Chronic pain means pain which is prolonged, lasting longer than 3 to 6 months. There are many types of chronic pain, and many symptoms including the pain itself. Living with chronic pain can be a difficult, complex experience
The mind and body are connected
The mind and body are deeply connected, which means that our emotions can influence our physical health. Chronic pain can be significantly impacted by our emotions, by stress levels and by how we perceive pain. This doesn’t mean that chronic pain isn’t ‘real’: it’s a very real physical experience. All pain is created in our brains, both acute pain (meaning the pain you get when you injure yourself) and chronic pain.
With acute pain, pain messages are sent out by the brain as a defence mechanism, to let you know that there is a threat present. For example, if you touch something hot, a pain message is sent by the brain to make you pull your hand away so you don’t get hurt. This protects you from further damage. If you are injured, for example if you trip and twist your ankle, the brain sends pain messages to let you know that your ankle is hurt so that you pay attention and seek treatment. These are very adaptive biological processes, meaning that they are useful.
However when pain becomes chronic, pain messages are no longer useful. Your brain is sending out pain messages causing you to feel pain even when there is no threat! This can happen for a number of reasons. Our brains are neuroplastic, which means that they learn from what is happening around us and from the experiences we go through in life. This doesn’t always mean they learn the right lessons though! The brain can ‘learn’ to continue producing pain messages, even after an injury has healed or a threat has passed. This is also known as central sensitization.
This study explains the World Health Organization (WHO) classification of chronic pain: “Chronic pain has been recognized as pain that persists past normal healing time and hence lacks the acute warning function of physiological nociception”.
This all sounds pretty dire, but there are lots of effective, scientifically proven treatments and self-management techniques which can help you to break the pain cycle and overcome your pain! Mindfulness is one of these highly effective techniques.
Mindfulness and chronic pain
Mindfulness is a powerful tool in treating and managing chronic pain. Let’s take a look at 11 truly amazing ways mindfulness can help pain patients:
1. Breaking the stress and pain cycle
When we’re stressed, this can worsen chronic pain symptoms. Just as the body isn’t designed to be in a prolonged state of pain, it’s also not designed to be in a prolonged state of stress. In this prolonged stress state, muscles become tense and inflammation increases, perpetuating pain. Yet the experience of living with chronic pain can be highly stress evoking in itself. This leads to a cycle of stress causing pain, and pain causing stress.
Mindfulness promotes a deep sense of relaxation and stress relief. This actively breaks the stress and pain cycle, reducing pain symptoms and providing relief for those with chronic pain.
2. Emotional regulation
The way we perceive our pain can also affect our pain levels. If we negatively perceive our pain, (for example feeling that we have no control over our pain or becoming fearful of our pain), we’re actually reinforcing to our brain that it ‘should’ continue producing these pain messages.
Those who practice regular mindfulness are able to gain greater control over their emotions. More control over their emotions can allow pain patients to feel more positive about the experience of chronic pain, therefore playing a part in retraining the brain away from pain.
3. Making adaptive choices
When we perceive our pain negatively, it can lead to us making maladaptive (meaning unhelpful) choices about managing our pain. If you don’t feel there’s ‘any point’ to trying to proactively manage your pain because you feel it can’t improve, then of course you’re unlikely to try and cope effectively or keep up with treatments. Understandably this can worsen pain.
When pain patients become fearful of making their pain worse, it can lead to withdrawal from activity through fear avoidance. This reduces levels of functioning and increases pain levels. Hypervigilance (meaning becoming overly aware of pain levels and anything that might worsen pain) and catastrophizing (thinking the worst about your pain) are also common, both of which perpetuate pain symptoms.
As patients gain greater control over their emotions and are able to regain the hope they may have lost. This can enable those with chronic pain to make more adaptive (meaning helpful) choices about how they cope with their pain. Adaptive coping strategies lead to better managed and even reduced chronic pain symptoms.
This 2019 study from the Journal of Pain tested mindfulness based stress reduction (MBSR) on patients with chronic migraines and found that it was, “effective in decreasing pain catastrophizing at the end of treatment compared to baseline”.
4. Increasing grey matter
Regular mindfulness practices have been proven to increase grey matter within the brain. Grey matter has many important jobs including helping to regulate emotions, helping you to make important and effective choices, aiding in solving problems and adapting to changes within your life.
This study on the effects of meditation explains that, “the stress reduction promoted by meditation contrasts hippocampal vulnerability to neurotoxicity and leads to increased hippocampal grey matter volume due to neuron preservation and/or neurogenesis.”
5. Improving memory and focus
Many chronic pain conditions include symptoms of cognitive problems. For instance, I live with fibromyalgia and struggle with ‘fibro fog’ which makes it hard to concentrate, leads to struggles with memory and even speech at times, among other cognitive symptoms. Over time, mindfulness can improve memory and the ability to focus, which can make a difference to pain patients who struggle with cognitive issues.
This in depth study makes a significant statement regarding the cognitive improvements to be gained through meditation: “meditation practice induces enhancement of at least four different abilities: sustained attention, monitoring faculty (to detect mind wandering), the ability to disengage from a distracting object without further involvement (attentional switching), and the ability to redirect focus to the chosen object (selective attention).”
6. Aiding in shifting the focus away from pain
As the ability to focus and actively shift that focus to another ‘object’ or situation is learnt, pain patients can gain the ability to shift the focus away from their pain. This ability to focus on other, more positive things, can notably improve quality of life.
