Mindfulness For Chronic Pain: A Comprehensive Guide

You might have heard the term mindfulness used more and more, and wondered if it’s a fad or if it can actually help with with chronic pain.

Mindfulness techniques have gained more attention over the last decade, particularly in relation to treating chronic pain. This article explains that, “mind and body practices, such as yoga and meditation, have raised interest in different scientific fields

What is mindfulness?

Mindfulness is about being present in the moment, accepting the thoughts and feelings you’re having without worrying about them, allowing you to achieve a sense of peace. Many of the principles that are utilized within mindfulness therapies come from Buddhism and other spiritual practices, which were originally integrated into Western medicine in the late 1970s. Mindfulness is now well-accepted by modern western science as a valid therapy for a variety of physical and psychological disorders.

Various forms of mindfulness are practiced, allowing practitioners to experiment to find what works best for them. Essentially, these mindfulness therapies teach you to be aware of the pain you are feeling and the thoughts you may be having about that pain, without attaching any negative connotations to them. This study explains the concept of mindfulness aptly as, “non-judgmental acceptance of physical pain or psychological distress, thereby reducing the tendency to ruminate over and catastrophize these experiences

Types of mindfulness

  • Individual mindfulness meditation

Meditation can involve sitting alone in a quiet comfortable space, typically with your eyes closed or with your eyes relaxed and not focused on anything specific. This time of quiet calm is about connecting with yourself, calming your nervous system and focusing on the moment.

You may focus on your breathing, on what you can hear around you or on various areas of your body one at a time, which is also known as a body scan. Typically thoughts will flow during this time: the mind does not have to be completely quiet for a successful meditation, it’s about letting thoughts flow past you without attaching any particular significance to them as this book on mindfulness explains.

  • Guided mindfulness meditation

Guided meditation involves listening to someone either on a recording or in person, who will help you to relax into a meditative state and then guide you through the meditation. Sometimes they will use imagery, asking you to picture specific things in your mind, or specific thought exercises, often to help you to address a certain issue while in a calm state.

Often guided meditations will focus on relaxing each part of the body, one at a time, to take tension away from each muscle; this is often called Progressive Muscle Relaxation (PMR). PMR helps you to be more aware of your muscles and how tense they feel so that you are actively able to relax them; typically, a session will guide you through tensing muscles in each individual part of the body and then relaxing them. This study concluded that PMR lowered cortisol, the stress hormone and, “increased levels of self-report levels of relaxation.”

Guided meditations may focus on breathing techniques, learning to focus on your breathing and slow it, often while visualising breathing out negative thoughts and breathing in calm and positive thoughts.

  • Mindful movement

Yoga and other calm, flowing body movements can be used in mindfulness practice; typically, you will focus on your breathing and how your body is moving in that moment during this type of mindfulness. For people who struggle to quiet their mind when sitting or lying down, mindful movement can be more appropriate as explained here, “Participants sometimes report that during yoga practice they are better able to maintain a state of relaxed alertness than during body scan and sitting meditation, which may induce boredom or sleepiness.”

For some people being out in nature helps them to be grounded in the moment; mindful walks within which you are quiet, focusing on your breathing and the steps you are taking, and the nature around you can be helpful. If your mind wanders, you learn over time to bring your mind back to focusing on the sensation of your body while you are walking. Once you get the hang of this, you can use it to incorporate more mindfulness into your daily life, such as when you are walking to work or walking to the shop.

Mindful movement has the added benefit of exercise; for many with chronic pain exercise can be worrying or they may avoid it. Learning how to maintain a state of calm during exercise can reduce that fear and make it a more pleasant experience, while also giving the body the exercise it needs.

  • Mindfulness Based Cognitive Therapy (MBCT)

Combining cognitive behavioural therapy (CBT) techniques with mindfulness-based techniques has been shown to have some significantly positive results for those with chronic pain. Typically, MBCT will involve various types of meditation, breathing exercises, body exercises like stretching combined with concentration and reflection.

MBCT is about focusing on the present moment without worrying about what will happen in the future or what has happened in the past. This study focused on treating patients with chronic headaches using MBCT and concluded that, “MBCT is a feasible, tolerable, acceptable, and potentially efficacious intervention for patients”

  • Mindfulness Based Stress Reduction (MBSR)

MBSR focuses on reducing stress and in turn the negative impacts it has on the body, in order to reduce pain and bring a peaceful state of mind to patients. Typically MBSR uses meditation, mind and body exercises and gentle exercise like yoga to help patients to achieve a state of relaxation.

