Americans Are Using More Alternative Pain Therapies

By Pat Anson, PNN Editor

It’s fair to say that almost every person living with chronic pain has been told by a doctor, loved one, friend or even strangers that they should try a “complimentary health approach” to pain management. Also known as a “multimodal” or “comprehensive” care, the idea is to get pain patients to reduce or stop using opioids and other medications by utilizing alternative health therapies such as massage, meditation and acupuncture.

A new study shows that there has been surge in the use of those therapies by Americans over the last two decades, with chronic pain sufferers leading the way.   

Researchers at the National Institutes of Health looked at data from the 2002, 2012, and 2022 National Health Interview Survey (NHIS) to evaluate the use of seven alternative therapies: yoga, meditation, massage, chiropractic care, acupuncture, naturopathy, and guided imagery/progressive muscle relaxation.

Their findings, published in JAMA Network Open, show significant increases in the use of all seven therapies. The most widely used alternative therapy was meditation, which rose from 7.5% of respondents in 2002 to 17.3% in 2022.The largest increase in utilization was for yoga, which rose from 5% of respondents in 2002 to 15.8% in 2022.

Complimentary Health Approaches Used by U.S. Adults

NATIONAL INSTITUTES OF HEALTH

By 2022, over a third of respondents (36.7%) reported using at least one complimentary health approach (CHA), up from 19.2% in 2002. Nearly half said they used a CHA for pain management.

The CHAs most widely used for pain in 2022 were chiropractic care (85.7%) and acupuncture (72.8%). Researchers think that expanded insurance coverage for those treatments may have contributed to their growing use. Significant reductions in opioid prescribing over the last decade may have also driven people to try other treatments.  

Complimentary Health Approaches Used for Pain

NATIONAL INSTITUTES OF HEALTH

“Between 2002 and 2022, US adults increasingly used CHAs, including for pain management. This shift in utilization coincides with increased pain prevalence nationally and may be attributable to several factors, including randomized clinical trials suggesting that some CHAs provide low to moderate levels of pain management, incorporation of CHAs into best practice pain management guidelines, and the need to mitigate unnecessary use of potentially harmful opioids through use of nonopioid interventions,” wrote lead author Richard Nahin, PhD, lead epidemiologist at the National Center for Complementary and Integrative Health.

As with many of these data mining studies, the NIH researchers did not document what kind of pain conditions the respondents had, how often they used an alternative therapy, or even whether the treatment worked.  

According to one estimate, 55 million U.S. adults spent $28.3 billion on CHAs in 2012, about 9% of total out-of-pocket health care expenses that year.

How to Overcome Repetitive Negative Thinking

By Anna Andrianova, Laval University

Do you ever find yourself caught in a cycle of negative thoughts? Maybe you ruminate on past mistakes, worry excessively about the future, or imagine worst-case scenarios?

Do you sometimes have a great day, everything goes well, and then your brain says, “Hey, remember that time you embarrassed yourself in front of everyone? Let’s relive that moment for the next 20 minutes.” And suddenly, your good day turns into a cringe-fest.

If so, know that you’re not alone. Many people struggle with repetitive negative thinking, and this can have a serious impact on mental health and well-being.

As the coordinator of expertise in caregiving at the Centre for Research and Expertise in Social Gerontology and an associate member of the Centre for Study and Research on India, South Asia and its Diaspora, I would like to shed light on the negative impact of repetitive negative thinking on the mental and physical health of caregivers.

Repetitive negative thinking (RNT) is a cognitive process characterized by persistent and intrusive contemplation on past events, commonly known as rumination, and apprehensions about future possibilities, often referred to as worries.

RNT is a recurring, unwelcome, and difficult to dislodge pattern of thinking that has been implicated in the onset and perpetuation of diverse mental disorders, including depression, anxiety, and post-traumatic stress disorder. Furthermore, RNT has been found to be associated with physical health and has been linked to an increased likelihood of future health issues. RNT may negatively impact one’s quality of sleep, decrease efficiency, and hinder decision-making abilities.

Recent studies have revealed that the severity of RNT is connected with changes in brain morphology, leading to a decline in general cognitive abilities and increasing the risk of developing Alzheimer’s disease. Even at low levels, RNT can have detrimental effects on the cardiovascular, autonomic nervous, and endocrine systems.

The Power of Mindfulness

So, what would be the most effective strategy for managing repetitive negative thinking? Research has demonstrated a negative correlation between RNT and mindfulness, implying that a low level of mindfulness can increase one’s susceptibility to RNT.

Mindfulness can be seen as a mental faculty or skill that can be developed through regular practice. It entails cultivating a non-judgmental and non-reactive awareness of the present moment. The objective is to be fully engaged in what’s happening right now, rather than dwelling on the past or worrying about the future.

There are two main styles of mindfulness practice: focused attention meditation and open monitoring meditation. Focused attention meditation involves choosing a specific object, such as the breath, and bringing your full attention to it. Whenever the mind wanders, it is simply brought back to the object of focus.

In contrast, open monitoring meditation involves being aware of everything occurring in the present moment. Instead of trying to focus on a specific object, one simply observes whatever arises in the experience, including thoughts, emotions, and physical sensations.

But what’s happening in the brain during these practices? Recent studies have revealed that only during focused attention meditation, there is a deactivation of the “default mode network” — a network of brain areas that are typically active when we’re not focused on any particular task. This network is implicated in “resting-state” thinking, which involves repetitive negative thinking. By deactivating the “default mode network,” focused attention meditation can help reduce this harmful type of thinking.

An Intervention for Caregivers

As part of our project, we will develop and examine an intervention targeted at reducing RNT in family caregivers.

