Mindfulness Is More Than Yoga

Barby Ingle, PNN Columnist

For years I’ve used mindfulness meditation techniques to help with my chronic pain. So imagine my surprise last week as I was watching the Pain Management Best Practices Inter-Agency Task Force meeting and a practitioner on the panel said yoga and mindfulness are essentially the same thing.

I’ve never done yoga as part of my mindfulness meditation. But it made me start to wonder. Have I been doing mindfulness wrong for years?

A quick Google search showed me there are more than 25 mindfulness activities. Yoga was one of the items on the list, but not everyone doing yoga is doing it for mindfulness. Most use it for physical exercise.

Another practitioner on the task force said that mindfulness is not a treatment by itself and that it is typically done in conjunction with other modalities. I totally agree. There are many group and individual activities that use mindfulness to reduce stress, anxiety, depression and pain.

Mindfulness is just one form of self-care that I use do to help manage the symptoms of living with chronic conditions. By itself, mindfulness is not enough to sustain me, but in conjunction with other treatments I find it helpful.  

woman meditating.jpg

I personally like individual mindfulness activities. Some of the activities are really short and some take up to an hour. Depending on what I need, I choose one that best suites me in the moment. Some of the activities I use for improving my life include virtual reality, self-compassion, reviewing my "I Am" list, meditation, 5 senses exercise, breathing exercises, music therapy and aroma therapy.

If you have trouble practicing mindfulness alone, one of the group activities is known as the FAKE plan, which involves about 8 members meeting for 2 hours every week for 12 weeks. The first portion of each session is devoted to a short mindfulness exercise and discussion, and each week is dedicated to a specific type of mindfulness exercise.

This is great for patients with social anxiety disorder but can also be helpful for others who want to work on their social skills through group mindfulness activities.  

Another mindfulness exercise that I found in my Google search (but have not yet tried) involves staring at a leaf for 5 minutes. A leaf is like a fingerprint or snowflake -- no two are the same. You can focus on the leaf’s colors, shape, texture and patterns. This type of activity brings you into the present and helps align your thoughts.

When I am not able to perform the physical or cognitive tasks I want to because of physical pain, I can get situational depression. For me, this is the best time to use my mindfulness activities. One study identified three ways mindfulness helps when you are depressed:

1.  Mindfulness helps people learn to be present in the moment, take stock of their thoughts and feelings, and choose an appropriate response rather than get caught up in negative emotions.

2.  Mindfulness teaches people that it’s okay to say “no” to others, which helps them balance their own lives and enhance self-confidence.

3.  Mindfulness allows people to be present with others, making them more attentive to their relationships, aware of their communication problems and more effective in relating to others.

These are important tools that can help chronic pain patients better manage their lives. Mindfulness activities help clear your mind of worry about the past or future and allow you to focus on the present.

Whether you are using mindfulness for anger, depression, chronic pain, anxiety or just for overall mental health -- it is important to keep an open mind. I know that is easier said than done when you are in severe pain. But the more you practice mindfulness the easier and more useful it becomes.

Can mindfulness cure you? No. Its purpose is to relax and help put life into perspective. If you are angry and distressed, that’s okay. I go there too sometimes. I use mindfulness to live in the moment and manage my emotions so that I am better able to manage my physical pain.

Barby Ingle.jpg

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain FoundationShe is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Why 'Mindful People' Feel Less Pain

By Pat Anson, Editor

Mindfulness meditation is a form of cognitive behavioral therapy (CBT) that is often recommended to chronic pain patients as a way to temporarily relieve their pain, anxiety and depression. 

Does it work? Pain sufferers report mixed results.

“I have tried CBT and mindfulness. They made me feel much worse emotionally, paradoxically enough, made me more acutely aware of the pain,” one reader told us.

“The quackery continues,” wrote another. “This is a modern day lobotomy experiment.”

“Mindful meditation is a wonderful tool in managing chronic pain and the depression that comes with it,” said another. “Those of us suffering daily need every tool in the shed.”

Researchers at Wake Forest University may have discovered why mindfulness works for some, but not for others. Their brains react differently to meditation.

"We now know that some people are more mindful than others, and those people seemingly feel less pain," said Fadel Zeidan, PhD, an assistant professor of neurobiology and anatomy at Wake Forest School of Medicine.

WAKE FOREST UNIVERSITY

WAKE FOREST UNIVERSITY

In a study involving 76 healthy volunteers, Zeidan and his colleagues found that a part of the brain that processes self-related thoughts, feelings and emotions is more active in people who reported higher pain levels during mindfulness meditation.

