Many think of lifestyle medicine for metabolic conditions like diabetes or heart disease. Not many think of lifestyle medicine for things like chronic pain. But it turns out lifestyle is HUGE for many conditions involving a lot of pain. True, some of this is through effects on inflammation, which is largely metabolic in how lifestyle impacts inflammation. But lifestyle goes far beyond this basic chemistry.
When we think of pain, like in degenerative osteoarthritis of the knees or hips, we think only of pain as coming from the knees or hips. The truth is there is a crazy amount of disconnect between the degeneration in our joints and the amount of pain we experience. We routinely get x-rays of joints that show even severe degeneration of joints and the person has no or very little pain. Other times a patient reports terrible pain and their joints look just fine on x-ray or MRI.
Pain is actually very complex. And what most people don’t realize is that a lot of what leads to perceived pain actually goes on inside one’s head. No, I’m not talking about just imagining things hurt. There are switches and regulation centers in the circuits between our joints and the part of our brain where we eventually do or don’t perceive something as painful. Emotions, for example, have an enormous impact on our pain experience (which is why anti-depressants are used for chronic pain treatment).
When you understand the pain pathways, it is no surprise that mindfulness has been found to be a very effective form of treatment for many with chronic pain. Mindfulness changes how our brains are functioning. Some of the latest research is documenting in more detail just how this is happening and what parts of our brains are involved. And it turns out that people who are naturally more “mindful” have less pain.
Lower activity in a brain area called the “posterior cingulate cortex” was found in those with higher natural mindfulness and lower pain experience than in those with greater experienced pain.
This adds to our knowledge about how effective engaging the brain and the rest of the nervous systems can significantly change the pain experience. Prior studies have shown:
1. An 11-week course of Cognitive Behavioral Therapy led to “significant improvements in clinical measures” and increased grey matter volume in areas of the brain that would help manage pain. (Seminowicz DA, Shpaner M, Keaser ML, Krauthamer GM, Mantegna J, Dumas JA, Newhouse PA, Filippi CG, Keefe FJ, Naylor MR. Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. J Pain. 2013 Dec;14(12):1573-84. doi: 10.1016/j.jpain.2013.07.020. Epub 2013 Oct 14.)
2. A 26-week study of Cognitive Behavioral Therapy (training to change pain-related thoughts and behaviors) and Mindfulness Based Stress Reduction (training in mindfulness meditation and yoga) showed they were similarly effective and produced greater improvement in back pain and functional limitations than Usual Care. (Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016 Mar 22-29;315(12):1240-9. doi: 10.1001/jama.2016.2323.)
3. Another similar study showed these brain-based options were also less expensive. (Herman PM, Anderson ML, Sherman KJ, Balderson BH, Turner JA, Cherkin DC. Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain. Spine (Phila Pa 1976). 2017 Oct 15;42(20):1511-1520. doi: 10.1097/BRS.0000000000002344.)
4. And following these patients out to 2 years seems to indicate that these benefits persist, perhaps more so for Cognitive Behavioral Therapy.
For this latest study, the lead researcher says that “this work shows that we should consider one’s level of mindfulness when calculating why and how one feels less or more pain…. Based on our earlier research, we know we can increase mindfulness through relatively short periods of mindfulness meditation training, so this may prove to be an effective way to provide pain relief for the millions of people suffering from chronic pain.”
This is a very welcome option in the era of the opioid crisis with thousands of people dying every year from pain medication overdoses.