Matters of the Mind

A look at some alternative solutions
for those with chronic pain

By Laurie Long

You know about pain. Pins and needles, lower back pain, facial pain, chronic headaches, burning sensations, spasms – these are just some of the manifestations of pain from MS. You know about the drugs to relieve that pain – anticonvulsants, tricyclics, corticosteroids, anti-spasticity medication and more. You have studied the research, followed the steps, taken the medications, done the exercises…and still it is not enough.

It is estimated that over half of people with MS will experience pain from their disease. Of those, chronic pain syndromes make up 50 – 80% of all pain experienced in MS. There are treatments available for the various kinds of MS pain, but for many people these treatments are just not sufficient.

While researchers work to find ever better drugs for chronic pain (see the article MS Pain and What to Do About It), some have been looking into other ways of controlling pain. This research focuses on the ability of the mind to change its perception of pain and stress from the body.

We spoke with two people who have been investigating alternative methods for dealing with pain, anxiety, depression and stress. Anil Coumar, MBBS, MA, Director of Hall Health Mental Health Clinic at the University of Washington, works with Mindfulness Based Cognitive Therapy (MBCT), and Marisol Hanley, PhD, licensed psychologist in Counseling Psychology at Harborview Rehab Clinic, works with hypnosis and biofeedback therapy.

Anil Coumar grew up in India, where he studied to become a doctor. He has studied hypnosis in London, took a Masters in psychology in the U.S. and became interested in mindfulness-based treatments for anxiety and depression.

The idea of ‘mindfulness’, he explains, grew out of the Buddhist tradition of meditation. According to Jon Kabat-Zinn, a pioneer in mindfulness-based therapy, your thoughts are ‘just thoughts’ - not ‘you’ or ‘reality’. “The simple act of recognizing your thoughts as thoughts,” he explains, “can free you from the distorted reality they often create and allow for more clear-sightedness and a greater sense of manageability in your life.” (Kabat-Zinn, 1990) Dr. Robert Anderson, President of the American Holistic Medical Assoc., noted that, “Meditation focuses attention away from the pain.” He explains, “The biochemical results of the state of meditation entrain muscle relaxation and an altered state of awareness – a state of detachment from the pain.” (Anderson, 2005)

Anil explains that mindfulness teaches people to recognize and acknowledge their pain, whether physical or emotional, without becoming so focused on the pain that it blots out everything else from their perception. “Often when something painful happens in our life,” he says, “our whole energy goes to that painful event, ignoring a beautiful sunrise or a smiling child’s face.” The object of mindfulness is to recognize negative and positive thoughts as they occur, and to be aware of how we react to, and deal with, the events and problems in our lives.

While this may sound overly psychological, the benefits of mindfulness meditation are firmly grounded in scientific fact. Numerous studies in the last 30 years have proven that the use of meditation can reduce the suffering from chronic pain, decrease depression and anxiety, slow heart rate and blood pressure, and even enhance the immune system. It has been used to help cancer patients, migraine sufferers, women with PMS, people with fibromyalgia and many others. Many of Anil’s students have found that mindfulness meditation has also changed other areas of their lives. Some found they were sleeping better, had started exercising, or quit smoking or drinking, and that the meditation had even improved their relationships with the people around them. “Mindfulness gives us a place to stand,” states Anil, “so that we are not swept away by life’s problems.” “It’s that simple,” he adds with a smile.

Marisol Hanley is studying another technique to relieve chronic pain. She works as a Research Associate at the University of Washington, focusing on psychological issues in persons with pain, and has a part-time private practice in the community. Her research centers on improving the quality of life in illness and disability and providing treatment for chronic pain using hypnosis and other forms of therapy such as biofeedback and cognitive behavior groups. “Mental health and physical health are closely related,” explains Marisol. “Our minds have great power to cope with pain and physical illness. Changing the way you think can have a huge impact on your perception of your pain.” Marisol points out that the physical sensation of pain and the suffering that is brought on by that pain are two separate things. Even though the physical pain is very real, negative and catastrophic thinking can increase the suffering and perceived pain greatly.

Marisol finds that hypnosis is very similar to meditation in the relaxation of the body and the alteration of the state of awareness of the mind. The difference is that meditation may not have a particular focus, whereas with hypnosis there is a specific goal. Hypnosis allows your mind to be more receptive to suggestions for pain control. In her work at the University of Washington pain studies, she found that even those people who could not be hypnotized still experienced a drop in pain. Although the studies are ongoing and final figures not yet available, Marisol observed that the majority found the study to be of benefit in reducing their perceived pain, and approximately 1/3 continued to experience significant pain decrease after they concluded the study. She believes that further training and practice in self-hypnosis could extend those beneficial effects. Marisol also found that people responded differently to different techniques. “Some people may respond better to one type of treatment than another,” she explains, “and you must find the one that works best for you.”

Hypnosis, biofeedback, meditation, cognitive therapy – no one technique will work across the board for everyone. Both Anil and Marisol stress that these therapies are used in addition to more conventional medicine to reduce pain. But no matter which avenue you try, the simple idea that you can do something to improve your situation – that you are not helpless in the face of your illness or your pain – is extremely self-empowering. Marisol quoted Dee Malchow, a nurse who works with amputees, who stated, “Pain may be inevitable, but suffering is optional.”