Being present in the moment through mindfulness can stop the brain from worrying about the future, dwelling on pain in the present or feeling stuck in the past. This can lift your mood and enable you to focus on what is happening in the here and now.
7. Improving mental health
Living with chronic pain can understandably have a detrimental effect on an individual’s mental health. It can be highly emotionally taxing to be in pain, to feel that you’ve lost your indepence and to not be able to do the things you used to do before you became chronically ill: these are only a few of the factors which can impact mental health for pain patients.
It’s well established that mindfulness has the ability to promote a more stable mood and improve mental health. A 2017 study on the benefits of mindfulness for chronic pain concluded that, “Mindfulness meditation was associated with statistically significant improvement in depression, physical health-related quality of life, and mental health-related quality of life.”
It can be difficult to accept the changes that happen to your life as a result of living with chronic pain, and in fact can be tough to accept chronic pain itself. Mindfulness can aid with this acceptance, leading to a sense of emotional peace from which effective treatments can be sought to overcome chronic pain.
This study focused on adults with chronic lower back pain taking 8 sessions of mindfulness, and discovered that those who took part in the mindfulness sessions were more accepting of their pain and more willing to actively seek treatment than those who weren’t in the mindfulness group. The study found those who took part in the sessions, “displayed significant improvement in the Chronic Pain Acceptance Questionnaire Total Score and Activities Engagement subscale (P = .008, P = .004)”
8. Untensing muscles
Stress and chronic pain can result in prolonged muscle tension, which can be very painful within itself. Tense muscles can also reduce range of movement and flexibility, making even simple movements more difficult.
Through the relaxation that comes with mindfulness, muscles can be untensed, reducing pain and providing relief for pain patients. Progressive muscle relaxation (PMR) is a type of mindfulness which actively guides patients through relaxing each muscle group one at a time.
9. Improving sleep quality
One of the biggest problems pain patients face, myself included, is maintaining a regular sleep schedule. It can be very difficult to get to sleep and stay asleep when you’re in pain or are experiencing other uncomfortable symptoms. Unfortunately this lack of sleep can actually worsen symptoms for pain patients.
Mindfulness can markedly help to improve sleep quality, which is highly beneficial for those who struggle with ‘painsomnia’. You can even practice mindfulness in bed before you fall asleep at night to help you drift off to a deep sleep.
A study from the Journal of Pain found that, “A number of participants reported improved sleep latency as well as quality of sleep.” Meanwhile this 2019 study concluded that, “mindfulness-based interventions (MBIs) may be promising treatments for improving sleep outcomes.”
10. Increasing a sense of control
It’s common to feel that you’ve lost control over your own life when you live with chronic pain. Engaging in mindfulness means that you’re actively doing something to improve your experience of chronic pain. Additionally, regaining control over things like your sleep patterns, your cognitive processes and your emotions allows you to feel empowered over your chronic pain! Regaining this sense of control can be incredibly liberating.
11. Building confidence
It’s common for pain patients to lose confidence in their own abilities and even in their own self image as a result of living with chronic pain. When you feel that your body is ‘letting you down’ or you aren’t able to function the way you were before, it can really knock your self-esteem.
As pain patients find their mental health improving and begin to regain their hope for the future through mindfulness, that confidence can gradually be rebuilt. The regaining of control we discussed can allow patients to feel more confident in their own abilities.
Mindfulness can significantly improve quality of life for those with chronic pain
For so many reasons, mindfulness can be an effective way to treat chronic pain. Not only does mindfulness work in the short term, but as you learn the skills of mindfulness you can implement them into your daily life. Almost any action can be done mindfully, such as walking mindfully, taking a mindful bath, or even washing the dishes! As you gain these skills, you can ensure the results you get from mindfulness are long term and sustainable.
Why not check out our comprehensive guide to the use of mindfulness for chronic pain?
References:
Treede, R. D., Rief, W., Barke, A., Aziz, Q., et al. (2015). “A classification of chronic pain for ICD-11.” Pain 156(6), 1003–1007.
A.Kearson, L.Samawi, S.Burrowes, et al, (2019), “The Effects of Mindfulness-Based Stress Reduction on Pain Catastrophizing in Episodic Migraine” The Journal of Pain: Volume 20, Issue 4, Supplement, April 2019, Page S52
Boccia, M., Piccardi, L., & Guariglia, P. (2015). “The Meditative Mind: A Comprehensive Meta-Analysis of MRI Studies.” BioMed research international, 2015, 419808.
Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., et al, (2017). “Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis.” Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 51(2), 199–213.
Natalia E.Morone, Carol M.Greco, Debra K.Weiner, (2008), “Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study”. PAIN, Volume 134, Issue 3, February 2008, Pages 310-319
Natalia E.Morone, Cheryl S.Lynch, Carol M.Greco, (2008), ““I Felt Like a New Person.” The Effects of Mindfulness Meditation on Older Adults With Chronic Pain: Qualitative Narrative Analysis of Diary Entries”. The Journal of Pain, Volume 9, Issue 9, September 2008, Pages 841-848
Amanda J Shallcross, Pallavi D Visvanathan, Sarah H Sperber, Zoe T Duberstein, (2019), “Waking up to the problem of sleep: can mindfulness help? A review of theory and evidence for the effects of mindfulness for sleep”. Current Opinion in Psychology, Volume 28, August 2019, Pages 37-41