MBSR programmes have scientifically proven results on improving chronic pain. This clinical trial found that MBSR, “reduced pain intensity and pain-related distresswhile this study concluded that, “Participation in an MBSR program is likely to result in coping better with symptoms, improved overall well-being and quality of life, and enhanced health outcomes.

  • Other interdisciplinary therapies

Other therapies take principles from mindfulness to enhance their therapies, combining treatment disciplines together to generate the best outcome for patients. Often mindfulness techniques are combined with movement therapies such as graded exposure therapy or physiotherapy, as explained here; this teaches the patient to relax and not fear pain while working on building up movement gradually. Some therapies like Acceptance and Commitment Therapy (ACT) integrate aspects of mindfulness as they share common concepts such as accepting that a thought is just a thought without attaching a negative or positive connotation to it.

  • Daily mindfulness

Mindfulness can be practiced formally meaning actively engaging mindfulness meditations or therapies, and informally, integrating mindfulness into your daily life as explained here.

By being focused on the here and now rather than allowing your mind to wander, you can appreciate the moment and reduce daily stress. Engaging in more formal mindfulness typically gives you the skills you need in order to employ mindfulness as part of your daily life.

You can integrate mindfulness into so many daily tasks such as doing the dishes, driving, eating and even things like how you talk and take a shower or bath! Once you get the hang of thinking mindfully, it becomes natural to do so throughout your day.

How mindfulness helps chronic pain

Buddhists have been aware that mindfulness has the power to reduce pain for thousands of years; this study explains that, “the ancient Buddhist text, the Sullatta Sutta (The Arrow), states that meditation practitioners have the unique ability to fully experience the sensory aspect of pain (first arrow) but to “let go” of the evaluation (second arrow) of pain”. Indeed, current medical research is starting to realise that mindfulness can indeed be a powerful tool.

Mindfulness meditation is known to improve four different facets of brain processes, as explained in this study, “sustained attention, monitoring faculty (to detect mind wandering), the ability to disengage from a distracting object without further involvement (attentional switching), and the ability to redirect focus to the chosen object (selective attention).

The same study explains that various brain scans have been done on someone during meditation, to figure out what happens to the brain during this state. It was found that the areas of the brain that were activated during meditation are those which:

  • Help to process memories and information
  • Regulate the internal processes in the body, which essentially is referring to all the bodies systems such as breathing, heart rate, blood blow and immune system just to mention a few.
  • Focus on problem solving
  • Help to focus attention
  • Regulating and controlling emotions
  • Helps with adaptive, healthy behaviours.
  • Increased gray matter was also found in those who meditated compared to those who did not; this grey matter helps you to control your emotions, to think things through and solve issues as well as to adapt to changes in your life.

In the context of chronic pain, this means that meditation can help you to stop your mind wandering back to your pain when you are trying to focus on something else, therefore improving your ability to give your entire attention to the task at hand and in turn, improve your level of functioning. It gives you the power to take your mind off your pain and refocus it, therefore aiding you in replacing unhelpful, behaviours with healthy ones which can reduce your pain and allow you to take better care of your health.

Mindfulness has been proven to reduce stress. Our body is not designed to withstand stress for long periods of time. When we’re stuck in that ‘fight or flight’ mode our body is being overworked, and so it exacerbates pain. Pain then causes stress because it’s tough to deal with, and so it becomes a pain and stress cycle.

There are two parts to the nervous system: the sympathetic nervous system which increases functioning in your body and the parasympathetic nervous system which calms things down. During mindfulness meditations the parasympathetic nervous system is activated, resulting in your muscles untensing, your heart rate reducing, your breathing slowing and your blood pressure reducing, essentially meaning that your mind and body are in a complete state of relaxation.

Mindfulness helps to improve mental health, reducing anxiety and giving a deeper sense of overall wellbeing and positivity; this in turn reduces stress as well as helping to control the mental health symptoms that so often come hand in hand with chronic pain. Mental health itself can lower quality of life, even without chronic pain, so improving this aspect for a patient can make a significant difference. This study concluded that, “Mindfulness meditation was associated with statistically significant improvement in depression, physical health-related quality of life, and mental health-related quality of life.  Improved mental health results in better coping strategies and allows you to feel empowered instead of helpless.

