Mindfulness Techniques For Pain Management
Welcome to Arkansas Colleges of Health Education School of Physical Therapy Musculoskeletal 1 Project. This space was created by and for the students at Arkansas Colleges of Health Education School in the United States. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Introduction[edit | edit source]
Body-mindfulness can be defined as an individual’s ability to understand their “state of being” and not their “state of mind”. The definition of “state of mind” is the act of mindlessness. Assembling the effects of mindfulness for pain management requires individuals to be in tune with their “state of mind.” The state of being mindful of the body involves being aware of the different sensory and mental experiences that generate thoughts, emotions, moods, and physiological responses. This awareness allows less energy to be consumed by external experiences and more focus on the internal experiences of the present moment as it unfolds.[1]
Mindfulness-based interventions have been proven effective in decreasing the perceived pain intensity of patients. The reductions experienced are also reported to be well maintained long after their introduction.[2]A state of mindfulness begins by accepting the current experience as it is.
Acceptance and Commitment Therapy (ACT)[edit | edit source]
ACT aims to incorporate psychological flexibility which involves emotional openness to confront and adapt one’s thoughts and feelings to better align them with their values and goals. Psychological flexibility involves six core processes:[3][4]
1. Acceptance: Acknowledge and accept the full range of emotions and feelings from experiences without judging them or altering your thoughts.
2. Cognitive Defusion: Distance yourself from harmful ways of reacting to distressful thoughts and feelings. Observe a thought without judgment, repeat a negative thought out loud until it is only a sound, and break down an externally observed event by giving it a shape, color, speed, or form.
3. Flexible Attention to the present: Experience the present more directly by observing and interacting with the present without judgment.
4. Self as Context: Do not be controlled by your thoughts and feelings. You can be aware of thoughts without being attached to them.
5. Values: Choose personal values that are positive such as ones that are related to family, spirituality, and career rather than choosing values based on fear avoidance or adherence to societal pressures.
6. Committed Action: Take purposeful steps to incorporate changes that will lead to positive outcomes such as confronting negative thoughts, altering distress management, and goal setting.
Research has shown ACT to be effective when used for pain management, specifically chronic pain.[5][6][7] The American Psychological Association’s division 12, the division of clinical psychology, has stated that ACT is a supported treatment for general chronic pain.[5][8]
The Body Scan:[edit | edit source]
The body scan is a key component of mindfulness meditation that allows the patient to focus on each body part and the sensations that are experienced and felt in the moment. The Body Scan requires:
1. Sit in a lotus position or chair with an engaged posture. Remove all potential distractions.
2. With eyes closed, turn all attention inward. Focus on breathing in and out through the nose only.
3. Stay in the present moment and disregard any thoughts of the past or future. Focus on the moment and let all other thoughts simply drift away.
4. Perform a mental body scan starting at the tips of the toes and working up towards the cranium. The body scan should be systematic and follow the same order with every performance regardless of starting point. For each body part, bring awareness to any sensations. When your mind wanders, observe where it's gone and return focus to the body part to continue with order. Do not pass judgment on the feeling or your attention. Accept each feeling that comes, then move on.
5. Become aware of your body as a whole. Become aware of lingering tension and relax those parts of your body. Stay present in the moment feeling any sensation that comes up fully and completely.
There is evidence to support the use of a mindfulness-based body scan to decrease pain intensity and pain distress when the technique is led by a provider in a clinical setting. While patients may be introduced to and become familiar with this exercise in the clinic, they must take action to continue additional home practice of the technique for a recommended minimum of 3 times a week. Patients agreed that at least 15 minutes of practice per session is ideal to experience desired results.[9] The body scan is just one technique typically used in conjunction with other mindfulness-based interventions to promote awareness, relaxation, and control of pain.
Integrating Mindfulness and Exercise:[edit | edit source]
1. Anchor attention via breathing - focus on inhalations and exhalations, observe the tempo of your breath
2. Anchor on components of the exercise - the rotation of pedals on a bike, ascent and descent of a dumbbell, the contraction of a muscle.
3. Focus on the purpose of Mindfulness and Exercise - bring attention to how the body’s muscles and joints are moving without judgement of sensation experienced
4. Avoid sensory overload, which reinforces the focus on internal experiences - exercise without audio, phones, podcasts, music or videos
5. Tap into sensation - compare body parts to each other, and to previous sessions (the body scan techniques work well here)
6. Note surroundings - focus on the atmosphere, any noises, the temperature as experienced sensations
7. Practice non-judgment - appreciate your current ability, speed, and endurance; if exercising in a group setting, practice avoiding comparisons
A systemic review found that incorporating mindful exercises during treatment was effective in patients with chronic low back pain. In the review, it mentions that mindful exercise showed a significant reduction in pain when compared to traditional strength or stretching exercises.[10] In addition, a randomized control trial found that chronic pain patients who participated in a program where mindfulness was incorporated into their physical activity had significant reductions in pain at rest and with activity, pain catastrophizing, and fear of pain due to movement.[11]
References:[edit | edit source]
- ↑ Pike AJ. Body-mindfulness in physiotherapy for the management of long-term chronic pain. Physical therapy reviews. 2008 Feb 1;13(1):45-56.
- ↑ Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Medicine. 2013;14(2):230-42.
- ↑ 1. Hayes SC, Strosahl K, Wilson KG. Acceptance and commitment therapy the process and practice of Mindful Change. New York: The Guilford Press; 2016.
- ↑ 1. Tatta J, Willgens AM, Palombaro KM. Mindfulness and acceptance–based interventions in physical therapist practice: The time is now. Physical Therapy. 2022 Jan 3;102(3).
- ↑ 5.0 5.1 1. McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist. 2014;69(2):178–87.
- ↑ 1. Ma T-W, Yuen AS-K, Yang Z. The efficacy of acceptance and commitment therapy for chronic pain. The Clinical Journal of Pain. 2023 Feb 3;39(3):147–57.
- ↑ 1. Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and commitment therapy (ACT) for chronic pain. The Clinical Journal of Pain. 2017 Jun;33(6):552–68.
- ↑ 1. Society of Clinical Psychology (Division 12) [Internet]. American Psychological Association; [cited 2024 Apr 7]. Available from: https://www.apa.org/about/division/div12
- ↑ McClintock AS, McCarrick SM, Garland EL, Zeidan F, Zgierska AE. Brief mindfulness-based interventions for acute and chronic pain: a systematic review. The Journal of Alternative and Complementary Medicine. 2019;25(3):265-78.
- ↑ Zou L, Zhang Y, Yang L, Loprinzi PD, Yeung AS, Kong J, Chen KW, Song W, Xiao T, Li H. Are mindful exercises safe and beneficial for treating chronic lower back pain? A systematic review and meta-analysis of randomized controlled trials. Journal of clinical medicine. 2019 May 8;8(5):628.
- ↑ Greenberg J, Popok PJ, Lin A, Kulich RJ, James P, Macklin EA, Millstein RA, Edwards RR, Vranceanu AM. A mind-body physical activity program for chronic pain with or without a digital monitoring device: proof-of-concept feasibility randomized controlled trial. JMIR Form Res. 2020 Jun 08; 4 (6): e18703. 10.2196/18703.