While practicing mindfulness, MRI’s were taken of the volunteers’ brains as they were exposed to painful heat stimulation (120°F).

Analysis of the MRIs revealed that those who reported lower pain levels when exposed to heat had less activity in the posterior cingulate cortex. Conversely, those that reported higher pain levels had more activity in that critical part of the brain.

"The results from our study showed that mindful individuals are seemingly less caught up in the experience of pain, which was associated with lower pain reports," said Zeidan. "Now we have some new ammunition to target this brain region in the development of effective pain therapies. Importantly this work shows that we should consider one's level of mindfulness when calculating why and how one feels less or more pain." 

The study is being published in the journal PAIN.

A previous study by Zeidan found that mindfulness activates parts of the brain associated with pain control, while it deactivated another brain region (the thalamus) that regulates sensory information. By deactivating the thalamus, meditation may cause signals about pain to simply fade away.

In addition to relieving pain, there is increasing evidence that meditation and CBT are effective in treating mental health issues, such as anxiety, depression and stress. One study, published in the British Medical Journal, found that online mindfulness courses were often just as effective as face-to-face meetings with a therapist.

You can sample a relaxing online pain management meditation at Meditainment.com (click here to see it). The initial course is free.

Can Reading Help Relieve Chronic Pain?

By Pat Anson, Editor

A good book is not only hard to put down -- it may also help relieve symptoms of chronic pain by triggering positive memories, according to a small British study.

Researchers at the University of Liverpool brought together a group of ten people with severe chronic pain once a week to read literature together aloud. The reading material included short stories, novels and poetry, and covered a wide variety of genres and topics.

While passages were read aloud in the “Shared Reading” exercise, regular pauses were taken to encourage participants to reflect on what is being read, on the thoughts or memories it stirred, and how the reading matter related to their lives.

Researchers compared the Shared Reading group to another group practicing a form of cognitive behavioral therapy (CBT).

While participants in the CBT group were encouraged to manage their emotions by focusing on the pain experience, Shared Reading encouraged pain sufferers to recall positive memories from their past before the onset of chronic pain.

"Our study indicated that shared reading could potentially be an alternative to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by chronic pain patients,” said Josie Billington, a researcher at the University’s Centre for Research into Reading, Literature and Society.

"The encouragement of greater confrontation and tolerance of emotional difficulty that Sharing Reading provides makes it valuable as a longer-term follow-up or adjunct to CBT's concentration on short-term management of emotion."

Researchers say Shared Reading has a therapeutic effect because it helps participants recall a variety of life experiences -- from work, childhood, family and relationships -- not just memories that involve chronic pain.

The study, published in the BMJ Journal for Medical Humanities, was funded by the British Academy.

While many pain sufferers are deeply skeptical of CBT, meditation and similar forms of “mindfulness” therapy, there is evidence that they work for some. A recent study found that CBT lessened pain and improved function better than standard treatments for low back pain.

Another study at Wake Forest University found that mindfulness meditation appears to activate parts of the brain associated with pain control.

Study Finds Meditation Effective for Low Back Pain

By Pat Anson, Editor

A form of meditation called mindfulness-based-stress-reduction is more effective in treating chronic low back pain than the “usual care” provided to patients, according to a new study published in JAMA. The study also found that cognitive behavioral therapy also lessened pain and improved function better than standard treatments for patients with low back pain.

Mindfulness-based stress reduction (MBSR) is a mind-body approach that focuses on increasing awareness and acceptance of moment-to-moment experiences, including physical discomfort and difficult emotions. Although MBSR is becoming more popular, few studies have been done on its effectiveness in treating low back pain.

Cognitive behavioral therapy (CBT) is a form of psychotherapy, in which a therapist works with a patient to reduce unhelpful thinking and behavior.

Researchers in Washington state enrolled 342 people in the study with chronic low back pain and divided them into three groups that received yoga, training and treatment with MSBR, CBT or usual care.

After 26 weeks, 61% of the patients in the MSBR group reported clinically meaningful improvement in function, compared to 58% in the CBT group and 44% of those who received usual care. Similar results were also found in pain relief.  

Participants in the MSBR and CBT groups also reported less depression and anxiety than the usual care group. 

The researchers said the results were “remarkable” because nearly half of the patients enrolled in the MSBR and CBT groups skipped several of the group sessions they were assigned to.

“In a time when opioid prescribing is on the decline I would think this would be exciting and welcome news for those of us who suffer severe, chronic pain,” said Fred Kaeser, who battled severe back pain for many years, and eventually found relief through a combination of meditation, exercise and changes in diet.

