Mindfulness for Chronic Pain Management

What is Mindfulness?

Mindfulness is ‘paying attention in a particular way: on purpose, in the present, and nonjudgmentally.’ ”4 (Kabat Zinn, 2009)

Mindfulness has a rich history originating from a blend of modern psychology and ancient meditation practices. In healthcare, mindfulness has two essential components:

• Focused attention

Focused attention includes noticing and thinking about an object or sensation (such as breathing, warmth, a light, movement, something being held, a taste or smell).

• Open monitoring

Open monitoring is the act of noticing thoughts and mental experiences while at the same time reflecting on the process of thinking (nonjudgmental observation).2,3

Chronic pain is pain that lasts longer or is stronger than what is considered to be normal within the healing period. Chronic pain can be the result of modulation (see Figure 1). In other words, pain signals can be altered and changed in the spinal cord—making them stronger than expected.6 This means the experience of pain can be changed (modulated), if we find the right techniques.

Why Mindfulness?

• Mindfulness is an evidence-based approach to dealing with chronic pain that has been tested and proven effective for over 35 years.7
• Mindfulness reduces reports of pain as well as use of pain medications.7
• Mindfulness-based approaches to reducing stress can increase coping ability, reduce pain, and lessen psychological distress (e.g., depression, worry, sadness, or anxiety).8,9
• Mindfulness has long-lasting effects: the changes in attention and thinking can continue to control pain even after it is practiced.7,10
• Mindfulness can be used anywhere and at any time to reduce pain.

Addiction to Pain Medication

Opioids have two effects in the brain, 1) an analgesic (pain-reducing) effect, and 2) a learned association of feeling relief. As the connection between medication and relief strengthens over time, lower levels of pain start to trigger the need for pain relief. This may result in early, inappropriate use of pain medication.11Treatment of chronic pain with opioids can create the experience of more pain (hyperalgesia) because of the changes in pain perception. The increase in pain can lead to increased stress. The pain and stress can start an addictive process of seeking more medication. The result can be a feeling of needing more medicine, even though the medicine isn’t helping as much as it did in the beginning.10 In other words, over time, individuals may feel more pain despite increasing their medication dosage, resulting in substance misuse.

How Mindfulness Works

Mindfulness targets sections of the brain that can be affected by stress, pain, and addiction.12 Mindfulness can restore the ability to mentally manage pain, emotion, and behavior.10 Instead of avoiding pain, mindfulness increases the ability to bear the unpleasant feeling without distress.

• Mindfulness is a type of mental training to develop skills in:
• Self-regulation—regulating pain, emotions, and actions without outside help
• Attentional re-orienting—not allowing a distracting thought or feeling to linger, or shifting attention away from distractions, back to the point of focus
• Metacognition—being aware of your thoughts
• Reappraisal—looking at something a second time to determine its meaning
• Inhibitory control—changing habitual reactions to things/situations

Getting the Most Out of Mindfulness 13

• Bring a beginner’s mind. Allow yourself to experience each moment as fresh and new without any expectations of what it could become.
• Nurture nonjudgment. It takes practice to slow things down and let distractions pass you by without passing judgement on likes/dislikes.
• Cultivate acceptance by actively recognizing that things are the way they are.
• Focus on non-striving by experiencing each moment of life without trying to make anything happen.
• Let go. Allow things to be what they are, without dwelling, and recognize that mindfully letting go is your doorway to freedom.
• Practice gratitude. Focus on the positive, don’t allow yourself to take the amazing things happening in your life each day for granted.

“Wherever you go, there you are.” (Kabat Zinn, 2009)

Some Examples of Every-Day Mindfulness Activities

Use your five senses to cultivate mindfulness in your daily life (sight, sound, taste, touch, and smell).

