For over thirty years now, we’ve seen the management of pain being treated by mindfulness. This technique was brought into the mainstream by Jon Kabat Zinn and his now highly successful mindfulness-based-stress-reduction (MBSR) program, which began at the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979. In his 1982 paper titled, “An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results.”, Zinn declares that there is a detachment experienced in meditators from the sensory experience and the “affective/evaluative alarm reaction” experience via the meditator’s new-found cognitive reappraisal.
What does that mean? It means that you disassociate your feelings and thoughts of the pain from the physiological sensation while you are experiencing pain. The act of doing so greatly diminishes the suffering involved. If you’re interested in this meditation technique, Shinzen Young, the well-known American meditation teacher and monk, has some great talks on pain and its management through meditation (through its mechanism of cognitive reappraisal). Here’s one you might enjoy:
Now let’s switch gears for a moment. This may seem obvious, but a number of studies suggest a relationship between pain and inflammation. For example, Laird et al., (2011) studied the relationship between pain and inflammation using C-reactive protein (CRP) as a marker, concluding a positive correlation using data from two clinical trials. Later, Laird et al., (2013) expanded their study, using a larger cohort of patients to test patient-reported outcomes (including the perception of pain) and inflammation levels (again using CRP). Much like their first study, they concluded that the majority of cancer symptoms are associated with inflammation — including pain.
Furthermore, in the Journal of Clinical Investigation article, “What is this thing called pain?” (Woolf, 2010), the author includes inflammatory pain as one of the three primary classifications of pain, stating:
“…pain assists in the healing of the injured body part by creating a situation that discourages physical contact and movement….pain is one of the cardinal features of inflammation.”
To this point, we’ve been assuming that meditation acts to reduce our perception of pain through Zinn’s mechanism of cognitive reappraisal. We may want to reconsider this long-held idea — it appears that meditation may actually have a biophysiological effect! A recent study by P. Kaliman et al., (2013) reveals that meditation may have an additional pain-reducing effect through its possible control over inflammatory pathways. Kaliman et al., shows that mindfulness may produce beneficial effects for peoples with chronic inflammation, by way of the mechanisms employed by anti-inflammatory drugs like HDACi (e.g. Trichostatin A) or cycloxygenase inhibitors (e.g. asprin). While Kaliman et al., (2013) could not demonstrate that the downregulation from meditation/HDAC gene expression had an impact on these anti-inflammatory pathways, this correlate is an important finding, warranting further research. Considering that meditation appears to have a profound effect on pain, yet needs more evidence outlining its mechanism of action, more research in this direction may help to increase funding for meditation and pain research researchers.
Laird, B., McMillan, D., Fayers, P., Fearon, K., Kaasa, S., Fallon, M., Klepstad, P. (2013). The systemic inflammatory response and its relationship to pain and other symptoms in advanced cancer. Oncologist, 18(9), 1050.
Laird, B., Scott, A., Colvin, L., McKeon, A., Murray, G., Fearon, K., Fallon, M. (2011). Cancer pain and its relationship to systemic inflammation: an exploratory study. Pain, 152(2), 460.
Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33.
Kaliman, P., A´lvarez-Lo´pez, M., Cosı´n-Toma´s, M., Rosenkranz, M., Lutz, A., Davidson, R. (2014). Rapid changes in histone deacetylases and inﬂammatory gene expression in expert meditators. Psychoneruroendocrinology, 40, 96.
Woolf, C. (2010). What is this thing called Pain? The Journal of Clinical Investigation, 120 (11), 3742.