Mindfulness Meditation Is More Than a Placebo
Brain scans show meditation technique impacts neural pathways for pain relief
After trying several over-the-counter and prescription medications and contemplating surgery for severe low back and neck pain and osteoarthritis for more than a decade, Rose Platt, 72, a painter from Irvine, California, felt hopeless and listless.
Then, at her group therapy class, a participant hinted at mindfulness meditation. She decided to give it a try.
A key component of mindfulness is decentering, referring to a mindset in which thoughts, feelings and other experiences are seen as transient events that are detached from oneself and do not reflect reality. | Credit: Lua Valentia
In the beginning, Platt had a hard time "sitting still and doing slow breathing" to relax. But she persisted. Gradually she eased into "sitting calmly and breathing slowly with eyes closed."
"It's relaxing," she says. "I feel my muscles are less tense. The pain intensity has gone down, though the pain remains."
Despite some skepticism about its efficacy, research shows that mindfulness-based interventions are effective for improving chronic pain, depression and physical function. And a recent joint study by UC-San Diego School of Medicine and Dartmouth College confirms that. Brain scans reveal that mindfulness meditation engages separate neural pathways from the well-documented placebo effect. Advanced brain imaging techniques comparing the pain-reducing effects of mindfulness meditation, a placebo cream and a sham mindfulness meditation were used in 115 participants.
Fadel Zeidan, professor in the department of anesthesiology in the Center of Pain Medicine and director of the Pain Health and Mindfulness Laboratory at UC San Diego explains that across several studies, researchers have found that mindfulness meditation "is stronger than other techniques and uses different physiological systems than a placebo. Mindfulness meditation engages the parasympathetic system in a different way than a placebo."
Explaining mindfulness meditation, Zeidan says the technique requires focusing on the changing sensations of breathing and acknowledging any distracting thoughts, feelings or emotions without judging yourself before gently returning attention back to breathing. It's not only focusing on the breath, but also regulating the emotions that arise sitting in a meditation practice. A key component of mindfulness is decentering, referring to a mindset in which thoughts, feelings and other experiences are seen as transient events that are detached from oneself and do not reflect reality.
Reducing Pain
"We found that mindfulness meditation reduces pain by modulating brain signatures that correspond to the feeling of pain," Zeidan says. "With every experiment we've learned more about how powerful the mindfulness technique is and uses multiple components. It's analogous to physical training. It's like you're going to the gym, but instead of trying to work out a bicep, you're working out the brain. Research on people 65 and older has revealed that very brief meditation training can dramatically reduce stress by about 80%, reduce depression by about 60% and increase social connectedness. Mindfulness meditation is great for pain management and anxiety."
"Research on people 65 and older has revealed that very brief meditation training can dramatically reduce stress by about 80%,"
"Other research has shown that in older adults, mindfulness meditation could potentially offset age-related cortical thinning," Zeidan adds. "The best meditators are older adults. They are more interested, and feel more benefit in the context of trying to appreciate their life by being present centered, non-reactive and non-judgmental. They're more motivated, mature and might have some ailments like pain, depression or memory deficits that they can use the mindfulness practice to alleviate. As we get older, we start to really appreciate how limited our time is and we want to find ways to be in the moment to take it all in."
Stress Relief
One of the main benefits of meditation for treating chronic pain is stress reduction. People in various cultures have been practicing meditation for thousands of years, reporting many positive effects on mental and physical health.
Chronic pain is a complex and pervasive health issue impacting the lives of millions. An estimated 50 million adults in the United States experience chronic pain that lasts longer than three months, according to the Centers for Disease Control and Prevention (CDC). Chronic pain can occur after an injury or without apparent damage or previous bodily injury. Common types of chronic pain include lower back, migraine and headache, neck and facial. Living with chronic pain can be debilitating not only on physical and mental health but also on relationships and quality of life by affecting mobility, independence and ability to work. It's common for people with chronic pain to also have symptoms of depression, anxiety and increased stress. People living with chronic pain often struggle with effectively managing pain.
"[With mindfulness meditation] we can now see that the brain is changing just like the bicep would if you exercise."
"Meditators are able to be more accepting of the pain, and that's very important for patients living with chronic pain, because chances are they're never going to get rid of the pain," Zeidan explains. "The recipe is easy. Just like physical exercise, if you go to the gym or you go running, you start to see changes in your body and the way you feel. For thousands of years, contemplatives have said that meditation can reveal the inherent nature of reality and make you healthier and happier. We can now see that the brain is changing just like the bicep would if you exercise."
"The brain is much more malleable than a muscle," he says. "You don't need to spend an hour of practice a day — five to 20 minutes a day a couple of times a week would be enough for you to restart and reset yourself. Because we live in a very emotional, turbulent time, our brain does need a break."
Consistency in Practice
A study on the type and dosage of mindfulness-based interventions that are most effective for chronic pain found that once per week for 90-120 minutes each for eight weeks was the best mindfulness dosage.
Stress reduction expert Jon Kabat-Zinn recommends the body scan mindfulness exercise as the best form of mindfulness meditation for pain conditions. He advises practicing the exercise every day for 45 minutes, even if it seems boring or doesn't seem to be helping. "You don't have to like it, you just have to do it," he explains in his book, "Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness." "Whether you find the body scan to be very relaxing and interesting or difficult and uncomfortable or exasperating is irrelevant to whether it will serve you well." The goal of the body scan is not to relieve the pain completely, but for you to get to know it and learn from it so that you can manage it.
"Mindfulness is not necessarily a relaxation practice, but can often elicit a relaxation response," says Rachel Wasson, Ph.D., a psychologist and pain medicine expert at Mayo Clinic in Jacksonville, Florida. "For acute pain concerns, such as post-surgery or an injury, mindfulness can help an individual calm their central nervous system, which reduces distress and pain perception. Mindfulness practices alone are not sufficient stand-alone treatments for long-term benefits for individuals with chronic pain."
"Mindfulness is a skill. The more you practice, the better the results."
Wasson says some types of mindfulness-based practices that patients with acute or chronic pain may try include seated meditation, diaphragmatic breathing, five-senses mindfulness exercise, clouds in the sky meditation, leaves on the stream meditation, loving kindness meditation, self-compassion break meditation, progressive muscle relaxation, passive progressive muscle relaxation, mindful movement or gentle yoga.
"The best mindfulness practice is one that you can do regularly," Wasson says. "Mindfulness is a skill. The more you practice, the better the results. Patients often describe that it can be difficult at first to practice mindfulness due to internal and external distractions, but that it gets easier over time as they build up their skill with consistent practice."
Patients report that mindfulness-based practices can help them emotionally, cognitively and physically. Emotionally, patients report feeling calmer, less stressed and less anxious. Cognitively, patients report that they feel less scattered in their thinking, it is easier to concentrate and they can think more clearly and logically. Physically, patients report that they feel more relaxed in their body and have less tension.
