain condition fibromyalgia, a recent study suggests.

The study, published in the journal Pain, looked at the effects of so-called mindfulness-based stress reduction — a technique developed by researchers at the University of Massachusetts in 1979 that combines mindfulness meditation and gentle yoga postures.

The technique is now available throughout the world — in the form of an eight-week program of classes — to help people manage general stress or health problems, including chronic pain.

For the new study, researchers led by Dr. Stefan Schmidt, of the University Medical Center in Freiburg, Germany, tested the program’s effects among 177 women with fibromyalgia.

Read the rest of this article…

They found that women assigned to the mindfulness program showed no greater gains in health-related quality of life than those assigned to a waiting list for treatment.

That meant no significant improvements in either physical symptoms or emotional well-being.

“I’m surprised it didn’t work better than it did,” Dr. Alex Zautra, a professor in psychology at Arizona State University in Tempe, told Reuters Health. Zautra, who was not involved in the study, said he would have expected better results since people with fibromyalgia would seem to be good candidates for the mind-body therapy.

Fibromyalgia is a syndrome marked by widespread pain — including discomfort at specific “tender points” in the body — along with symptoms like fatigue, irritable bowel and sleep problems. It is estimated to affect up to 5 million U.S. adults, most commonly middle-aged women.

The precise cause of fibromyalgia is unknown. There are no physical markers, like inflammation or tissue damage in the painful areas — but some researchers believe the disorder involves problems in how the brain processes pain signals.

Standard treatments include painkillers, antidepressants, cognitive-behavioral therapy and exercise therapy. However, many people with fibromyalgia find that their symptoms persist despite treatment.

One reason, some researchers suspect, may be because standard treatments do not specifically address the role psychological stress and emotions can play in triggering pain.

Studies have found that people with fibromyalgia have higher-than-average rates of stressful life events, like childhood abuse and marital problems. There’s also evidence suggesting they are less aware of their own emotions and have more difficulty holding on to positive feelings compared to people without fibromyalgia.

The idea behind mindfulness practices, Zautra said, is that people become more aware of how they are feeling, emotionally and physically, from moment to moment. Then they can start to see how their emotions affect their perceptions of their physical symptoms.

But maybe the problem, Zautra said, is that “awareness by itself is not enough for patients with fibromyalgia.”

That is, people with the disorder may need extra help in learning how to manage the emotions that come up when they meditate or practice mindfulness-based yoga.

Another recent study of the “mind-body” approach to fibromyalgia suggested that patients can benefit from addressing their emotions. In that study of 45 women with fibromyalgia, about half of those who underwent a therapy called “affective self-awareness” reported a significant improvement in their pain over six months.

Affective self-awareness — a newer therapy that is not widely available — tries to get people to “directly engage” their emotions with the help of various techniques. Mindfulness meditation and “expressive” writing are two of them.

Zautra and his colleagues are in the middle of a clinical trial testing their own mindfulness-based program against standard cognitive-behavioral therapy and general health education for people with fibromyalgia.

So the “jury is still out,” Zautra said, as to whether some fibromyalgia patients can benefit from mindfulness practices.

In the meantime, if someone with the disorder wants to try a mindfulness meditation class, “this study doesn’t tell them not to,” Zautra said.

“But don’t expect it to cure your pain,” he added. “This study raises questions about when and for whom (mindfulness techniques) may be helpful.”

The current findings are based on 177 women with fibromyalgia who were randomly assigned to one of three groups: one that went through the eight-week mindfulness-based stress reduction program; an “active” control group that received relaxation training and learned gentle stretching exercises; and a second control group where patients were put on a waiting list for treatment.

All of the women completed a standard questionnaire to rate their health-related quality of life at the beginning of the study, directly after the therapy program ended, and again two months later.

Overall, Schmidt’s team found, the entire study group showed a small improvement in quality of life over time. But there were no significant differences between the three groups.

According to Zautra, one possibility is that only certain subsets of fibromyalgia patients stand to benefit from this or other mindfulness-based therapies.

In one of his own studies, Zautra said, people with rheumatoid arthritis who also had a history of depression benefited more from mindfulness meditation than arthritis patients who had never battled depression.

It’s possible — though not proven — that the same pattern could hold true for fibromyalgia patients, he noted.

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Yoga by prescription: Doctors treat back pain with yoga

After months of agonizing back pain, Suellen Rinker was at a loss.

A surgeon suggested a range of options: painkillers, medication injected into the spine, back surgery. An MRI scan revealed a herniated spinal disk, and the pain, like a stabbing ice pick, filled her days with misery and robbed her nights of sleep.