According to a recent report, over eight million Canadians aged 15 and older, or 25 per cent of the population, provide care to a family member or friend with a long-term health condition, disability, or aging-related needs.

While caregiving can be rewarding, it can also be challenging and stressful, particularly for those who provide extensive or complex care. Chronic stress is a common experience for family caregivers, and it can take a toll on their health and well-being. A survey of caregivers found that the top areas of need for caregivers were emotional health (58 per cent) and physical health (32 per cent). RNT is strongly associated with caregiver burden and predicts negative impacts on the physical and mental health of caregivers.

We will recruit 100 caregivers with high levels of RNT. The intervention will be presented to participants in the form of interactive videos that guide them through the practice of focused attention meditation. We will measure changes in RNT, stress, anxiety, depression, and quality of life before and after the intervention, as well as at a six-month follow-up.

If the intervention is effective, it could serve as the basis for the development of an innovative tool for monitoring and reducing RNT. This tool could be deployed as a mobile app or on virtual reality platforms, providing caregivers with access to an intervention that they can use at their convenience. This could significantly expand the reach of the intervention, making it more accessible and convenient for caregivers who may not have the time or resources to participate in traditional face-to-face interventions.

Overall, the potential of the focused attention meditation intervention to improve the mental and physical health of caregivers, as well as the development of new innovative tools, represents a promising avenue in the field of caregiver support services. Further research and implementation of such interventions could significantly improve the quality of life for caregivers and the people they care for.

After all, to echo the words of philosopher Marcus Aurelius, “the happiness of your life depends upon the quality of your thoughts.”

Anna Andrianova holds degrees in psychology and social work, and is currently a doctoral candidate in social work at Laval University in Quebec. As part of her doctoral thesis, she explores the impact of the practice of mindfulness on the reduction of repetitive negative thoughts on well-being and health.

This article originally appear in The Conversation and is republished with permission.

Hypnosis Works Better Than Prayer as Pain Reliever

By Pat Anson, PNN Editor

When it comes to relieving acute pain, praying to God for help isn’t nearly as effective as a single session of hypnosis or mindfulness meditation, according to an unusual new study.

Intrigued by research that found Muslim prayer rituals reduce pain, an international team of researchers recruited 232 healthy adults in Portugal to further study the effects of spirituality on pain.

Short-term acute pain was induced in all participants by wrapping their arms and hands in a cold compress for up to 5 minutes. After a rest period, participants listened to either a 20-minute recording of guided hypnosis, mindfulness meditation, or a passage from the New Testament followed by a short Christian prayer. A fourth group listened to a reading from a natural history book and served as a control group.

After listening to the recordings, acute pain was induced again with a cold compress, while participants had their pain intensity, pain tolerance, cardiac function and stress levels monitored.

The study findings, recently published in the Journal of Pain Research, show that hypnosis was effective in lowering pain intensity and raising pain tolerance, followed closely by mindfulness meditation. The benefits from Christian prayer (CP) were small and not considered statistically significant.

“The findings suggest that both single short-term hypnosis and mindfulness meditation training, but not biblical-based CP, may be viable options for effective acute pain self-management,” researchers reported. “The findings also suggest that hypnosis might be slightly more efficacious than mindfulness meditation, at least in the short-term, and perhaps especially among novice individuals with very limited hypnosis or meditation practice/training.”

The research team was somewhat surprised by the lack of results for Christian prayer, and think it may have been due to the complexity of the bible-based prayer. A shorter, simpler form of prayer may have worked better. Another factor was that only a third of the study participants described themselves as Christian, while a third said they were atheists or agnostics.

“It is therefore possible that the prayer used in this study might have had a larger beneficial effect among those describing themselves as Christian than those describing themselves as being in one of the non-Christian groups and have had little (or even opposite) effect on atheists and agnostics. For the latter, prayer might have been bothering or even distressing, leading the individuals to focus more on the pain and on the distress caused by prayer itself,” researchers said.

Could Hypnosis Replace Opioids?

Previous studies have found that hypnosis and mindfulness can reduce acute pain in hospitalized patients, and that hypnosis can relieve chronic pain for patients with irritable bowel syndrome (IBS), complex regional pain syndrome (CRPS) and other intractable pain conditions.

A new study published in The Journal of Molecular Diagnostics even suggests that hypnosis can be an alternative to opioids in relieving post-operative pain.

Researchers at Stanford University say genetics play a role in “hypnotizability” — the tendency of some people to respond to hypnosis more than others — and developed a molecular diagnostic tool to identify individuals who would benefit from hypnosis through their blood and saliva samples. They believe the tool could be used as a “point-of-care” test in a hospital setting to determine how patients are treated for pain. Depending on the test results, a patient recovering from surgery could get “hypnotic analgesia” as an adjunct or alternative to pain medication.

“It is a step towards enabling researchers and healthcare professionals to identify a subset of patients who are most likely to benefit from hypnotic analgesia,” said co-lead investigator Jessie Markovits, MD, Department of Internal Medicine, Stanford School of Medicine.

“Precision medicine has made great strides in identifying differences in drug metabolism that can impact medication decisions for perioperative pain. We hope to provide similar precision in offering hypnosis as an effective, non-pharmacological treatment that can improve patient comfort while reducing opioid use.”

Mindfulness Program Reduced Chronic Pain and Opioid Use

By Pat Anson, PNN Editor

A mindfulness therapy program reduced chronic pain and emotional distress in patients on long-term opioid therapy, in what’s being touted as the first randomized clinical trial to demonstrate the effectiveness of psychotherapy in reducing pain and opioid use simultaneously.

Researchers at the University of Utah enrolled 250 patients being treated for chronic pain at primary care clinics in the Salt Lake Valley. Most participants took oxycodone or hydrocodone, reported two or more painful conditions, and met the clinical criteria for major depression. Over two-thirds had also been diagnosed with opioid use disorder.

