rheumatoid arthritis

Mindfulness meditation may relieve chronic inflammation

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eople suffering from chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease and asthma — in which psychological stress plays a major role — may benefit from mindfulness meditation techniques, according to a study by University of Wisconsin-Madison neuroscientists with the Center for Investigating Healthy Minds at the Waisman Center.

Mindfulness-based stress reduction, originally designed for patients with chronic pain, consists of continuously focusing attention on the breath, bodily sensations and mental content while seated, walking or practicing yoga.

While interest in meditation as a means of reducing stress has grown over the years, there has been little evidence to support benefits specific to mindfulness meditation practice. This was the first study designed to control for other therapeutic mechanisms, such as supportive social interaction, expert instruction, or learning new skills.

A class in stress reduction can be beneficial in many ways, some of which have little to do with mindfulness, according to Melissa Rosenkranz, assistant scientist at the center and lead author on the paper, which was published recently in the journal Brain, Behavior and Immunity. For example, learning to manage stress by engaging in regular physical activity may be therapeutic.

“We wanted to develop an intervention that was meant to produce positive change and compare the mindfulness approach to an intervention that was structurally equivalent,” Rosenkranz says.

The study compared two methods of reducing stress: a mindfulness meditation-based approach, and a program designed to enhance health in ways unrelated to mindfulness.

The comparison group participated in the Health Enhancement Program, which consisted of nutritional education; physical activity, such as walking; balance, agility and core strengthening; and music therapy. The content of the program was meant to match aspects of the mindfulness instruction in some way. For example, physical exercise was meant to match walking meditation, without the mindfulness component. Both groups had the same amount of training, the same level of expertise in the instructors, and the same amount of home practice required by participants.

“In this setting, we could see if there were changes that we could detect that were specific to mindfulness,” Rosenkranz explains.

Using a tool called the Trier Social Stress Test to induce psychological stress, and a capsaicin cream to produce inflammation on the skin, immune and endocrine measures were collected before and after training in the two methods. While both techniques were proven effective in reducing stress, the mindfulness-based stress reduction approach was more effective at reducing stress-induced inflammation.

The results show that behavioral interventions designed to reduce emotional reactivity are beneficial to people suffering from chronic inflammatory conditions.

The study also suggests that mindfulness techniques may be more effective in relieving inflammatory symptoms than other activities that promote well-being.

Rosenkranz emphasizes that the mindfulness-based approach is not a magic bullet.

“This is not a cure-all, but our study does show that there are specific ways that mindfulness can be beneficial, and that there are specific people who may be more likely to benefit from this approach than other interventions.”

Significant portions of the population do not benefit from available pharmaceutical treatment options, for example. Some of these patients suffer from negative side effects of the drugs, or simply do not respond to the standard-of-care for treatment of the disorder.

“The mindfulness-based approach to stress reduction may offer a lower-cost alternative or complement to standard treatment, and it can be practiced easily by patients in their own homes, whenever they need,” Rosenkranz says.

Scientists at the Center for Investigating Healthy Minds conduct rigorous research on the physiological effects of meditation on the brain, and the power of the brain to influence human health. This study adds to the growing body of knowledge concerning the mechanisms of mindfulness and how it affects the body.

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Mindfulness therapy no help in fibromyalgia trial

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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.

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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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Buddha Lessons (Newsweek)

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Claudia Kalb, Newsweek International: A technique called ‘mindfulness’ teaches how to step back from pain and the worries of life.

At the age of 39, Janet Clarke discovered that she had a benign spinal tumor, which caused her unremitting back pain. Painkillers helped, but it wasn’t until she took a meditation course in Lytham that Clarke discovered a powerful weapon inside her own body: her mind. Using a practice called Mindfulness-Based Stress Reduction (MBSR), Clarke learned to acknowledge the aching, rather than fight it. “It was about getting in touch with your body, rather than your head,” she says. “Mindfulness gives you something painkillers can’t—an attitude for living your life.”

With its roots in ancient Buddhist traditions, mindfulness is now gaining ground as an antidote for everything from type-A stress to depression. At the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts, where MBSR was developed by Jon Kabat-Zinn, 15,000 people have taken an eight-week course in the practice; hundreds more have signed up at medical clinics across the United States. Now scientists are using brain imaging and blood tests to study the biological effects of meditation. The research is capturing interest at the highest levels: the Dalai Lama is so intrigued he has joined forces with the Mind & Life Institute in Boulder, Colorado, which supports research on meditation and the mind. Next month, scientists will meet with the Dalai Lama in Dharamsala, India, for a major conference on the neuroplasticity of the brain. “People used to think that this was a lot of mystical mumbo jumbo,” says psychologist Ruth Baer, of the University of Kentucky. “Now they’re saying, ‘Hey, we should start paying attention’.”

Paying attention is the very essence of mindfulness. In 45-minute meditations, participants learn to observe the whirring thoughts of the mind and the physical sensations in the body. The guiding principle is to be present moment to moment, to be aware of what’s happening, but without critique or judgment. It is not easy. Our “monkey mind,” as Buddhists call the internal chaos, keeps us swinging from past regrets to future worries, leaving little time for the here and now. First attempts may provoke frustration (“I’ll never be able to do this”), impatience (“When will this be over?”) and even banal mental sparks (“What am I going to make for dinner?”). The goal, however, is not to reach nirvana, but to observe the cacophony in a compassionate way, to accept it as transient, “like bubbles forming in a pot of water or weather patterns in the sky,” says Kabat-Zinn.

