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Mindfulness-Based Approaches to Managing Chronic Pain
March 2014
Kimberly Murdoch BSW, RSW, dipl HSC, NTS, DAc
Disclosure
As a partner in For Health Wellness Consultants Kimberly Murdoch profits from sales of:
For Health meditation CDs and downloads For Health corporate seminars on
resiliency and productivity
Objectives
Learn about the neurobiology and research related to mindfulness approaches
Understand and experience mindfulness techniques
Discuss ways to introduce mindfulness in the exam room with complex chronic pain patients
Become aware of books and online resources for your own learning and to support your patients in using mindfulness for managing distress
Strong evidence that mind‐bodyinterventions such as mindfulness elicit beneficial psychological and pathophysiological effects on various human diseases
What is Mindfulness?
• The most basic definition is the regulation of attention through mind-body awareness skills
•Operational definition, “Mindfulness is a particular way of paying attention, on purpose, in the present moment, and non-judgmentally” Jon Kabat-Zinn, PhD
• Mindfulness is developed through a relaxed, passive attention to a repetitive or absorbing stimulus that turns off the “inner dialogue” thereby decreasing arousal of the sympathetic nervous system Herbert Benson, MD, Harvard Medical School
What is Mindfulness?
•Mindfulness includes:
• the aim
• the methods
• the outcomes
J Kabat-Zinn
Pain and the Mind-Body Connection
“Pain is not just a “body” problem, it is a whole-systems problem.” Jon Kabat-Zinn
Mindfulness-Based Chronic Pain Management programs are biopsychosocial interventions that address several of the factors that impact pain and the ability to heal
Multiple Factors Intersecting
Multiple factors impact perception of pain and ability to heal:
thoughts, emotions, attentional biases, sleep, nutrition, physical activity, socio-economics and social support, life history, medical interventions and medications, concurrent pathologies, stress levels…
Mindfulness Skills
Breath Awareness
Guided Body Scan
3-Minute Breathing Space
Mindful Daily Living
Breath Awareness
• Find a quiet place and consistent time for practicing
• Attentional bias: Cultivate an attitude of “trying easy”
• Training attention on
breathing sensations
Mindfulness Research Summary
Research suggests that mindfulness-based therapies may be effective adjunctive interventions for:
chronic pain, depression, anxiety, trauma, Borderline Personality Disorder, OCD, ADHD, addiction, stress
Currently few valid, reliable measures of mindfulness
Research and Mindfulness-Based Interventions in Patients with Chronic Pain
Reiner et al.: most of the reviewed chronic pain studies (9/16) demonstrated a statistically significant decrease in pain intensity among persons receiving mindfulness-based interventions (MBIs)
Reductions in pain intensity were generally well maintained in 3-month follow ups
Along with other beneficial effects of mindfulness approaches, MBIs may help to reduce pain intensity
Reiner K, Tibi L, Lipsitz JD. Do Mindfulness-Based Interventions Reduce Pain Intensity? A Critical Review of the Literature. Pain Med. 2013;14:230–242
Limitations of Research
Minimum threshold of 10 participants per group for study inclusion was probably too low
Large majority of studies (13/16) included data only for treatment completers which could bias results to favor MBIs
Some studies involved novice meditators and other studies focused on experienced meditators
Some of the controlled trials lacked randomization Some studies investigated the effects of mindfulness on other processes (e.g. emotion reactivity
or regulation) instead of the basic processes of mindfulness itself
Reiner K, Tibi L, Lipsitz JD.(2013). Do Mindfulness-Based Interventions Reduce Pain Intensity? A Critical Review of the Literature. Pain Med.14:230–242
Mindfulness Impact on Threat Appraisal and Emotions
The Center for Investigating Healthy Minds (CIHM), University of Wisconsin, Richard Davidson, neuroscientist and team conducting studies of “The Brain on Meditation” since 1992, identified outcomes:
“Meditators' brains were active, particularly in the left prefrontal cortex, the part of the brain responsible for positive emotions” (Davidson, 2004)
What We Know About the Effects of Mindfulness on Neurobiology
fMRI Conclusions:
Mindfulness meditation induces specific changes in fMRI signal in several structures, including the amygdala, hippocampus, pons, anterior cingulate, and intraparietal sulcus
Lazar, G. Bush, G. Fricchione, R.L. Gollub, G. Khalsa, H. Benson, H. (2000). Functional Brain Mapping of the Relaxation Response using 3T fMRI S.W. Neuroreport, 11, 7
What About Briefer Mindfulness Interventions?
