Chronic Pain

What is pain?

Seems like a simple question with an obvious answer, right? We all know that it’s the experience of hurting, feeling unpleasant sensations, physical (and mental) suffering. But what makes us feel physical pain? Pain, after all, exists only in the brain; that is, in the mind. If you’ve ever had surgery, you know how you feel when that painkiller medication wears off and you become aware that you’re in pain. The surgical incision (the injury), after all, was there before the painkiller wore off. You just weren’t aware of it because the drug was blocking or inhibiting the “You have tissue damage!” message being sent from your nerve fibers to brain areas that register pain and prompt the thought: I’m in pain! So the experience of pain is actually a complex one, with many levers and switches that can determine how — or, for that matter if — you perceive pain.

Pain may not feel good, but it’s one of our most important adaptive mechanisms. It’s your body’s way of sending a warning message to your brain via your nervous system that something is wrong. We have thousands of receptor nerve cells in and beneath the skin that sense heat, cold, light, touch, pressure, and injury. Pain may be acute or transitory, lasting only until the harmful stimulus is removed or the underlying damage or pathology has healed (e.g., post-surgical pain), or it may be chronic, persisting for months or even years (e.g., rheumatoid arthritis, peripheral neuropathy, idiopathic pain resulting from a disease such as cancer).

There are three general classes of pain — nociceptive, inflammatory, and pathological (Woolf et al, 1998) — and each many be resolved through different mechanisms.

Nociception is the neural process of encoding and processing harmful or painful stimuli, initiated by nociceptors (nerve receptors), which can detect harmful mechanical, thermal or chemical changes. Thus, nociceptive pain is caused by excessive, intense stimulation of peripheral nerve fibers. Inflammatory pain results from tissue damage, hypersensitized nerves or infiltration of immune cells. Neuropathic pain (e.g., burning, tingling, stabbing, shooting pain or “pins and needles”) is caused by disease or damage to our somatosensory nervous systems. Damaged nerve fibers misfire and send incorrect signals to other pain centers. Nerve fiber injury produces a change in nerve function both at the site of injury and areas around the injury (e.g., as in fibromyalgia, phantom limb syndrome, irritable bowel syndrome). Examples of common causes include diabetes, shingles, back, leg and hip problems, chemotherapy, multiple sclerosis.

Around 40 percent of people who suffer from chronic pain say that their current treatment is not sufficiently managing their pain (Brown, Jones, 2010). But no matter what type of pain you’re experiencing, Sahaja meditation can help change your experience of pain. Meditation offers a number of pain reduction methods. Here are some highlights:

• Improves attention skills, allowing us to direct our attention away from painful sensations and remain fully engaged with the present moment experience
• Improves self-awareness and improved insight into negative emotional processing that worsen pain, ultimately leading to behavioral changes
• Directly reduces pain by altering neural pathways that modify the experience of pain
• Relieves psychological distress, which helps manage all mental and physical health problems, which, in turn, helps reduce chronic pain
• Reduces anxiety, boosts mood and improves coping skills and resilience
• Reduces emotional reactivity, which enables emotional self-regulation and its positive corresponding physiological responses, such as down-regulating the hypothalamic–pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) to modulate hormones
• Influences key neurotransmitters and neurohormones that regulate mental and physical health and play a role in pain perception
• Reduces levels of the stress hormone cortisol, which helps reduce inflammation and boost overall immune system function (including T-cell function), facilitating faster healing and recovery

Negative affect such as depressed mood, anxiety, negative stress and fear is known to increase our sensation of pain (Keefe et al, 2004). But the flip side is that by improving these aspects of mental health — reducing negative thoughts and feelings — meditation can help reduce the experience of pain.

Around 50 percent of people with chronic pain experience depression (Brown, Jones, 2010). An Oxford University study found that depressed mood disrupted neurocircuitry that regulates emotion, causing an enhanced perception of pain. When healthy people were saddened by negative thoughts and depressing music, their brains processed pain more emotionally, which led them to find the pain more unpleasant. Sadness and low mood disables our ability to regulate the negative emotion associated with feeling pain, thus the pain has a greater impact. Rather than merely being a consequence of having pain, may drive pain and cause it to feel worse (Berna et al, 2010).

Over time, Sahaja meditation allows us to consciously control our attentional and emotional responses. The simplest, most obvious methods for combatting chronic pain is ignoring it or finding a distraction. If we direct our attention towards something else — anything else — we aren’t focusing on the pain, thus we don’t notice it as much.

But one cannot live a life of complete distraction, thus other measures are called for.

