Mindfulness Meditation and Pain Management: Recent Findings!

by Ram

Branches by Melina Meza

This is part one of two articles that focus on some of the latest findings on meditation and its an amazing variety of neurological benefits. Dhyana or meditation is a state of being where the mind stops wandering, is calmer, and maintains a period of stillness. In this state of mind, an individual no longer possess bodily awareness, the sense organs are not distracted, and the stillness produces few or no thoughts at all (see Yoga Meditation Techniques). One of the original goals of meditation was to quiet the mind. Because our minds are typically busy with thoughts and emotions�many of which disturb our equanimity�quieting the mind and letting go of these daily dramas of life allows us to experience feelings of peace and contentment. Meditation also fosters feelings of compassion, which improve relationships with others. And you can also use meditation to cultivate feelings of gratitude that in turn fosters contentment (Honesty and Contentment in the Yoga Room). There are many different kinds of meditation. Some are designed to help us relax; others are meant to produce altered states of consciousness. 

Mindfulness meditation is one of the techniques where your mind is not only fully aware of the stillness but also keeps observing when your attention starts to wander from the object of the meditation (in most cases the object of meditation is the repetitious breath, flow of thoughts, emotions or feelings). And as you observe these objects with a sense of detachment, you will notice familiar patterns that may seem irrelevant to harbor and you may want to let go these patterns. Detachment or letting go of these patterns helps in cultivating equanimity in your daily life (Meditation and Equanimity). Thus, mindfulness meditation allows you to observe your habitual thought patterns and emotional responses and provides the opportunity to change them to more positive ones. Mindfulness meditation helps us become aware of what is already true at every moment, providing us with an opportunity to become more present with ourselves just as we are. This, in turn, helps us to overcome the unnecessary suffering that results from trying to escape the discomfort and pain that we experience in our daily lives.

Today�s discussion is about mindfulness meditation and its role in alleviating the acute pain response. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and is part of the body�s inherent protective mechanism to motivate the individual to pull out from a damaging situation and prevent further damage to the tissue, allow the damaged tissue to rest and heal, and avoid similar encounters. Thus, the phenomenon of pain is beneficial in a true sense when, for example, your back sustains a blow and the injured tissues need care and protection (Understanding Pain). 

Just like inflammation, the phenomenon of pain is generally transient, and recedes when the stimulus is removed or the damaged tissue has healed (How and Why Yoga Helps with Pain). When your body encounters an acute pain stimulus, your brain releases a large number of pain reducing chemicals called opioids. Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs in the body. The binding of the endogenous opioids to their specific receptors results in reduction of the perception of pain. However, there are certain abnormal pathological conditions where pain is a constant feature and persists for a long time (chronic pain). While in some chronic cases the levels of the endogenous opioids are not sufficient to alleviate the pain response, in most cases the body becomes insensitive to the body�s levels of opioids. Chronic pain that lasts beyond the expected period of healing can interfere with a person's quality of life and general functioning. Unfortunately, chronic pain brings with it other health issues including constant fear, worry, anxiety, depression, and memory deficits and turns out to be the most common reason for individuals to visit their physician (Techniques for Managing Pain with Yoga). 

One of the methods of pain management is the external administration of opioids like vicodin, morphine, codeine, or oxycontin. These external opioids not only blunt the pain response, they also produce a euphoric response since they also affect the brain regions involved in reward. Regular or long-term use or abuse of opioids can lead to physical dependence and, in most cases, addiction. Naloxone is a drug that works as an antidote to the opioids and is mainly used to reverse an opioid overdose. Naloxone works by blocking the analgesic (anti-pain) and the euphoric response of the opioids in the system. Naloxone only works if a person has opioids in their system; the medication doesn't work on other drugs. 

