Most if not all of us have suffered with chronic pain either in the past or now. The definition of “chronic” varies for each of us, perhaps as a reflection of what psychological impact the pain has had on us as individuals.
For some people, chronic pain may mean a headache that lasted for a week. For others, chronic pain may mean the relentless central nervous system wind-up as a result of permanent rheumatoid arthritis in multiple joints. Neither is more correct than the other, and it’s not a competition.
The effect of mindfulness in the management of chronic pain has been debated for decades. It has been difficult to measure people’s degree of mindfulness especially when not in a meditative state.
What we can measure, however, is the activity in the different areas of the brain responsible for cognition, emotion, reasoning, etc. and how they respond to a known painful stimulus.
The brains of meditators respond differently to pain
Grant and Rainville (2011) used functional and structural MRI to ascertain the brain mechanisms involved in mindfulness-related pain reduction. They found that during pain, meditators (albeit in a non-meditative state while being studied) had increased activation in areas associated with processing the actual sensory experience of pain (including primary and secondary somatosensory areas, insula, thalamus and mid-cingulate cortex). They also found decreased activity in regions involved in emotion, memory and appraisal (including medial pre-frontal cortex (mPFC), orbital frontal cortex (OFC), amygdala, caudate and hippocampus).
Grant and Rainville … found that during pain, meditators (albeit in a non-meditative state while being studied) had increased activation in areas associated with processing the actual sensory experience of pain
Activation of a different neural pathway than a placebo
Zeidan et al. (2015) found mostly consistent results and went a step further and accomplished the feat of proving that mindfulness meditation has a different neural pathway, and reduces pain intensity above and beyond, when compared to a placebo. In this study, mindfulness meditation was associated with decreased activity in the thalamus relative to other comparison groups. This possibly reflects the inability of sensory information to reach areas of the brain associated with thinking and evaluation.
Mindfulness or opioids? Both
In previous articles we have explained mindfulness-based stress reduction (MBSR). Very briefly, this practice uses mindfulness to perceive pain from a non-judgemental perspective. So, it doesn’t claim to reduce pain, but rather to reduce the suffering experienced as a result of intractable pain.
In 1985, Jon Kabat-Zinn studied 90 chronic pain patients who were trained in mindfulness meditation (Kabat-Zinn et al., 1985). The results of the study indicated statistically significant reductions in measures of present-moment pain, negative body image, inhibition of activity by pain, mood disturbance and psychological symptoms such as anxiety and depression. Also, opioid self-medication doses were voluntarily reduced among the group.
In brief, mindfulness trains us in the ability to put a space between the objective sensory elements of the pain and the more subjective judgement that we have of the pain
The mechanisms behind how mindfulness meditation works to reduce the suffering caused by pain aren’t mysterious or magic. In brief, mindfulness trains us in the ability to put a space between the objective sensory elements of the pain and the more subjective judgement that we have of the pain.
If you have a pain, any pain – it can be a mild ache or permanent migraine – try for a moment to list all the feelings you have regarding that discomfort. Write them down. Then see if you can divide them into two lists: one for the physical elements of the pain, the other for the psychological and emotional feelings which the pain has caused (eg frustration, yearning for it to go away, striving to find a solution).
Which list is longer?
Most people find that the psychological list has many more elements to it, which is great news, really. This is because we can do something to reduce the impact that the feelings in this list have on our quality of life.
If you have a pain … try for a moment to list all the feelings you have regarding that discomfort. Write them down. Then see if you can divide them into two lists: one for the physical elements of the pain, the other for the psychological and emotional feelings which the pain has caused
Pain is a complex phenomenon, perhaps due to it being a subjective and multidimensional experience with sensory and cognitive elements. When we first experience pain, we usually jump to the instant judgement of it being “bad” and something which must be extinguished. As vets, we are masters of analgesia with an enviable array of drugs in our personal pharmacies. Most of our physically painful experiences are short-lived as a result.
So, when the long-term pain arrives with its resistance to our drugs, its obstinacy and its persistence, the actual sensations are compounded by the frustrations it causes. How dare this pain escape my cures? We may be angry, yearning for it to stop, exhausted by trying to diagnose and cure it.
Ironically, the psychological pain enhances the suffering and distress caused by the original stimulus (the pain) and we try to escape it all with excessive use of alcohol, opioids, double dose NSAIDs, anything: only to be left beaten by the monster we have created out of the pain we judged.
Mindfulness meditation can be used as a tool to create more awareness of the sensation of pain itself, without judgement or resistance. It sounds counterproductive.
Jon Kabat-Zinn defines mindfulness as paying attention, on purpose, to the present moment non-judgementally. By paying attention to the site of our pain with full focus on the physical sensations and deciding that we do not have to judge them as bad, good, anything, it’s a start.
Then, allowing yourself to notice the emotional sensations it gives rise to, one at a time, focusing on each emotion for as long as is possible, you can distinguish between the physical sensations and the psychological sensations a bit better. As we discussed before, often just noticing an emotion, looking it in the eyes for as long as you possibly can, giving it a name and then allowing it to pass by, defuses its hold on you.
Thus, we can belittle this monster. Notice we aren’t trying to stop the pain; we are merely managing our reactions to it.
Allowing yourself to notice the emotional sensations [pain] gives rise to, one at a time, focusing on each emotion for as long as is possible, you can distinguish between the physical sensations and the psychological sensations… we aren’t trying to stop the pain; we are merely managing our reactions to it
When we become more aware of what we are actually experiencing, without the overlay of our judgement, the overall perception of pain is reduced. Ironically, accepting the discomfort, and being quietly aware of its presence, sometimes makes the monster skulk away. Or at least be a bit less monstrous.
