Spirituality • 27 May 2020

Lay Out the Welcome Mat for Pain

By uci_admin

Lay Out the Welcome Mat for Pain

By Jessica Drew de Paz, PsyD

Susan Samueli Integrative Health Institute

UCI Susan and Henry Samueli College of Health Sciences

I must admit . . . I was surprised when I first learned that mindfulness, the practice of bringing one’s attention to the present moment, can reduce chronic pain. Why would anyone want to show up for the present moment while experiencing pain?

As it turns out, pain was the focus of the initial research examining the ancient practice of mindful meditation. Four decades ago at University of Massachusetts Medical School, Dr. Jon Kabat-Zinn (a long-time meditator who believed that moment-to-moment, non-judgmental awareness can help alleviate suffering) developed Mindfulness-Based Stress Reduction (MBSR). This highly participatory course cultivates mindfulness through practices such as focusing on the breath, body scan, gentle yoga, and sitting and walking meditations.

With curriculum in hand, Kabat-Zinn asked physicians to send him their patients who were in chronic pain. Measures taken before and after MBSR demonstrated significant improvements in pain levels, mood, and psychiatric symptoms (Kabat-Zinn 1982; Kabat-Zinn et al. 1985), and this was also the case when compared to patients who only had the pain clinic’s usual treatment (Kabat-Zinn et al. 1985). Follow-up assessments revealed that although pain ratings returned to baseline within about 6 months, general distress and psychological symptoms remained improved (Kabat-Zinn et al. 1987).

Mindfulness has also been investigated with some specific pain conditions. A study examining fibromyalgia demonstrated greater improvements for MBSR participants compared to those in an active support condition on measures of pain, quality of life, coping, anxiety, depression, and somatic complaints, results that were sustained three years later (Grossman et al. 2007). In addition, people with back pain who completed MBSR reported greater improvements than those on a wait-list on measures of chronic pain acceptance, engagement in activities, and overall physical functioning (Morone et al. 2008).

A recent study (Zorn et al., 2020) examined the interplay between different components of pain:  1) physical sensations (e.g. a dull ache), 2) cognitive thoughts (e.g. “I am never going to feel better.”), and 3) emotional/ affective reactions (e.g. frustration, depression). Compared to a group engaged in attentional distraction techniques, those who practiced mindful meditation (both novices and experts) appeared to reduce emotional/affective unpleasantness (but not physical intensity) ratings of pain. Across the board, those who scored higher on the Pain Catastrophizing Scale (a cognitive measure) reported higher pain ratings during short painful stimuli, and demonstrated less of an ability to separate their emotional reactions during long stimuli. Expert meditators had lower catastrophizing scores, increased sensory-affective uncoupling, and reduced unpleasantness during long stimuli.

Essentially, our thoughts and our feelings impact our level of suffering. Dr. Kristin Neff, co-founder of the Center for Mindful Self-Compassion, explains:  “Suffering = Pain x Resistance” (2011). There is the pain itself, but resistance (e.g. distraction, pushing it away, living in fear that it will never resolve) exacerbates stress and erodes our quality of life. In contrast, mindful meditation can liberate people from cognitive and emotional contributions to pain, which tends to soften the sensory experience.

Given the pain relief that ensues, it is no wonder that MBSR has been embraced worldwide. A qualitative study (Morone et al. 2008) examining the impact on older adults with chronic pain shared numerous positive evaluations, including the following:

“It felt good to be ’directed’ to these quite soluble problems and I realized that in my stoic, actually…rather angry, ‘at the end of my rope’ reaction to my seemingly insoluble back pain…I was neglecting my whole body trying as it were to blot out all pain even the minor “itch” I can scratch.”, and

“This program has really changed my life. Because of the meditation, I not only have less back pain, I am more aware of my life and am learning to live it to the fullest.”

To learn more about how mindfulness counteracts pain, consider enrolling in an MBSR course at the Susan Samueli Integrative Health Institute (see photos of Dr. Nicole Reilly and Hugh O’Neill teaching online). You might also enjoy Kabat-Zinn’s best-selling book, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (2013).

So go ahead, lay out the welcome mat . . . greet your pain at the door, and invite it in! You might even be pleasantly surprised how your relationship evolves.

Grossman P., Tiefenthaler-Gilmer U., Raysz, A., Kesper U. (2007). Mindfulness Training as an Intervention for Fibromyalgia: Evidence of Postintervention and 3-Year Follow-Up Benefits in Well Being. Psychotherapy and Psychometrics, 76, 226-233.

Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33-47.

Kabat-Zinn, J. (2013). Full Catastrophe Living (Revised Edition): Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness.

Kabat-Zinn, J., Lipworth, L. & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163–190.

Kabat-Zinn, J., Lipworth, L., Burncy, R., & Sellers, W. (1987). Four-Year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clinical Journal of Pain, 2(3), 159-173.

Morone, N., Greco, C., Weiner, D. (2008). Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain, 134 (3), 310-319.

Morone, N., Lynch, C., Greco, C., Tindle, H., Weiner, D. (2008). “I felt like a new person.” the effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. The Journal of Pain:  Official Journal of the American Pain Society, 9(9), 841–848.

Neff, K. (2011). Self-Compassion: The Proven Power of Being Kind to Yourself.

Zorn, J., Abdoun, O., Bouet, R., & Lutz, A. (2020). Mindfulness meditation is related to sensory-affective uncoupling of pain in trained novice and expert practitioners. European Journal of Pain.

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