Now what does all this have to do with mindfulness meditation? Well, we know that meditation produces relaxation and the lovely blissful feelings that result from release of tension. The question is: does meditation trigger the release of endogenous opioids which in turn produces the pain relief and the pleasant effects thereafter? This was the premise of a new study Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids in which the researchers set out to ask a simple question, �does mindfulness meditation (MM) produce pain relief and if yes, then does it do so through the release of endogenous opioids�? 

The double blind randomized study involved 78 healthy, pain-free people who were randomly assigned to receive different interventions. The first group was trained in mindfulness meditation for 20 minutes a day for four days. And the second group, which served as a control group, spent the same amount of time listening to a book read aloud. The scientists then exposed all the participants to a pain stimulus by placing a hot probe on the back of their legs. The group that practiced mindfulness meditation experienced significantly reduced pain intensity and pain unpleasantness than the control group. 

The next thing to determine was if the pain reduction in the mindfulness meditation group was due to release of endogenous opioids. One way to test this was to block the release of endogenous opioids (if any) by administering the drug Naloxone, which would then reverse the beneficial analgesic effects of mindfulness meditation. (A control group was given simple saline as a placebo.) To the surprise of the researchers, the meditators who received the drug Naloxone before being subjected to the hot probe continued to experience significantly reduced pain intensity and pain unpleasantness than the control group, suggesting that Naloxone administration failed to reverse the meditation-induced pain relief. There were also no significant differences in pain intensity or pain unpleasantness reductions between the meditation + naloxone and the meditation + saline groups.

The findings clearly demonstrate that mindfulness meditation eases pain through some distinct pathways that are independent of the endogenous opioid mechanisms, suggesting that meditation-based pain relief does not require the role of endogenous opioids. The researchers do not have a clear explanation of the effect of mindfulness meditation on the brain that results in the pain relief. But based on their past results, they believe that meditation activates several regions of the brain that are associated with emotion regulation, focus, and cognitive control. At the same time, meditation also down-regulates the thalamic activity that transmits painful information from and to the body. Thus, the global effect of mindfulness meditation helps to prevent pain and painful information from spreading throughout the brain and body. 

It remains to be determined whether mindfulness meditation would be helpful in the treatment of chronic pain and also be effective in overcoming opiate drug abuse. For now though, mindfulness meditation seems to be a very attractive technique for acute pain relief and for those seeking a non-opiate pain therapy. And, if this is the case, getting hooked on meditation would also be a perfect panacea for pain and other pathological systems some of which we described earlier (Meditation: Effects on Gene Expression). 

This reminds me of an anecdotal report of a senior monk who underwent a complicated surgery without the use of any anesthetics. His years of meditation practice helped him to tide over the pain during and after the surgery. But based on the above-mentioned scientific study, it is also clear that you don�t need to be a monk to reap the benefits of mindfulness meditation. 

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Meditation and Equanimity

by Nina

Of course most of us realize that while meditation is an excellent stress management tool this is not its original goal nor its only benefit. But because I wanted to explain something to people who are newer to yoga about the relationship between meditation and equanimity, I�ve been delving a bit deeper into this subject. In general here�s what I�ve come up with so far. 

One of original goals of meditation was to quiet the mind. Because our minds are typically busy with thoughts, many of which disturb our equanimity�regrets about the past, worries about the future, and dissatisfaction with the present�quieting your mind allows you to experience feelings of peace and contentment. Meditation also fosters feelings of compassion, which improve your relationships with others. And you can use meditation to cultivate feelings of gratitude, which allows you to be more content with what you have and what you don�t have. In addition, the process of meditating allows you to observe your habitual thought patterns and emotional responses, which is the first step in changing them to more positive ones. 

Here are my thoughts about these four different aspects of meditation. If you have any of your own you�d like to contribute, I�d love to hear from you! 