By learning to accept the pain you may be feeling in the moment, you are able to feel less weighed down by negative thoughts and more in control. This study on the effects of meditation found, “improvements in pain, pain acceptance, quality of life, and functional status.”

When you live with chronic pain, it’s natural to find it tough to take your focus away from your pain; sometimes this focus becomes constant awareness of your pain, also known as hypervigilance. On the same note, patients can become fearful of causing more pain, which leads to them avoiding situations that they anticipate may worsen their systems: this is known as fear avoidance. Both hypervigilance and fear avoidance are maladaptive for those with chronic pain, they feed into the pain cycle, worsen symptoms and reduce functioning. Mindfulness techniques can be used to tackle these problems.

Pain catastrophizing is common in those with chronic pain, meaning that you are worrying about your pain in a way that becomes all-consuming and emotionally distressing. Since mindfulness gives you the tools to think more clearly and control your thoughts and emotions, it can be used to overcome pain catastrophizing.

During regularly practiced mindfulness, the amygdala (an area of the brain that is reactive and creates fear) starts to shrink and the neurons within it become less active, while the prefrontal cortex (the area of the brain that allows us to have greater control over our emotions) expands and the neurons within it become more active; this allows us to reduce fear and take control of it, as this study explains.

Difficulties sleeping are common for many chronic pain conditions for obvious reasons; being more relaxed and having reduced levels of pain through mindfulness leads to better sleep, which also improves cognitive abilities, energy levels and mental health. You can even practice a mindfulness meditation in bed to help you drift off to sleep.

Living with chronic pain can become such a big part of your life that it can make you lose that sense of self, being confused about who you are and lacking in confidence. Mindfulness has been proven to help patients regain their sense of self and re-establish lost confidence as explained in this study.

These improvements in quality of life and reduction of pain aren’t just in the short term; once individuals have been given the tools they need to incorporate mindfulness in their daily lives and practice meditations at home, the progress is proven to be sustained for the long term. This study focused on Mindfulness Based Stress Reduction (MBSR), and found that, “improvements were sustained after a 3-year follow-up

How you can access mindfulness therapies and what to expect

You can access mindfulness through a therapist in a face to face setting; you could find a therapist privately or ask your doctor about being referred. You can do your own research on mindfulness and practice it at home; you can find mindfulness sessions online through YouTube or buy CDs or books that guide you through mindfulness. You can also access mindfulness through a pain relief app like ours which combines mindfulness techniques with other types of therapy such as cognitive behavioural therapy and graded exposure therapy to help you tackle your pain. Here’s a sample session for you to enjoy:

Depending on where and how you access mindfulness therapy, it may be done individually or within a group. Mindfulness therapies tend to run for between 8 to 12 weeks depending on the therapist and individual; consistent sessions are needed to really pick up the skills needed and continuing to practice mindfulness regularly in your daily life brings the best results as mentioned in this study.

During sessions you may be asked to sit comfortably, to lie down or to practice gentle movement depending on the specific session you are engaging in. You may be asked to visualise certain things in your mind or be guided through breathing exercises. If you’re in a group you may sit around in a circle to engage in these exercises.

If you try one way of being guided through mindfulness and it doesn’t work for you, don’t let it put you off, simply try another method. For some people being face to face will work while for others being in their own home is going to be more relaxing. The same applies to mindfulness exercises, if you try a sitting meditation and find that you can’t redirect your mind, try moving meditation. Everyone is different and there are so many ways you can engage in mindfulness; it’s about finding what works for you.

Here are some things to remember when you’re first getting started with mindfulness:

  • It can feel strange and can take time to get the hang of; try not to put too much pressure on yourself.
  • Your mind will wander and that’s ok, you don’t need a completely quiet mind to practice mindfulness; it’s about learning to recognise that your mind has wandered so you can then bring your thoughts back to the present moment.
  • It’s not about being perfect or judging yourself against others; mindfulness is about you!
  • You don’t need any special equipment to engage in mindfulness, just yourself, your mind and if you choose, a form of therapy to guide you.
  • Everyone can engage in mindfulness, it’s a skill that can be learnt, but you must be patient and consistent.

