In the two years since Time Magazine proclaimed the “Mindfulness Revolution” on its cover, meditation has really caught on. But few realize mindfulness meditation as an effective medical intervention was established with research on chronic pain sufferers.
Back pain, neck pain, shoulder pain—these are difficult conditions for conventional medicine to treat. Treatment of chronic pain with drugs or surgery comes with substantial negatives. Drugs are expensive, often ineffective, and have side effects. Surgery carries the risk of infection or complications and may not alleviate the pain. The problem is that pain is a complex phenomenon, and medical science only recently developed models to explain this complexity.
Normal pain is an adaptive response. If someone touches a hot iron and burns a finger, the resulting pain is a signal to the brain that skin cells are damaged. The neurological process triggers a motor response: the person immediately removes her hand from the hot iron. Chronic pain, on the other hand, is pathological. Pain of long duration causes stress and is of no physical benefit.
In the 1970s, medical researchers began to understand the difference between normal and chronic pain. Ronald Melzack and his colleagues developed a psychophysiological model that explained why chronic pain tended to intensify over time. They discovered additional second-order cognitive and affective-motivational effects that prolonged the pain cycle. A person’s thoughts about the pain such as “this is unbearable,” added a cognitive dimension. When angry or helpless feelings were generated by such thoughts, this added an affective dimension. These added effects could heighten and sustain the experience of pain. This complex mind-body interaction explains why pain persists, even after the initial stimulus is removed.
University of Massachusetts Medical School Professor Jon Kabat-Zinn realized that chronic pain sufferers had something in common with serious meditators: the experience of extreme pain. Although meditation is often relaxing, when a meditator sits motionless for hours, for example when on retreat, muscles and joints ache intensely. However, traditional meditation instruction offers a coping mechanism. Meditators learn a habit of non-judgmental observation that allows them to detach the physical sensation of pain from the cognitive and emotional reactions to it. Recognizing that this process fit with the scientific theory of pain complexity, Kabat-Zinn reasoned that meditation might be an effective medical intervention.
Mindfulness was taught to chronic pain sufferers in an outpatient program at the University of Massachusetts Medical Center as part of Kabat-Zinn’s carefully designed research study (published in 1982). Two-thirds of the patients reported that their pain was reduced by at least one-third. Half of the patients reported their symptoms were reduced by 50% or more. This research provided the justification for continuing to develop mindfulness as a medical intervention. In the last three decades, mindfulness has been applied in many different settings, and thousands of research studies have been published.
Chronic pain sufferers can follow the same path today. There are many resources available for mindfulness training. (Some are listed at the end of this article.) The basic process is not difficult to learn, but the positive effects are not experienced unless a person practices consistently. The Mindfulness-Based Stress Reduction (MBSR) course developed by Professor Kabat-Zinn unfolds over eight weeks, with weekly meetings and daily homework. Participants move through a sequence of different mindfulness practices: the body-scan, sitting and walking meditations, and hatha yoga exercises. But the basic set of instructions remains the same across these different forms. Participants are instructed to:
Participants are told to observe everything–thoughts, feelings, body sensations–without judgement. Even a judgmental thought can be observed in a detached fashion. A person thinking, “This is a stupid waste of time,” may realize they have mentally wandered off. Then the mindfulness training kicks in. They say to themselves, “judging, judging,” and return their attention to the in-breath, the out-breath. The purpose is to develop an awareness of the transient nature of sensations, thoughts, and feelings. Through this method, individuals learn how to let go of obsessive thinking and focus attention deliberately on objects of their choosing.
Mindfulness, then, is a skill. And it is a skill that can be used to combat chronic pain. Here are the three ways that this works:
Desensitization to primary pain stimulus
Seeking to avoid intense, chronic pain is natural. Consequently, chronic pain sufferers often curtail activities they fear might trigger pain. In some cases, chronic pain leads to depression and attempts to self-medicate, leading to substance abuse. This pain-avoidance behavior is counterproductive. Mindfulness techniques, on the contrary, instruct the individual to treat the pain as a sensory experience and to observe it. The person watches as the pain modulates, perhaps becoming stronger or weaker; he observes as the wave of sensation ebbs and flows. Scientists consider this to be prolonged exposure, which– in the absence of traumatic consequences– can help desensitize the patient to the primary pain stimulus.
Interrupt Pain Reactivity Cycle
The practice of non-judgmental observation interrupts the alarm/reaction spiral that causes the most suffering. Obsessive thinking about the pain, and the emotional charge added to these thoughts, heightens and prolongs distress. The mindfulness techniques of labeling cognitions and emotions (e.g., “judging,” “complaining,” “frustration,” “anger”) and then returning attention to the breath, interrupts the sequence of pain-alarm-reaction. Thus, the second-order effects are eliminated, so the duration and intensity of pain is reduced.
Strengthen Coping Responses
By uncoupling the second order effects (thoughts and feelings) from the primary pain stimulus through mindfulness, the individual develops her higher brain centers. The process of self-observation that is practiced in mindfulness training helps to strengthen the individual’s ability to cope with stressors in general–including chronic pain.
Book: Jon Kabbat-Zinn, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, Rev. ed. New York: Bantam, 2013.
Article: Ruth A. Baer, “Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review,” Clinical Psychology: Science and Practice, Vol. 10, No. 2, (Summer 2003): 125-143.
MBSR on-line course: http://www.soundstrue.com/store/the-mbsr-online-course-3226.html
BIO (58 Words)
Maryjane Osa, PhD, is a sociologist, speaker, and educator. She is writing a book about the "spiritual but not religious" cultural trend in American society. Maryjane is a spiritual practitioner working in the New Thought tradition.