Study participants were randomly assigned to either a standard psychotherapy support group or a mindfulness program called Mindfulness-Oriented Recovery Enhancement (MORE). Both groups met for 8 weekly two-hour sessions. Patients in the MORE group were trained to meditate on their breathing and body sensations, and to practice 3 minutes of mindfulness before taking opioid medication -- focusing on whether their opioid use was due to drug craving or the need for pain relief.

The study findings, published in JAMA Internal Medicine, showed sustained and significant reductions in pain symptoms, depression and opioid use in the MORE group nine months after treatment ended. Researchers say 45% of MORE participants were no longer misusing opioids (compared to 24% in the support group) and 36% had cut their opioid use in half.

“MORE demonstrated one of the most powerful treatment effects I’ve seen,” lead author Eric Garland, PhD, director of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah, said in a press release. “There’s nothing else out there that works this well in alleviating pain and curbing opioid misuse.”

Garland believes the sustained benefits of MORE might be related to the program’s ability to restructure the way the brain processes rewards, helping patients shift from valuing the physical and psychological effects of drugs to valuing natural, healthy rewards like a beautiful sunset or the smile on the face of a loved one. 

“Remarkably, the effects of MORE seem to get stronger over time,” said Garland, who has been studying mindfulness for over a decade. “One possible explanation is that these individuals are integrating the skills they’ve learned through MORE into their everyday lives.”  

MORE participants are taught to reevaluate the experience of pain and opioid craving, “zooming in” on what they are feeling and breaking it down into different sensations like heat, tightness or tingling. They learn how those experiences change over time, and to adopt the perspective of an observer.

“Rather than getting caught up in the pain or craving, we teach people how to step back and observe that experience from the perspective of an objective witness,” Garland explained. “When they can do that, people begin to recognize that who they truly are is bigger than any one thought or sensation. They are not defined by their experiences of pain or craving; their true nature is something more.”

Garland said the findings are particularly noteworthy because many participants had multiple chronic pain conditions, were on high-opioid doses and also had psychiatric disorders. The average pain duration of participants at the start of the study was nearly 15 years and their average pain score was 5.5 on a 1 to 10 pain scale.

Only 1 in 7 Chronic Pain Patients Use Opioids

By Pat Anson, PNN Editor

Have you tried physical therapy? What about yoga or Tai Chi? Did massage help you feel better?

Just about everyone in chronic pain has been asked that by family members, friends, doctors and sometimes even complete strangers.  The questions are innocent enough and usually well-meaning, but they often imply that a pain sufferer hasn’t looked beyond opioids for pain relief.

A new study shows that most people with chronic pain make extensive use of non-opioids and other “alternative” pain treatments – and that it’s relatively rare for a patient to only use opioids for pain relief.

The findings, published in JAMA Network Open, are based on answers to the 2019 National Health Survey by nearly 32,000 U.S. adults with chronic pain. The 2019 survey was the first to ask people about their use of 11 pain management techniques during the previous three months.

It turns out most people with chronic pain (54.7%) only used non-opioid pain management. And nearly a third (30.2%) used no pain therapy whatsoever. The rest either used opioids alone (4.4%) or a combination of opioids with one or more alternative treatments (10.7%).

That means only about 1 in every 7 adults with chronic pain even use opioids – a startling number when you consider the constant harping from anti-opioid activists and public health officials about how opioids are “overprescribed” in the U.S.   

“This study found that adults with chronic pain in the US use a variety of pain management techniques, including opioids,” wrote lead author Cornelius Groenewald, MB, a pediatric anesthesiologist and associate professor at the University of Washington School of Medicine. “Nonpharmacologic and nonopioid pharmacologic therapies are preferred treatments for chronic pain, and it is encouraging to note that most adults with chronic pain use a combination of various nonopioid modalities for treatment.”

Alternative Chronic Pain Therapies Used in 2019

• 18.8% Physical Therapy

• 17.6% Massage

• 15.6% Meditation or Relaxation Techniques

• 11.6% Spinal Manipulation or Chiropractic Care

• 8.5% Yoga or Tai Chi

• 5.1% Pain Self-Management Workshops

•  3.8% Psychological or CBT Therapy

• 1.8% Peer Support Group      

Nearly 40% of chronic pain sufferers reported using other therapies that were not listed in the survey. That may include treatments such as cannabis, kratom, medical devices, acupuncture or even ice packs. It would be good to include more of those options in future surveys.

Groenewald and his colleagues were disappointed that so few people used psychological techniques such as cognitive behavioral therapy (CBT), which was the only alternative pain therapy that they said was “underused.”   

The researchers found that complementary, psychological or psychotherapeutic therapies were more likely to be used by younger adults, females and people with more education. Adults using physical, occupational or rehabilitative therapies were more likely to be older, female, highly educated and have medical insurance.

What I Learned About Meditation and Acceptance

By Mia Maysack, PNN Columnist

Recently I was asked how I've managed to deal with agonizing pain every day for over 20 years. The answer is far from simple, as it has been an extraordinarily long road that I'll continue to travel for the rest of my life.  

After over a decade of attempting mainstream remedies such as pills, injections, procedures and other therapies, I reached a point of hopelessness that led to contemplating the possibility of giving up. I had become tired and sick of being sick and tired. 

I still am! 

At the beginning of my holistic journey, I felt as though all my options were exhausted. Enough already with the corporate approach to medicine, along with being treated as either a drug seeker or experimental lab rat. 

To be clear, I'm tremendously grateful for all the avenues I've been able to travel, as well as the providers who did what they could to help me along the way. I am even thankful for the doctor who initially misdiagnosed my ear infection as “swimmer’s ear” -- even though it almost cost my life and led to a permanent state of discomfort. 