Mindfulness techniques you can utilize

Starting the day mindfully

When you wake up in the morning, take your time to sit up slowly, to engage your five senses: what can you see, hear, taste, feel and smell? Ground yourself and think about what your goals for the day are. Setting your intentions clearly and starting your day off with a sense of distinct purpose can give you the best possible start to the day. You could even choose to stretch and practice breathing exercises while setting your intentions, inhaling slow deep breaths, holding them for a moment and then slowly releasing them.

Taking your time to pay attention

Starting to really pay attention to what is happening around you in your everyday life is truly being mindful. We have a tendency in our lives to skip past the present moment, always thinking about what comes next. Learning to appreciate the present can be so beneficial.

When anxiety strikes, focus on your breathing

If you start to feel stressed, anxious or negative thoughts creep in, stop what you are doing even if you are around other people, and just take a few moments to focus on your breathing. Breathe in and out slowly, taking deep breaths to calm your mind and body, really visualizing the stress leaving your body as you breathe out.

Trying a simple sitting meditation

  • Set aside some quiet time, perhaps five minutes to start with which you can build up to longer as you get the hang of it, in a quiet space where you are not going to be disturbed. Ensure that you turn off your phone and eliminate any other noises as much as possible.
  • Find a way to sit or lie down comfortably; there isn’t one specific way you must sit for meditation, you don’t have to have your legs crossed, it’s about finding what is comfortable and relaxing for you.
  • Close your eyes or soften your gaze so that you are not focusing on anything.
  • Take notice of your breathing, taking one deep breath in, holding it for the count of three and then releasing it, imagining breathing in positive thoughts and breathing out stress.
  • Allow your mind to wander, don’t worry too much about what you are thinking, but if you notice you are starting to worry about the past or make plans for the future, even just thinking about your shopping list, redirect your mind to focus on your breathing and how your body feels in the present.
  • End your meditation when you are ready, take your time to refocus and praise yourself for taking the time to focus your mind.

Mindfulness really can be used by anyone and is scientifically proven to help reduce pain and improve quality of life for those with chronic pain conditions. In fact, there’s no reason why you can’t get started today!

References

  • Fadel Zeidan, David Vago, (2016), “Mindfulness meditation–based pain relief: a mechanistic account”
  • Biological Psychology, Volume 60, Issue 1, Pages 1-16, Laura A Pawlow, Gary E Jones (2002), “The impact of abbreviated progressive muscle relaxation on salivary cortisol”
  • Ruth A. Baer, (2006), “Mindfulness-Based Treatment Approaches: Clinician’s Guide to Evidence Base and Applications”
  • The Clinical Journal of Pain: Volume 30, Issue 2,  p 152–161, Day, Melissa A. MA, Thorn, Beverly E. PhD; Ward, L. Charles PhD, et al (2014), “Mindfulness-based Cognitive Therapy for the Treatment of Headache Pain: A Pilot Study”
  • Journal of Behavioral Medicine, Volume 8, Issue 2, pp 163–190, Jon Kabat-Zin, Leslie Lipworth, Robert Burney  (1985), “The clinical use of mindfulness meditation for the self-regulation of chronic pain”
  • Britta K. Hölzel, Sara W. Lazar, Tim Gard, (2011), “How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective”
  • Annals of Behavioural Medicine, Lara Hilton, MPH, Susanne Hempel, PhD, Brett A. Ewing, MS, et al (2017), “Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis”
  • Biomedical Research International, Maddalena Boccia, Laura Piccardi, Paola Guariglia (2015), “The Meditative Mind: A Comprehensive Meta-Analysis of MRI Studies”
  • PLoS One, Shaheen E. Lakhan, Kerry L. Schofield, (2013), “Mindfulness-Based Therapies in the Treatment of Somatization Disorders: A Systematic Review and Meta-Analysis”
  • Clinical Journal of Pain,Wong SY, Chan FW, Wong RL, Chu MC, et al (2011), “Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain: a randomized comparative trial.”
  • Merkes M, (2010), “Mindfulness-based stress reduction for people with chronic diseases.”

Please note: This article is made available for educational purposes only, not to provide personal medical advice.

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