“Very encouraging to think that we are getting very close to being able to say that MBSR and CBT are empirically valid, pain-reducing, complimentary therapies to whatever medical care one might usually receive for the mitigation of pain.  The thought that one might also be able to reduce one's intake of pain medications and possibly other intrusive pain interventions by engaging in a therapy that is extremely safe with no side-effects is exceptionally encouraging,” Kaiser wrote in an email to Pain News Network.

“Hopefully, people who have previously dismissed the idea of mindfulness meditation or CBT as a valid pain reducing strategy will re-think their position and give these, as well as other promising complimentary pain reducing modalities, a try.”

Recent studies by researchers at Wake Forest University found that mindfulness meditation appears to activate parts of the brain associated with pain control.

Lower back pain is the world’s leading cause of disability. About 80 percent of adults experience low back pain at some point in their lives.

Study May Explain How Meditation Relieves Pain

By Pat Anson, Editor

Some pain sufferers report success using cognitive behavioral therapy and mindfulness mediation to reduce their pain. But how those techniques work is a bit of mystery and has led to speculation that they have a placebo effect on pain.

But a new study by researchers at Wake Forest University suggests that meditation really does provide pain relief – but not by utilizing the body’s natural endogenous opioid system.

“Our finding was surprising and could be important for the millions of chronic pain sufferers who are seeking a fast-acting, non-opiate-based therapy to alleviate their pain,” said Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center.

Zeidan and his colleagues enrolled 75 healthy, pain free volunteers in a study. Some were injected with naloxone, which blocks the pain reducing effects of opioids, while others were injected with a placebo saline solution.

Participants were then divided into four groups: meditation plus naloxone; no meditation plus naloxone; meditation plus placebo; or no meditation plus placebo.

Pain was induced in all four groups with a thermal probe that heated their skin to over 120 degrees Fahrenheit (49 degrees Centigrade), a level of heat that most people find very painful.

The group that meditated and was injected with naloxone had a 24 percent reduction in their pain ratings, showing that even when the body’s opioid receptors were chemically blocked, meditation still was able to significantly reduce pain. Pain ratings were also reduced by 21 percent in the meditation group that received the placebo injection.

By comparison, the two control groups that did not meditate  reported increases in pain regardless of whether they got the naloxone or placebo-saline injection.

“Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain,” said Zeidan. “And now this study shows that meditation doesn’t work through the body’s opioid system.

“This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain. These findings are especially significant to those who have built up a tolerance to opiate-based drugs and are looking for a non-addictive way to reduce their pain.”

The next step for researchers is to determine how mindfulness meditation can affect a spectrum of chronic pain conditions.

“At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without it producing the addictive side effects and other consequences that may arise from opiate drugs,” Zeidan said.

An earlier study by Zeidan found that mindfulness meditation activates parts of the brain (orbitofrontal and anterior cingulate cortex) associated with pain control, while it deactivated another brain region (the thalamus) that regulates sensory information. By deactivating the thalamus, meditation may cause signals about pain to simply fade away.

In addition to relieving pain, there is increasing evidence that mindfulness meditation is effective in treating a broad range of mental health issues, including anxiety, depression and stress. One study, published in the British Medical Journal, found that online mindfulness courses were often just as effective as face-to-face meetings with a therapist.

You can sample a relaxing online pain management meditation at Meditainment.com (click here to see it). The initial course is free.

Meditation Changes Brain Activity to Reduce Pain

By Pat Anson, Editor

Mindfulness meditation significantly reduces both physical and emotional pain, according to a new placebo controlled study that used MRI imaging to document changes in the brain that occur during meditation.

"We were completely surprised by the findings. While we thought that there would be some overlap in brain regions between meditation and placebo, the findings from this study provide novel and objective evidence that mindfulness meditation reduces pain in a unique fashion," said Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center in Winston-Salem, NC.

Zeidan and his colleagues enrolled 75 healthy volunteers in the study and used a thermal heat probe on their skin to test their reaction to pain. The probe was heated to 120 degrees Fahrenheit (49 degrees Centigrade) – a level most people find painful. Participants were then asked to rate the pain intensity (physical sensation) and pain unpleasantness (emotional response).

Those who had undergone mindfulness meditation reported their physical pain was reduced by 27 percent and the unpleasantness by 44 percent.

In contrast, volunteers who had used a placebo analgesic cream before the heat probe test said their physical pain was reduced by 11 percent and their emotional pain by 13 percent.