Quieting the Mind

In the Yoga Sutras, Patanjali defines yoga as: 

1.2 �Yoga is the stilling of the changing states of mind.� �Edwin Bryant

Stilling the changing �states of mind��also translated as the �whirls of consciousness��means quieting the thoughts that cycle over and over in your mind. While not all our thoughts disturb our equanimity, when we are worried, anxious, sad, depressed, or even overly excited, we can be tormented by thoughts and emotions that whirl uncontrollably through us. What if I miss my deadline? What if the plane crashes? What if I can�t fall asleep tonight? If only my lover hadn�t left me. If only I wasn�t so helpless/afraid/overwhelmed. If only my parents had loved me more. I hate that person. I wish I had a different body. I suck at meditating. 

In classical yoga, quieting the mind is a necessary prerequisite for achieving the union with the divine that is yoga. But it is also recommended as the antidote to the kleshas, our reactions to life that disturb our equanimity and that are the source of our suffering. 

2.3 The five afflictions (klesas) which disturb the equilibrium of consciousness are: ignorance or lack of wisdom, ego, pride of the ego or the sense of �I,� attachment to pleasure, aversion to pain, fear of death and clinging to life. �Edwin Bryant

The simple act of regular meditation quiets your mind, but you may find that certain techniques work more effectively for you than others, depending on your particular personality or even just your current circumstances. So you might wish to experiment with several different techniques, perhaps even keeping record of the state of your mind both before and after practice for several days in a row. See Yoga Meditation Techniques for information about how to meditate. See Thoughts About Quieting the Mind for more information about quieting the mind. 

Self-Study with Meditation 

By using our witness mind as we meditate, we can engage in self study (svadhyaya) to learn more about habitual thought patterns and emotional responses that we might not even be aware of. The witness mind is that part of our minds that allows us to observe ourselves in action while we are acting. The Sankrit word for witness is sakshi (saa-kshe), and it refers to the �pure awareness� that witnesses the world but does not get affected by it or involved with it. The term combines �sa,� which means �with,� and �aksha,� which means �senses or eyes.� So the sakshi is an awareness that can disengage from any identification with thoughts and observe them �with its own eyes.� Another meaning of the word aksha is �the center of a wheel.� When a wheel turns, the spokes revolve and the outer rim rotates, but the center�the hub of the wheel�is still. So the witness mind remains steady while events turn around it. 

In meditation, your witness mind observes when your attention has wandered from the object of your meditation�and to what. Rather than floating down the stream of your thoughts, you sit on the shore and impartially observe from a distance. And as you observe with detachment what�s happening within you�your sensations, thoughts, emotions, and feelings�you start to recognize patterns that you may later decide to change. Observing your habits can help you change the way you react to stress (see Changing the Brain's Stressful Habits). And it can help you in general to change your patterns of reactivity (see Meditation and Brain Strength). All of this will help you cultivate equanimity in your daily life. 

You can also use your witness mind during your asana practice by cultivating mindfulness. To do this, step back and tune into the constant judging and reacting to inner and outer experiences that constantly stream through your mind. Eventually you can use on your witness mind during any activity. 

See The Power of Svadhyaya (Self Study) for more information about self study. See Yoga Meditation Techniques for information about how to meditate. 

Compassion 

1.33 By cultivating an attitude of friendship toward those who are happy, compassion toward those in distress, joy toward those who are virtuous, and equanimity toward those who are nonvirtuous, lucidity arises in the mind. �trans. by Edwin Bryant 

In addition to quieting your mind and teaching you its workings, meditation provides interpersonal benefits. Scientists have shown that the practice of meditation increases compassion. And becoming more compassionate clearly fosters better relationships with people in your life as well as strangers who are suffering.

In general, a regular meditation practices seems to have this effect. Scientists who studied this phenomenon speculated that there are two possible explanations for this. The first is that because meditation improves your ability to pay attention, this might improve your ability to notice what�s going on with someone else (as opposed to being lost in your own thoughts). Another explanation is that meditation helps us to experience the interconnectedness of all beings. Interestingly, a study showed that when people meditated on "non-referentail" compassion, the regions of their brains responsible for planned action were activated, as if they were preparing to aid people in distress. So you may find yourself with an urge to help others�always a good thing, both for them and you.

