Q: Peter, in this interview we will be discussing the impact of meditation on chronic pain and the recent scientific research on this subject. Do you have any overview comments you’d like to share?
PVH: Yes. At the outset I need to clarify that there are two different pain syndromes. One is what I call “acute pain,” which is the byproduct of a tissue injury such as a sprained ankle, a serious burn, or an abscessed tooth. When dealing with acute pain, if we treat the injury, the pain will go away.
“Chronic pain” is pain that has persisted for more than three months. When pain persists beyond three months, the brain begins to change in ways that intensify the pain and perpetuate the pain syndrome. After three months, as one commentator put it, “chronic pain is the disease.”
The example of “phantom limb pain”
Q: Do the brain changes associated with chronic pain begin when the pain first starts?
PVH: Yes, but when the pain is fairly brief, even if severe, the brain will go back to normal after the underlying problem has been resolved. But the longer the pain-related areas of the brain are receiving pain signals, the more the brain adapts to those signals, and it’s usually at the three-month mark that the brain becomes part of the pain syndrome.
After three months, even if we eliminate the cause of the pain, the patient will often experience ongoing pain. For example, a person whose leg has been removed will continue to feel severe pain in the leg. We call this phenomenon, “phantom limb pain.” When we look at the brain scans of people with “phantom limb pain,” we see very high activity in the part of the brain that registers pain sensations.
Chronic pain and the brain
Q: Is there a growing consensus in the scientific community that meditation can reverse changes in the brain caused by chronic pain?
PVH: Yes there is. One of the breakthrough studies was published in 2011. It involved 15 non-meditators who were taught a mindfulness meditation technique of watching the breath and letting go of distracting thoughts. A pain-producing heat device was placed on the skin of each participant’s right leg. Both before and after meditation training, this heat device was heated to a temperature of 120 degrees F – a temperature that most people would find painful.
The study resulted in two important findings: 1) the scans taken after meditation training showed decreases of up to 95% in participants’ pain ratings, and 2) meditation significantly reduced activity in brain areas that register pain sensations.
Q: Exactly how does meditation reduce pain in these areas?
PVH: There are two ways this happens. Chronic pain affects many areas in the brain, including the prefrontal cortex, the amygdala, the hippocampus, and the anterior cingulate gyrus. Abnormal activity in any of these areas of the brain can be a sign of a chronic pain syndrome.
From scientific studies, we know that meditation does two things. One, it can directly affect the pain-related activity in the prefrontal cortex, and also in each of these other pain-related areas. Two, meditation can so strengthen the prefrontal cortex that it alone can inhibit pain-related activity in other areas of the brain.
Q: Are you saying, then, that to reduce pain-related activity throughout the brain, all someone needs to do is to meditate with the mind focused at the point between the eyebrows, thereby strengthening the prefrontal cortex?
PVH: Yes, that’s exactly what I’m saying, and this strengthening process is evidenced by a thickening of the prefrontal cortex. Meditation causes other changes to the prefrontal cortex besides thickening, but thickening is often offered as proof that meditation changes the brain in a way that inhibits pain, and that we can actually measure.
A 2010 study determined, based on MRI scans, that the prefrontal cortex was significantly thicker in meditators than in non-meditators. Recent studies have shown that these kinds of changes in the prefrontal cortex are measurable on scans within eight weeks.
From opiate pain relievers to meditation
Q: Peter, I understand that for some years, your clinic has offered a pain management program that focuses on meditation as a key pain-reducing practice. Why did you decide to make meditation the cornerstone of your program?
PVH: As recently as ten years ago, opiate (narcotic) pain relievers were the mainstay of chronic pain management, but these medications lose their effectiveness over time. There comes a point when, no matter how much medication people take, they don’t receive much additional relief. Also, the opiates have many side effects, including depression, loss of motivation, and severe constipation. The result is that people end up confined to their homes, unable to lead normal lives.
The goal of our program is to improve our patients’ functioning and quality of life. We realized that to reverse the debilitating brain changes caused by chronic pain, we needed to teach our patients some form of meditation.
