When I return from my summer holidays, I often dread dealing with the deluge of email that awaits. But this time, my trepidation dissipated quickly as I opened several messages from people sharing the benefits of mindfulness in their lives. These messages are such a delight to read and help reenergize our commitment to teaching. I was particularly struck by the ones where there was a relationship between pain and anxiety, especially since I have been working quite a bit recently with people experiencing both.
The first email was from someone who had been trying to conceive, despite dealing with a fair bit of chronic pain from endometriosis and another painful condition. Two years after being in a mindfulness program, she wrote:
“I have a daughter! Using the meditation techniques, I managed to labor 18 hours drug-free! I am very proud of this.”
Very heartwarming indeed.
A second email related a participant’s recent experience with a root canal. Jen gave me permission to share this with you. She wrote:
“About two weeks ago, I had a root canal. There was some difficulty with freezing the nerves, so the procedure was a tiny bit painful, and I was super-stressed out and anxious about it to begin with. But what I learned in MBSR II really helped!!
For one thing, I was able to scan my whole body throughout the procedure, noticing more than just the pain. Secondly, I worked at paying attention to what the pain really felt like, the true sensations of it, noticing that it came and went.
But most of all, it helped with the anxiety, because while paying attention to my entire body, I was able to notice all the tightness I was creating in my neck and shoulder, even my hands, and was able to relax over and over again. The whole thing was actually done before I knew it and wasn’t so bad at all!”
Wow. We couldn’t have scripted her response any better. She really got it… And on so many levels. Right down to how she was relating to her experience both mentally and emotionally, as well as recognizing how her expectations and concepts didn’t match the actuality. No catastrophe ensued and the whole experience was impermanent.
Now, both these writers make their responses sound fairly simple – but, of course, the benefits of mindfulness are not instantaneous. Both women had participated in their first mindfulness course 1- 2 years before. And Jen had taken a second course. Although MBSR is usually given as an 8-week program, ongoing practice is needed (Basson, 2012). When researchers followed up with MBSR participants (of randomized clinical trials), they noted that evidence of stress reduction may not be seen until 2- 6 months later (Pradhan et al., 2007).
This is important to realize for people who have chronic pain and who might otherwise give up practice. With chronic pain, a kind of pain hypersensitivity occurs, called central sensitization. Functional changes happen within the brain and central nervous system that increase excitability of pain sensitive circuits (Woolf, 2011). It seems that the usual neural signals that serve to inhibit pain in most conditions, become dysfunctional where chronic pain is involved.
The thinking now is that higher excitability of pain sensitive circuits in some chronic pain conditions could not only maintain the chronicity of the pain but could even be the main causal factor (Woolf, 2011). In other words, we don’t necessarily need a painful stimulus to experience pain. If neurons in the pain pathways are sensitive enough, they will be activated by innocuous stimuli.
But what makes these pathways so excitable in the first place? It appears that chronic stress is a big culprit. Chronic pain is believed to develop due to accumulated stress that on its own can sometimes be enough to dysregulate the brain’s ability to modulate pain sensitivity (Black, 2002; Chapman, et al., 2008; McEwan & Kalia, 2010).
Some researchers have recognized that central sensitization plays a role in the pain of irritable bowel syndrome (Price et al, 2006) and fibromyalgia (Staud, 2007).
In the more than 30 years since the mindfulness-based stress reduction program was designed, it has been widely used to lessen the stress and pain of those living with chronic disease. Just how change takes place in participants is currently being clarified, and there is now empirical evidence that the practice of mindfulness lessens perceived stress and restores altered cortisol and other immune responses (Carlson et al., 2007).
Well-practiced mindfulness meditators experience analgesic effects and lower pain sensitivity than non-meditators in an experimental pain condition, when they adopt a mindful state (Grant & Rainville, 2009). Others studies of mindfulness report benefits in those with fibromyalgia and substantial symptom reduction in people with IBS (Grossman et al., 2007; Gaylord et al., 2011) as well as other pain conditions. It seems that ongoing practice decreases that hypersensitivity in the nervous system, but it takes time for this to happen.
Next time, I’ll write more on this and the relationship between pain, emotion and brain activity. In the meantime, I wanted to encourage you to keep up your practice, even if it’s only 10 minutes a day; so many health benefits are just percolating below the surface! As Jen shared with us in her email, “… as I suspected, the real usefulness/benefits of the course have only just begun.”
To learn more about the MBSR II course offering, please visit the Course Descriptions page.
Thank you and be well,