A regular meditation practice of any kind will foster compassion but if you wish to work on this intentionally, you could: 

1. Choose a person for whom you wish to cultivate compassion and before meditating set the intention that your practice will dedicated to them. Then check in again by thinking of that person after you finish. 
2. Use the word �compassion� as a mantra. 
3. Practice the Loving Kindness Meditation, a structured meditation designed to help you open your heart and cultivate compassion towards people close to you as well as strangers. Or practice any other formal meditation designed to foster compassion. 

See Meditation and Compassion for more information about meditation and compassion. See Yoga Meditation Techniques for information about how to meditate. 

Gratitude

Meditating on gratitude can have a profound effect on your mood and state of mind. In fact, scientists have actually identified the biochemical explanations for this. Apparently feeling grateful activates the brain stem region that produces dopamine, your reward and pleasure center, and gratitude toward others increases activity in your social dopamine circuits, which makes social interactions more enjoyable. And even just trying to think of things you are grateful for forces you to focus on the positive aspects of your life, which boosts our serotonin levels, which increases happiness. 

To cultivate gratitude in your meditation practice, you can use the following techniques: 

1. Use the word �gratitude� as a mantra. 
2. Use one thing for which you are grateful as the object of your meditation, either as a mantra or an image. 
3. Set the intention that as you meditate you will notice things you are grateful for as they naturally arise in your mind. 
4. Practice any formal meditation practice designed to cultivate gratitude. 

Of course, when you are being harassed by negative thoughts, it often isn�t easy to find and focus on things you are grateful for. But apparently the effort of remembering to look for gratitude alone provides the benefits. And just like strengthening a muscle, a regular gratitude practice makes you stronger at being grateful over time. So you�ll be improving in your gratitude practice as you age! See The Biochemical Basis for a Gratitude Practice for more information on a gratitude practice. See Yoga Meditation Techniques for information about how to meditate. 

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Working with the Witness

by Beth

Layer of Earth by Kazoo Shiraga*

As we age, we change. Wrinkles and gray hair appear, muscles begin to lose mass, and our relationship to society can change. In some cultures aging earns us status as wise elders to be revered; in others we are ignored or seen as no longer having value. Also, we may begin thinking about end of life issues, seeing death as loss, something to fear, or as a natural transition to something else (the something else often depends on our culture, country, family or spiritual beliefs). However, no matter who we are or where we live, cultivating and enhancing awareness and the ability to witness �what is� will enable us move through our aging process with integrity.

A simple definition of awareness is: knowledge or perception of a situation or fact. Awareness is at the heart of any definition of yoga. Practicing this becomes especially important to anyone who has ever stepped foot on a yoga mat or sat on a meditation cushion. You can read about Nina�s experience with awareness in her post The Power of Svadhyaya (Self Study).

The science of yoga offers many tools to cultivate awareness. Working with the Witness is a good one to consider. The Witness is the aspect of self that allows us to see ourselves in action as we are acting. The kosha model of yoga psychology focuses on five levels of awareness and is my go to context for working with the Witness. I�ll list them all separately here to talk about them but they are all ultimately one interrelated system. The five levels are:

1. Physical Level (Annamayakosha). This is the level that we experience through all of our senses including sight, hearing, taste, touch and smell. The ability to become aware of body sensations is a key step in activating the Relaxation Response and the healing process. This is the level that most people readily relate to and the level most focused on through yoga asana.

For me, working with the Witness helped me connect the dots between discomfort in backbends, such as Locust and Half Wheel, and headaches that followed a day or two after practicing. That awareness led to an appointment with a sports medicine doctor, who diagnosed me with spondylolisthesis. So I�ve been modifying my back bends and was delighted to read Shari�s post about spinal movements All About the Spine, which confirmed my experience. 

