By Elizabeth Akincilar
Mindfulness meditation. Even if you’re not exactly sure what it is, I’m going to bet you’ve heard of it. It has gotten a lot of attention recently. It’s everywhere. It’s not like the mediation of 20 years ago. Back then meditation was considered “alternative” or “fringe” that few people practiced, especially in western countries. Now, mindfulness has become mainstream. Hip even. There are hundreds of apps that will guide us through a mindfulness practice. Our yoga studios are offering it in conjunction with our yoga classes. Our medical providers are talking to us about it. We see it show up in our social media feeds. PHRC wrote about the benefits of meditation in a previous blog post. Personally, I talk it about it to my patients on a daily basis! Depending on what you read or are told, it sounds downright magical! We are told it can improve our well being by allowing us to be in the here and now and not get so caught up with regrets and worries. We are told it can improve our physical health by relieving stress, treating heart disease, reducing blood pressure, improving sleep, alleviating gastrointestinal difficulties, and reducing chronic pain. We are told it can also improve our mental health by, in part, treating depression, substance abuse, eating disorders, anxiety disorders, and compulsive-obsessive disorders. See, I told you it sounds magical.
For those of you who may need a little refresher on what mindfulness is exactly, let’s start with a definition. It was originally created by Jon Kabat-Zinn and was called mindfulness-based stress reduction or MBSR. It focused on improving awareness and acceptance of moment to moment experiences, including physical discomfort and difficult emotions. Its core features include the following:
- Observe the reality of the present moment by attending to the objective qualities of the present experience or situation existing in one’s inner and outer world.
- Maintain one’s attention to a single aspect of awareness and accept it as is without acting, judging or elaborating on its implications.
- Remain open to everything that is salient without attachment to any particular point of view or outcome.
In a world where we are constantly bombarded with fake news, I want to give you the facts about mindfulness, at least with regards to its effect on chronic pain. I scoured the research to see whether there was data to support mindfulness as a valid and effective treatment for chronic pain. Here’s what I found:
In 2010 a meta-analysis of eight randomized controlled outcome studies were performed to investigate the effects of MBSR for adults with chronic medical conditions, including chronic pain. They concluded that the evidence supports the efficacy of MBSR for reducing distress and disability in this population.¹
Several correlational studies found that higher levels of mindfulness are associated with lower pain intensity ratings in chronic pain populations.²⁻⁴
Zeidan et al. found that three days of mindfulness meditation training lead to reduced sensitivity to pain, indicated by lower pain intensity ratings for predetermined electrical stimuli. They felt that the changes in the mindfulness and anxiety assessments suggested that meditation’s analgesic effects are related to reduced anxiety and the enhanced ability to focus on the present moment.⁵
Kingston et al. showed that compared with guided imagery, participants receiving mindfulness training showed increased pain tolerance in a cold pressor test. In this study they examined 42 asymptomatic university students and randomly assigned them to either six mindfulness sessions or six Guided Visual Imagery sessions.They obtained pre and post pain tolerance (cold pressor test), mood, blood pressure, pulse, and mindfulness skills.⁶
In 2013 Reiner et al. completed a literature review to examine whether mindful-based interventions (MBIs) reduced pain intensity. They reviewed 16 studies, eight controlled and eight uncontrolled. When comparing the effect of mindful-based interventions on pain intensity to control groups, six of the eight studies report significantly greater reductions in pain intensity for the MBI groups compared with controls.⁷
Goldenberg et al. found that reduction in pain intensity was significantly greater for the MBI group compared with the waiting list control group. In this study 79 people with fibromyalgia completed a 10 week stress reduction, cognitive behavioral program. The controls were 42 of the subjects, 18 of which were put on a waiting list for treatment and the other 24 did not express interest in completing the program.⁸
A study by Esmer et al. examined patients with failed back surgery syndrome. They included 25 patients, 15 who underwent mindfulness based stress reduction (MBSR) therapy and 10 in the control group. At the 12 week follow up, they reported significant and moderate reductions in pain intensity ratings following MBSR compared with non-significant reductions for the traditional therapy control group.⁹
A study by Grossman et al. looked at 58 female patients with fibromyalgia, comparing MBI to a control group which utilized social support, relaxation, and stretching exercises. Results from this study indicated significantly greater pain reduction for the MBI group compared with the control intervention.¹º
Another study compared the effects of mindfulness-based and cognitive-behavioral stress reduction. They found substantial decreases in pain intensity ratings for the MBSR group and a moderate advantage in posttreatment mean effect size for MBSR vs CBT control group.¹¹
It has been suggested that participants in mindful-based interventions learn a life skill, and that the beneficial effects of this skill can gradually grow rather than diminish over time. This is consistent when examining follow-up assessments, in the articles reviewed, ranging from 3 months to 3 years, significant reductions in pain intensity were maintained in all studies, regardless of the assessment period, suggesting long-term benefits for chronic pain patients, regarding the intensity of their pain.
After a review of the literature, it seems clear that mindfulness can have a positive effect on a person who is managing a chronic pain syndrome. It can and should be part of an interdisciplinary treatment program for someone living with chronic pain. That being said, it is important to recognize that practicing mindfulness meditation is very often accompanied by the process of learning to access a personal “inner space.” For some, this process is exciting and interesting; for others, it is a constant battle that in itself is painful. When taken seriously, mindfulness meditation might not suit every patient or affect every patient in the same way. In addition, when mindfulness meditation is taken seriously, it involves changes in lifestyle, which patients must be motivated to undergo. Regardless, when considering all the possible treatment interventions available for chronic pain and their possible adverse effects, mindfulness is a valid and effective treatment intervention, with no adverse effects, that should be, at the least, explored, as it could have significant and lasting positive effects for a person with chronic pain.
References:
- Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis. J Psychosom Res 2010;68(6):539–44.
- Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med 2008;31(1):23–33.
- McCracken LM, Gauntlett-Gilbert J, Vowles KE. The role of mindfulness in a contextual cognitive behavioral analysis of chronic pain-related suffering and disability. Pain 2007;131(1–2):63–9.
- McCracken LM, Thompson M. Components of mindfulness in patients with chronic pain. J Psychopathol Behav Assess 2009;31(2):75–82.
- Zeidan F, Gordon NS, Merchant J, Goolkasian P. The effects of brief mindfulness meditation training on experimentally induced pain. J Pain 2009;11(3): 199–209.
- Kingston J, Chadwick P, Meron D, Skinner TC. A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity. J Psychosom Res 2007;62(3):297–300.
- Reiner K1, Tibi L, Lipsitz JD.Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Med. 2013 Feb;14(2):230-42. doi: 10.1111/pme.12006. Epub 2012 Dec 13.
- Goldenberg DL, Kaplan KH, Nadeau MG, et al. A controlled study of a stress-reduction, cognitive behavioral treatment program in fibromyalgia. J Musculoskel Pain 1994;2(2):53–66.
- Esmer G, Blum J, Rulf J, Pier J. Mindfulness-based stress reduction for failed back surgery syndrome: A randomized controlled trial. J Am Osteopath Assoc 2010;110(11):646–52.
- Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: Evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom 2007;76(4):226–33.
- Smith BW, Shelley BM, Dalen J, et al. A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. J Altern Complement Med 2008;14(3):251–8.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Wow, it sure is interesting to know that mindfulness meditation can help reduce stress and manage chronic pain. My sister has been suffering from chronic pain for 3 months now after getting involved in a pretty serious road accident. She is currently seeking pain management treatment for her chronic pain, and I think this type of meditation can really help supplement her existing treatment.