Exploring the Science Series: Meditation for Pain

Chronic pain is defined as pain lasting more than 3 months.  Unfortunately, it is extremely prevalent. In the United States, 20% of adults suffer from chronic pain, with 8% experiencing debilitating pain. For all of my Australian followers (yes, I’ve noticed you and thank you for reading!), the numbers are very similar.  There is slightly more prevalence for females, and increasing prevalence with age (31% in females age 80-84). There are an estimated 5-8 million Americans with chronic pain currently on opioids. 

If you are someone experiencing pain, what can be done? 

Of course, my answer is predictable. Meditation! 

Let’s review some of the relevant literature.

If you are in pain, your body is trying to tell you something. It’s yelling, “HEY YOU! OVER HERE!! PAY ATTENTION TO ME!!!” Although some types of meditation practices may teach you to ignore pain, or become immune to it, others may actually help your body to heal the pain.

You’ve probably heard of the “placebo effect”  (For those of us in medicine, it’s the “annoying” ever-present factor in clinical trials that mucks up our results. Haha.) The placebo effect is a beneficial effect of a placebo drug (a sugar pill) that cannot be attributed to the placebo itself, and is therefore attributable to the patient’s belief in the treatment.

Trials in patients with chronic pain have been done comparing opioid pain medication with placebo. Roughly half of patients taking a placebo notice a greater than 30% improvement in their pain level. Furthermore, 35% of patients taking a placebo noticed a greater than 50% improvement in their pain level! These sugar pills are powerful stuff! (1)

The placebo effect is a display of, right there in black and white published in the scientific literature, the POWER OF THE HUMAN MIND. It’s truly remarkable.

So…sugar pills can reduce pain via the mind-body connection, but does meditation? 

The answer is yes. A multitude of studies have shown that meditation reduces pain, and the effect is even greater than that of placebo. Here are a few examples:

John Kabat Zinn, the pioneer of mindfulness who created Mindfulness Based Stress Reduction (MBSR), published a study in 1985 showing that a 10-week MBSR program resulted in statistically significant reductions in present-moment pain, negative body image, inhibition of activity by pain, and mood disturbance (specifically anxiety and depression). Pain-related drug utilization decreased, and activity levels and feelings of self-esteem increased (2).  In theory, this type of meditation may help to decrease pain by guiding participants to be more versed at experiencing only the physical quality of pain without the mental overlay of negative thoughts and judgment, which subsequently lessens the perceived pain intensity.

Second, a study in veterans with chronic pain by Dr.’s Nassif and Norris showed that during the first few weeks of meditation practice, pain actually increased.  The pain was brought to consciousness and more fully experienced (instead of ignored or medicated). Subsequently, with continued practice, the pain lessened and for some even disappeared by 8 weeks of practice (3).

There are many more examples, but let’s switch gears a bit.

We know that meditation reduces pain… but, how?

 Activation of different neural pathways: A team of researchers led by Dr. Zeidan in 2015 performed a study comparing mindfulness meditation with placebo and showed that mindfulness meditation resulted in greater pain relief than placebo.  It was associated with greater activation in brain regions associated with the cognitive modulation of pain, including the orbitofrontal, subgenual anterior cingulate, and anterior insular cortex.  These are different neural pathways than are activated with placebo (4).

Thalamic gating theory: There is a theory of pain called the thalamic gate theory which hypothesizes that the brain can be in a receptive state to receive incoming pain information (gates open), or can be in a blocked state (gates closed).  This is best illustrated in traumatic injuries, when patients are under stress and often don’t register the pain associated with a severe injury until they are away from the threat. At the time of threat/greatest stress, the pain gates are closed as a protective mechanism to allow the person to escape the threat. Once the threat is gone, the gates are opened allowing the pain to be experienced. Attention on the experience of pain in the body has been shown to be a critical element in activating the body’s ability to heal itself.

Physical changes in brain structure: Another mechanism through which meditation is seen to achieve positive results for pain is through the neuroplastic properties of the brain, as mentioned in my previous blog. The structure of the brain can change through meditation. There is a bulking up of areas that are important for pain processing, resulting in higher pain tolerance (5).

In sum, although the mechanisms aren’t fully fleshed out, we do know that meditation works to lessen, and sometimes eliminate pain. 

If you’d like to implement meditation into your routine for chronic pain, I’d suggest starting with a progressive full body relaxation once per day, like the number one and seven meditations listed here: www.jointhecircleofhope.com/meditations