Mindfulness, Meditation and Pain
“If you get the inside right, the outside will fall into place. Primary reality is within; secondary reality without.”
Eckhart Tolle, The Power of Now: A Guide to Spiritual Enlightenment
Within many traditional clinical practices, mindfulness-based or meditation-based exercises are considered alternative, eastern, touchy-feely or even "voo-doo." It is often seen as a complementary treatment that may be helpful...but really isn't going to "treat" the client. I've had many clinicians I respect significantly tell me that they don't use guided meditation within their practice for this exact reason. Respectfully, I have to disagree with that sentiment. I recommend mindfulness-based relaxation or guided meditation to my patients on almost a daily basis, and I believe strongly that there are so many benefits in this practice for a person struggling with persistent pain.
Pain Neuroscience
To understand why meditation is helpful in overcoming persistent pain, it is crucial to understand what pain is, and to truly grasp the role of the brain in pain (Summary: No brain, no pain). If you are new to this blog, or new to pain science in general, you have a few prerequisites before you move forward:
"The Pain Illusion" from Body in Mind (as well as literally every other blog post and article on this site...I'm not kidding, if you've never heard of them, take a few minutes...err..hours...days.. and go read their stuff. They're super super smart.)
"Neuroception and the Hierarchy of Needs" as well as "Awareness as an Agent of Change" by my friend/colleague, Seth Oberst (He guest-blogged for us a few weeks ago, here!)
Ok, I could go on and on...but I won't. So, we'll move on.
What is Meditation/Mindfulness Training?
Mindfulness is described here as a "non-elaborative, non-judgmental awareness of present moment experience." There are a few different types of mindfulness based meditation practices, usually broken into:
Focused Attention: This involves focusing attention on a specific object or sensation (i.e. focusing on breath moving, or focusing on a certain space). If attention is shifted to someone else, the person is then taught to acknowledge it, disengage, and shift the attention back to the object of meditation.
Open Monitoring: This is a non-directed practice of acknowledging any event that occurs in the mind without evaluation or interpretation
Variations: There are multiple variations of these practices, usually trending toward one variety or the other. For example, there are guided relaxation exercises which will shift the focus from one body part to another, meditation exercises based on focusing on a color moving through the body, etc.
Meditation and the Brain
The cool thing is meditation has been found to have some pretty profound effects on the brain. This meta-analysis of fMRI studies aimed to determine how meditation influenced neural activity, and the results were pretty interesting. They found that brain areas from the occipital to frontal lobes were more activated during meditation, specifically areas involved in processing:
self-relevant information (ie. precuneus)
self-regulation, problem-solving, and adaptive behavior (ie. anterior cingulate cortex)
interoception and monitoring internal body states (ie. insula)
reorienting attention (ie. angular gyrus)
"experiential enactive self" (ie. premotor cortex and superior frontal gyrus)
Basically, the authors state that all of these areas are characterized by "full attention to internal and external experiences as they occur in the present moment."
For more information on how meditation impacts the brain, check out this great TEDx talk by Catherine Kerr.
Persistent Pain Implications
Now, you may be thinking, why does that matter for a person experiencing persistent pain? Well, it matters because for most people, pain does not solely exist in the present, but rather, is an experience influenced by a complex neural network, integrating:
1) what you know about the pain
2) how dangerous you feel it is
3) your history relating to that pain
4) your fears/concerns/worries about the future
5) how this problem relates to your family, job, relationships, home, etc. and
6) so so much more. (Including everything helpful and unhelpful your health care providers have told you about your pain.)
Here's an example. Let's say you start having some back pain one day after bending over to pick up something off the floor. Happens right? But, what if you used to have back pain years ago and had an MRI that showed degenerative changes in your spine? And what if you have a two year old you have to carry around frequently? What if work has been difficult recently and you're worried your job is in jeopardy? What if you had a physical therapist tell you that you should never bend down like that or you would "hurt your back?" The amazing thing is that all of these experiences, histories, thoughts, emotions are seamlessly integrated by your brain to determine the immediate "threat level" of your low back, and create an overall pain experience (ultimately, designed to be helpful and protect you against harm). This story is a real one, and actually happened to a patient of mine...by the time she came into my office, she couldn't bend forward at all, had severe pain, and was very worried about the level of "damage" in her low back. But, the truth was, she had really just moved in a way that her body chose to guard, and nothing was really "damaged" at all. After a quick treatment session, she was back to full motion without any pain. Now, am I magical in "fixing" backs like that? Yes. But that's besides the point. But really, all I did was remove the threat level by taking her back to the present moment (ie. Your back is not damaged. Bending is totally fine and functional to do. This is going to get better really soon.) and restore movement to a system that was guarding against it.
So, what does this have to do with meditation/mindfulness?
Well, at it's core, meditation is about changing awareness and improving focus to the present moment. This can then change the "pain story" to decrease the threat level for the present moment, and thus help a person move toward recovery.
Does it work?
The best part is that it actually seems to make a significant impact (although, of course, we need better larger studies!) Of course, it is just one piece of the puzzle--but I really believe it can be an important component of a comprehensive program to help someone experiencing persistent pain. And, the research actually is trending toward it being beneficial too. In fact, meditation and mindfulness-based stress reduction has been shown to be helpful in reducing pain and improving quality of life in men and women experiencing chronic headaches, chronic low back pain, and non-specific chronic pain. There have not been many studies looking specifically at chronic pelvic pain, but there was one pilot study I found, and it also seemed to show favorable results in improving quality of life. Will it take you 10 years of channeling your inner guru to see the benefits? Actually, the research seems to indicate that changes happen pretty quickly. This study actually found improvements after just four sessions.
Getting Started
If you are experiencing persistent pain, or are a human who happens to have a brain, you would likely benefit from using meditation as part of your daily exercise program (Yes, I consider meditation exercise!) There are so many fabulous resources out there to get started in practicing mindfulness/meditation. Here are a few of my favorites.
Books that are helpful in understanding meditation:
The Power of Now, by Eckhart Tolle
Peace is Every Step, by Ticht Naht Han
Free Guided Meditation Exercises ONLINE/APPS
Note, I find different people tend to enjoy different guided meditations/programs. Try a few different ones here, or even go on to youtube and do a little search. You may find some you love and some you hate, and that really is ok. Try to find what works best for you!
Relax Lite with Andrew Johnson
available free on itunes and as an app!
Breathe to Relax
available free on itunes and as an app!
Headspace
available free on itunes and as an app!
Insight Timer
available free on itunes and as an app!
Sattva Meditation Tracker & Timer
available free on itunes and as an app!
Yoga for Pelvic Pain
by Dustienne Miller, PT, available free on her website.
Tara Brach
Great resources with meditations, lectures, and more!
I hope this is helpful for you! What other resources do you enjoy for relaxation/mindfulness/meditation? Let us know!
Wishing you a very merry Christmas and a happy new year!!
~Jessica