People in chronic pain often feel abandoned by the medical profession, especially as physicians cut back on prescribing opioids. They may be interested in some nondrug approaches that could help them manage chronic pain better. Scientists have been gathering evidence that supports mindfulness meditation for pain.
Mindfulness May Help People Manage Chronic Pain:
One study suggested that mindfulness meditation can help people cope much better with their pain (Evidence Based Mental Health , Jan. 31, 2019). The researchers reviewed 13 trials of cognitive behavioral therapy compared to control. They also analyzed seven studies of mindfulness-based stress reduction for pain management. In addition, one trial compared mindfulness-based stress reduction to cognitive behavioral therapy as well as to control. Altogether, more than 1,900 volunteers participated in these clinical trials.
How Well Do These Non-Drug Approaches Work to Manage Chronic Pain?
The investigators found that both techniques had comparable effects on reducing pain intensity and psychological distress. Participants also experienced similar improvement in physical functioning with cognitive-behavioral therapy and mindfulness-based stress reduction. The authors suggest that they need further research to help determine who might benefit most from one or the other of these treatments.
Mindfulness Meditation Does Not Work Through the Placebo Effect:
For years, scientists have assumed that the power of mindfulness meditation to help manage chronic pain should be attributed to the placebo effect. A recent study contradicts that assumption (Biological Psychiatry, Aug. 29, 2024).
Researchers at the University of California, San Diego, School of Medicine scanned the brains of 115 volunteers while they used mindfulness meditation, sham meditation and a placebo pain-relieving cream. Mindfulness meditation reduced the intensity and unpleasantness of pain. It did so by changing brain activity patterns in ways that do not resemble the response to either placebo. Areas of the brain important for self-awareness, introspection and emotional regulation became less connected. Apparently, their links form an important part of the experience of pain.
The senior researcher commented,
“By separating pain from the self and relinquishing evaluative judgment, mindfulness meditation is able to directly modify how we experience pain in a way that uses no drugs, costs nothing and can be practiced anywhere.”
Cognitive Behavioral Therapy Can Help People Manage Chronic Pain:
A different nondrug approach to manage chronic pain has also shown promise. An earlier study indicated that cognitive behavioral therapy (CBT) can help alleviate chronic low back pain (The Lancet, Feb. 26, 2010). The researchers randomly assigned 700 people with bothersome low back pain to standard care or to standard care plus cognitive behavioral therapy. The group on cognitive behavioral therapy started with one individual session. Six group sessions followed.
After a year, 60 percent of those who had gotten the counseling had recovered. This compares to 30 percent in the group receiving only ordinary care, such as advice and pain medicine. The investigators judged cognitive behavioral therapy to be cost-effective. That makes it one of the few treatments to manage chronic pain in the lower back.
In a different study, investigators found that a single class in pain management skills worked as well as eight sessions of cognitive behavioral therapy (JAMA Network Open, April 1, 2022). For this trial, they recruited 263 volunteers with chronic low back pain. Through random assignment, participants took a class in “empowered relief” pain management skills, a health education class of the same length, or a set of 8 cognitive behavioral therapy sessions. The people who took the empowered relief class were no more likely to catastrophize their pain and reported similar pain intensity and sleep disturbance as those in the CBT sessions. Both groups did better than the volunteers who got the health education class. After three months, however, those who did the CBT were functioning better.
