Dr Joanna Makovey is a scientist with over 20 years experience in medical research. She has been a member of the musculoskeletal research group at the Department of Rheumatology of the RNSH since 1996. She completed her PhD in 2009 and has over 30 publications. She is affiliated with the Institute of Bone and Joint Research (Northern Clinical School, the University of Sydney). Outside of work, Joanna enjoys yoga and travelling.
Mindfulness is about being here, now. It’s about being 'present' or in the moment. While the idea is really very simple, embodying mindfulness is not always easy. We’ve all had experiences of being completely absorbed in what we are doing - perhaps walking on the beach, playing with a child, looking up at a magnificent sunset, or enjoying the first mouthful of a delicious meal. These moments are moments of mindful awareness and we have them all the time. It’s just that they are brief and fleeting.
Soon enough our minds wander off into streams of consciousness – analysis, remembering, planning and a myriad of other distractions. We might pull into the driveway and suddenly come to our senses, unable to remember the drive home because we were replaying the day’s events in our minds.
What does mindfulness meditation involve?
The practice of mindfulness meditation is really just about stretching out these moments of present-focused awareness by training our minds to keep coming back to what is happening right now. It is described as shifting out of the 'doing' mode and into the ‘being’ mode, or switching out of autopilot.
At first this involves picking something to pay attention to – like the flow of your breathing, the shifting sensations in your body, or the many sounds around you – and noticing each time you end up distracted so that you can gently coax your attention back. This returning to the now, over and over, becomes a habit, just as practising scales on a piano or kicking the footy develops muscle memory. We stop 'missing precious moments' and start being fully engaged with what is happening as it unfolds.
What does mindfulness meditation have to do with pain?
Practising mindfulness meditation can be helpful for people with persistent pain, which has shown moderate effect in reducing pain intensity. Compared to standard care for pain, meditation also seems to improve other aspects of life, such as depression, quality of life, acceptance, sleep quality and physical function. When it comes to short term pain, people report less distress and can tolerate more pain when they have had meditation training, compared to people who do not meditate6.
Overall, the current evidence suggests that mindfulness-based treatments are about as good as well-established psychological treatments for pain, like Cognitive Behaviour Therapy (CBT). However, since the research on meditation is newer, it is not yet as strong and convincing as the research on CBT. We still need to do more high quality studies to figure out which types of pain meditation helps most with, what doses of meditation work best, and what the essential ingredients are that make meditation helpful.
How does mindfulness meditation help with pain?
While research on meditation and pain are still in its early days, there a few important ingredients that we know of:
Relaxation is a helpful side effect of meditation and is very important for coping with pain. This is because while pain is stressful in itself, the stress also exacerbates and maintains pain. Relaxation helps to calm down your nervous system, which often becomes 'sensitised' when pain persists for a long time and boosts your body’s natural pain modifiers, such as "feel good" hormones.
Mindfulness is about accepting what is here right now as best we can, including pain, so that we can soften and be more receptive to what happens next. This is very different from being resigned to a life of pain. Mindfulness is all about curiosity and what some people call 'beginner’s mind'. Research shows that people who learn how to accept their pain respond better to various treatments and have better overall pain outcomes.
Negative thoughts drive negative feelings, which can sensitise our nervous systems and increase our pain. Thinking very negatively about pain, or what we call 'pain catastrophising', is one of the strongest predictors that short-term acute pain will become longer-term persistent pain. Mindfulness meditation can reduce the burden of these negative thoughts because it changes our relationship to thinking itself. We start to see thoughts as just 'mental events' rather than facts, which lessens their impact. In other words, we don’t as easily buy into the negative story around our pain. This is especially important in overcoming the upsetting emotional impacts of pain, such as depression and anxiety.
4.Pain with less distress
Exciting research using brain scanning technology like functional magnetic resonance imaging (fMRI) is beginning to shed light on patterns of activity in the brain when a person is in pain and when they are meditating. It looks like people are still aware of the sensory aspects of pain during mindfulness meditation but they experience it as less unpleasant since it does not activate as many of the brain networks related to memory and emotion. In other words, meditation trains your brain to experience pain with less distress.