Through meditation, we learn to regulate our attention. We become more aware of what we pay attention to and can choose how we direct our attention. We are better able to fully engage in present moment activities — working, listening to music, exercising, whatever. Total absorption in activity may effectively distract us from pain, at least temporarily. But if you live with chronic pain, you need a long-term solution, which may require both a shift in your perspective of pain and how you respond to it.

One 2016 Sahaja meditation study using MRI and Voxel-Based Morphometry found that long-term Sahaja practitioners (compared with non-meditators) had significantly larger grey matter volume (GMV) across their entire brains, a phenomenon that has not previously been found in practitioners of any other meditation technique (Hernández et al, 2016). In addition, GMV was found to be especially enlarged in left and right hemispheric regions associated with sustained attention and cognitive control, emotional control, self-awareness, interoceptive perception, and monitoring of autonomic functions. These results suggest that the long-term practice of Sahaja meditation may increase neuroplasticity and enhance our long-term ability to self-regulate.

Detaching from pain.

Sahaja meditation brings about the state of mindfulness, being present and in the moment, and observing our thoughts and feelings in a detached, nonjudgmental way. One mechanism through which we can combat pain is to detach from it.

In Sahaja meditation, we maintain an attitude of detached observation toward a sensation (e.g., pain) when it becomes prominent in our field of awareness, and can observe, with similar detachment, the accompanying but independent cognitive processes which lead to evaluating and labeling the sensation as “painful.” The state of thoughtless awareness allows us to “uncouple” the different components of the complex experience of pain; for example, we can uncouple the physical sensation of pain from the emotional and cognitive experience of pain, which ultimately diminishes our perception of pain. Over time, this ability to uncouple the elements of pain may apply to everyday life, even while not meditating.

Heightened Awareness

Ignoring pain sensations is typically considered to be a mechanism for coping with pain. But one meditation study found that becoming more aware of the bodily sensation of pain has a paradoxical effect — that is, attending to the experience of one’s pain can actually reduce pain. One possible explanation is that we develop an increased awareness of physical activities or postures that worsen pain. Heightened awareness allows us to intervene before pain escalates. It enhances our ability to simply stop a pain-causing activity at the first hint of pain can allow us to (Morone et al, 2008).

Acceptance

Acceptance may be a precursor for effective cognitive control. Acceptance promotes control by allowing us to become less invested in our emotional appraisals of pain. Enhanced mindfulness encourages you to accept who you are, trust yourself and not judge yourself for having the feelings you have; rather, you are able to simply allow yourself to feel them.

Serotonin and norepinephrine.

While a number of neurotransmitters and nerve receptors are likely involved in regulating pain pathways, serotonin and norepinephrine appear to be the primary mediators of our natural analgesic (pain relief) mechanisms (Lamont et al, 2003).

Increases in the activity of brain and spinal cord serotonin (5-HT) has been found to trigger an analgesic or pain relief effect on nociceptive (pain) processing in pathological pain states, whereas, decreases in serotonin activity increased pain sensitivity (Bardin, 2011; Messing, Lytle, 1978). In fact, some studies have found that some antidepressant medications (specifically Serotonin-Norepinephrine Reuptake Inhibitors) help treat some chronic pain syndromes, particularly neuropathic pain and fibromyalgia. SNRIs inhibit serotonin and norepinephrine reuptake, which helps inhibit centrally sensitized pain (Marks et al, 2009).

In influencing serotonin and norepinephrine activity, meditation may play a similar role. Serotonin is also the primary neurotransmitter involved in mood regulation — the feel-good neurotransmitter. Norepinephrine is a stress hormone that causes the heart rate to increase, stored glucose (simple sugar) to be released, and increased blood flow to the muscles. Norepinephrine plays a major part in helping us escape danger, but also in creating or exacerbating anxiety and fear, both of which worsen pain.

Cortisol

When the body is under stress, the adrenal cortex ramps up secretion of steroid hormones, particularly the stress hormone cortisol. Cortisol helps regulate inflammation, the body’s natural response to injury or infection, but chronic, prolonged high levels of cortisol in the bloodstream damage the immune system. Many studies have established that meditation has a lasting influence on adrenocortical activity (steroid hormones produced by the adrenal glands) — both during meditation and after.

(For a comprehensive look at how meditation influences other neurotransmitters & neurohormones, see Evidence of Meditation’s Impact on Neurotransmitters & Neurohormones.)