I wouldn't be who I am without those experiences, nor would I now be in this position to assist others in the treacherous journey that is chronic illness. 

Acknowledging grief, as real a symptom as the hurt itself, was a first step for me. I had to come to terms with knowing what I experienced was not a personal punishment, and also develop a relationship or coexistence with it that was mandatory for my survival.  

After growing in affirmation of those truths, I was then able to wrap my mind around acceptance. That didn't mean I liked the situation and I still don't! My illness doesn't define who I am as a person or where I'm able to go from here -- based on the things that I can control.  

This would be about the time some of you may question the merit of what I'm speaking about. So let me take this moment to break it down.  

Is an altered state of mind going to address or correct all my problems?  No.

Am I suggesting the idea that "positivity" cures?  Also no.  

I am reminded of a medical professional who endured a traumatic spinal injury and was told they'd never walk again. This began a four month long meditative process for this individual, who envisioned having surgery to the point of feeling its physical effects. Needless to say, they are not only walking again, but still practicing medicine.

Of course, there are things that cannot be "fixed." But shifting gears in how we think about a problem cultivates space for an opportunity to no longer dwell on what we're unable to change. Instead, we can invest and focus on what we can change.  

Dwelling isn't the same as grieving, so give yourself permission for having thoughts of "screw this!"  

Exploring new territory is what it means to be human. When we decide our experiences are opportunities for evolution, there's always a chance of merging onto an “on-ramp” that leads to personal growth and acceptance. 

That's another benefit of meditation that I encourage you to study for yourselves. When our bodily systems are more relaxed and we're breathing adequately, there's often improvement in how we’re feeling. Each moment consists of evolution because things are always changing, 

It took a while, but I've come to embody that same sort of energy. There's a lot throughout the world I can’t do very much about. But there are small things I can handle with great love, which includes coexisting with the different aspects of my life. Compassionate nurturing is a monumental and radical task, but it's vital and necessary.  

Mia Maysack lives with chronic migraine, cluster headache and fibromyalgia. Mia is the founder of Keepin’ Our Heads Up, a Facebook advocacy and support group, and Peace & Love, a wellness and life coaching practice for the chronically ill.

Emotional Awareness: How I Learned to Connect with Life and Disconnect from Pain

By Dr. David Hanscom, PNN Columnist

Last month I wrote about the importance of environmental awareness – being aware of your moods, anxiety and other senses and learning how to calm them through active meditation.

In this column we’ll look at emotional awareness – living a life full of rich relationships and satisfying endeavors. You must understand the nature of someone else’s emotional needs before you can interact with them in a meaningful way.

In the presence of chronic pain however, this is a problem. When you are in pain, you are justifiably angry, which can block emotional awareness. You are just trying to survive and don’t have the capacity or energy to reach out to others.

Another problem with pain-induced anger is that it not only disconnects you from others, but also from yourself. You are so used to being in this agitated state that you feel it is the norm.

I am quite aware of this scenario, as this was my experience. I was constantly agitated, but did not perceive it as anger. I thought I could hear what others were saying and see issues through their eyes. I was idealistic and thought I was right – but was so wrong.

It wasn’t until I had every layer stripped away in the midst of suffering from severe chronic pain, that I could see the problem. Meanwhile, I lost my marriage.

Self-Discovery

The problem with becoming emotionally aware is that you have to allow yourself to feel unpleasant emotions, such as anxiety, sadness, vulnerability, shame and so on. If you don’t allow yourself to feel the dark side of life (which is core to the human experience), then you won’t be able experience deep joy, happiness and love.

My strategy for most of my life was to suppress all negativity and keep my emotions on an even keel. One of my nicknames was “The Brick.” At the time, I thought it was a compliment because it meant I was tough.

It all worked until it didn’t. At age 37, I began to experience severe anxiety in the form of panic attacks. They came out of the blue and I had no idea what had hit me. I didn’t emerge from this hole for another 13 years.

Unless you actively choose a journey of self-discovery, you can’t connect with your true emotional state. You must commit to stepping outside of your mind and looking at yourself from a different perspective.

Ask yourself these questions: Am I open? Am I coachable? Can I really listen and feel?

That is a starting point. Once you get in touch with what’s going on in your mind, you can embark on a powerful journey. Allowing yourself to feel your emotions is a learned skill with many ways of accomplishing it. You will fail endlessly, but the key is remaining open and persistent.

Many people choose not to take this journey. But they make that choice at their own peril. It is what you’re not aware of that will run your life. The result may be a lot of physical and emotional suffering for the individual and especially for those close to him or her.

Why don’t more people pursue a path of self-discovery? It may be because in our culture most of us spend a lot of emotional energy trying to look good to people around us. We also try to look good to ourselves.  

Truly connecting with your emotions is an act of humility. Most people don’t want to do something so difficult and unpleasant. However, it’s also extremely rewarding and makes life so much easier in the end. It was the beginning of my recovery from my own chronic pain.

Dr. David Hanscom is a retired spinal surgeon. In his latest book -- “Do You Really Need Spine Surgery?” – Hanscom explains why most spine operations are unnecessary and usually the result of age-related conditions that can be addressed through physical therapy and other non-surgical methods.

How to Control Anxiety and Pain Through Meditation

By Dr. David Hanscom, PNN Columnist

Every sense in your body has a threshold that indicates danger – hot, cold, bitter, loud, bright, sharp, pressure, burning, nausea, etc. Without that immediate feedback from your senses, you could not protect yourself from whatever the danger is.   

