An Outpatient Program in Behavioral Medicine for Chronic pain

Report
AN OUTPATIENT PROGRAM IN BEHAVIORAL
MEDICINE FOR CHRONIC PAIN PATIENTS
BASED ON THE PRACTICE OF MINDFULNESS
MEDITATION: THEORETICAL
CONSIDERATIONS AND PRELIMINARY
RESULTS
By: John Kabat-Zinn, Ph.D.
STRESS REDUCTION & RELAXATION PROGRAM
Training in mindfulness or awareness meditation
 Serves as major self-regulatory activity
 Used as an “net” for patients
 Based on development of internal resources of patients
 Alternative to traditional methods
 Self-regulation is promoted and learned via the
directed attention characteristic of mindfulness
meditation

CONCENTRATION

Transcendental Meditation- involves the
restriction of attention to a single point or object,
commonly a mantra, the experience of breathing,
or a visual object and holding it in the mind for
extended periods of time.

Mantra- mental sound

Based on Indian philosphy
MINDFULNESS MEDITATION

Mindful Meditation- characterized by the
specialized use of attention and careful selfobservation





Emphasizes the detached
Concentration on one primary object until attention
is stable
Allows field of attention to expand to include all
physical and mental events exactly as they occur
in time
No event is considered a distraction
No mental event is allotted relative or absolute value
PAIN


Pain is the result of the functioning of a
normally adaptive neurological pathway.
Chronic Pain- non-adaptive function


Imposes severe emotional, physical, and economic
stress
Three interactions of pain experience
Sensory-discriminative
 Motivational affective
 Cognitive- interpretative

GATE CONTROL THEORY

Psychophysiologicial
model for explaining
the modulating effects
that higher nervous
system behaviors can
have on perception
and interpretation of
pain.
PAIN & MEDITATION
Meditation practice
often accompanied by
pain.
 Pain in meditation
periods resemble
chronic pain.
 Traditional meditation
articles offer
recommendations for
achieving detachment

Mindfulness requires
focusing on unpleasant and
painful sensations and
discourages efforts to escape
 De-conditioning of alarm
reaction

CURRENT STUDY
Used mindfulness meditation as the basis for a
self-regulation strategy for chronic pain patients
 Uncoupling hypothesis- detaching the sensory
component of pain from the affective and
cognitive dimensions.

Uncoupling is thought to be associated with higher
brain centers
 Generate descending signals to close or narrow the
spinal gate, resulting in primary sensory dimensions
as well.
 “Refinement” of awareness

CURRENT STUDY
Program was a 10 week course ( 3 cycles)
 Patients attended once per week for 2hrs
 51 participants

18 male, 33 female
 22 to 75 years old


Classes of pain
Lower back pain
 Upper back & shoulder pain
 Cervical pain
 Headaches


Pre & post interviews were conducted
MINDFUL MEDITATION PRACTICES
Sweeping- a gradual sweeping
through the body from feet to head
with the attentional faculty with
periodic suggestions of breath
awareness.
 Mindfulness of breath- practiced
sitting in chair
 Hatha Yoga- introduced meditative
exercise, developing mindfulness
during movement
 Also taught mindfulness meditation
using various activities

METHODS
 Hospital sessions taught mindfulness of breath
and sensations
 Sweeping was practiced for 4weeks
45 minute homework cassette tape
 Once a day, 6 days a week


Hatha yoga introduced next 4 weeks
Alternate the sweeping with the yoga
 Practiced yoga 35-40 min per day

Allowed to use any form last two weeks
 Given material on the physiology of stress and
methods of coping
 Follow up questionnaires ( 2.5, 7, & 11 months )

MEASURES
Pain Measures


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Pain Rating Index- scores
which reflect quality and
intensity of clinical pain
experienced ( “right now”)
Body Parts Problem
Assessment (BPPA) –
measures view of how
problematic body parts are (
“this week)
Three –color Dermatome
Pain Map (DPM)- visual
representation of the areas
and intensities of pain
Table of Levels
interference (TLI)frequency with which pain
interferes with life activities
Daily pain related drug uses
was monitored
Non- pain Measures
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MSCL – number of medical
symptoms
Profile of Mood States
(POMS)- change in
emotional affect and mood
SCL -90R- change in
psychological
symptomatology
Multidimensional Health
Locus of Control – change
in health related beliefs
Outcome questionnaire
Evaluated progress toward
patient set goals
KEY ELEMENTS
Group format
 Expectation of relief
 Non- goal orientation
 Self responsibility
 High demand
characteristics
 Low cost

Spectrum of meditation
techniques
 Didactic material
 Finite duration
 Long-term perspective
 Advanced program

RESULTS
65% showed reduction in pain (10 weeks) of ( ≥
33%
 50% showed reduction of pain (10 weeks of ( ≥
50%).
 Large reduction in mood disturbance and
psychiatric symptoms (26% -49%)
 Evidence suggest pain reductions are related to
changes in attitudes and modes of perception of
pain (TMD score ↓ 60% )
 Some reductions maintained for up to 1.5 years
follow up

ANDES SURVIVORS



Pain and suffering similar to that of patients
with chronic pain.
Rosary for some period of mental relaxation or
period of thought
Survivors able to endure great physical and
emotional pain

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