Treating Chronic Pain With Meditation

In some cases, the holistic practice could replace narcotics. Integrating meditation into regular treatment could significantly cut healthcare costs.
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Sarah Kehoe tried Aleve for her back pain. She tried stretching. She tried yoga. She tried forgetting about it. She tried pain patches. She tried acupuncture. A shot of painkillers into her back. Prescription anti-inflammatory pain patches. Opiates. Surgery. Physical therapy. Heat and compresses. Ignoring it again. Steroids. More opiates. Acupuncture again. She couldn’t sit, stand up straight, lie down on her back. She was weak, had lost muscle tone. She fainted on the subway. Sarah Kehoe, an otherwise healthy 36-year-old woman, a former high school and college athlete, a yogi of 10 years, was falling apart.

Sometime during the summer of 2011, Kehoe doesn’t know exactly when, a disc in her back herniated. After her surgery that September, pain seized hold of her again in the winter: the surgeon said the disc had reherniated slightly. Neither he nor Kehoe wanted to do surgery again, leaving Kehoe to search for other pain management options. Her brother had recently completed a meditation course to treat his depression and bought her a course for Christmas.

In early January 2012, Kehoe stood in the back corner of a barre studio on 29th Street in Manhattan. She and the one other class member listened quietly, each holding a white flower, while their instructor Emily Fletcher sang tranquilly in Sanskrit to begin the initiation ceremony. A ribbon of perfume danced gently off the end of an incense stick in the dim, candlelit room. Peace settled over the studio quickly, despite the calls of actors rehearsing next door bursting through the wall. Kehoe was hinging her last hope on the mantra she was given while the instructor and the other student closed their eyes. Silence swelled in the room and the meditation began.

* * *

Millions of Americans live with chronic pain. The Medical Expenditure Panel Survey, conducted in 2008, approximated 100 million adults are affected by pain, including joint pain and arthritis. Other studies, discounting joint pain and arthritis, estimate chronic pain prevalence at around 15 percent of American adults.

Persistent pain is not only life-altering for the patient, (causing missed worked days or early retirement, traumatic experiences, discomfort, and lack of sleep), but it is extremely costly to the nation. And at this moment, the U.S. has turned its eyes to healthcare cost and management. One article by Darrell Gaskin in The Journal of Pain estimated persistent pain to cost from $560 to $635 billion annually, far exceeding the price of other costly diagnoses such as cardiovascular disease, injury, and cancer. These costs arise from medical expenditures for the pain, as well as for other conditions complicated by pain, and a hindering of the patient’s ability to work or function.

Aside from being costly, pain is difficult to manage. Narcotics are the mainstay for treating pain. Narcotics, also known as opiates, are a class of drug that affects the brain and helps reduce pain, while also producing euphoria. Oxycodone and morphine are both narcotics, as is heroin. While a number of specialists advocate for opiate use for intractable pain, and a growing number of physicians dole out narcotic prescriptions, guidelines for safe prescribing have conflicting recommendations.

With such a large number of patients with chronic pain, and such a large number of narcotics being prescribed, prescription drug abuse is rampant. (So much so that in April 2011 President Obama released a multi-agency plan aimed at reducing the “epidemic” of prescription drug abuse.) Studies show that hydrocodone and oxycodone are by far the most abused prescription drugs in the country.

While narcotics can help patients considerably, many patients on opiates whom I have worked with feel they can’t function as well. They develop a drug high, have cloudy thought processes, and while they do not feel the pain as strongly (many still have pain despite taking drugs), they are not at a their baseline functioning level.

Chronic pain is not the same as the pain you feel from an injury. That’s acute pain—the sensing of tissue damage by nerves. Your body gets injured and you hurt. Chronic pain often, though not always, begins with an injury or tissue damage, but is perpetuated, usually by other factors, long after a reasonable time has passed for the injury to heal. Data have shown that an accurate diagnosis can only be established in approximately one-third of patients with low back pain. The relentless nature of chronic pain suggests that stress, environmental, and emotional effects likely overlay the original tissue damage in an injury, adding to the intensity and tenacity of the pain.

Mental processes can alter sensory phenomena, including pain. This is how war wounds can go unnoticed until after battle, athletes can continue to play with debilitating injuries, or minor traumas can lead to incapacitating pain. As knowledge of the nervous system has expanded and technology allowing scientists to visualize the nervous system has advanced, the last five to 10 years have seen a dramatic increase in the amount of studies focusing on how meditation works.

In hundreds of studies conducted over the past decade, researchers have examined meditation’s effects on people, such as attention regulation, awareness of the body, depression, post-traumatic stress disorder, and addiction. Scientists have also studied the use of meditation as a treatment for pain. In these studies, meditation has been shown to help pain, sometimes significantly, though not cure it.

In research on meditation and pain, scientists have asked two questions: “Does meditation help?” and “How does meditation help?” The first question proved much simpler to answer. A Wake Forest University study conducted by Fadel Zeidan in April 2011 took 15 healthy volunteers and performed MRI scans of their brains while inducing pain. In the four days that followed, a certified instructor taught the subjects mindfulness meditation (in which the pupil is taught to focus on a sense, often his or her breath, while accepting transient thoughts). On the fifth day, the researchers scanned the volunteers again, once while not meditating, and another time while meditating, with pain induced during both sessions. The study showed an approximately 40 percent reduction in pain intensity ratings during meditation when compared with non-meditation.

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Brian Steiner is a pediatrics resident at the New York University Langone Medical Center and Bellevue Hospital.

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