The keystone of mindfulness is daily meditation, but the practice is intended to become a way of life. At Stanford University, Philippe Goldin encourages patients battling social-anxiety disorder to take “meaningful pauses” throughout the day as a way to monitor and take charge of their fears and self-doubts. Inner control can be a potent tool in the fight against all sorts of chronic conditions. In a pilot study of 18 obese women, Jean Kristeller, director of the Center for the Study of Health, Religion and Spirituality at Indiana State University, found that mindfulness meditation, augmented with special eating meditations (slowly savoring the flavor of a piece of cheese, say), helped reduce binges from an average of four per week to one and a half.

Mindfulness takes you out of the same old patterns. You’re no longer battling your mind in the boxer’s ring—you’re watching, with interest, from the stands. The detachment doesn’t lead to passivity, but to new ways of thinking. This is especially helpful in depression, which plagues sufferers with relentless ruminations. University of Toronto psychiatry professor Zindel Segal, along with British colleagues John Teasdale at Oxford and Mark Williams at Cambridge, combines mindfulness with conventional cognitive behavioral therapy, teaching patients to observe sadness or unhappiness without judgment. In a study of patients who had recovered from a depressive episode, Segal and colleagues found that 66 percent of those who learned mindfulness remained stable (no relapse) over a year, compared with 34 percent in a control group.

The biological impact of mindfulness is the next frontier in scientific research. In a study published several years ago, Kabat-Zinn found that when patients with psoriasis listened to meditation tapes during ultraviolet-light therapy, they healed about four times faster than a control group. More recently, Kabat-Zinn and neuroscientist Richard Davidson, of the University of Wisconsin, found that after eight weeks of MBSR, a group of biotech employees showed a greater increase in activity in the left prefrontal cortex—the region of the brain associated with a happier state of mind—than colleagues who received no meditation training. Those with the greatest left-brain activation also mounted the most vigorous antibody assault against a flu vaccine.

There’s more in the pipeline. Stanford’s Goldin is taking brain images to see if mindfulness affects emotional trigger points, like the amygdala, which processes fear. And at the University of Maryland, Dr. Brian Berman is tracking inflammation levels in rheumatoid arthritis patients who study mindfulness. One of them, Dalia Isicoff, says the payoff is already clear: “I’m at peace,” she says. Mind and body, together.

With Clint Witchalls in London

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Meditation helping arthritis patients (Kansas City Star)

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Dalia Isicoff knows pain. A lifelong sufferer of rheumatoid arthritis, she has had seven hip replacement surgeries.

Since leaving the hospital in February following her latest operation, however, she hasn’t taken any painkillers. Not because the pain isn’t there — it is. But Isicoff, 52, said she has learned to accept the pain, the disease, and herself, thanks to meditation.

“When you have an illness like this, what one tends to do is say, ’Oh, my God! Here we go again, this is going to render me disabled, I’m going to wind up in a wheelchair!’ and you rush to the medicine cabinet,” she said. “This has allowed me to have the patience to deal with these flare-ups and become relaxed enough so the need for pain medication is almost not there.”

The 52-year-old Clarksville resident said meditation has made her symptoms less severe, helping relieve stress that she said made the condition worse.

“With this type of approach, you learn to acknowledge you have pain and, by realizing it and by being in this relaxed state, the pain is less,” she said.

Researchers at the University of Maryland School of Medicine in Baltimore are studying others like Isicoff to see if meditation helps sufferers of the autoimmune disorder, which affects about 2.1 million Americans, mostly women. Those with the disease often have general fatigue, soreness, stiffness and aches at first. Joints may swell and become damaged over time.

‘Mindfulness’ technique counters stress

Groups of rheumatoid arthritis patients are being trained in “mindfulness,” a form of stress reduction meditation developed 30 years ago at the University of Massachusetts. Their progress is being compared to patients not in the program.

Mindfulness is similar to many meditation techniques. Participants are taught to focus on breathing to quiet the mind and become aware of the moment.

The method has been used successfully to help patients with chronic pain from a variety of conditions, but this marks the first time it is being studied to see if it can help the physical and psychological symptoms of rheumatoid arthritis patients, said Lisa Pradhan, one of the study leaders for the University of Maryland’s Center for Integrative Medicine.

Evidence suggests flare-ups of the disease are associated with stress, she said.

Thirty-six patients took an eight-week course that started in March and will be given their third and final evaluation later this month. Participants are being sought for a second group of a similar size, which will take the course beginning later this month and be tracked for six months.

Results from the first group are not available yet, but “the people who have come through the study have been very pleased to have been involved with it,” Pradhan said.

Trish Magyari, director of the mindfulness program, said participants are taught to “quiet the mind and feel more connected to your body.”

Isicoff said she tries to meditate in the morning and at night, although mindfulness can be as simple as being aware of feeling the wind on your skin. Such a simple process, however, can be difficult to put into practice, she said.

“Most of us have this crazy internal dialogue,” she said. “For me, it was difficult to say, ’I want to relax’ and, ’I don’t want to think.’ You learn to be an observer of the thought. It’s sort of best to acknowledge it: ’Oh, there you are,’ there’s a judgment, there’s an angry thought, and the moment you acknowledge them, they go away.”

Eventually, she said she learned to be patient — with herself and the situation.

“Yes, I have the arthritis and the suffering, but it doesn’t have to be so negative, so devastating, focusing on that thing day in and day out and not knowing, not believing that it can get better,” Isicoff said.

“You learn to cultivate other areas of your life that are there, that are untapped. When someone is in that frame of mind you can handle anything, you can be more compassionate. You don’t put yourself down so much, you don’t have to struggle with yourself trying to be perfect.”

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