2. Breath-Energy Level (Pranamayakosha). Breath is the vehicle for the entry of oxygen and life energy, or prana, into the body. Learning to breathe effectively and efficiently is one of the most important lessons in yoga. When we are aware of our breath and how we breathe, we can better manage our moods and states of mind. This is key to managing stress and remaining calm no matter what is happening. 

3. Mental-Emotional Level (Manomayakosha). Mental awareness is based on what we perceive through our thoughts and feelings in two ways: 1) by analyzing and organizing our knowledge and experiences and 2) by intuition, hunch, inner voices, images, instant knowing, and fantasy. Emotional awareness helps us perceive and understand our habits, patterns and life lessons. 

By witnessing my periodic �blue funk days� while in the middle of them, I�ve discovered something interesting. When they lift�and so far they always do�I often experience intuitive flashes that result in writing ideas, home decoration projects, and themes for my yoga classes, or those AHA! moments that lead to new understandings. I�m now aware of them as they make their appearance and I�ve learned to �ride the emotional wave� instead of trying to cut it short. 

4. Wisdom-Witness Level (Vijnyanamayakosha). The Witness is the lamp that illuminates all aspects of ourselves (persona and shadow) for integration and acceptance. When we are able to witness our thoughts, emotions, and behaviors without judgment, we can cultivate and deepen our ability to recognize our patterns and consciously choose to make changes. 

5. Bliss Level (Anandamayakosha). This is unity consciousness, going with the flow of life whether positive or difficult. It is direct experience of the universal energy or connectedness that we can tap into through consistent practice, which we control, and grace, which we do not control. 

One tool to wake and work with the Witness is the body scan. The technique focuses on engaging and deepening awareness at all levels of being to promote healing (as opposed to curing, which may sometimes be a happy side effect). Depending on your needs and readiness, body scans will focus on some or all of the koshas. There are many techniques and ways to practice this, and you can learn to self-guide. 

Here is a short self-guided script that you can practice in any comfortable position. First, make an intention to witness whatever arises without judgment and then gradually move your awareness through your body, breath, and mind as you say the following to yourself:

I am aware of my feet, ankles, lower legs, knees, upper legs, hips, waist, belly, low back, rib cage, mid-back, chest, upper back, shoulders, neck, face and the top of my head. (Pause) 

From the top of my head awareness moves over my face, down my neck, out over my shoulders and down my arms to my hands and fingers. I welcome any sensations or information I receive. (Pause) 

I notice my breath and watch the inhalation and exhalation. The breath comes and goes naturally, not changing in any way. Where is the movement of the breath felt? In my belly, chest, throat, nostrils? (Pause)

I watch the ebb and flow, the rise and fall, the in and out of the natural, essential breathing process. I am totally aware of my breath and my breathing. (Pause) 

Now, I move my attention to the mind and my thoughts. Do they flow easily from one thing to another or are they fixed on one thing? (Pause) 

Are they focused on the past or do they center on the future? (Pause) 

Can I see each thought, simply rising and passing one by one? Can I be aware of thinking while I am thinking? (Pause) 

I am now calm, relaxed, and aware. I rest in myself, breathing slowly and deeply. (Pause and rest here as long as you like)

Personally, I find this useful for grounding during stressful times, and it works like a charm those fortunately rare nights when I have trouble falling asleep. With practice, you can lengthen or shorten your explorations. Or you can begin the practice with prepared recordings. A little research will turn up many options. Voice, pace, length, tone, and content vary. Most will allow you to sample your choice before you buy. Be sure to pick one that feels just right for you.

With practice we learn to become aware, or conscious, of ourselves on all levels of our being. We can then bring clear and focused attention to what we find; accept and integrate all aspects of the aging process, pleasant and not so pleasant, and if we chose make conscious changes that bring us into alignment with our individual lives. Working with the Witness helps us move through our aging process with strength, flexibility, balance, wisdom, and grace.

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