When any physical threat is sensed, your body secretes chemicals and hormones to increase your chances of survival. They include cortisol, adrenaline and histamines. This chemical bath affects every cell in your body and you are on “high alert.” The feeling generated is anxiety and it is not a psychological reaction. 

Humans have a problem in that mental threats manifested by unpleasant thoughts are processed in similar area of the brain and cause the same hormonal response. But since we can’t escape our thoughts, we are subjected to sustained levels of these chemicals. One of the effects is increasing the speed of nerve conduction. All of our senses are heightened, including various types of pain.  

Environmental Awareness 

Being aware of your senses – known as environmental awareness –-- is a strategy that allows you to switch sensory input from racing thoughts to another sensation. It doesn’t matter which sense you choose.

I practice one that I call “active meditation” or “meditation on the run.” Being aware of your senses has a calming effect on your nervous system. Active meditation enabled me to be a calmer person and more effective in my work.  

As a retired spine surgeon with many years of experience, I was often referred complicated spine problems that required complex surgeries. Sometimes those surgeries resulted in complications for the patient. Although I was committed to having no complications from the first day I walked into the operating room, there was a point a few years ago when I faced up to the fact that I hadn’t been able to eliminate them. My own thoughts were interfering with my work.  

The most common interferences I felt during surgery were frustration, anxiety, distraction, complacency, and, especially, being in a rush to finish. They all detracted from the consistency of my performance. This led me to develop a somewhat defensive mindset. If I could get through the week without a surgical complication, it was a huge relief.  

Learning Active Meditation

Things changed when I decided to enlist the help of a performance coach to help me reduce any mistakes in surgery. That was a major turning point in my professional life. I brought my coach into the operating room and clinic so he could better understand my world. For 18 months, he and I underwent regular debriefings and coaching. I began to use active meditation in the operating room. 

This meditation model is not based on suppressing interference – for instance, if you’re frustrated, you don’t pretend otherwise – rather, you face these frustrations and then detach from them. Using tools and approaches that have been employed for centuries in the practices of meditation and mindfulness, I learned to identify any interference either before or during surgery, and then let go of it.  

This is how it worked: Each surgical morning, I woke up and assessed how I was feeling. Like everyone, my feelings ranged from calm and relaxed to tired and anxious. Then, I immediately started sensing every smell, touch and taste possible. I felt the water on my back in the shower. I smelled the coffee. I also reminded myself that although that day’s surgery is “just another case” for me, it’s one of the most important days of my patient’s life.  

I continued this process in the operating room. I carefully arranged the room, talked to each member of the surgical team, and reviewed the imaging studies. I was focused and immersed in what’s right in front of me, when previously I’d rush into the operating room at the last minute just before making the incision. 

During surgery, awareness allowed me to perform my next move at an optimum level. I felt my grip pressure on each surgical tool; noticed the shape of the contours of the anatomy; felt my shoulder and arm muscles stay relaxed; and just watched the flow of the case.  

If I felt any disruptive emotions intrude into my state of mind, I quickly practiced my environmental awareness techniques in order to re-focus. I learned to be more fully engaged on a higher percent of cases, so I could “program” myself into the “zone.” 

Since I started practicing active meditation, my complication rate in surgery noticeably decreased. For instance, from 1999 until 2003 I had an “acceptable” 9% rate of inadvertently entering the dural sac (a sack of fluid surrounding the brain and spinal cord). After I started using meditation, I made this mistake only two or three times a year, which is less than one percent. 

Surgery became a wonderful experience for me. I eagerly looked forward to Monday instead of Friday. I committed to getting a good night’s sleep before my surgeries.  If I woke up “wired” and uneasy, I slowed down until I felt relaxed, no matter how many things were on my to-do list.  

I continue to practice active meditation daily. Environmental awareness is more difficult outside the operating room, in the less controlled areas of my life, but it is still my go-to active meditation.   

One tool I use to practice awareness is my “to do” list. I remind myself that this list is an expression of my life, and so I practice being aware as I go about each item. For instance, when I have an appointment with a patient, I listen to myself talk to him or her.  I feel the pen on the paper as I jot down notes.  I also practice meditative techniques. such as watching the disruptive thoughts of “need to finish up here, I have other things to do” enter my consciousness and then leave.  

I remember that my goal is to engage and enjoy every second of my “to do” list. It doesn’t always work, but it’s surprising how often it does.

Environmental awareness engages me in the present moment regardless of the circumstances. It is not positive thinking, but just switching the sensory input. With repetition, it has become somewhat automatic. It is a simple strategy that can help the quality of your life, regardless of the level of your pain.  

Dr. David Hanscom is a retired spinal surgeon who has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery.

In his latest book, Do You Need Spine Surgery?, David explains why spinal surgeries are often risky and unnecessary.

This column is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Study Finds Mindfulness Reduces Pain and Despair

By Pat Anson, PNN Editor

“Mindfulness” may as well be a four-letter word to chronic pain patients. Many have tried mindfulness meditation – a form of cognitive behavioral therapy (CBT) – and found it does not relieve their pain.

“The quackery continues,” one reader told us. “This is a modern-day lobotomy experiment.”

“I have tried CBT and mindfulness. They made me feel much worse emotionally, paradoxically enough, and made me more acutely aware of the pain,” another patient said.

“We have ALL been through almost every other treatment you can think of including psychological therapy, mindfulness, yoga, etc. before given opiates. We still use these to help cope, but they do not really help much when all you want is to die to stop the pain you are in,” another patient wrote.

A new study at the University of Utah provides some intriguing evidence that mindfulness can enhance the quality of life, while also reducing pain and the need for opioids.

The study, published in the journal Science Advances, looked at data from four experiments involving 135 adults who took opioids daily for chronic pain.

