Mindfulness & Chronic Pain

Last week we shared about the Autonomic Nervous System, it’s two branches, the sympathetic nervous system and the parasympathetic nervous system and explored how engaging in practices like Non-Sleep Deep Relaxation can help to bring us into a more relaxed state and help decrease our pain. You can read more about that here.

This week we’re going to be diving a little deeper into the research regarding mindfulness and pain.

Specifically looking at the research done by 3 of the major researchers in the area of chronic pain and mindfulness and how you can incorporate what they have learned.

First let’s review chronic pain.

Chronic pain is often considered a sensory processing disorder because it involves changes in the way our nervous system processes sensory information, specifically pain signals. We’ve talked about that in the past here.

Normally, when we experience pain, sensory nerves in our body send signals to the spinal cord and then to the brain, which interprets these signals as pain.

However, in chronic pain, the nervous system becomes hyperactive and overreacts to pain signals. This means that the brain is receiving constant, exaggerated pain signals, even when there is no actual tissue damage or injury.

Furthermore, chronic pain can lead to changes in the structure and function of the nervous system. For example, the brain regions that process pain signals can become more sensitive and activate more easily, and the connections between different brain regions can become altered.

These changes can contribute to the persistence of chronic pain, as the nervous system becomes locked into a cycle of pain and hyperactivity. This is why chronic pain is sometimes described as a "maladaptive learning" process, in which the nervous system learns to respond inappropriately to pain signals.

Overall, chronic pain is considered a sensory processing disorder because it involves dysfunction in the way the nervous system processes sensory information, specifically pain signals.

On top of that when we are chronically in pain we are in a hyper-vigilant state and the hyperawareness that occurs in this state can leak into all aspects of our life.

When it comes to chronic pain it usually doesn’t resolve on its own. Like every aspect of health it takes work to get out of it and even after working to get out of pain sometimes pain is still there. For many of us dealing with chronic pain it is not complete resolution we are looking for but rather trying to increase the amount of good days over bad and making the bad days more tolerable. Luckily for us many individuals have devoted their lives to studying chronic pain and tools that we can use to help reverse the chronic pain state.

Three of those researchers are Jon Kabat-Zinn, Fadel Zeidan, and Melissa Rosenkranz.

Jon Kabat-Zinn was first a molecular biologist at MIT before founding the Center for Mindfulness in Medicine, Health Care, and Society in 1979. From 1979 to now him and his group of researchers have studied; Prison inmates and staff, patients undergoing bone marrow transplant, workplace stress in various corporate settings and work environments, effects of Mindfulness Based Stress Reduction(MBSR) on the brain and immune system under stress, MBSR and mindfulness meditation with women with breast cancer and men with prostate cancer, clinical applications of mindfulness meditation for chronic pain and stress-related disorders in healthcare settings.

Kabat-Zinn’s approach of MBSR training uses a combination of mindfulness meditation, body awareness, yoga, and exploration of patterns of behavior, thinking, feeling, and action. This approach can be understood as the non-judgemental acceptance and “open-hearted” investigation of present moment experiences. MBSR training includes awareness of body sensations, internal mental states, thoughts, emotions, impulses, and memories.  This reduces stress and anxiety and increases well-being.

MBSR has been used across different populations groups and found benefits in nearly all of them. For instance one study found that individuals who underwent MBSR during standard cardiac rehabilitation had a 41% decrease in mortality and a reduction in weight, blood pressure, psychological distress, and even blood glucose levels. Truly incredible stuff! However, we are here to discuss chronic pain. So what has Kabat-Zinn found when it comes to MBSR and chronic pain?

Let’s jump to one of his first studies that looked at the clinical use of mindfulness meditation for the self-regulation of chronic pain.

Through this research they wanted to find if mindfulness meditation could reduce pain levels over an extended period of time (10 weeks), lead to improvement in body image and reduced exacerbations of symptoms due to psychological distress, help in coping with persistent pain so that it will interfere less with the performance of routine activities of normal living, reduce the characteristically elevated negative affective states in chronic pain patients, in particular depression, hostility, low self- esteem, and anxiety, compare favorably in outcome with more traditional and more expensive medical treatments for the same pain conditions, produce positive long-term improvements in pain, coping behaviors, and affect, and lead to a continued, voluntary practice of the meditation following training.

They used different pain measurements like the following; Pain Rating Index(measuring pain that is present in the moment), Body Parts Problems Assessment (measuring how problematic one vies various body parts), Table of Levels of Interference (measuring how pain affects activities of normal daily activity), Body Pain Map (measure pain distribution, intensity, and frequency) and a few more metrics looking at mental health as it relates to anxiety, depression, OCD, and feeling of inferiority, I.e. General Sensitivity Index.

Here’s what they found.

Overall Pain, measured by the Pain Rating Index was reduced on average by 58%. Based on the Body Parts Assessment individuals had a reduction by 29%, and pain affected the activities of daily life by 30% less. 48% of individuals also saw a moderate to great improvement of their body pain map, showing less pain distribution, intensity, and frequency. When it came to looking at improvements of mental health there was significant reductions specifically related to anxiety and depression.