Moyer and colleagues at the University of Wisconsin-Stout
Random assignment to either a 5-week mindfulness meditation group or wait list group
Meditation group meditated at home 2x/week, 25 minutes each time, on average
Meditation subjects showed same significant increase in left hemisphere cortical activation as those who did full intervention of earlier studies
Wait list group did not demonstrate these changes
Moyer, C. A. et al. (2011). Frontal Electroencephalographic Asymmetry Associated With Positive Emotion Is Produced by Very Brief Meditation Training. Psychological Science
Research Summary
75% of all illness is related to stress and lifestyle habits. Former U.S. Surgeon General
Studies have found that regular practice of meditation or relaxation provides benefits to:
cardiac patients, surgery recovery, immune function, pain relief, diabetics, anxiety…
Physiological Benefits of Mindfulness Skills
Decrease blood pressure, heart rate, muscle tensionReduction in serum
cholesterol Improved immune function Reduction in cortisol levelsReduce pain and anxiety Improve sleepChanges in neurotransmitters
- ↑ serotonin, ↓ depressionDecrease inflammation
Psychological Benefits of Mindfulness Skills
More optimism and decreased depressionGreater self-awarenessImproved coping abilitiesReduced aggressionGreater efficiency and productivityImproved learning capabilities, concentration
and memoryPromote feelings of inner calm and tolerance
Mindfulness Skills
Breath Awareness
Guided Body Scan
3-Minute Breathing Space
Mindful Daily Living
Applications and Benefits
To alter physical symptoms such as hypertension, IBS, nausea, insomnia etc.
To decrease pain and the use of pain medications
To decrease anxiety and fearTo alleviate depression and angerTo prepare for and experience medical
procedures, treatments and tests
Applications and Benefits continued…
To promote healing and recoveryTo enhance inner strengths, resiliency,
optimism, and self-esteemTo increase feelings of well-being, comfort and
controlTo increase self-awarenessTo change negative thought patternsAt end of life
Exclusion/Inclusion Recommendations
Exclusion: Patients with cognitive impairmentsPatients experiencing mental clouding
associated with their pain conditions or medications
Inclusion:“Patient preference and enthusiasm are a good
guide” Dr. William Marchand, George E. Wahlen Veterans Affairs Medical Center and the University of Utah (July 11, 2012 ScienceDaily.com)
How to Make Mindfulness Meditation Miserable
I shouldn’t have thoughts during meditation.My body is supposed to be relaxed.My body should be still.Emotions keep coming up. I shouldn’t have
feelings such as anxiety or anger. I shouldn’t cry during meditation.
My environment should be perfectly quiet.I can’t do this. I’m not a patient person.
Difficulties and Challenges
No timeIntrusive thoughts or body sensations (pain)Emotions or memories come to the surfaceRestlessness, can’t sit stillFalling asleep, wandering mindEnvironmental noisesAnxiety about “letting go”I’m not doing it ‘right, trying too hard = frustrationAppearance of images
Summary
Many studies have found that mindfulness-based approaches provide benefits to:
pain management, surgery recovery, anxiety, depression, immune function, cardiac patients, diabetics, resiliency
Mindfulness approaches can be introduced to patients with chronic pain in the exam room
Key Components to Mindfulness Practice
● Find a quiet place for practicing
● Cultivate an attitude of “trying easy”
● Train the mind to focus attention
● Practice daily
© 2013