Q: How does meditation enter the treatment picture?
PVH: We use very simple techniques, simple breathing or relaxation exercises. Scientific studies have shown that short periods of this type of meditation –12-15 minutes a day – are very effective in reducing brain-related pain. Even simple breathing exercises will strengthen the prefrontal cortex.
Q: Do most people in your pain program experience a reduction of pain and improved functioning?
PVH: Yes. Probably 90% of our patients experience a significant reduction of pain and are happy with the program. Patients will often say, “If I do my meditation exercises regularly, my pain stays at a manageable level.” We have patients who initially were on very large amounts of opiate pain relievers but who are now taking much smaller amounts. Their pain is under control and they’re making other positive changes as well.
What’s interesting is that once our pain patients start meditating, even for that short period of time, they feel so much better that they often ask whether it’s all right to do more than 15 minutes once a day.
Q: Does meditation result in some patients become completely pain-free?
PVH: Yes. When people no longer need any opiate pain relievers, they graduate from the pain program. From then on, whether to continue meeting periodically with our behavioral therapist to discuss life-style issues is their choice.
Paramhansa Yogananda: use the power of the mind
Q: We’ve been discussing the impact of meditation on pain. Paramhansa Yogananda wrote about using the power of the mind to reduce pain. Was he referring to meditation or to something else?
PVH: He was referring to something else. Specifically he was quoted as saying, “You can decrease the amount of pain you’re experiencing tenfold just by focusing your mind correctly, by working with your mind in a different way,” which is something we also teach our pain patients.
Q: Can you explain why it’s necessary to teach your patients this additional practice?
PVH: Even people who are meditating regularly, and are on good pain medication regimens, will occasionally have a worsening of their pain, but they don’t want to take more medication.
Often we give them mental exercises – visualizations, for example, so that wherever they are, they can use the visualization and immediately experience a reduction in their pain levels.
The successful use of visualization to control pain has been substantiated in scientific studies. One study discussed a patient who had terrible back pain from an accidental spinal cord injury during surgery. When asked to visualize an image of his pain, he visualized a knife in his back, and his doctor measured the electrical signals in the brain reflecting the amount of pain he was experiencing in that area.
Then his doctor told him to picture a way the knife could be removed. His patient then envisioned an angel pulling out the knife, and the electrical signals reflecting the amount of pain in the area decreased by 90%. During the ride home, he was able to sit up without any pain.
With some of our patients, we use visualization as a rescue technique, something they can use any time they’re feeling increased pain, or worried that they might feel increased pain. For other patients, we might use a breathing exercise. We tailor the rescue technique to the person and what seems to work best for him or her, but it’s always something they can do anywhere.
It’s very empowering for our chronic pain patients to realize that they have power over their pain. They feel more functional and better able to deal with life in general.
Q: Is it stress that triggers a worsening of pain and if so, how does stress suddenly reactivate physical pain?
PVH: Pain is a brain phenomenon, and stress turns up the pain signals in the brain. It’s a bit like turning up the volume on a radio. Stress reduction techniques like meditation are so very helpful because they turn down the pain signals in the brain.
Meditation offers a new, more positive perspective
Q: Researchers at Drexel University School of Medicine, in a recent survey of more than 100 patients with arthritis and other chronic pain conditions who practiced mindfulness meditation, concluded that meditation significantly decreased patients’ pain levels and functional limitations.
Commenting on this research, the lead researcher at Drexel writes, “People diagnosed with arthritis may think that their futures are grim and that their pain will always limit their enjoyment of life….Mindfulness practice allows us to step back from that negative thinking.”
Peter, does the statement I just quoted capture your views of the prospects of people with chronic pain conditions?
PVH: Yes. At our clinic we’ve seen that everyone has a choice in how much their pain is going to influence their lives. Meditating daily, having a strategy for “bad” pain days, and maximizing helpful thought patterns, are an important starting point for all our patients. Overall, our patients experience a dramatic improvement in their enjoyment of life, better daily functioning, and the freedom that comes from not having to rely on narcotic pain pills.