Meditation & Chronic Pain

Jeremy James: DC, CSCS

Pain can be divided into two broad categories: chronic pain and acute pain. Chronic pain and acute pain differ in significant ways. Acute pain is the pain that you feel immediately after an injury. Acute pain is well understood and follows predictable pathways and patterns. Chronic pain is commonly defined as pain that persists for more than 12 weeks. Chronic pain is poorly understood and can be very unpredictable and difficult to treat. Chronic pain can begin as acute pain with a clear cause such as an injury, which then persists beyond normal tissue healing time. Sometimes, the initial cause of chronic pain is unidentifiable. The costs of chronic pain are enormous. A 2010 study by Gaskin and Richard found that chronic pain costs the United States $560 to $636 billion dollars annually.

In addition to causing pain in the chief complaint area, chronic pain also commonly causes a cascade of unfortunate events: loss of mobility, loss of the ability to do daily activities and be self-reliant, as well as contributing to depression, anxiety, and hopelessness.

I work with patients in chronic back pain daily and see this pattern regularly. Some of these patients respond well to the standard approach to chronic back pain treatment: a spinal stabilization program, manual therapy, and changes in foundational movement patterns. Sometimes, though, the missing link for these patients is meditation. Those suffering from chronic pain undergo changes in the function of parts of their brains over time. These changes can promote and reinforce chronic pain patterns. The most exciting new research in the treatment of chronic pain deals with the changes in the brains of chronic pain sufferers and the ability of meditation to affect these changes. To put it very simply and generally (and believe me, this is a very complex topic), meditation reduces chronic pain by decreasing the amount of arousal in the nervous system, the stress that exacerbates pain. Arousal in the nervous system aggravates pain, which in turn becomes another stressor, causing more arousal, which aggravates pain. You get the picture. Meditation changes this cycle by affecting the four areas of the brain that modulate pain: the primary somatosensory cortex, anterior insula, anterior cingulate cortex, and prefrontal cortex.

This is difficult for many patients to wrap their head around at first. Most people accept that repetitive exercise is necessary to change one’s body to promote healing and overcome chronic back pain. You can’t do an exercise once and expect to be better. Many people are less likely to accept the importance of regular meditation to change the way the brain functions to interpret and process pain. Meditation can be thought of as exercise for your brain. It needs to be done regularly to have the desired effect, just like exercise does for the rest of your body. Regular meditation changes the way that the brain functions in the areas that process pain. For most people, around 20 minutes per day is enough to see significant changes. I find it easiest and most effective to do this first thing in the morning before I even get out of bed. I recommend instruction in the beginning, whether it be a class or listening to a podcast or webinar. It takes a bit of practice but is doable for almost anyone with a little perseverance. If you struggle with chronic pain and are interested in giving meditation a try, email me for suggestions on how to get started. You won’t regret it.