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Mind Over Pain: What Really Works?
Findings support cognitive behavioral therapy and mindful meditation

03/04/2019 By Michelle Lee with Craig Weatherby

About one in five Americans suffers from chronic pain — which can limit mobility and lead to anxiety, depression, and dependency on opioid drugs.

Worse, nearly one out of 10 Americans experience high-impact pain, which is defined as pain that limits at least one major life activity.

It’s estimated that the annual costs of chronic pain from medical care, lost productivity and disability programs reach $560 billion.

But emerging evidence is beginning to validate some alternative, non-drug methods of pain management — particularly cognitive therapy and mindfulness meditation.

New evidence review shows mindfulness may ease chronic pain
Earlier this year, scientists from several Canadian universities published the results of a novel evidence review (Khoo EL et al. 2019).

They searched the medical literature for randomized, controlled clinical trials designed to compare the effectiveness of cognitive behavioral therapy and mindfulness-based stress reduction at relieving chronic pain.

Cognitive behavioral therapy (CBT) is a type of psychotherapy that teaches patients how to change unhealthy emotions, behaviors and thoughts.

Mindfulness (or mindful) meditation is a 2,500-year-old Buddhist tradition, and practitioners simply focus on their breathing or heartbeat, letting thoughts pass by without lingering over them.

When employed or studied as a therapy, it’s sometimes referred to as mindfulness-based stress reduction or MBSR.

While prior research has shown that CBT can ease chronic pain, it’s less accessible to many due to cost and the need for a qualified therapist.

In contrast, MBSR can be practiced alone at virtually no cost — unless you include the price of books or smart phone apps designed to teach the practice.

The Canadian scientists search the medical literature for relevant clinical trials and found 21 trials involving 1,981 people — mostly women between the ages of 35 and 65 who suffered from musculoskeletal pain, often for a decade or more.

The Canadian team’s analysis didn’t detect any appreciable differences between MBSR and CBT — both provided significant pain relief and improved physical functioning.

However, the team offered some insights in their conclusions: “While CBT is considered to be the preferred psychological intervention of [chronic pain], not all patients with [it] experience a clinically significant treatment responsean additional solution may be to offer patients mindfulness-based stress reduction since it shows promise in improving pain severity and reducing pain interference and psychological distress.”

New York City pilot program showed promising results
A small study published last year tested whether meditation can help adults manage chronic pain and reduce their use of pain medications such as opioids (Wimmer M et al. 2018).

Researchers at the Hospital for Special Surgery (HSS) in New York City recruited 122 adult patients in their Ambulatory Care Center, which serves a low-income community with chronic pain and other chronic conditions.

The volunteers attended a monthly workshop led by a meditation teacher and a social worker and participated in a weekly telephone conference call designed to help them maintain their meditation routine.

At home, participants practiced mindful breathing and meditation techniques intended to help them manage their chronic pain and stress.

After each monthly meeting, participants were evaluated by the research team to determine how often the participants practiced meditation, and how their pain and stress levels changed, if at all.

These were the findings about the participants:

  • Almost all (93%) indicated that they would recommend the program to others.
  • One third (33%) reported using the mindfulness tools five or more times a week instead of medication, and 11% practiced mindfulness meditation three to four times per week in place of medication.
  • More than half of the participants indicated that mindful breathing helped them manage their chronic pain and stress.

The debriefings conducted by the social worker during the monthly sessions also revealed that — in addition to reduced pain and stress — many participants enjoyed improved daily function, calmness and state of mind after using the techniques.

As study co-author Robyn Wiesel said, “The results indicate that alternative approaches are effective in reducing pain and stress, and in improving self-management and general well-being. Based on the success of the Pain and Stress Management program in the orthopedic clinic, it has been expanded to include patients in the HSS Rheumatology Clinic, many of whom rely on opioid medication to manage chronic pain.”

And the study’s lead researcher, Maggie Wimmer, stressed the broad public health implications of their findings: “Opioid misuse and addiction are a major public health issue in the United States, and approximately 70% of individuals who use opioids on a long-term basis have a musculoskeletal disorder, such as low back pain or arthritis.”

Small study in U.S. veterans finds meditation helpful for chronic pain
Among Americans, military veterans suffer some of the highest rates of chronic pain.

The results of a small pilot study published four years ago suggest that they may be able to ease some of their chronic pain with meditation (Nassif TH et al. 2015).

This very small study — conducted at the Washington, D.C. Veterans Affairs Medical Center — was intended determine whether meditation therapy might be worth pursuing in larger trials.

Researchers at the VA Medical Center enrolled nine male military veterans, four of whom received iRest meditation treatment, while the other five served as a no-meditation control group.

The specific form of meditation — called iRest — was already in use at Veterans Health Administration medical centers and active-duty military facilities nationwide.

iRest is a meditation practice based on the ancient tradition of Yoga Nidra (also called yogic sleep), which clinical psychologist Dr. Richard Miller, who combined the traditional yogic practice with techniques from Western psychology and neuroscience.

All the study participants were combat veterans who’d returned with chronic pain and some amount of traumatic brain injury.

The test group attended twice-weekly meditation sessions and were given iRest recordings to assist their continued meditation practice at home.

At the end of the eight-week trial period, the veterans assigned to practice iRest meditation reported a 20% reduction in pain intensity, and less interruption of their daily activities and mood by pain (so-called pain interference).

As study co-author Thomas Nassif, Ph.D., said, “Meditation allows a person to accept pain and to respond to pain with less stress and emotional reactivity. Our theory is that this process increases coping skills, which in turn can help veterans to self-manage their chronic pain.”

And Dr. Nassif made an important point: “One of the most commonly used tools we have in our toolbox is opioids. Veterans in this study, and many who come to meditation sessions, find that opioid medication is a short-term solution. Meditation could be a useful tool to help veterans manage their pain over the long term.”

Based on this and other research, the Defense Centers of Excellence has approved iRest as a Complementary and Alternative Medicine warranting continuing research for its use in the treatment of post-traumatic stress disorder (PTSD).

In addition, the U.S. Army Surgeon General has listed iRest as a Tier 1 approach for addressing Pain Management in Military Care.

Sources

  • Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, Kerns R, Von Korff M, Porter L, Helmick C. Prevalence of chronic pain and high impact chronic pain among adults – United States, 2016. MMWR. September 14, 2018.
  • Hatchard T et al. Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioral therapy for the treatment and management of chronic pain disorders: protocol for a systematic review and meta-analysis with indirect comparisons. Syst Rev. 2014; 3: 134. Published online 2014 Nov 10. doi: 10.1186/2046-4053-3-134
  • Khoo EL, Small R, Cheng W, Hatchard T, Glynn B, Rice DB, Skidmore B, Kenny S, Hutton B, Poulin PA. Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis. Evid Based Ment Health. 2019 Feb;22(1):26-35. doi: 10.1136/ebmental-2018-300062. Review. PubMed PMID: 30705039.
  • Nassif TH, Chapman JC, Sandbrink F, Norris DO, et al. Mindfulness meditation and chronic pain management in Iraq and Afghanistan veterans with traumatic brain injury: A pilot study. Military Behavioral Health. 2015: pages 82-89. DOI:10.1080/21635781.2015.1119772
  • Wimmer M, Wiesel R, Adams B, Goldman M, Ologhobo T, Sun Y, Seehaus M, Goldsmith S, Robbins L. Complementary Practices As Alternatives to Pain: Effectiveness of a Pain Management Program for Patients in an Orthopedic Clinic [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10).