Participants were randomly assigned to two groups that participated in eight weeks of support group therapy or eight weeks of a meditation program called Mindfulness-Oriented Recovery Enhancement (MORE), which was primarily designed to treat addiction. Patients in the MORE group were asked to focus on rewarding experiences, such as watching a beautiful nature scene.

At the beginning and end of the study, researchers collected electroencephalogram (EEG) data from the participants, using electrodes on the face and scalp to track their eye movements, smiles, frowns, changes in heart rate, and brain function.

Researchers say patients in the MORE group had fewer cravings for opioids and became more responsive to pleasant images by using mindfulness. They also reported significantly less pain, more positive emotions, enhanced joy and more meaning in life compared to patients in the therapy group.

IMAGE COURTESY UNIVERSITY OF UTAH

"Previous research shows that prolonged use of opioids makes our brains more sensitive to pain and less receptive to the joy one might normally experience from natural rewards, like spending time with loved ones or appreciating a beautiful sunset," said lead author Eric Garland, PhD, an associate dean for research at the University of Utah College of Social Work.

“This blunted ability to experience natural positive feelings leads people to take higher and higher doses of opioids just to feel okay, and ultimately propels a downward spiral of opioid dependence and misuse. Because of this downward spiral, scholars are increasingly referring to chronic pain and opioid misuse as 'diseases of despair.'"

Garland developed MORE as a mindfulness therapy to promote positive psychological health while simultaneously addressing addiction, pain and stress. MORE teaches mental training techniques to help people find meaning in the face of adversity, while simultaneously alleviating physical and emotional pain by cultivating positive feelings and experiences.

"MORE teaches people to better notice, appreciate and amplify the good things in life, while also deriving meaning and value from difficult situations," said Garland.

Previous studies on mindfulness using MRI imaging found that changes in the brain do occur during meditation, making people less sensitive to pain. Meditation activated brain regions associated with the self-control of pain, while deactivating regions that process sensory information.

You can take a free 20-minute guided meditation at Meditainment.com. The online mindfulness program takes you into a “secret garden” of your own imagination, designed to help your pain seem less important.

Mindfulness Is More Than Yoga

Barby Ingle, PNN Columnist

For years I’ve used mindfulness meditation techniques to help with my chronic pain. So imagine my surprise last week as I was watching the Pain Management Best Practices Inter-Agency Task Force meeting and a practitioner on the panel said yoga and mindfulness are essentially the same thing.

I’ve never done yoga as part of my mindfulness meditation. But it made me start to wonder. Have I been doing mindfulness wrong for years?

A quick Google search showed me there are more than 25 mindfulness activities. Yoga was one of the items on the list, but not everyone doing yoga is doing it for mindfulness. Most use it for physical exercise.

Another practitioner on the task force said that mindfulness is not a treatment by itself and that it is typically done in conjunction with other modalities. I totally agree. There are many group and individual activities that use mindfulness to reduce stress, anxiety, depression and pain.

Mindfulness is just one form of self-care that I use do to help manage the symptoms of living with chronic conditions. By itself, mindfulness is not enough to sustain me, but in conjunction with other treatments I find it helpful.  

I personally like individual mindfulness activities. Some of the activities are really short and some take up to an hour. Depending on what I need, I choose one that best suites me in the moment. Some of the activities I use for improving my life include virtual reality, self-compassion, reviewing my "I Am" list, meditation, 5 senses exercise, breathing exercises, music therapy and aroma therapy.

If you have trouble practicing mindfulness alone, one of the group activities is known as the FAKE plan, which involves about 8 members meeting for 2 hours every week for 12 weeks. The first portion of each session is devoted to a short mindfulness exercise and discussion, and each week is dedicated to a specific type of mindfulness exercise.

This is great for patients with social anxiety disorder but can also be helpful for others who want to work on their social skills through group mindfulness activities.  

Another mindfulness exercise that I found in my Google search (but have not yet tried) involves staring at a leaf for 5 minutes. A leaf is like a fingerprint or snowflake -- no two are the same. You can focus on the leaf’s colors, shape, texture and patterns. This type of activity brings you into the present and helps align your thoughts.

When I am not able to perform the physical or cognitive tasks I want to because of physical pain, I can get situational depression. For me, this is the best time to use my mindfulness activities. One study identified three ways mindfulness helps when you are depressed:

1.  Mindfulness helps people learn to be present in the moment, take stock of their thoughts and feelings, and choose an appropriate response rather than get caught up in negative emotions.

2.  Mindfulness teaches people that it’s okay to say “no” to others, which helps them balance their own lives and enhance self-confidence.

3.  Mindfulness allows people to be present with others, making them more attentive to their relationships, aware of their communication problems and more effective in relating to others.

These are important tools that can help chronic pain patients better manage their lives. Mindfulness activities help clear your mind of worry about the past or future and allow you to focus on the present.

Whether you are using mindfulness for anger, depression, chronic pain, anxiety or just for overall mental health -- it is important to keep an open mind. I know that is easier said than done when you are in severe pain. But the more you practice mindfulness the easier and more useful it becomes.

Can mindfulness cure you? No. Its purpose is to relax and help put life into perspective. If you are angry and distressed, that’s okay. I go there too sometimes. I use mindfulness to live in the moment and manage my emotions so that I am better able to manage my physical pain.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Why 'Mindful People' Feel Less Pain

By Pat Anson, Editor

Mindfulness meditation is a form of cognitive behavioral therapy (CBT) that is often recommended to chronic pain patients as a way to temporarily relieve their pain, anxiety and depression. 

Does it work? Pain sufferers report mixed results.

“I have tried CBT and mindfulness. They made me feel much worse emotionally, paradoxically enough, made me more acutely aware of the pain,” one reader told us.

