Study Finds Mindfulness Reduces Pain and Despair

By Pat Anson, PNN Editor

“Mindfulness” may as well be a four-letter word to chronic pain patients. Many have tried mindfulness meditation – a form of cognitive behavioral therapy (CBT) – and found it does not relieve their pain.

“The quackery continues,” one reader told us. “This is a modern-day lobotomy experiment.”

“I have tried CBT and mindfulness. They made me feel much worse emotionally, paradoxically enough, and made me more acutely aware of the pain,” another patient said.

“We have ALL been through almost every other treatment you can think of including psychological therapy, mindfulness, yoga, etc. before given opiates. We still use these to help cope, but they do not really help much when all you want is to die to stop the pain you are in,” another patient wrote.

A new study at the University of Utah provides some intriguing evidence that mindfulness can enhance the quality of life, while also reducing pain and the need for opioids.

The study, published in the journal Science Advances, looked at data from four experiments involving 135 adults who took opioids daily for chronic pain.

Participants were randomly assigned to two groups that participated in either eight weeks of support group therapy or eight weeks of a meditation program called Mindfulness-Oriented Recovery Enhancement (MORE). Patients in the MORE group were asked to focus on rewarding experiences, such as watching a beautiful nature scene.

At the beginning and end of the study, researchers collected electroencephalogram (EEG) data from the participants, using electrodes on the face and scalp to track their eye movements, smiles, frowns, changes in heart rate, and brain function.

Researchers say pain patients in the MORE group had fewer cravings for opioids and became more responsive to pleasant images by using mindfulness to savor them.

Compared to patients in the therapy group, MORE patients reported significantly less pain, more positive emotions, enhanced joy and more meaning in life.

IMAGE COURTESY UNIVERSITY OF UTAH

IMAGE COURTESY UNIVERSITY OF UTAH

"Previous research shows that prolonged use of opioids makes our brains more sensitive to pain and less receptive to the joy one might normally experience from natural rewards, like spending time with loved ones or appreciating a beautiful sunset," said lead author Eric Garland, PhD, an associate dean for research at the University of Utah College of Social Work.

“This blunted ability to experience natural positive feelings leads people to take higher and higher doses of opioids just to feel okay, and ultimately propels a downward spiral of opioid dependence and misuse. Because of this downward spiral, scholars are increasingly referring to chronic pain and opioid misuse as 'diseases of despair.'"

Garland developed MORE as a mindfulness therapy to promote positive psychological health while simultaneously addressing addiction, pain and stress. MORE teaches mental training techniques to help people find meaning in the face of adversity, while simultaneously alleviating physical and emotional pain by cultivating positive feelings and experiences.

"MORE teaches people to better notice, appreciate and amplify the good things in life, while also deriving meaning and value from difficult situations," said Garland.

Previous studies on mindfulness using MRI imaging found that changes in the brain do occur during meditation, making people less sensitive to pain. Meditation activated brain regions associated with the self-control of pain, while deactivating regions that process sensory information.

You can take a free 20-minute guided meditation at Meditainment.com. The online mindfulness program takes you into a “secret garden” of your own imagination, designed to help your pain seem less important.

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.  

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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.

4 M’s That Can Help Lower Pain Levels

By Barby Ingle, Columnist

This month I am looking at the 4 M’s of pain management as part of my series on alternative pain treatments: magnets, massage, mindfulness and music.  

Once again, I know and understand that these therapies will not help everyone. And when they do offer some relief, it will be temporary and vary in nature. That’s no reason not to try them.

Mindfulness

I found mindfulness helpful and now use mindfulness techniques in my daily life to assist in pain management.

When I first started to look at mindfulness, I turned to Melissa Geraghty, PsyD, for input on the benefits and techniques. Dr. Geraghty serves on iPain’s medical advisory board and is a chronic pain patient herself.

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“It’s human nature to pull away from pain, whether that pain is physical or emotional. We inherently try to avoid pain or distract ourselves from pain,” she told me.

“Maybe in the short term we feel avoiding or distracting ourselves helps, but this is not sustainable with chronic pain. The pain will always be there, so we can either continue to be stuck in the cycle of fighting it, or we can accept that we have chronic pain and figure out how to engage in our lives.”

Mindfulness is used to reduce stress, depression, anxiety and pain levels, and can also be used in drug addiction counseling. Clinical studies have documented both physical and mental health benefits of mindfulness for different medical conditions, as well as in healthy adults and children.

Mindfulness involves several meditation exercises designed to develop mindfulness skills. One method is to sit comfortably, close your eyes, and bring attention to either the sensations of breathing in one’s nostrils or to the movements of the abdomen when breathing in and out. When engaged in this practice, the mind will often run off to other thoughts and associations. When this happens, one passively notices that the mind has wandered, and in an accepting, non-judgmental way, you return to focus on breathing.

