Faculty Peer Reviewed
A woman in her 60s with a history of fibromyalgia presented with productive cough and fevers for one week, and also complained that she had been experiencing diffuse, chronic pain since she was diagnosed with fibromyalgia 2 years ago. After assessing her acute symptoms, I began asking routine questions regarding the characteristics of her chronic pain. Upon asking her about alleviating factors, her unexpected response was simply “meditation.” She stated that meditation helps not only to manage her pain but also to cope with the stresses of having a chronic illness. Although this was the first time in my limited experience that I had heard such a response, ten million adult Americans claim that they regularly practice some form of meditation.
Derived from the Latin word meditatio, which means “contemplation,” meditation is a term that is broad in scope and can be defined as the following: the focusing of attention on a single idea or object; a state of mind created when the mind is liberated of all thoughts; a psychological “opening up” to a higher power; or an analysis of religious teachings. The purposes of meditation, which include the achievement of eternal peace and the end of suffering, appear to be as numerous as its definitions. Along with the traditional practices of yoga and acupuncture, meditation is becoming increasingly mainstream in Western culture. In recent years, it has been touted not only for its ability to provide beneficial effects on emotional well-being but also its ability to improve physical health. In fact, it is now being offered in schools, law firms, corporate offices, government buildings, and even prisons.
An increasing number of physicians are recommending meditation as a method of attenuating chronic pain, a major problem in the United States which has a prevalence of as high as 50% in the general population [1] and is a primary reason for work absenteeism and loss of employment. Because chronic pain has remained a challenge to treat with pharmacological therapies due to costs, side effects, and often minimal effect on symptom severity, many patients have resorted to complementary alternative medicine. The results from a national survey indicate that meditation is the most widely used mind-body therapy among sufferers of chronic pain [2].
What fuels this trend is the belief that the mind and body interact with each other much like an integrated entity, essentially blurring the division between the two. For example, in the classic paper “The Physiology of Meditation” by Wallace and Benson, published in Scientific American in 1972, subjects practiced transcendental meditation while an arterial line provided constant measurements of heart rate, blood pressure, oxygen, carbon dioxide, and lactate levels, and an electroencephalogram measured their brain waves [3]. Wallace and Benson observed that meditation created an “integrated response” that altered a number of physiological functions that were previously believed to be entirely involuntary. In a subsequent study by Benson, it was demonstrated that Tibetan monks who practice a form of meditation called g Tum-mo in eight-hour sessions could increase the temperature of their fingers and toes by as much as 8.3ºC [4]. In a more clinically relevant study by Kabat-Zinn, the influenza vaccine was administered to a group of newly taught meditators and nonmeditators and serum antibody levels were subsequently measured [5]. As hypothesized, the meditators had a significantly greater rise in antibody titers compared with the controls [t(33) = 2.05, p < .05], providing evidence that meditation also improves the health of the immune system. Further support of the positive impact of meditation on the immune system is provided by results from a small randomized controlled trial by Creswell et al in which a sample of HIV-1 infected adults with at least minimal symptoms of psychological distress at baseline entered treatment in either an 8-week Mindfulness-Based Stress Reduction (MBSR) meditation program modeled on the work of Kabat-Zinn, or a 1-day control education seminar on CD4+ lymphocyte counts in stressed HIV-infected individuals [6]. Participants in the 1-day seminar had a raw mean decrease of 185 CD4+ T lymphocyte counts from baseline, whereas participants in the 8-week MBSR program were unchanged from baseline, independent of antiretroviral treatment status, suggesting that meditation may be a beneficial adjunct for HIV-1 infected patients under stress.
Regarding the effect of meditation on chronic pain, a number of studies modeled on the MBSR program have been performed. The most common pain conditions were fibromyalgia, headache, musculoskeletal, and low back pain. In a study by Kabat-Zinn, 51 patients with various chronic pain conditions who had not improved with traditional medical care participated in a 10-week mindfulness meditation program. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total pain rating index, and 50% showed a reduction of greater than or equal to 50% [7]. Kaplan et al conducted a study of patients with fibromyalgia, with outcome measures including pain, function, psychological distress, and health status [8]. Of 59 subjects who completed the MBSR program, 30 were defined as “responders,” showing at least 25% improvement on at least half of the instruments (p < .01), which corresponded to a clinically significant improvement. In a randomized controlled trial by Morone et al participants with chronic low back pain of moderate intensity were randomized to the MBSR program or to a wait-list control group [9]. Pain acceptance was measured using the Chronic Pain Acceptance Questionnaire (CPAQ), with improvement being reflected by higher scores. In comparison to the control group, in which pain acceptance actually worsened over the 8-week period with a baseline score of 68.1 + 20.3 and a post-treatment score of 64.8 + 23.0, the intervention group showed statistically significant improvement in pain acceptance with a baseline score of 72.2 + 13.4 and post-treatment score of 75.5 + 16.0. In addition to its positive effects on patients with impaired immunity or chronic low back pain, meditation has also been shown to benefit those with cancer, irritable bowel syndrome, and transplant patients.
These examples clearly demonstrate that one’s mental state can have a measurable impact on one’s health. Although research on the physical effects of meditation is still in its infancy, these results are promising indications that meditation can serve as an adjunct or even as an alternative to pharmacologic therapy. Studies about the health benefits of meditation support the practice of treating the patient as a whole, integrated person, and not simply treating the disease. They also imply that in addition to physicians, patients can be their own healers, which is an empowering statement. The capacity to train the mind to become aware of, accept, and control pain rather than being a passive victim to pain is an invaluable tool that is worth emphasizing, especially to sufferers of chronic conditions who have attained minimal relief from traditional medical therapies. The patient with chronic pain secondary to fibromyalgia is a prime example of someone who has taken advantage of her innate ability to manage the physical manifestation of her disease rather than allowing it to manage her.
In conclusion, while meditation initially began as a cultural and spiritual phenomenon thousands of years ago—and may still be practiced by monks in the frigid Himalayan mountains to tolerate extreme conditions—it has now “transcended” boundaries and become a feature of modern medical practice, earning itself yet another purpose to add to the list: an evidence-based treatment for chronic pain.
Dr. Patel is a 4th year medical student at NYU School of Medicine
Peer reviewed by Barbara Porter, Section Editor, Myths and Realities, Clinical Correlations
Image courtesy of Wikimedia Commons.
References
[1] Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001;7:417–31.
[2] Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical therapies. Results of a national survey. J Gen Intern Med. 2004;19:43–50. http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2004.21019.x/full.
[3] Wright, Leonard D. Meditation: A New Role for an Old Friend. American Journal of Hospice and Palliative Medicine. 2006;23(4):323. http://ajh.sagepub.com/content/23/4/323.long.
[4] Benson, H, Lehmann, JW et al. Body temperature changes during the practice of g Tum-mo yoga. Nature. 1982;Vol 295. http://www.nature.com/nature/journal/v295/n5846/abs/295234a0.html.
[5] Kabat-Zinn J, Davidson RJ, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;64(4):564-70. http://www.psychosomaticmedicine.org/cgi/content/full/65/4/564.
[6] Creswell, DJ, Myers HF, Cole, SW, Irwin MR. Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: A small randomized controlled trial. Brain, Behavior, and Immunity. 2009;23(2):184-188. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725018/?tool=pubmed.
[7] Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982 Apr; 4(1):33-47.
[8] Kaplan KH, Goldenberg DL, Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry. 1993; 15:284-289.
[9] Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain 2008;Vol 134:310-319. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254507/?tool=pubmed.