“The quackery continues,” wrote another. “This is a modern day lobotomy experiment.”

“Mindful meditation is a wonderful tool in managing chronic pain and the depression that comes with it,” said another. “Those of us suffering daily need every tool in the shed.”

Researchers at Wake Forest University may have discovered why mindfulness works for some, but not for others. Their brains react differently to meditation.

"We now know that some people are more mindful than others, and those people seemingly feel less pain," said Fadel Zeidan, PhD, an assistant professor of neurobiology and anatomy at Wake Forest School of Medicine.

WAKE FOREST UNIVERSITY

In a study involving 76 healthy volunteers, Zeidan and his colleagues found that a part of the brain that processes self-related thoughts, feelings and emotions is more active in people who reported higher pain levels during mindfulness meditation.

While practicing mindfulness, MRI’s were taken of the volunteers’ brains as they were exposed to painful heat stimulation (120°F).

Analysis of the MRIs revealed that those who reported lower pain levels when exposed to heat had less activity in the posterior cingulate cortex. Conversely, those that reported higher pain levels had more activity in that critical part of the brain.

"The results from our study showed that mindful individuals are seemingly less caught up in the experience of pain, which was associated with lower pain reports," said Zeidan. "Now we have some new ammunition to target this brain region in the development of effective pain therapies. Importantly this work shows that we should consider one's level of mindfulness when calculating why and how one feels less or more pain." 

The study is being published in the journal PAIN.

A previous study by Zeidan found that mindfulness activates parts of the brain associated with pain control, while it deactivated another brain region (the thalamus) that regulates sensory information. By deactivating the thalamus, meditation may cause signals about pain to simply fade away.

In addition to relieving pain, there is increasing evidence that meditation and CBT are effective in treating mental health issues, such as anxiety, depression and stress. One study, published in the British Medical Journal, found that online mindfulness courses were often just as effective as face-to-face meetings with a therapist.

You can sample a relaxing online pain management meditation at Meditainment.com (click here to see it). The initial course is free.

Can Reading Help Relieve Chronic Pain?

By Pat Anson, Editor

A good book is not only hard to put down -- it may also help relieve symptoms of chronic pain by triggering positive memories, according to a small British study.

Researchers at the University of Liverpool brought together a group of ten people with severe chronic pain once a week to read literature together aloud. The reading material included short stories, novels and poetry, and covered a wide variety of genres and topics.

While passages were read aloud in the “Shared Reading” exercise, regular pauses were taken to encourage participants to reflect on what is being read, on the thoughts or memories it stirred, and how the reading matter related to their lives.

Researchers compared the Shared Reading group to another group practicing a form of cognitive behavioral therapy (CBT).

While participants in the CBT group were encouraged to manage their emotions by focusing on the pain experience, Shared Reading encouraged pain sufferers to recall positive memories from their past before the onset of chronic pain.

"Our study indicated that shared reading could potentially be an alternative to CBT in bringing into conscious awareness areas of emotional pain otherwise passively suffered by chronic pain patients,” said Josie Billington, a researcher at the University’s Centre for Research into Reading, Literature and Society.

"The encouragement of greater confrontation and tolerance of emotional difficulty that Sharing Reading provides makes it valuable as a longer-term follow-up or adjunct to CBT's concentration on short-term management of emotion."

Researchers say Shared Reading has a therapeutic effect because it helps participants recall a variety of life experiences -- from work, childhood, family and relationships -- not just memories that involve chronic pain.

The study, published in the BMJ Journal for Medical Humanities, was funded by the British Academy.

While many pain sufferers are deeply skeptical of CBT, meditation and similar forms of “mindfulness” therapy, there is evidence that they work for some. A recent study found that CBT lessened pain and improved function better than standard treatments for low back pain.

Another study at Wake Forest University found that mindfulness meditation appears to activate parts of the brain associated with pain control.

Study Finds Meditation Effective for Low Back Pain

By Pat Anson, Editor

A form of meditation called mindfulness-based-stress-reduction is more effective in treating chronic low back pain than the “usual care” provided to patients, according to a new study published in JAMA. The study also found that cognitive behavioral therapy also lessened pain and improved function better than standard treatments for patients with low back pain.

Mindfulness-based stress reduction (MBSR) is a mind-body approach that focuses on increasing awareness and acceptance of moment-to-moment experiences, including physical discomfort and difficult emotions. Although MBSR is becoming more popular, few studies have been done on its effectiveness in treating low back pain.

Cognitive behavioral therapy (CBT) is a form of psychotherapy, in which a therapist works with a patient to reduce unhelpful thinking and behavior.

Researchers in Washington state enrolled 342 people in the study with chronic low back pain and divided them into three groups that received yoga, training and treatment with MSBR, CBT or usual care.

After 26 weeks, 61% of the patients in the MSBR group reported clinically meaningful improvement in function, compared to 58% in the CBT group and 44% of those who received usual care. Similar results were also found in pain relief.  

Participants in the MSBR and CBT groups also reported less depression and anxiety than the usual care group. 

The researchers said the results were “remarkable” because nearly half of the patients enrolled in the MSBR and CBT groups skipped several of the group sessions they were assigned to.

“In a time when opioid prescribing is on the decline I would think this would be exciting and welcome news for those of us who suffer severe, chronic pain,” said Fred Kaeser, who battled severe back pain for many years, and eventually found relief through a combination of meditation, exercise and changes in diet.

“Very encouraging to think that we are getting very close to being able to say that MBSR and CBT are empirically valid, pain-reducing, complimentary therapies to whatever medical care one might usually receive for the mitigation of pain.  The thought that one might also be able to reduce one's intake of pain medications and possibly other intrusive pain interventions by engaging in a therapy that is extremely safe with no side-effects is exceptionally encouraging,” Kaiser wrote in an email to Pain News Network.

