Mindfulness Meditation and Pain

A technique called ‘mindfulness’ teaches how to step back from pain and the worries of life -By Claudia Kalb Newsweek Sept. 27 issue –

For decades, Dalia Isicoff has suffered the agony of rheumatoid arthritis—joint pain, spinal fusion, multiple hip surgeries. Painkillers dull the aches, but it wasn’t until she took a course at the University of Maryland’s Center for Integrative Medicine that Isicoff discovered a powerful weapon inside her own body: her mind.

Using a meditative practice called Mindfulness-Based Stress Reduction, or MBSR, Isicoff learned to acknowledge her pain, rather than fight it. Her negative and debilitating thought patterns—”This is getting worse,” “I’m going to end up in a wheelchair”—began to dissipate, and she was able to cut back on her medication.

The pain hasn’t gone away, but “I view it is an ally now,” she says.

“Mindfulness is transformational.” With its roots in ancient Buddhist traditions, mindfulness is now gaining ground as an antidote for everything from type-A stress to chronic pain, depression and even the side effects of cancer treatment.
At the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School, where MBSR was developed by Jon Kabat-Zinn, a leader in the field, 15,000 people have taken an eight-week course in the practice; hundreds more have signed up at medical clinics across the country. Studies have shown that mindfulness can reduce pain and anxiety.

Now researchers are using brain imaging and blood tests to study its biological effects, and early results are intriguing: this spring, the National Institutes of Health hosted its first conference on the topic. “People in the scientific community used to think that this was a lot of mystical mumbo jumbo,” says psychologist Ruth Baer, of the University of Kentucky. “Now they’re saying, ‘Hey, we should start paying attention’.” Paying attention is the very essence of mindfulness.

In 45-minute meditations, participants learn to observe the whirring thoughts of the mind and the physical sensations in the body. The guiding principle is to be present moment to moment, to be aware of what’s happening, but without critique or judgment. It is not easy. Our “monkey mind,” as Buddhists call the internal chaos, keeps us swinging from past regrets to future worries, leaving little time for the here and now.

First attempts may provoke frustration (“I’ll never be able to do this”), impatience (“When will this be over?”) and even banal mental sparks (“What am I going to make for dinner?”).

The goal, however, is not to reach nirvana, but to observe the cacophony in a compassionate way, to accept it as transient, “like bubbles forming in a pot of water or weather patterns in the sky,” says Kabat-Zinn.

The keystone of mindfulness is daily meditation, but the practice is intended to become a way of life.

At Stanford University, Philippe Goldin encourages patients battling social anxiety disorder to take “meaningful pauses” throughout the day as a way to monitor and take charge of their fears and self-doubts. “It breaks the circuit,” says one participant. “I always thought that anxiety had me in its grip, but I realized it’s the other way around. I have it in my grip. It’s a matter of learning to let it go.”

Inner control can be a potent tool in the fight against all sorts of chronic conditions. In a pilot study of 18 obese women, Jean Kristeller, director of the Center for the Study of Health, Religion and Spirituality at Indiana State University, found that mindfulness meditation, augmented with special eating meditations (slowly savoring the flavor of a piece of cheese, being aware of how much is enough), helped reduce binges from an average of four per week to one and a half. Now Kristeller is wrapping up a larger study that she says confirms her earlier findings. Mindfulness helped participant Chuck Cooley, 43, identify anxiety as a trigger for overeating—and cut back on the pizza buffets. “Before, I was on automatic pilot,” he says. Now “I can take my time and enjoy a smaller portion.”

Mindfulness takes you out of your same old patterns. You’re no longer battling your mind in the boxer’s ring—you’re watching, with interest, from the stands. The detachment doesn’t lead to passivity, but to new ways of thinking. This is especially helpful in depression, which plagues sufferers with relentless ruminations. At least half of all patients who have had one or two episodes of clinical depression will relapse into another; the more episodes, the higher the risk. University of Toronto psychiatry professor Zindel Segal combines mindfulness with conventional cognitive behavioral therapy, teaching patients to observe sadness or unhappiness without judgment.

In a study of patients who had recovered from a depressive episode, Segal and colleagues found that 66 percent of those who learned mindfulness remained stable (no relapse) over a year, compared with 34 percent in a control group. Now Segal has a $2.1 million grant from the NIH to compare mindfulness against antidepressants as a maintenance therapy after relapse. Segal’s patient Suzanne Simoni, 47, says she has learned to identify the early signs of an emotional hurricane—fatigue, irritability, hopelessness—before it hits. “I have the chance to catch it earlier,” she says. And possibly steer it away altogether.

The biological impact of mindfulness—on the brain, the blood, the immune system—is the next frontier in scientific research. In an intriguing study published several years ago, Kabat-Zinn found that when patients with psoriasis listened to meditation tapes during ultraviolet-light therapy, they healed about four times faster than a control group. In an effort to understand how this kind of dramatic response is possible, scientists are hunting down mindfulness’s biological footprints.

Kabat-Zinn and neuroscientist Richard Davidson, of the University of Wisconsin, found that after eight weeks of MBSR, a group of biotech employees showed a greater increase in activity in the left prefrontal cortex—the region of the brain associated with a happier state of mind—than colleagues who received no meditation training. When the techies were given a flu vaccine, those with the greatest left-brain activation mounted the most vigorous antibody assault against the virus. There’s more in the pipeline.

The University of Massachusetts’ mindfulness center is studying the impact of mindfulness and diet on PSA levels in prostate cancer. Stanford’s Goldin is taking brain images of social-anxiety patients to see if the practice affects emotional trigger points, like the amygdala, which processes fear.

And at Maryland’s Center for Integrative Medicine, director Dr. Brian Berman is tracking measures of inflammation, including gene expression, in patients with rheumatoid arthritis. For Dalia Isicoff, the payoff is already clear: “I’m at peace,” she says. Her mind and her body, together.