Since the 1980's Minduflness-Based Stress Reduction (MBSR) has been used successfully to help people manage stress and anxiety in relation to chronic pain, and learn how to better cope with pain. Chronic pain in this context is when pain persists longer than expected. Mindfulness training cannot necessarily reduce or cure pain of this type, but it does seem successful in minimising distress and anxiety about pain, and in reducing the impact pain can have on living one's life. In so doing it can help improve mood and the quality of life.
Research listed below that has evaluated the MBSR program has shown that it produces statistically significant improvement in ratings of pain, medical symptoms, and psychological symptoms, that are generally maintained over an extended period of time. Consistent with these research findings, Grossman et al. (2004) in a meta-analytic review of MBSR research concluded that mindfulness training is associated with increased coping with disability, reduced pain, and improved physical well-being for people with chronic and serious health conditions. Studies of Acceptance and Commitment Therapy (ACT) have also produced positive findings. On balance mindfulness training and ACT are associated with reductions in stress related symptoms, disability, sick days and utilization of health resources.
Recommended Reading:
- Dahl, J. & Lundgren, T. (2006). Living beyond your pain: Using acceptance and commitment therapy to ease chronic pain. New Harbinger Publications. Oakland, CA.
- Harris, R. (2008). The happiness trap: How to stop struggling and start living. Boston: Trumpeter.
- Kabat-Zinn, J. (1990). Full catastrophe living. New York: Dell Publishing.
- Nicoholas, M., Molloy, Tonkin, L., & Beetson, L. (2000). Manage your pain: Practical and positive ways of adapting to chronic pain. Sydnye: ABC Books.
Website Links:
- MBSR: www.umassmed.edu/content.aspx?id=41252
- ACT: www.actmindfully.com.au
- MBCT: www.mbct.co.uk
Technical References:
- Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10 (2), 125-143.
- Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and commitment therapy and the treatment of persons at risk for long term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy 35, 785-801.
- Grossman, P., Niemann, Schmidt, S., Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta analysis. Journal of Psychosomatic Research, 57, 35-43.
- Kabat-Zinn, J. (1982). An out-patient program in Behavioral Medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. Gen. Hosp. Psychiatry, 4:33-47.
- Kabat-Zinn, J., Lipworth, L. and Burney, R. (1985) The clinical use of mindfulness meditation for the self-regulation of chronic pain. J. Behav. Med., 8:163-190.
- Kabat-Zinn, J., Lipworth, L., Burney, R. and Sellers, W. (1986) Four year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clin.J.Pain, 2:159-173.
- McCracken, L., & Vowles, K., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, longstanding chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43 (10), 1335-1346.
- Siegel, R. D. (2005). Psychophysiological disorders: Embracing pain. In K. Germer, R. Siegel, & P. Fulton (Eds). Mindfulness and Psychotherapy, pp 173-196. The Guilford Press: New York.
- Turk, D. & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70 (3), 678-690.
The basic premise of how mindfulness training programs like MBSR and MBCT help with pain management is that they help to alleviate problematic psychological and behavioural coping responses to pain that counterproductively increase distress and the experience of pain. This view is based on the Biopsychosocial Model of Pain Perception and Disability. In this model, the perception of pain is based not only on biological factors, but a complex interaction of psychological and social factors, such as: emotion, beliefs, social environment, attitudes, expectations, and behaviours (see review by Turk & Okifuji, 2002). As such, people with chronic pain can get caught in spirals of negative thinking, negative emotion, and unhelpful behaviour that can increase pain, reduce mood and motivation, and thus cause pain experience to be more distressing and persistent (Nicholas et al. 2000). On this basis, mindfulness and mindfulness training cannot necessarily make pain dissappear, but can ease suffering and sensitivity towards pain by:
- Increasing present-moment focus.
- Cultivating acceptance towards unwanted experience.
- Increasing more helpful coping responses.
- Reducing fear of pain.
Together mindfulness practices can lead to change in how one experiences and appraises pain sensations, and how one thinks about one's ability to cope with pain when it arises (i.e., coping self-efficacy and pain tolerance increases). If a person fears pain less, then they are less likely to exert excessive attempts to control or avoid pain when it occurs. Indeed, excessive fear of pain and attempts to control pain may be important factors in turning sporadic pain into chronic pain (Dahl & Lundgren, 2006; Turk & Okifuji, 2002). In this view, pain is different from suffering. Suffering can be represented by the formula:
Suffering = Pain X Resistance to Pain (Siegel, 2005)
Thus, mindfulness leads to less suffering by reducing one's resistance to pain in the form of transforming unhelpful attitudes, expectations, and action tendencies into more balanced and accepting responses.
On this basis, MBCT and MBSR can be very useful psychological treatments that can help people manage and cope with chronic pain. However, Cognitive Behaviour Therapy (CBT) has also been very successful in helping people to manage with pain, and is employed in many pain management clinics (see Nicholas et al. 2000; Turk & Okifuji, 2002 in references). Both mindfulness and CBT promote new ways of thinking, behaving, and responding. In fact, a multi-pronged approach is probably the best approach. Although, appropriate medical assessment and advice is necessary before deciding on specific treatment options. Medical management, and a combination of appropriate physical, and psychological therapies is usually necessary (Nicholas et al. 2000). Start by discussing with your doctor the various options available, and then obtain a referral to appropriate allied health services.