Other meditation exercises to develop mindfulness include body-scan meditation, where attention is directed at various areas of the body and body sensations. You can also focus on sounds, thoughts, feelings and actions that are going on around you. A mindfulness session is typically done in short periods of about 10 minutes. The more you practice, the easier it is to focus your attention and breathing.

I recently had a mindfulness session with a therapist as part of a documentary I was filming. I noticed that having someone guide me through a session, as opposed to doing it on my own, was very beneficial. I got to focus on positive thinking, letting go of negatives that happen in life, and living life in the now.

“Mindfulness practice allows people with chronic pain to participate in the moment instead of watching life pass you by. Life may not flow in the way you expected it to before chronic pain, but living in an endless cycle of psychological misery isn’t living at all,” says Dr. Geraghty.

Massage Therapy

Massage therapy is another treatment that I use. My husband and I purchased a massage table back in 2005 at the suggestion of my physical therapist. I can do exercises on it or have my husband give me massages as needed. This is especially good for migraines, headaches and overall blood flow in my body.

There is conflicting information on whether massage helps relieve pain and others symptoms associated with nerve pain diseases. Much of the scientific studies show beneficial short term effects, and I agree with them based on my own experiences.

Not only do I find massage therapy helpful with my pain levels, it also helps me relax and let go of stress. My massage therapist told me that even a single massage session has been shown to significantly lower heart rate, cortisol and insulin levels --- which  reduce stress.

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Massage can also improve posture, which helps reinforce healthy movement. Other benefits of massage are better breathing and training the body how to relax. Clinical studies have shown that massage may be useful for chronic low-back pain, neck pain and osteoarthritis of the knee.

Magnet Therapy

Magnet therapy dates back at least 2,000 years, according to New York University Langone Medical Center. Healers in Europe and Asia used magnets to treat many different ailments, believing that the magnets can draw disease from the body.

Typically, therapeutic magnets are integrated into bracelets, rings, shoe inserts, clothing and even mattresses. Despite a lack of scientific evidence that magnet therapy works, an estimated $1 billion a year is spent on the sale of therapeutic magnets worldwide. Makers of these products claim they help increase blood flow to areas of the body where the magnet is worn, which brings in more oxygen and helps tissues heal faster. While larger studies have shown little to no therapeutic value in magnets, some smaller studies have found some benefit.

Pain patient Elizabeth Kandu is a believer in magnet therapy, although she’s not sure how it works.

“Who really knows if it’s a placebo effect or really works in everyone,” she says. “For me, without at least the metal to skin in 2 or 3 places, I am an electric nightmare.”

Elizabeth is right that there may be some placebo effect in play, but if magnets provide some relief they may be worth a try. It will be interesting to hear from PNN readers who have tried magnets and if any therapeutic value was found.

Music Therapy

I have been using music to excite my soul since childhood. I now also use it to address physical, emotional, cognitive and social needs that come with living in pain.

According to Warrior Music Foundation’s Michael Caimona, music provides sensory stimulation, stirs emotional responses, facilitates social interaction and communication, and provides diversion from inactivity.  Music also helps us get through sad times and helps us heal from bad times.

I’ve found music to be an effective tool in reducing pain levels and anxiety, and it helps stimulate the brain. I have even had surgeons put on music during my procedures. Although I cannot hear it consciously under anesthesia, I am able to hear it subconsciously and believe in the positivity of it. I also use music during infusion therapy and on moderate pain days.

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Another study I found reported that children who listened to music while having an IV needle inserted into their arms showed less distress and felt less pain than the children who did not listen to music. Research also shows that music therapy helps patients become more engaged in their treatment and physical therapy.

There are two different forms of music therapy, active and receptive. The patient can actively create music with instruments or by singing. In receptive therapy, the patient is more relaxed and is listening or participating in other activates while the music is being played.

I hope that spotlighting these alternative pain treatments will help readers understand that there are many forms of therapy, and it’s up to each patient to find what works for them. Many times as patients we feel we have tried everything. But until your pain is at a constant low number on the 1-10 pain scale or a zero, I encourage you to keep discussing options and trying new treatments.

The goal is to get the best living you can out of each day. I look forward to hearing what has and hasn’t worked for you.

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 She 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.

Hypnosis and Mindfulness Reduce Acute Pain

By Pat Anson, Editor

Hypnosis and mindfulness training can significantly reduce acute pain in hospital patients, according to a small study published in the Journal of General Internal Medicine.