The Multiple Sclerosis Association of King County would like to thank Anil Coumar and Marisol Hanley for their cooperation, assistance and insights.

For information on recruitment for current pain studies at the University of Washington, call 1-800-377-9707.

Suggested Books:

Caudill-Slosberg, M., Managing Pain before It Manages You , The Guilford Press, 1994

Hart, William, The Art of Living : Vipassana Meditation: As Taught by S. N. Goenka , Harper, SanFrancisco, 1987

Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness, Delta, Reprint 1990

Kabat-Zinn, J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life, Hyperion, New York, 1994.

Kabat-Zinn, J. Coming to Our Senses: Healing Ourselves and the World Through Mindfulness, Hyperion, New York, 2005.

Kamen, Paula, All In My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable, and Only Slightly Enlightening Headache , Da Capo Lifelong Books, 2005

Moyers, Bill, Healing and the Mind, Main Street Books, Reprint 1995 (also available on cassette tape)

Price, Reynolds, A Whole New Life: An Illness and a Healing, Scribner, 2003

Santorelli, Saki, Heal Thyself: Lessons on Mindfulness in Medicine, Harmony/Bell Tower, 2000

Segal, Zindal, Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, The Guilford Press, 2001

Pain Websites:  

http://www.theacpa.org The American Chronic Pain Association 

http://www.paincare.org The National Foundation for the Treatment of Pain 

http://www.painmed.org American Academy of Pain Medicine 

http://www.painfoundation.org The American Pain Foundation 

http://www.ampainsoc.org The American Pain Society 

http://www.painsupport.co.uk/ Pain Support - Natural Pain Relief 

http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm National Institute of Neurological Disorders and Stroke Chronic Pain Page

Other Websites:

http://www.seattleinsight.org/ Seattle Insight Meditation Society ( 206) 366-2111

http://www.uwmedicine.org/PatientCare/MedicalSpecialties/SpecialtyCare/UWMEDICALCENTER/MPC/ University of Washington Multidisciplinary Pain Center (206) 498-4282

http://www.swedish.org/body.cfm?id=1207 Mindfulness Based Wellness Class at Swedish Medical Center, Seattle (206) 215-6966

Psychologists with pain and health psychology expertise:

Marisol Hanley, Seattle, 206-341-4137

Joseph Barber, Seattle, 206-328-2919

Lauren Schwartz, Seattle, 206-774-3838

Michelle Toshima, UW, Seattle, 206-598-4295

Kristy Brewer-Sherman, UW, Seattle, 206-598-4295

UW Multidisciplinary Pain Clinic (Doctor’s referral needed), 206-498-4282

Was this information helpful? Then please consider making a donation. We are a small, independent nonprofit agency and are dependent on donations from our supporters. Thank you from all the staff at the MSA.

Bibliography

Anderson, R.A., More on Pain and Meditation, The Townsend Letter Group, 2005

Astin, J. A., Mind-Body Therapies for the Management of Pain, Clinical Journal of Pain. (2004) 20:1 27-32

Barber, Joseph, Hypnotic Analgesia for Chronic Pain in Persons with Disabilities: A Case Series 1 AbstractInternational Journal of Clinical and Experimental Hypnosis, Volume 53, Number 2/April 2005

Davidson, R and Kabat-Zinn, J, et al, Alterations in Brain and Immune Function Produced by Mindfulness Meditation. Psychomatic Medicine 65:564-570 (2003)

Goleman, D., Behavior; Finding Happiness: Cajole Your Brain to Lean to the Left. The New York Times, 2/4/2003

Kabat-Zinn, J. An out-patient program in Behavioral Medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. Gen. Hosp. Psychiatry (1982) 4:33-47.

Kabat-Zinn, J., Lipworth, L. and Burney, R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J. Behav. Med. (1985) 8:163-190.

Kabat-Zinn, J., Lipworth, L., Burney, R. and Sellers, W. Four year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clin.J.Pain (1986) 2:159-173.

Kabat-Zinn, J., Mindfulness Meditation. What It Is, What It Isn’t, and It’s Role in Health Care and Medicine, in Maruki, Y. and Suzuki, M. (eds.) Comparative and Psychological Study on Meditation. Eburon, Delft, Netherlands, 1996, PP. 161-170.

McEwan, Lynn, RN, MScN, MS Pain: It’s Real and It Can be Treated, The World of Multiple Sclerosis, 2000

Moyers, B., Healing and the Mind, J. Meditation, Doubleday, NY, 1993, pp. 115-143.

Lerche Davis, J. Biofeedback Trains Mind, Body to Make Changes, WebMD

Lerche Davis, J. Meditation Balances the Body’s Systems, WebMD

Lerche Davis, J. Hypnosis: Focusing Subconscious on Change, WebMD

Vaney, Claude, MD, Understanding Pain Mechanisms in Multiple Sclerosis, From The World of Multiple Sclerosis

Vermote R, et al., Pain in multiple sclerosis patients. A prospective study using the Mc Gill Pain Questionnaire, Clin Neurol Neurosurg 1986; 88(2): 87-93

Sourcebook - Pain , From The MS Information Sourcebook, Information Resource Center and Library of the National Multiple Sclerosis Society

Therapeutic Benefits of Yoga and Meditation , Pacific Meditation Center

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The Multiple Sclerosis Association of King County
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