“Hopefully, people who have previously dismissed the idea of mindfulness meditation or CBT as a valid pain reducing strategy will re-think their position and give these, as well as other promising complimentary pain reducing modalities, a try.”

Recent studies by researchers at Wake Forest University found that mindfulness meditation appears to activate parts of the brain associated with pain control.

Lower back pain is the world’s leading cause of disability. About 80 percent of adults experience low back pain at some point in their lives.

Study May Explain How Meditation Relieves Pain

By Pat Anson, Editor

Some pain sufferers report success using cognitive behavioral therapy and mindfulness mediation to reduce their pain. But how those techniques work is a bit of mystery and has led to speculation that they have a placebo effect on pain.

But a new study by researchers at Wake Forest University suggests that meditation really does provide pain relief – but not by utilizing the body’s natural endogenous opioid system.

“Our finding was surprising and could be important for the millions of chronic pain sufferers who are seeking a fast-acting, non-opiate-based therapy to alleviate their pain,” said Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center.

Zeidan and his colleagues enrolled 75 healthy, pain free volunteers in a study. Some were injected with naloxone, which blocks the pain reducing effects of opioids, while others were injected with a placebo saline solution.

Participants were then divided into four groups: meditation plus naloxone; no meditation plus naloxone; meditation plus placebo; or no meditation plus placebo.

Pain was induced in all four groups with a thermal probe that heated their skin to over 120 degrees Fahrenheit (49 degrees Centigrade), a level of heat that most people find very painful.

The group that meditated and was injected with naloxone had a 24 percent reduction in their pain ratings, showing that even when the body’s opioid receptors were chemically blocked, meditation still was able to significantly reduce pain. Pain ratings were also reduced by 21 percent in the meditation group that received the placebo injection.

By comparison, the two control groups that did not meditate  reported increases in pain regardless of whether they got the naloxone or placebo-saline injection.

“Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain,” said Zeidan. “And now this study shows that meditation doesn’t work through the body’s opioid system.

“This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain. These findings are especially significant to those who have built up a tolerance to opiate-based drugs and are looking for a non-addictive way to reduce their pain.”

The next step for researchers is to determine how mindfulness meditation can affect a spectrum of chronic pain conditions.

“At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without it producing the addictive side effects and other consequences that may arise from opiate drugs,” Zeidan said.

An earlier study by Zeidan found that mindfulness meditation activates parts of the brain (orbitofrontal and anterior cingulate cortex) associated with pain control, while it deactivated another brain region (the thalamus) that regulates sensory information. By deactivating the thalamus, meditation may cause signals about pain to simply fade away.

In addition to relieving pain, there is increasing evidence that mindfulness meditation is effective in treating a broad range of mental health issues, including anxiety, depression and stress. One study, published in the British Medical Journal, found that online mindfulness courses were often just as effective as face-to-face meetings with a therapist.

You can sample a relaxing online pain management meditation at Meditainment.com (click here to see it). The initial course is free.

Meditation Changes Brain Activity to Reduce Pain

By Pat Anson, Editor

Mindfulness meditation significantly reduces both physical and emotional pain, according to a new placebo controlled study that used MRI imaging to document changes in the brain that occur during meditation.

"We were completely surprised by the findings. While we thought that there would be some overlap in brain regions between meditation and placebo, the findings from this study provide novel and objective evidence that mindfulness meditation reduces pain in a unique fashion," said Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center in Winston-Salem, NC.

Zeidan and his colleagues enrolled 75 healthy volunteers in the study and used a thermal heat probe on their skin to test their reaction to pain. The probe was heated to 120 degrees Fahrenheit (49 degrees Centigrade) – a level most people find painful. Participants were then asked to rate the pain intensity (physical sensation) and pain unpleasantness (emotional response).

Those who had undergone mindfulness meditation reported their physical pain was reduced by 27 percent and the unpleasantness by 44 percent.

In contrast, volunteers who had used a placebo analgesic cream before the heat probe test said their physical pain was reduced by 11 percent and their emotional pain by 13 percent.

The participants' brains were also scanned with magnetic resonance imaging (MRI) before and after the heat probe experiment.  

"The MRI scans showed for the first time that mindfulness meditation produced patterns of brain activity that are different than those produced by the placebo cream," said Zeidan.

Mindfulness meditation activated brain regions (orbitofrontal and anterior cingulate cortex) associated with the self-control of pain; while the placebo cream lowered pain levels by reducing brain activity in pain-processing areas (secondary somatosensory cortex).

Another brain region, the thalamus, was deactivated during mindfulness meditation. The thalamus serves as a gateway that determines if sensory information is allowed to reach other parts of the brain. By deactivating this area, researchers say, mindfulness meditation may cause signals about pain to simply fade away.

Mindfulness meditation also was significantly better at reducing pain intensity and pain unpleasantness than a placebo sham meditation. The placebo-meditation group had relatively small decreases in pain intensity (9%) and pain unpleasantness (24%).

"This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation," Zeidan said. "Based on our findings, we believe that as little as four 20-minute daily sessions of mindfulness meditation could enhance pain treatment in a clinical setting. However, given that the present study examined healthy, pain-free volunteers, we cannot generalize our findings to chronic pain patients at this time."

The Wake Forest study is published in the Journal of Neuroscience,

In addition to relieving pain, there is increasing evidence that meditation and mindfulness cognitive therapy are effective in treating a broad range of mental health issues, including anxiety, depression and stress.

One study, published in the British Medical Journal, found that online mindfulness courses were often just as effective as face-to-face meetings with a therapist.

You can sample a relaxing online pain management meditation at Meditainment.com (click here to see it). The initial course is free.