Mindfulness Based Stress Reduction – Skillfully Well & Painfully Aware

Meditation for Fibromyalgia & Pain: Does it Really Work?

Meditation is a way to practice being present. According to Jon Kabat-Zinn, a pioneer in the field of meditation and medicine, meditation is a practice of cultivating mindfulness, which means “paying attention, on purpose, in the present moment, non-judgmentally.”

For this post, I wanted to look at some recent research on mindfulness meditation programs involving participants with chronic pain. The purpose of these studies was to assess whether mindfulness can lower pain, reduce depression, and improve quality of life.

The Mindfulness Based Stress Reduction (MBSR) program created by Jon Kabat-Zinn to teach mindfulness meditation to patients had demonstrated remarkable benefits for reducing chronic pain as well as anxiety and depression. I personally have found that this approach has helped me to reduce my anxiety, improve my quality of life, and manage my pain. The MBSR intervention is structured so that participants attend weekly sessions where they learn “different types of formal mindfulness practice, mindful awareness during yoga postures, and mindfulness during stressful situations and social interactions” (p. 227, Grossman et al., 2007).

Researchers investigated the effect of MBSR programs for participants with mixed chronic pain conditions and the significance of at-home practice for pain management. The study measured results in terms of bodily pain, quality of life and psychological symptoms for each chronic pain condition (neck/back pain, arthritis, fibromyalgia, chronic headache, and two or more coexisting conditions). The researchers discovered that the degree of benefit of participating in mindfulness programs varied depending on the chronic pain condition, but that overall improvements were seen in almost every category (Rosenzweig et al., 2010).

Rosenzweig (2010) suggests different possible causes for how meditation practice can improve chronic pain conditions:

First of all, nervous system pathways to parts of the brain associated with stress can be inhibited through mindfulness practice.
Secondly, reducing psychological symptoms like anxiety and depression can help because those symptoms can amplify the perception of pain.
Third, mindfulness practice can help improve emotional regulation and coping skills in stressful situations.
Fourth, mindfulness contributes physical self-awareness which could help lead to better self-care.
Finally, mindfulness can help activate nervous system function associated with rest and calm (parasympathetic nervous system), which in turn can lead to deep muscle relaxation that may reduce pain.

Similar results were found in a study of the effects of participating in an MBSR course for people with fibromyalgia (Grossman, et al., 2007). Significantly, the researchers interviewed about half of the original participants from the mindfulness training group 3 years later, and found sustained long-term benefits among those who continued their mindfulness practice (Grossman et al., 2007).

One research review compared 38 studies involving a total of 3500 participants. It examined previously published studies which investigated the effectiveness of mindfulness meditation as a treatment for chronic pain. They found that “mindfulness meditation was associated with a statistically significant improvement in depression, physical health-related quality of life, and mental health-related quality of life” (Hilton et al., 2017). In this review, participants showed promising outcomes on pain symptoms, but the degree of improvement was limited.

Research reviews like this are limited in their ability to compare and contrast different studies. Different meditation techniques were used in the different studies, such as Mindfulness Based Stress Reduction and Mindfulness Based Cognitive Therapy. In addition, the studies investigated outcomes in patients with different conditions, like fibromyalgia and migraine – which is like comparing apples to oranges. This highlights the need for more high-quality studies that include a greater number of participants with the same condition, using the same type of meditation program.

When it comes to trying mindfulness meditation, for people with chronic pain, there is nothing to lose and everything to gain. Prescriptions rarely offer total relief, and come with unpleasant side effects. The only cost to meditation is a little bit of time. while the potential benefits are less pain, better mood, and a greater quality of life.

References:

Paul Grossman, Ulrike Gilmer, Annette Raysz and Ulrike Kesper. 2007. Mindfulness Training as an Intervention for Fibromyalgia: Evidence of Postintervention and 3-Year Follow-up Benefits in Well-being. Psychology and Psychosomatics 76: 226-233.

Steven Rosenzweig, Jeffrey Greeson, Diane Reibel, Joshua Green, Samar Jasser and Denise Beasley. 2010. MIndfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research 68: 29-36.

Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., Maglione, M. A. (2017). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Annals of Behavioral Medicine, 51(2), 199–213. http://doi.org/10.1007/s12160-016-9844-2

Meditation (Photo credit: holisticgeek)

I am about to go to the second class of my Mindfulness Based Stress Reduction (MBSR) course. In the summer I wrote several posts on reading the Mindfulness Solution to Pain and practicing meditations described in the book. Mindfulness involves “paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment”, as defined by Jon Kabat-Zinn, founder of the MBSR program. I also posted on research showing how effective mindfulness practice is for chronic pain.

I have really enjoyed doing the assigned “homework” from the first class. The first part was to do a 30 minute body scan from the course CD. (A body scan meditation involves paying attention to different parts of your body for a few moments and observing the sensations you feel). This is the longest meditation I’ve ever done. The practices I have done before were breath meditations, usually only for a max time of 20 minutes. I really like the body scan because I am able to really focus and feel more in touch with what’s going on in my body. I feel like my mind wanders less then when I am doing breath meditation (focusing on your breath). It is very relaxing to have a break from your mind!

Of course, I’m not always in such a good mood when I go to meditate. Before I was meditating when I felt like it, which was usually when I already felt relaxed or calm. The idea of the MBSR program is that you commit to practice seven days a week for eight weeks – as Jon Kabat-Zinn says “you don’t have to like it, you just have to do it”. It sounds a little bit rigid but it’s really important while you are trying to establish meditation has a habit. When you go to practice and you realize you are stressed, agitated, and your mind is wandering everywhere, focusing can seem like the last thing you want to. But that’s when you realize how helpful mindfulness can be! It doesn’t necessarily produce calm every time. It does give you a chance to observe what is going on inside your head. Usually that helps me to figure out a more helpful way of dealing with things then spazzing out, or to recognize stressful patterns of thinking.

One thing I do have to keep working on is not to judge myself when I realized my mind has wandered off or I’m not feeling calmer/better after meditating. As the facilitator of my class says “if you have a mind, it’s going to wander”. You really can’t get into mindfulness with expectations about what it “should” do for you.

The other part of our homework was to try to eat mindfully at least once everyday. It’s really nice to realize how many sensations and moments are available to you if you stop to enjoy them. I love food, cooking and eating. When you realize how many times you just wolf down delicious meals… I always feel like my life is so limited now that I have fibromyalgia, so I think it’s really good for me to realize how much I do have around me to enjoy!