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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.

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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:

1.Relaxation
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.

2.Acceptance
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.

3.Mental flexibility
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.

Ten-Step Meditation for Pain Relief Technique
Meditation can help with coping and pain relief. This technique works best if practiced every day for 20 minutes. Here I will review how to do a meditation for pain relief exercise that you can practice every day to relieve pain.

Environment
Find a quiet place with minimal distractions where you can be undisturbed for 20 minutes.
Get into a comfortable position, such as sitting in a firm but comfortable chair with feet flat on the floor, legs and arms uncrossed, and hands in the lap or at the sides.


Instructions
For a 20-minute meditation session, each step will take about 2 minutes, but it is fine to spend more time on some steps than on others according to your preferences. There is no right or wrong way to meditate; what is most important is to keep a passive attitude, simply allowing and observing without trying to make anything happen (Raudebaugh 2010). Go through each of these steps in order to do the full meditation for pain relief exercise.

1. Calm breathing – breathe slowly in and slowly out. Observe each breath and allow your breathing to become deep, slow, and calm.

2. Passive awareness – become aware of everything perceived by the senses by noticing one thing at a time. Notice one sound you can hear. Notice how your clothing feels against your skin. Notice your breaths. Notice your pain. Observe without trying to change anything.

3. Body scan – concentrate your attention on one area of your body at a time, starting at the tips of your toes, and moving your focus slowly upward all the way to the top of your head. Observe without trying to change how your body feels.

4. Noticing and accepting – observe your thoughts without trying to make any changes. Accept each thought that arises and allow it to move on.

5. Focus on breaths – concentrate on your breathing. Observe each breath as it enters and leaves the body.

6. Repeat a meaningful phrase – choose a phrase that is meaningful to you and repeat it with each breath in, and with each breath out. Every time your mind wanders, focus again on repeating the phrase.

7. Noticing and accepting – observe your thoughts without trying to make any changes. Accept each thought that arises and allow it to move on.

8. Passive awareness – become aware of everything perceived by the senses by noticing one thing at a time. Observe without trying to change anything.

9. Calm breathing – breathe slowly in and slowly out. Observe each breath and allow your breathing to become deep, slow, and calm.

10. Brief stretch – open your eyes. Stretch your muscles. Take a moment to reflect on the meditation experience.

What to Expect
During and after the meditation for pain relief session you will probably feel calm and relaxed, and your mood may improve. Your pain is likely to be less upsetting, less noticeable, and easier to tolerate.
With practice you will become more and more skilled at meditating and more easily enter a relaxed, focused state of mind. After just a few days you might start to notice improvements in concentration, memory, sleep, and coping.
As your skills improve further, it is possible to develop the ability to directly eliminate pain through meditating (Morone et al. 2008). Meditation can allow you to become happier, experience reduced pain, and have an overall better quality of life.

References
Morone N.E., Lynch C.S., Greco C.M., Tindle H.A., & Weiner D.K. (2008). "I felt like a new person." The effects of mindfulness meditation on older adults with chronic pain: Qualitative narrative analysis of diary entries. Journal of Pain, 9(9), 841-8.
Raudebaugh, C. (2010). Words to Relax: Relaxation Scripts for Personal Growth and Stress Relief. Red Deer, Alberta: Inner Health Studio.
Wachholtz, A.B., & Pargament, K.I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28(4), 369-384.

http://painhealth.csse.uwa.edu.au/pain-management-mindfulness-and-pain.html
http://www.innerhealthstudio.com/meditation-for-pain-relief.html
http://www.racgp.org.au/afp/2013/march/mind-body-therapies/

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