From the Guidelines
Mindfulness and meditation should be used as a complementary approach to standard medical treatments for pain management, rather than as a replacement. The most recent and highest quality study, 1, suggests that nonpharmacologic therapies, including mindfulness-based stress reduction, can be associated with small short-term improvements in pain.
Key Points to Consider
- The effectiveness of mindfulness and meditation for pain management varies by individual and pain type, with better results for chronic rather than acute pain 1.
- Mindfulness-based stress reduction (MBSR) programs, typically involving 20-45 minutes of daily practice for 8 weeks, show the most consistent benefits for chronic pain conditions 1.
- To implement mindfulness for pain, start with short 5-minute sessions of focused breathing or body scan meditations, gradually increasing to 20 minutes daily.
- Apps like Headspace or Insight Timer offer guided pain-specific meditations.
- While mindfulness can help reduce reliance on pain medications like opioids, it's essential to maintain prescribed pharmacological treatments and discuss any changes with healthcare providers, as meditation alone is rarely sufficient for managing significant pain conditions 1.
Important Considerations
- The evidence for mindfulness and meditation in pain management is not strong enough to recommend it as a replacement for standard medical treatments 1.
- Multidisciplinary rehabilitation, which may include mindfulness and meditation, can be associated with small to moderate improvements in pain and function compared to usual care or control groups 1.
- The choice of therapy should be individualized, taking into account the patient's preferences, values, and medical history.
Implementation and Monitoring
- Healthcare providers should discuss the potential benefits and limitations of mindfulness and meditation with patients and monitor their progress regularly.
- Patients should be encouraged to maintain a consistent practice and to communicate any changes in their pain or medication use to their healthcare provider.
From the Research
Effectiveness of Mindfulness/Meditation in Reducing Pain
- Mindfulness meditation is associated with a small decrease in pain compared with all types of controls, with low-quality evidence supporting its effectiveness in reducing pain, depression symptoms, and improving quality of life 2.
- The practice of mindfulness meditation reduces pain by engaging mechanisms supporting the cognitive control of pain, and does not rely on endogenous opioidergic mechanisms to reduce pain 3.
- Mindfulness meditation-induced pain relief is mechanistically distinct from placebo analgesia, with mindfulness meditation activating higher-order brain regions, including the orbitofrontal and cingulate cortices 4.
Use of Mindfulness/Meditation in Addition to Standard of Care
- A pilot randomized controlled trial found that a mindfulness meditation and cognitive behavioral therapy (CBT) intervention reduced pain severity and sensitivity in opioid-treated chronic low back pain patients, without adverse events 5.
- Mindfulness meditation has been shown to improve chronic pain, particularly in reducing depression and improving quality of life, with a trend towards benefit in reducing affective pain, sensory pain, and anxiety 6.
- The use of mindfulness meditation as an adjunct pain therapy may be beneficial, as it employs different neural mechanisms than pharmacological treatments and may foster greater acceptance of meditation as a treatment option 3, 4.
Comparison to Pharmacological Treatment
- Mindfulness meditation does not rely on endogenous opioidergic mechanisms to reduce pain, which may make it a useful adjunct or alternative to opiate-based medications 3.
- The treatment of chronic pain may be more effective with meditation due to a lack of cross-tolerance with opiate-based medications, suggesting that mindfulness meditation could be used in addition to or instead of pharmacological treatment in some cases 3.