One of the mechanisms through which meditation may help prevent disease and dysfunction is by reducing the level of oxidative stress in our bodies. Oxidative stress is a destructive process in which free radicals or reactive oxygen molecules react with the components of cells (e.g., proteins or fats and nucleic acids such as DNA), ultimately damaging those cells. Oxidative stress can lead to chronic inflammation, which, in turn, plays a role in chronic diseases such as cancer. In activating inflammatory pathways, oxidative stress can, for example, transform normal cells to tumor cells and trigger treatment complications such as chemo-resistance or radio-resistance (Reuter, 2010).

Oxidative stress and chronic inflammation are closely linked to chronic pain and disease processes. A compromised immune system makes us more vulnerable to injury or disease and impairs the body’s ability to recover. While inflammation is part of the body’s natural immune response, chronic, out-of-control inflammation plays a significant role in perpetuating pain and driving disease processes.

Meditation helps modulate the nervous system, which has a number of calming physiological effects, including producing powerful pain-relieving effects in the brain.

Several studies have provided neurological evidence that meditation changes how the brain perceives and experiences pain, reducing pain sensitivity and reactivity (e.g., Davidson, 2000; Kabat-Zinn, 1982).

Several studies have demonstrated how meditation modifies the experience of pain…

Decreases chronic pain and pain sensitivity… better than morphine?

Several studies have pinpointed mechanisms through which meditation may relieve pain. NIH-funded neuroimaging studies found that long-term meditation can mitigate the brain’s response to pain by 40 to 50 percent. Neuroimaging studies have found that meditation’s ability to help people let go of negative or distracting thoughts and emotions produced a 40 percent reduction in pain intensity and a 57 percent reduction in pain unpleasantness by reducing brain activity in the primary somatosensory cortex, the area responsible for creating the feeling of where and — how intense — pain is (Zeidan et al, 2011). Meditation increased brain activity in areas that shape how relevant areas of the brain (such as the anterior cingulate cortex, anterior insula and orbito-frontal cortex) build the experience of pain from nerve signals received from the body.

So, meditation was effective in reducing pain at multiple levels of processing. Meditation, in fact, was found to produce an even greater pain reduction than pain-relieving drugs such as morphine.

Heightens self-awareness and personal insight.

One study of seniors found that meditation helped relieve chronic back pain by increasing awareness of the present moment and by inhibiting negative emotional processing that worsened the pain. Meditation taught participants how to become aware of their negative emotional responses to their pain, which, in turn, allowed them to manage their reactions in a less self-destructive manner. By encouraging awareness of present moment experience, meditation also regulated attentional skills such as focus and concentration, which allowed participants to consciously direct their attention and become fully engaged in activities. Meditation in a peaceful, natural setting (e.g., garden or water setting) was found to be especially effective at reducing chronic pain, as well as helping to improve fine motor skills and overall feelings of well-being (Morone et al, 2008).

Reduces the emotional impact of pain.

Meditation, which trains us to focus on the present moment, reduces anticipatory anxiety (worrying about future events), thus can reduce the anticipation of pain, as well as decrease our negative appraisals of pain. One study using laser devices to trigger pain sensations found that a specific area in the brain’s prefrontal cortex (PFC) were less active as participants practicing mindfulness meditation anticipated pain (Brown, Jones, 2010). The PFC is involved in controlling attention and thought processes when potential threats are perceived, and the anticipatory area of the PFC, the mPFC, is known to signal the need for cognitive control when a threat (such as) is perceived. These meditators were less anxious about future pain and rated the pain they experienced as less unpleasant. (Experienced meditators showed the least anticipation of pain.)

In other words, meditation was able to control anticipation of pain, rather than simply respond to it.

Directly alters neural pain pathways.

Neuroimaging studies have suggested that meditation may modify our experience of pain by altering neural pathways over time.

Experiencing either high or low pain unpleasantness has been found to produce corresponding changes in activity in the anterior cingulate cortex (ACC) of the brain, but not the primary somatosensory cortex where actual pain is registered (Rainville et al, 1997).

In other words, the participants were still aware of the pain, but through meditation, found it to be less unpleasant.

Enhances voluntary control of pain perception.

Another fMRI study showed that individuals using real-time neurofeedback learned to voluntarily modulate activity in the rostral anterior cingulate cortex (rACC), with a corresponding change in pain perception (deCharma et al, 2005). The rACC is involved in pain processing, thought to be influenced by the high density of receptors for the neurotransmitter GABA (LaGraize, Fuchs, 2007).

Meditation has been found to help modulate GABA, which has an anti-anxiety, calming effect and may, in turn help reduce the experience of pain (Elias, A.N., Wilson, A.F., 2000; Streeter, C.C., 2007).

Increases melatonin.