The participants' brains were also scanned with magnetic resonance imaging (MRI) before and after the heat probe experiment.  

"The MRI scans showed for the first time that mindfulness meditation produced patterns of brain activity that are different than those produced by the placebo cream," said Zeidan.

Mindfulness meditation activated brain regions (orbitofrontal and anterior cingulate cortex) associated with the self-control of pain; while the placebo cream lowered pain levels by reducing brain activity in pain-processing areas (secondary somatosensory cortex).

Another brain region, the thalamus, was deactivated during mindfulness meditation. The thalamus serves as a gateway that determines if sensory information is allowed to reach other parts of the brain. By deactivating this area, researchers say, mindfulness meditation may cause signals about pain to simply fade away.

Mindfulness meditation also was significantly better at reducing pain intensity and pain unpleasantness than a placebo sham meditation. The placebo-meditation group had relatively small decreases in pain intensity (9%) and pain unpleasantness (24%).

"This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation," Zeidan said. "Based on our findings, we believe that as little as four 20-minute daily sessions of mindfulness meditation could enhance pain treatment in a clinical setting. However, given that the present study examined healthy, pain-free volunteers, we cannot generalize our findings to chronic pain patients at this time."

The Wake Forest study is published in the Journal of Neuroscience,

In addition to relieving pain, there is increasing evidence that meditation and mindfulness cognitive therapy are effective in treating a broad range of mental health issues, including anxiety, depression and stress.

One study, published in the British Medical Journal, found that online mindfulness courses were often just as effective as face-to-face meetings with a therapist.

You can sample a relaxing online pain management meditation at Meditainment.com (click here to see it). The initial course is free.

Using Meditation for Chronic Pain Relief

By Pat Anson, Editor

“Imagine standing by a fountain in a beautiful garden on a warm summer day.”

The female voice is both soothing and alluring, as she invites you into a garden and guides you toward a hammock.

"It is peaceful and safe. And no one expects anything from you here,” she says. “Here you can escape from the troubles of daily life.”

The birds are chirping. The fountain is gurgling. You close your eyes and relax.

And your pain disappears.

That’s the goal of a meditation program created by Wellmind Media, a UK company that specializes in online courses for managing pain, stress, anxiety and depression.

The 21-minute pain management course hosted at Meditainment.com (click here to see it) takes you into a “secret garden” of your own imagination, designed to help your pain seem less important. Tens of thousands of people have visited the site for pain relief.

““I was able to drift away and place myself somewhere else besides in my chair. I didn't think about the pain,” said Taber Fellows in an online post.

“Amazing! Way better than painkillers,” wrote Holly Maslen.

“Been fighting a migraine all day, and this helped tone it down to a more bearable level. Will check out the other meditations as well, thank you,” said Kristi Morningstar.

In all, Meditainment offers 18 different online courses (including one to help you sleep) that can take you anywhere from an island paradise to a mountain refuge to an arctic igloo – all without getting out of your chair. The first two courses you watch are free, but gaining access to the other 16 will cost you $15.

“When meditation is used as a form of relaxation when in pain, it can be of great benefit, reducing the fear aspect and emotional responses of experiencing pain as well as changing the contextual evaluation of stimuli, and sensory events,” said Rebecca Millard, Project Manager at Wellmind Media.

“Although we haven’t conducted any scientific research into this ourselves, there is increasing evidence to support meditation for the relief of pain. For us, the testimonials and comments on the pain management meditation speak for themselves.”

Online meditation and “mindfulness” cognitive therapy have been available for several years, and there is increasing evidence showing that they are effective in treating a broad range of mental health issues, including anxiety, depression and stress.

“Mindfulness is about paying attention to the present moment, non-judgmentally, with a gentle curiosity. It’s an awareness that emerges from paying attention on purpose to the present moment. It’s a mind-body approach, which involves paying attention to thoughts, feelings and body sensations,” said Millard in an email to Pain News Network.

“If we have more awareness and understanding of ourselves we can use this as a tool for pain management. Stress is linked to pain and too often pain is seen as something that the body experiences rather than linked to the mind.”

One study, published in the British Medical Journal, found that online mindfulness courses were often just as effective as face-to-face meetings with a therapist.

“The people choosing to use the course in this mode of delivery appear to be finding it helpful,” the study concluded. “That the levels of negative emotion reduced significantly on completion of the online mindfulness course and further decreased at 1 month follow-up is suggestive of significant improvements.”

You can try an online mindfulness course by visiting Be Mindful Online. The mindful and meditation programs mentioned in this story are offered by the UK National Health Service, but are available to anyone around the world.