Mindfulness, Meditation, and Pain

Mindfulness. It’s an evocative term, conjuring images of yoga retreats and burning incense.

Right here, right now

It’s an evocative term, conjuring images of yoga retreats and burning incense. While certain practices like meditation are often associated with mindfulness, they’re neither equivalent nor synonymous.

American author and professor Jon Kabat-Zinn, a pioneer in the field of mindfulness-based stress reduction, describes mindfulness as “the awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally.” The core of mindfulness, Kabat-Zinn says, is to focus conscious attention on the “right here, right now.”

The mind-body connection

Many physical therapy professionals are familiar with the mind-body connection, particularly those who work in pelvic therapy. The pelvic floor muscles are innervated by the pudendal nerve, which is made up of both motor and autonomic nerve fibers.

In contrast, most other skeletal muscles are innervated by nerves that only contain motor fibers, not autonomic ones. Because of this unique physiology, the pelvic floor muscles can respond to mindfulness training.

Components of mindfulness

There are two components of mindfulness.

1. Self-regulation of attention. Individuals must concentrate on their immediate experiences, allowing for increased recognition of mental events in the present moment.
2. Orienting oneself toward one’s experiences in the present moment. This is characterized by curiosity, openness, and acceptance.

This mental training is used to reduce cognitive vulnerability to reactive modes of mind that might otherwise heighten stress and emotional distress. Training in meditation can be used to cultivate the capacity to evoke and apply mindfulness to enhance emotional well-being and mental health.

Related: Pain Physiology and the Pain Experience

Incorporating meditation

Meditation can take many forms, and there are countless variations of those forms. They do share a few basic traits. Here are some of the key elements:

• Get into a comfortable position.
• Maintain attention on a particular focus, i.e. breath.
• Take note of any intrusive thoughts or feelings before releasing them.
• Repeat this refocusing process each time attention wanders from the focus.

A scientific grounding

Practicing mindfulness has clear emotional and psychological benefits, but what impact does it have on pain?

In a recent study conducted by the University of California San Diego School of Medicine, researchers showed that mindfulness meditation interrupted the communication between brain areas involved in pain sensation and those that produce the sense of self.

In another 2019 study, researchers used fMRI machines to examine subjects with varying levels of meditative experience as they experienced experimentally induced pain.

After brief mindfulness-based mental training (i.e., less than 10 hours of practice), researchers saw mindfulness-based pain relief associated with higher order (orbitofrontal cortex and rostral anterior cingulate cortex) regulation of low-level nociceptive neural targets (thalamus and primary somatosensory cortex).

In contrast, the study associated mindfulness-based pain relief after extensive training (greater than 1000 hours of practice) with the deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to reduce appraisals of arising sensory events.

The conclusion? The researchers hypothesized that the physiological and chemical changes in a brain actively engaged in mindfulness practices can function in ways like an analgesic. These mindfulness practices, they suggest, may be used in the future to inform pain-targeted therapies.

This article was adapted from our sister site, Elite Learning, written by Kristen Digwood, MSPT, DPT, CLT.