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.
- 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.