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.
Mindfulness is not a replacement for medical care. It can work alongside the treatment plan you and your doctor or pain specialist have agreed on, so talk with them before changing your treatment.
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. Current pain science holds that 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 can keep sending out pain messages, causing you to feel pain even when there is no ongoing 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 2015 paper proposing a chronic pain classification for the World Health Organization’s ICD-11 describes chronic pain this way: “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 many treatments and self-management techniques that can help you manage pain and break the pain cycle. Mindfulness is one technique that research suggests can help.
Mindfulness and chronic pain
Mindfulness can be a useful tool in managing chronic pain. Let’s take a look at 11 ways mindfulness may 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 can become tense and inflammation can increase, 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 can promote relaxation and stress relief. This may help break the stress and pain cycle, easing pain symptoms for some people 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 may gain greater control over their emotions. That can allow pain patients to feel more positive about the experience of chronic pain, which may play 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, they may regain the hope they 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 can lead to better managed and even reduced chronic pain symptoms.
This 2019 conference abstract in the Journal of Pain reports a secondary analysis of a randomized trial of 89 people with episodic migraine. Mindfulness-based stress reduction (MBSR) and a comparison stress-management program were “similarly effective in decreasing pain catastrophizing at the end of treatment compared to baseline”, and the authors note that MBSR “may not be more effective than providing disease and stress management education”.
4. Increasing grey matter
Some brain-imaging research suggests that regular meditation is linked to structural changes in the brain, including in areas involved in self-awareness and self-regulation. Grey matter is involved in functions such as regulating emotions, making decisions, solving problems and adapting to change.
A 2015 meta-analysis of MRI studies found that meditation practice “induces functional and structural brain modifications in expert meditators, especially in areas involved in self-referential processes such as self-awareness and self-regulation.” The authors also note it has been hypothesized 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.” That is a hypothesis, and this research was not specific to chronic pain.
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 may improve memory and the ability to focus, which could make a difference to pain patients who struggle with cognitive issues.
The same meta-analysis describes a model proposed by Lutz and colleagues, which posits that “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 improve quality of life.
Being present in the moment through mindfulness can help ease worry about the future, dwelling on pain in the present and feeling stuck in the past. This may lift your mood and help you 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 independence 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.
Research suggests mindfulness can support a more stable mood and better mental health. A 2017 systematic review and meta-analysis of mindfulness meditation for chronic pain found “low-quality evidence that mindfulness meditation is associated with a small decrease in pain” and reported that, “Mindfulness meditation was associated with statistically significant improvement in depression, physical health-related quality of life, and mental health-related quality of life.” The authors say larger, more rigorous trials are still needed.
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 may help with this acceptance, which can make it easier to seek out the treatments and activities that help.
This 2008 pilot study randomized 37 adults aged 65 and older with chronic low back pain to an 8-week mindfulness meditation program or a wait-list control group. Compared with the control group, the mindfulness group “displayed significant improvement in the Chronic Pain Acceptance Questionnaire Total Score and Activities Engagement subscale (P = .008, P = .004)”. The authors concluded that the program “may lead to improvement in pain acceptance and physical function.”
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 can come with mindfulness, muscles may loosen, which can reduce pain and provide relief for some pain patients. Progressive muscle relaxation (PMR) is a related relaxation practice that 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 may help to improve sleep quality, which is 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.
A qualitative study in the Journal of Pain analyzed diary entries from 27 older adults with chronic low back pain who took an 8-week mindfulness program, and found that “A number of participants reported improved sleep latency as well as quality of sleep.” Meanwhile this 2019 review concluded that, “mindfulness-based interventions (MBIs) may be promising treatments for improving sleep outcomes,” while noting that the evidence is mixed and more rigorous trials are needed.
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 may help you feel more in charge of how you live with chronic pain.
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 may improve quality of life for those with chronic pain
For many reasons, mindfulness can be a useful part of managing chronic pain, alongside the care you receive from your healthcare team. As you learn the skills of mindfulness you can bring 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! Practicing these skills regularly can help you build habits that last.
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