What	How
Mindful stretching or relaxation in the morning	Before getting out of bed in the morning, notice your breathing and take a few deep breaths or do some light stretching while focusing on the present moment and mentally accept the experiences this day will bring.
Mindfullness during daily grooming	During daily grooming tasks (teeth brushing, bathing, hand washing, etc.) notice your five senses (i.e., smells, sights, sounds, tastes, sensations from touch) in the moment and be present in your experience to minimize a wandering mind.
Mindful walks	Be mindful by noticing what is going on around you and focus on your five senses (i.e., smells, sights, sounds, tastes, sensations from your feet touching the ground) or focus on finding things in your environment for each color on the color wheel (i.e., red, orange, yellow, green, blue, and purple) to stay present.
Mindful eating	Focus on each aspect of eating through your fivc senses (i.e., smells, sights, sounds, tastes, sensations from touch) with emphasis on taste in the moment and be present in your experience to minimize a wandering mind.
Mindfulness during repetitive tasks	During repetitive tasks (ie., dish washing, waiting in lines, laundry) notice your five senses (i.e., smells, sights, sounds, tastes, sensations from touch) in the moment and be present to experience mindfulness.
Mindful meditation, pondering, or prayer at morning or night	Experience your thoughts or prayers in a nonjudgemental and accepting way, notice any judgements you may have and let them go, or replace negative thinking with a focus on things you are grateful for or keep a gratitude journal.

Getting Started in Mindfulness Meditation 13

• Set aside a time and place to meditate.
• Sit comfortably in a chair or on the floor with your back straight.
• Close your eyes, or loosely focus your gaze on an object.
• Breathe slowly, deeply, and gently.
• Keep your mind focused inward or on an object. If your mind wanders, gently guide it back to center.
• Breathe peace and quiet into your heart and mind.
• Be kind to yourself and let go of judgments or negative thoughts you may be having.
• Start small, without expectations or judgment of how long or how often to practice.

Mindfulness Resources**

Websites:

• American Mindfulness Research Association (AMRA): https://goamra.org/
• Self-Compassion (Dr. Kristin Neff): https://self-compassion.org/
• UC San Diego Health (Center for Mindfulness, Guided video about stress and mindfulness, and audio files to practices MBSR):  https://cih.ucsd.edu/mindfulness/guided-audio-video

Books:

• The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management by Jackie Gardner-Nix
• Mindfulness for Beginners by Jon Kabat-Zinn
• Wherever you go, There you are by Jon Kabat-Zinn
• Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World by Danny Penman and J. Mark G. Williams

Disclaimer

*Always consult a doctor when considering treatment or management of a medical condition.

**Please note that all of the resources provided are for educational purposes and USU does not specifically endorse their services. Mindfulness resources are intended to provide information, not to treat chronic pain or other mental health concerns. USU does not control the websites or books referenced above.

References

• Garland EL, Froeliger B, Howard MO. Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion Frontiers in psychiatry. 2014;4:173.
• Vago DR, Silbersweig DA. Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in human neuroscience. 2012;6:296.
• Bishop SR, Lau M, Shapiro S, et al. Mindfulness: A proposed operational definition. Clinical psychology: Science and practice. 2004;11(3):230-241.
• Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hachette Books; 2009.
• Wood S. Anatomy and physiology of pain. Nursing Times. 2008.
• Reichling DB, Levine JD. Critical role of nociceptor plasticity in chronic pain. Trends in neurosciences. 2009;32(12):611-618.
• Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985;8(2):163-190.
• Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004;57(1):35-43.
• Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010;68(1):29-36.
• Garland EL, Manusov EG, Froeliger B, Kelly A, Williams JM, Howard MO. Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. Journal of consulting and clinical psychology. 2014;82(3):448-459.
• Volkow ND, McLellan AT. Opioid Abuse in Chronic Pain--Misconceptions and Mitigation Strategies. N Engl J Med. 2016;374(13):1253-1263.
• Garland EL, Howard MO. Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research. Addiction science & clinical practice. 2018;13(1):14.
• Fabiny A. What meditation can do for your mind, mood, and health. Harvard women's health watch. 2014;21(12).

Authors

Maren Voss, Kandice Atisme, Ashley Yaugher, Sandy Sulzer

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