“I was taking massive amounts of ibuprofen,” the 51-year-old Portland woman says. “I did have one of the spinal shots. It wasn’t particularly effective.”

Suspicious of surgery, Rinker decided to try a therapy her surgeon hadn’t offered but her primary care physician enthusiastically endorsed: yoga. Working one-on-one with a physical therapist yoga instructor, Rinker learned to practice three simple stretching positions along with breathing exercises and meditation. After about a month of daily practice, Rinker no longer felt crippled by back pain.

“Now I’m back to hiking. I went snowshoeing this winter,” she says.

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Her back pain isn’t gone, but she’s gained the upper hand. “I still feel it. I can usually go home, do one of these stretches and I don’t seem to have a problem.”

With clinical trials now backing up many uses of yoga as therapy, physicians and other mainstream health professionals are giving serious consideration to the 5,000-year-old practice. In the latest national survey by the magazine Yoga Journal, 6.1 percent of U.S. adults said a doctor or therapist had recommended yoga to them. It’s part of a broader acceptance of non-Western healing traditions by U.S. medical schools and health systems. Oregon Health & Science University and Providence Health & Services offer yoga in addition to standard medical care for cancer and other diseases, and both health systems employ physicians who are also yoga teachers.

“I’ve started recommending it to patients pretty regularly for a large number of issues,” says Dr. Meg Hayes, an avid yoga practitioner and an associate professor of family medicine at Oregon Health & Science University. Hayes recently co-authored a journal article reviewing results of clinical trials with yoga and offering advice to physicians interested in prescribing it.

Time, cost pose problems

In Hayes’ experience, most patients are happy to try yoga. The biggest barrier she’s found is the cost and time commitment needed to learn and practice yoga. Group classes range from $10 to $25 a session, less for a package of classes. Private instruction ranges from $50 to hundreds of dollars an hour. And health insurance generally won’t pay for yoga classes.

During office visits, Hayes routinely teaches yoga moves to patients who aren’t familiar with the ancient practice. “If they have low back pain, I might show them a half-pigeon pose,” she says. “Often if we do a little bit of that stretching they start to see right away that they feel better, that there is a move or posture that is available to them and will give them some pain relief right away.”

Unlike medical therapies aimed at fixing one problem, yoga works on many levels at the same time. “You get stronger muscles, you get more flexible joints, you get joints that are better lubricated, the spine lengthens, you breath more deeply,” Hayes says. “All of those benefits combined really help you to be strong, function better and have a sense of emotional well-being.”

In recent clinical trials, yoga improved symptoms of asthma and obstructive pulmonary disease when added to conventional care. Yoga breathing can help lower blood pressure. There’s some evidence that yoga practice during pregnancy can reduce the risk of pre-term labor and low birth weight.

Helping people cope with chronic pain that defies conventional treatment may be yoga’s most significant medical benefit.

Fibromyalgia trial

Bobbie Wethern, who’s lived with fibromyalgia for 20 years, reached a low in 2008. Physical activity became so exhausting she couldn’t climb stairs, clean house or carry laundry. “There were days I couldn’t get dressed,” says the 57-year-old. Wethern, who grew up in South Dakota, never considered yoga a good fit.

“I thought it was for really pretzel-like people,” she says. “I thought it was kind of weird.”

But a trusted therapist suggested she enroll in a clinical trial offering a yoga program tailored for people with fibromyalgia. Wethern volunteered.

Kimberly Carson and her husband James Carson, a clinical health psychologist at OHSU, eliminated some potentially stressful yoga movements and adapted standing poses so they could be performed sitting or lying down. Weekly sessions also included extensive instruction on applying yoga principles to cope with illness. The Carsons and their research colleagues published the clinical trial results earlier this year in the journal Pain.

After eight weeks, women in the yoga group showed significant improvement in measures of pain, fatigue, stiffness, sleep quality, depression, memory, anxiety and balance, while the control group showed none. Wethern cut her pain medicine doses by half. Pain interfered less with sleep. She regained enough stamina to walk five miles and to resume gardening.

“The poses are very, very important and have helped me become more flexible and have more strength, but it’s much more than that,” she says. Yoga breathing techniques help her relax rather than tense up during bouts of pain. While her pain, fatigue and other symptoms are far from cured, meditation has changed her response.

“Yoga teaches you to work through it or allow it to take place rather than resist it,” she says. “That experience was very foreign to me. It felt like years of pressure being removed from my body.

“It’s taken the power of pain away.”

-– Joe Rojas-Burke

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