By Deborah Norris, Ph.D.
After decades of research evaluating the clinical benefits of meditation, mindfulness practices are now promoted as part of the standard of medical care by the Centers for Disease Control, the National Institutes of Health, the Department of Veteran’s Affairs, and other health organizations for the treatment of chronic pain. This means that doctors are encouraged to prescribe meditation and other mindfulness practices such as yoga and tai chi as a first-line approach for the treatment of chronic pain, over the use of opiates and other drugs. These new recommendations are in response to recent concern over the addictive nature of prescription opiates, a growing opiate epidemic, and the evidence-basis demonstrating the effectiveness of mindfulness practices in successfully alleviating pain.
Only now are researchers becoming curious about the elements of the practices we call mindfulness that account for their potential to relieve pain. Mindfulness meditation can be practiced in many different ways, and different phenomena may occur in the mind and in the body, depending upon these details of the practice. A common characteristic of most forms of meditation is the use of a single point of focus to begin to still the mind. Once the momentum of the mind has slowed, mindfulness meditators may release that point of focus, and simply bear witness to sensate experiences as they arise, aware of sensations as they move through the consciousness.
When one suffers from chronic pain, it is most likely that during meditation, the sensations that will arise are the sensations of pain. While it is a gift to have the mental capacity to ignore pain, researchers are now confirming what psychologists have claimed all along, denial does not serve to heal our pains. In other words, what we resist persists.
Alternatively, research shows, a practice that allows pain into the awareness is most effective for relieving pain. Obviously, in cases of severe pain, this may be done slowly, in gradual stages, in a safe environment.
My research with Dr. Thomas Nassif and colleagues at the Veteran’s Affairs Medical Center found that practicing meditation over eight weeks was able to gradually and significantly reduce or eliminate pain in veterans suffering from chronic pain, traumatic brain injury and post-traumatic stress. Interestingly, we also found that meditation had a biphasic effect on the perception of pain. In the first few weeks of the study, veterans reported an increase in their awareness of the pain. Although they reported a greater awareness of pain, veterans also explained that the pain was not worse. They were simply more aware of or in touch with, their pain. The important outcome was that in the weeks following the initial increased awareness of pain, the pain resolved, either significantly or completely. Awareness healed.
Scientists and practitioners refer to this type of sensate awareness of the body in several ways. Somatic sensing, interoceptive awareness, body awareness, body scanning, all refer to a practice of opening the awareness to sensations arising from the physical body. For example, focusing on the sensations of the breath, or scanning the body from head to toe, taking your time to connect with the sensations as you go. You explore muscles or areas such as the heart or the gut. You might even focus on the brain, not the content of the thoughts themselves, but the sensation of thoughts as they move through the brain. If, initially, the sensations arising are messages of pain, studies are confirming that opening the consciousness to heed these messages is allowing the conscious brain to also heal the pain.
I remind my students that pain exists for a reason. If we were not able to sense pain, we would not survive. If there is a problem somewhere in the body, the body has a mechanism for informing the brain of this problem. It does not send text messages or emails to the brain. (Thank goodness!) It sends a message via our nervous system. That message is necessarily interpreted as “bad”; as a problem, with a potentially negative experience, to motivate us to pay attention, in the moment.
Mindfulness of the sensate experience of the physical body is proving to be an active ingredient in healing pain. In addition to mindfulness meditation, somatic awareness is a common element of other practices as well, such as yoga, tai chi, qigong, and other forms of physical exercise which do not emphasize ignoring pain, but rather honor the physical body in a form of mindful self-care.
I am not presently surprised at the power of the mind to relieve and heal pain. The first evidence of a physiological basis for the power of the mind to heal pain appeared in studies of the placebo effect in the 1970’s. Researchers studying dental patients found that placebo treatments could be more than 90% effective in relieving pain, leaving little room for drugs to contribute an effect. Furthermore, placebos caused chemical responses in the brain similar to those of drugs. Neuroscientist Fabrizio Benedetti at the University of Turia showed that placebos activate the same neurotransmitters as opiates and other drugs. Benedetti also found that placebo treatments affect the regions of the brain that regulate pain perception. A basic understanding of psychopharmacology is that drugs are able to have their effects on the brain and behavior because they act on pre-existing systems within the brain. Opiates act on a part of our nervous system that is already in place for the purpose of regulating pain. If this system did not already exist, drugs would have no way of exerting their effects. By simulating natural (endogenous) neurotransmitters, drugs are able to activate this pre-existing system to alleviate pain.
What the science of mindfulness is discovering, and practitioners have discovered for themselves, is that with practice, we can learn to activate and self-regulate these pain-relief systems through our own intention, and without the use of addictive drugs. As with any form of coordination and self-regulation, practice improves the outcome. Mindfulness practices in which we explore the body, and the sensations arising from within, help us to build our capacity for self-regulation, self-control, and coordination of subtle internal phenomenon, such as activating the mechanisms that relieve pain.
In upcoming articles, I will explore how to activate the brain with intention to heal, through the use of breath and other tools to unleash the power of mindfulness. For more on the subject, find my book, In the Flow: The Power of Mindfulness, to be released November 1, 2016.