Overall the researchers concluded that, “the data suggest that mindfulness meditation training in the context of a Stress Reduction and Relaxation Program can be highly effective in reducing self-reports of both pain and pain-related behaviors in the majority of the patients referred to it for chronic pain.” Not only was improvement in chronic pain seen but there was also improvement in; negative body image, less inhibition to engage in everyday activities due to the concern of pain, improvement in medical symptoms, improvement of anxiety depression, and improvement of self-esteem.

Jon Kabat-Zinn’s group and other researchers have continued to study MBSR. In fact a recent study published in the Journal Psychiatry showed that MBSR was as effective as the SSRI drug typically prescribed for anxiety, Lexapro. In fact in this study 78% of those on Lexapro had negative side effects and 8% dropped out due to the side effects while the MSBR group only 15% had negative side effects and none dropped out. You can read more about this study here.

One of the most important when it comes to developing a mindfulness practice is realizing that it takes time. It takes effort and it takes consistency. However, when it comes to reducing chronic pain every little bit helps and Mindfulness Based Stress Reduction is one more tool that we can use to help reduce our pain.

For some helpful mindfulness-based stress reduction links you can click here to access some recordings from Yale’s School of Medicine.

Next lets talk about Fadel Zeidan. Fadel Zeidan is a neuroscientist who has dedicated his career to studying the effects of mindfulness meditation on pain perception and brain function.

Zeidan's research has shown that mindfulness can reduce pain by up to 57%, making it a promising tool for those struggling with chronic pain. Zeidan's research has shown that it can change the way the brain processes pain signals. By activating regions of the brain involved in the regulation of pain, mindfulness can help to reduce the intensity of pain signals being sent to the brain, leading to a reduction in pain perception.

One of Zeidan's most notable studies involved testing the effects of mindfulness meditation on pain perception in healthy individuals. Participants were subjected to painful heat stimuli, and were instructed to either engage in mindfulness meditation or simply sit quietly and relax. The results showed that the mindfulness meditation group experienced a 57% reduction in pain intensity, compared to a 40% reduction in the control group.

Another study by Zeidan looked at the effects of mindfulness meditation on pain in people with fibromyalgia, a condition characterized by chronic pain and fatigue. Participants in the study were randomly assigned to either a mindfulness meditation group, a cognitive-behavioral therapy group, or a wait-list control group. The results showed that the mindfulness meditation group had significant reductions in pain intensity, compared to the other two groups.

Zeidan's research suggests that mindfulness meditation can be an effective tool for reducing pain and improving quality of life, both in healthy individuals and in those with chronic pain conditions. By activating regions of the brain involved in pain regulation, mindfulness can help to reduce the intensity of pain signals being sent to the brain, leading to a reduction in pain perception.

Lastly, let’s talk about Dr. Melissa Rosenkranz, a neuroscientist who has studied the effects of mindfulness meditation on pain and emotion regulation.

Dr. Rosenkranz, like the previous researchers, has focused on mindfulness and reduction of pain. However, one additional aspect of research that Dr. Rosenkranz has focused on specifically is emotional regulation. In the past we discussed the brain and the role the pre-frontal cortex plays in stress. Essentially the pre-frontal cortex is the conscious main controller of the brain. When we are able to actively engage it, it can lead to an override in some of the secondary systems like the amygdala and a “reprocessing of pain”.

Dr. Melissa Rosenkranz has continued to show this ‘reprocessing’ in her research and has shown that mindfulness can alter the way the brain processes pain and can improve emotional responses to pain.

Let’s dive into a few of Dr. Rosenkranz studies.

The first study we’re going to be looking at involved testing the effects of mindfulness meditation on pain perception in healthy individuals. Participants were subjected to painful stimuli, and were instructed to either engage in mindfulness meditation or an active control including, physical activity, balance, agility, and core strength, nutritional education, and music therapy. The results showed that the mindfulness meditation group had a smaller inflammatory response and lower pain ratings.

Dr. Rosenkranz has also studied the effects of mindfulness on emotion regulation. Psychological stress is a major contributor to symptom exacerbation across many chronic inflammatory conditions and can increase inflammation in healthy individuals. When it comes to chronic pain a decrease in chronic inflammation and a decrease in inflammation can lead to an improvement in symptoms and overall health.  In this study Dr. Rosenkranz looked at how experienced meditators faired when facing psychological stress and neurogenic induced inflammation(often seen in migraines, fibromyalgia, and muscle dystonias). Dr. Rosenkrantz and her fellow researchers found meditators had a smaller stress response as measured by cortisol and neurogenically induced inflammation. Meditators had a smaller stress response compared to non-meditators and mediators were more accurately aware of how stress effected them and their physiological response.

Overall meditation and actively engaging in mindfulness activities have the potential to help reduce chronic pain and improve overall function of the brain. When it comes to improving our health and improving our pain engaging in mindfulness activities is another way we can help ourselves feel and heal better.

I hope you enjoyed this blog and as always feel free to reach out with any questions to drcoffman@optimizecolumbus.com.