Meditation increases melatonin, which has been found to play a role in reducing pain sensitivity in addition to its well-established role of regulating sleep. Melatonin also acts as an antioxidant and immunomodulator, stimulating the immune system and the antioxydative defense system and reducing oxidative stress. It’s been closely linked to serotonin in stabilizing mood, positive emotions, stress-prevention and aging. Several studies of meditation have revealed increases in blood plasma levels of melatonin (Harinath et al., 2004; Massion et al., 1995; Solberg et al., 2000a, 2004a, b; Tooley et al., 2000) in long-term meditators, as well as acutely after meditation.

Helps regulate serotonin and norepinephrine.

During meditation, respiration and heart rates decrease, which in turn, reduces the activity of brain areas that produce norepinephrine (Newberg, A., Iverson, J., 2003). Serotonin has been found to increase after meditation, and higher overall levels have been measured in long-term meditators (Newberg, A., Iverson, J., 2003; ; Walton, et al, 1995; Solberg et al., 2000a, 2004b).

Helps reduce cortisol.

Regular meditators have been found to have significantly lower levels of cortisol (Sudsuang et al, 1991; Newberg, Iverson, 2003). During meditation, respiration and heart rates decrease, which reduces activity in areas of the brain that trigger production of stress-related hormones, including cortisol, epinephrine, norepinephrine, and ACTH (Newberg, Iverson, 2003). Several studies have found that urine and plasma cortisol levels are decreased during meditation (Rai et al, 2013; Livesey J. H., et al, 2000; Walton, K., et al, 1995; Sudsuang, R., 1991; Jevning, R., 1978). Two clinical studies found that Sahaja meditation significantly reduced blood cortisol levels (Rai et al, 2013).

Reduces oxidative stress.

Several studies have found that oxidative stress is significantly lower among those who practice meditation (e.g., Van Wijk et al, 2008; Sharma et al, 2008). Two clinical studies found that Sahaja meditation had a significant effect on oxidative stress, endothelial function, serum cortisol, perceived stress levels and heart rate variability (HRV). HRV and endothelial function improved and blood cortisol levels significantly decreased, which decreased oxidative stress and perceived stress levels in long-term Sahaja meditators, compared to non-meditators (Rai et al, 2013).

Boosts immunity.

Studies have found that mindfulness meditation boosts immune system function by increasing antibody production (Davidson et al, 2003). Meditation has been found to stop the decline of CD4 T-cells (the “brains” of the immune system ) in HIV-positive patients (Creswell et al, 2009).

Meditation promotes accurate appraisals, effective coping and psychological thriving.

In increasing our awareness of present moment experience, meditation acts as a stress-buffer, increases positive thoughts and feelings, gives us a sense of control (and a decreased need to control), increases our acceptance of our emotional experience, and enhances our ability to accurately appraise stressful situations. Thus, meditation reduces the likelihood of rumination, exaggerated pain appraisals, and distress about distress. Meditation helps us develop cognitive shifts that reorganize our outlook on life, which improves our ability to appraise situations as challenges rather than threats, and facilitates positive coping (Epel, 2004; 2009). These shifts are more than just coping strategies or acute stressor appraisals. They’re not tied to specific situations; rather, they serve as meta-cognitions about your entire life. They stay with us, becoming ingrained mental schemas that affect all our future appraisals.

Perhaps not. One study compared the pain regulation abilities of two general types of meditative practice: Focused Attention or Concentration (e.g., some forms of Buddhist meditation), which involves one-pointed concentration and focusing on a fixed object (e.g., a small coin) and Open Monitoring or Open Presence (e.g., Sahaja meditation, Mindfulness-Based Stress Reduction (MBSR), which generates a state of total openness and allows practitioners to simply observe thoughts and feelings as they rise and fall in a detached way.

Researchers theorized that Focused Attention meditation might regulate negative cognition through a sensory gating mechanism (filtering out redundant or unnecessary stimuli), but they found that Focused Attention or Concentration meditation had no significant effects for either novices or long-term partitioners. However, they found that long-term Open Monitoring or Open Presence meditators experienced significantly reduced pain unpleasantness (though not intensity of pain) through a mechanism of non-judgmental, non-reactive awareness of sensory experience (Perlman et al, 2010).

Billions of dollars are spent on painkiller meditations every year, and often, they’re not enough to completely combat pain and restore quality of life. Not to mention that there may be unpleasant side effects to contend with. Sahaja meditation may prove to be an effective alternative therapy, or at the least, a complimentary or adjunct therapy. There’s no cost attached and meditation has no side effects.