Mindfulness and pain

Mindfulness is about being here, now. It’s about being ‘present’ or in the moment. While the idea is really very simple, embodying mindfulness is not always easy. We’ve all had experiences of being completely absorbed in what we are doing – perhaps walking on the beach, playing with a child, looking up at a magnificent sunset, or enjoying the first mouthful of a delicious meal. These moments are moments of mindful awareness and we have them all the time. It’s just that they are brief and fleeting.

Soon enough our minds wander off into streams of consciousness – analysis, remembering, planning and a myriad of other distractions. We might pull into the driveway and suddenly come to our senses, unable to remember the drive home because we were replaying the day’s events in our minds.

The practice of mindfulness meditation, then, is really just about stretching out these moments of present-focused awareness by training our minds to keep coming back to what is happening right now. Some people describe it as shifting out of the ‘doing’ mode and into the ‘being’ mode, or switching out of autopilot.

At first this involves picking something to pay attention to – like the flow of your breathing, the shifting sensations in your body, or the many sounds around you – and noticing each time you end up distracted so that you can gently coax your attention back. This returning to the now, over and over, becomes a habit, just as practising scales on a piano or kicking the footy or pruning the roses develops muscle memory. We stop ‘missing precious moments’ and start being more fully engaged with what is happening as it unfolds.

Practising mindfulness meditation can be helpful for people with persistent pain, with moderate effect in reducing pain intensity^1,2. Compared to normal medical care for pain, meditation also seems to improve other important aspects of life, such as depression, coping ability, quality of life, acceptance, sleep quality and physical functioning^2-5. When it comes to acute or short term pain, people report less distress and can tolerate more pain in the research laboratory when they have had meditation training, compared to people who do not meditate⁶.

Overall, the current evidence suggests that mindfulness-based treatments are about as good as well-established psychological treatments for persistent pain, like Cognitive Behaviour Therapy (CBT). However, since the research on meditation is newer, it is not yet as strong and convincing as the research on CBT. We still need to do more high quality studies to figure out which types of pain meditation helps most with, what doses of meditation work best, and what the essential ingredients are that make meditation helpful.

It is still early days in terms of understanding why meditation can be so helpful in coping with pain, although the ancient origins of meditation in the different yoga and contemplative traditions suggests that people have known of these benefits for hundreds of years. However, there a few important ingredients.

Although meditation is not simply a relaxation technique, relaxation is a common helpful side effect. Relaxation is very important for coping with pain because pain is not only stressful in itself, but stress exacerbates and maintains pain. Relaxation is very helpful in calming down your nervous system, which often becomes ‘sensitised’ when pain persists for a long time. Relaxation also boosts your body’s natural pain modifiers, such as endogenous endorphins, or “feel good” hormones.

We can feel like we’re locked in a fierce battle with our pain and just want to get rid of it. While this is completely understandable, it can make us more frustrated, anxious or depressed when we can’t control the pain. Mindfulness is about accepting what is here right now as best we can, including pain, so that we can soften and be more receptive to what happens next. This is very different from being resigned to a life of pain. Mindfulness is all about curiosity and what some people call ‘beginner’s mind’. Research shows that people who learn how to accept their pain respond better to various treatments and have better overall pain outcomes.

Negative thoughts drive negative feelings, which can sensitise our nervous systems and increase our pain. Thinking very negatively about pain, or what we call ‘pain catastrophising’, is one of the strongest predictors that short-term acute pain will become longer-term persistent pain. Mindfulness meditation can reduce the burden of these negative thoughts because it changes our relationship to thinking itself. We start to see thoughts as just ‘mental events’ rather than facts, which lessens their impact. In other words, we don’t as easily buy into the negative story around our pain. This is especially important in overcoming the upsetting emotional impacts of pain and disability, such as depression and anxiety.

Exciting research using brain scanning technology like functional magnetic resonance imaging (fMRI) is beginning to shed light on patterns of activity in the brain when a person is in pain and when they are meditating. It looks like people are still aware of the sensory aspects of pain during mindfulness meditation but they experience it as less unpleasant since it does not activate as many of the brain networks related to memory, emotion and self-referential thought. In more technical terms, this relates to a decoupling of sensory-discriminative and cognitive-evaluative brain networks^6,7. In other words, meditation trains your brain to experience pain with less distress.

There are many other ways in which meditation seems to help people in pain. Below we outline HOW to meditate and provide 2 meditations (one short and one longer one) to help you get started.

Ideally you have a space in your home or garden where you can be undisturbed for the duration of your practice (10-45mins). You don’t need any special equipment, just a comfortable chair, stool, meditation cushion or anywhere you can sit, stand or lie for the duration of the exercise.

Yes, mindfulness practice is generally an individual practice, although we may also benefit from practising with a friend or family member. Sometimes, to get yourself started or motivated it can be helpful to attend a meditation group or undertake a mindfulness meditation course. These days you can even do these online and connect with the facilitator and other participants remotely, or even use smartphone apps to keep your practice going (see the links below).

It’s always worth discussing trying any new intervention with your different health professionals, and to use meditation as a complementary therapy rather than abandoning your usual care.

You don’t have to be in pain to benefit from meditation, so why not get a friend or family member to do the mindfulness meditation with you?

Mindfulness practice at home is free! Attending a structured 8-week meditation course like Mindfulness-Based Stress Reduction will cost around $500. Teaching yourself at home with a book and CD like ‘You Are Not Your Pain’ (see below) will cost about $25. There are sometimes free online mindfulness courses through FutureLearn (httpss://www.futurelearn.com) or you can get a brief taste of meditation through the free smartphone apps below.

A good way to start mindfulness meditation is by choosing a time and place to practice, where you can be undisturbed for a good chunk of time (anywhere from 20-45 minutes). You could start by trying the body scan meditation and follow the instructions. As mentioned above, if you are finding motivation is a problem, consider looking for a mindfulness group or course to get you started or even try one of the books or free smartphone apps below. The mindfulness programs that have been researched for pain include: Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT) and Breathworks.

It’s helpful to aim at doing this daily for a few weeks (4 weeks is good, 8 is better) before assessing how it is affecting you. Throughout the rest of the day practice consciously coming back to your senses. For example, eat slowly and mindfully, tasting each mouthful completely. Or try paying attention to the feeling of shifting pressure in your feet as you walk from your car to the shops. When you are stopped at traffic lights tune in to the movement of your belly as you breathe in and out…

Another good regular practice is to do a short 3-5 minute meditation by listening to the breathing space meditation or whenever you get the chance, or whenever you feel you need it. After a while you will be able to use this approach without needing the audio.

For more information about mindfulness and pain, visit the Mindfulness Based Stress Reduction Program or the Mindfulness Based Cognitive Therapy website.

For consumer summaries go to Cochrane Summaries. Alternatively, if you need to speak to your GP or health care professional, please seek further assistance.