Researchers at the University of Utah enrolled 244 hospital patients in the study who reported “intolerable pain” or “inadequate pain control” as a result of illness, disease or surgical procedures. Participants were randomly assigned to a single 15-minute session in one of three mind-body therapies: mindfulness, hypnotic suggestion or pain coping education.

All three types of intervention reduced the patients’ pain and anxiety, while increasing their feelings of relaxation.

Those who received hypnosis experienced an immediate 29 percent reduction in pain, while those who received mindfulness training had a 23 percent reduction and those who learned pain coping techniques experienced a 9 percent reduction.

Patients who received hypnosis or mindfulness training also had a significant decrease in their desire for opioid medication.

“About a third of the study participants receiving one of the two mind-body therapies achieved close to a 30 percent reduction in pain intensity,” said Eric Garland, lead author of the study and associate dean for research at the University of Utah’s College of Social Work. “This clinically significant level of pain relief is roughly equivalent to the pain relief produced by 5 milligrams of oxycodone.”

Garland’s previous research has found that multi-week mindfulness training programs can be an effective way to reduce chronic pain and decrease prescription opioid misuse. The new study added a new dimension to that work by showing that brief mind-body therapies can give immediate relief to people suffering from acute pain.

“It was really exciting and quite amazing to see such dramatic results from a single mind-body session,” said Garland. “The implications of this study are potentially huge. These brief mind-body therapies could be cost-effectively and feasibly integrated into standard medical care as useful adjuncts to pain management.”

Garland and his research team are planning a larger, national study of mind-body therapies that involve thousands of patients in hospitals around the country. Garland was recently named as director of the university’s new Center on Mindfulness and Integrative Health Intervention Development. The center will assume oversight of more than $17 million in federal research grants.

Many chronic pain patients are skeptical of mindfulness, cognitive behavioral therapy (CT) and other mind-body therapies, but there is evidence 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.

You can experience a free 20-minute online meditation program designed to reduce pain and anxiety by visiting Meditainment.com.

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.

Learning Mindfulness and a Positive Attitude

By Barby Ingle, Columnist

Mental health can be disrupted when living with chronic pain. Anxiety, depression, isolation, and feelings of hopelessness and helplessness can increase to dangerous levels. Life can become overwhelming -- particularly for people who have been suffering with chronic pain for a long period of time. The idea of living with this horrible disease with no cure is astounding.

When my chronic pain started doctors often told me, “Just do this and you will be okay.” I would build up my hopes and follow their directions. But when I did not get better, I came crashing down and so did life around me.

When I finally realized there was no cure for my chronic pain and that my future would include pain on a daily basis, I began to have dark thoughts. I went through a grieving process in the course of coming to grips with my new reality. It is hard for many pain sufferers to accept their changing life, and the loss of independence and function.

It is very important for you and your family to recognize the symptoms of diminished emotional well-being and take action or you may end up at risk of suicide. There are going to be good and bad days, and if this is a bad day for you, remember to focus on the good days, good feelings and positive past and future experiences.

It was when I began looking for solutions, and displayed a positive attitude, self-esteem and confidence, that I began to attract other people who wanted to help me accomplish my needs and goals. Be sure to surround yourself with a team that is on your side, or you will be in a fight in which you will have trouble winning.

Creating a positive attitude starts with being inspired. You can begin by finding new interests and hobbies you can enjoy. A few suggestions are joining a non-profit cause, solving puzzles, writing a journal, joining or starting a support group, or even starting a blog. Creating a purpose can assist with your self-esteem and confidence.

I have learned that every person has a value no matter how big or small they seem. Believing in yourself and in your abilities, choosing happiness and thinking creatively is good motivation when it comes to accomplishing your goals. Learn to expect success when you are going through your daily activities. It might take you longer or you may need to use more constructive thinking to achieve success, but it is possible. 

There are great benefits to having a positive attitude, especially when things are not going your way. Staying optimistic will give you more energy, happiness and lower your pain levels. Success is achieved faster and more easily through positive thinking, and it will inspire and motivate you and others. I have found that when I am letting the pain get the better of me, it comes across to others as disrespect and brings those around me down.

No matter the challenges of today, they will pass, and will not seem as bad as time moves on. Challenges often turn out to be a bump that looked like a mountain at the time. You can be mentally positive and happy even when there are large obstacles to overcome.

No person or thing can make you happy and positive. Choosing to be happy starts with mindfulness.  

You can learn about mindfulness and moving beyond psychological suffering in a free two-part webinar I’ll be hosting, featuring Dr. Melissa Geraghty on April 28 and Dr. Karen Cassiday on May 13.  You can register for the webinars and learn more about treatments for anxiety and depression by clicking here.

Barby Ingle suffers from Reflex Sympathetic Dystrophy (RSD) and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation (iPain). She 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.