Inspired Medics gives you insights from 3 practicing medical professionals on using meditation techniques in clinical practice
What does the evidence say?
by Dr Emma Short
There is a wealth of studies examining the medical benefits of mindfulness and meditation for many conditions including hypertension, cardiovascular disease and mental health disorders. In this article we look at the impact that they have on pain.
The practices of mindfulness and meditation have been shown to modulate how noxious stimuli are interpreted and also the severity of pain. A paper in the Journal of Neuroscience (1) describes a study in which 15 healthy volunteers took part in a 4-day programme of mindful meditation. After the intervention, the participants were exposed to a noxious thermal stimulus. The investigators reported that meditating led to a reduced perception of pain 'unpleasantness' by 57% and reduced pain intensity ratings by 40%. The individuals taking part in the study also underwent MRI imaging. This showed that meditation-induced reductions in pain intensity ratings were associated with changes in neuronal activity in areas of the brain involved in the cognitive regulation of pain processing, the contextual evaluation of sensory events and in pain transmission. The study authors concluded that meditation engages multiple brain mechanisms that can alter how we subjectively construct a pain experience.
Mindfulness can have an important role to play in the management of chronic pain conditions. A randomised clinical trial published in JAMA (2) allocated adults aged 65 years or older with chronic low back pain to either undergo a mindfulness-based stress reduction program (n=140) or a health education programme (n=142). The mindfulness training comprised an 8-week programme followed by 6 monthly sessions. The patient cohort who underwent mindfulness training experienced improved pain ratings compared to the control group, in addition to an improvement in short-term function scores.
Dr Emma Short is a Histopathologist with a PhD in Cancer Genetics, published Author and Editor and a Meditation Teacher. She has written a new module on Meditation and Mindfulness for the Inspired Medics course, The Future of Healthcare is Lifestyle Medicine.
Using meditation and mindfulness in Specialist Pain Clinics
by Dr Sanjeeva Gupta
Dr Sanjeeva Gupta, is a Consultant in Pain Management at the Bradford Teaching Hospital NHS Foundation Trust and Nuffield Hospital, Leeds. He recommends mindfulness and meditation to some of his patients with persistent / chronic pain as a supplementary measure. In Sanjeeva's opinion, mindfulness and meditation is like "physiotherapy" for emotions, feelings and mind. It can complement mainstream medicine in a very useful manner. The patients preferences are key, i.e. personalised care, as the benefits are seen for the individuals who have a willingness to practice mindfulness and meditation as part of their management plan.
Sanjeeva has edited 5 books on Pain Medicine and was Winner of the British Medical Association, Medical Book of the Year Award 2015.
What to recommend to your patients interested in exploring meditation and mindfulness?
by Dr Angela Goyal
I often use the term 'relaxation breathing' to appeal to patients who have not heard of mindfulness or meditation before.
So for example, if I see a patient with anxiety or raised blood pressure, I might suggest we try some relaxation breathing together and see what happens. For patients who are willing, we do this for a couple of minutes together. To date, this has been a very positive experience for my patients. Together, we see that the anxiety immediately improves and blood pressure reduces. In addition, I feel my own stress levels are reduced, during a busy clinic! In the same way it can be suggested to a patient with chronic pain, although the effects may not occur there and then but from regular practice.
This then leads on to a conversation about a regular routine of relaxation breathing. It really does feel like shared-decision making in action as the patient is fully on board now.
Some simple tips for your patients (and you) :
explain that when we are feeling stressed, we breathe faster or hold our breath, and we rarely notice how we are breathing.
by simply observing our breathing we can slow it down, which makes us feel more relaxed
I use a simple breathing exercise in clinic
simply observe the breath. Notice the breathe entering the nostrils, notice the pause and the exhale. Notice how the chest expands and contracts
this naturally slows the breathing down
start small - as you would when recommending physical activity
suggest trying a couple of minutes of relaxation breathing a day
set aside a couple of minutes a day at the same time so it becomes a habit
try to stick with it every day
if you feel comfortable, try doing this with your patient in clinic
There are many more methods of relaxation breathing, mindfulness meditation and it is about finding something that suits the individual.
Take a look at these:
Dr Angela Goyal is a GP and Clinical Lead of Community Dermatology Services at One Medical Group. Angela is Founder of Inspired Medics and has published two educational online courses on Lifestyle Medicine for Clinicians. She is also a Regional Director of the British Society of Lifestyle Medicine and on the Advisory Panel for the UK Health Coaches Association
If you want to learn more:
If you wish to feel more confident to recommend mindfulness and meditation to your patients, then it would be worth looking at our course 'The Future of Healthcare is Lifestyle Medicine' which includes a module on this topic, as well as a host of other topics!
It will give you the understanding of what the terms mindfulness and meditation mean, the beneficial impact this can have on medical conditions and how to incorporate this into clinical practice as part of a shared decision making process.
This module is an excellent resource with a video presentation and handbook, detailing the health impacts of meditation and mindfulness for example; on pain, hypertension, cardiovascular risk, immunity and inflammation, brain structure and function and mental wellbeing. The module is fully referenced from the peer reviewed scientific and medical literature. Dr Emma Short has written and presents the module. For your own wellbeing, we've included some enjoyable sample meditations.
(1) Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011 Apr 6;31(14):5540-8. doi: 10.1523/JNEUROSCI.5791-10.2011.PMID: 21471390; PMCID: PMC3090218.
(2) Morone NE, Greco CM, Moore CG, Rollman BL, Lane B, Morrow LA, Glynn NW, Weiner DK. A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med. 2016 Mar;176(3):329-37. doi: 10.1001/jamainternmed.2015.8033. PMID: 26903081; PMCID: PMC6361386.