Does Meditation Change How We Perceive Pain

We can all agree that pain is an unpleasant feeling. Because of this, researchers are on a constant search for pharmaceuticals or psychological behavioural intervention to help with the symptoms of pain.  Meditation is one such psychological intervention, and meditation teachers have long time argued that meditation might help with the symptoms of pain by altering how we perceive pain.   But does meditation change how we perceive pain?  In the following blog post we look at what is pain, the difference between acute and chronic pain and look at how scientist have used an unusual method called Medoc thermal stimulator to study how might meditation change how we perceive pain.  Finally, we look at what research says and if meditation can help with alleviating pain symptoms.

What is pain

Pain is a signal that helps us recognise that something might be wrong with our body. We usually experience it as an unpleasant bodily sensation, like pricking, tingling, stinging, burning, or ache, at varying degrees of intensity.  Pain might be a sharp or dull sensation which might come and go, or it may be constant.

You may experience pain in just one area of the body like your back, leg or arm, or you may experience pain all over your body like when we have the flu.

Although pain is unpleasant at occasions, it can also be helpful. Imagine if you never felt pain and while you are cutting some vegetables, and you accidentally start cutting your finger and do not realise because you feel no pain.  Without our ability to feel pain, we might end up seriously hurting ourselves, or we might not even realise that we might have a medical problem which requires treatment. 

We can experience short term pain which can help us avoid bodily harm, “acute pain” or pain that can be constant due to a medical condition or syndrome, “chronic pain” (Taylor, 2015).

Acute and chronic pain

There are many types of pain, but mainly they all fall under two of the following categories: acute and chronic (Taylor, 2015).

Acute pain usually has a sudden onset and comes about because of a disease, physical injury, or inflammation. Most often, with modern medical technology, it can be diagnosed and treated and usually goes away.  Sometimes acute pain can turn into chronic pain were it lasts for a long time. But nowadays, some treatments can relieve the symptoms of chronic pain.  However, sometimes it can be so acute and long-lasting (over six months) that it can make life miserable and be the cause of severe psychological problems (Day, 2017).

It is the latter chronic pain that is a problem.  As although it is at times treatable it is not always curable and here is where researchers have been hotly debating if meditation might help buffer against the psychological consequences of chronic pain and improve quality of life.

Meditation and pain

Pain is mainly composed of two components; physiological sensations, like burning, prickling or tingling sensations and how we react psychologically to those sensations (Wager et al., 2013).  Researchers have theorised that meditation might help with the psychological component of pain as it might act as a buffer or help us better cope with pain psychologically by altering or “muting” our emotional response to pain and so make it more bearable.

For example, researchers found that with time Zen meditation practitioners learn to suspend their mental reactions and categorisation towards whatever arises in their experience. This with time creates a mental buffer between you and your experience and this mental stance gradually spills over into everyday life and might help us in being less cognitively fused and reactive towards our experience (Austin, 1999).

As the Zen Meditation teachers, Miura and Sasaki (1984) wrote, “the experienced practitioner of zazen does not depend on sitting quietly,” Later, adding that, “States of consciousness at first attained only in the meditation hall gradually become continuous in any and all activities (p. xi). So is this applicable to chronic pain, and how does meditation change how we perceive pain?

So how Does Meditation change How We Perceive Pain

A research study conducted by Grant et al. (2011) recruited experienced Zen Meditators to try to answer such a question.  In doing so, the researchers used a Medoc thermal stimulator to measure the participant’s tolerance to a burning sensation while at the same time using brain scanning imagery fMRI to measure which brain areas were more active while participants experienced the burning sensations.

The researchers noticed that the more experienced among the Zen students were not only able to withstand the pain more than could the control group, but their brain scans also showed little activity in brain areas related to executive, evaluative, and emotional function.

The executive, evaluative, and emotional regions of the brain are those that usually light up when we are experiencing intense stress such as that caused by pain. Tellingly the researchers doing the study argued that it seemed as if their brains were able to switch off the link between the executive evaluative centre circuits of the brain which evaluates experience (This hurts!) and the neural circuitry for feeling physical pain (This burns).

In other words, the Zen meditators seemed to respond to pain as though it was more of a neutral sensation. Or as the scientists argued that their brains seemed to show a pattern of “functional decoupling” of the neocortex and the lower brain regions that register pain (Grant et al., 2011).  It seemed as if their neural circuitry felt the pain, but their thoughts and emotions did not react to it.

As other researchers point out it’s as if meditation creates a space between us and what we are experiencing called “decentering” which might help us become less cognitively fused with our experience (Bernstein et al., 2015; Dhal et al., 2015).  Which, in turn, can enhance our capacity to reappraise our situations or in this particular instance how we psychologically experience pain (Dhal et al., 2015).

In theory this “functional decoupling” could help us appraise the subjective experience of pain in a less threatening way, which in turn can lessen its subjective severity as well as how our brain responds to it. However, it has to be pointed out that this was not developed overnight, but it took the practitioners hours of meditation practice.

Still, such results indicate the possibility that meditation might help with chronic pain which lead to the creation of several self-help books and the development of Mindfulness-Based Cognitive Therapy for Chronic Pain (Day, 2017).  Below is a webinar by the author of the book Melissa A. Day explaining what Mindfulness-Based Cognitive Therapy for Chronic Pain is.

Webinar on Mindfulness-Based Cognitive Therapy For Pain

Conclusion and state of research

Taking in the above research, the question remains, does meditation change how we perceive pain?  A review of current scientific literature on meditation and pain by Ball et al. (2017) argued that overall studies indicate, “that mindfulness meditation in chronic pain shows it’s most prominent effect not on reducing the perception of pain but on psychological aspects on living with chronic pain; improving associated depression and quality of life” (p. 365).  While claiming that, “mindfulness meditation should be considered as an evidence-based adjunct in the treatment of chronic pain” (Ball et al., 2017, p. 365).   

While acknowledging that pain sufferers might benefit from meditation another literature review and meta-analysis conducted the same year argues for a more balanced view.  In their review, Hilton et al. (2017) argued that although there is an indication that, “mindfulness meditation interventions showed significant improvements for chronic pain, depression, and quality of life, the weaknesses in the body of evidence prevent strong conclusions” (p. 211). 

This because although acknowledging there is an indication that meditation reduces depression symptoms and improves the quality of life of chronic pain sufferers there is also a publication bias towards the positive effects of meditation this, reflected in statements such as the one by Ball et al. (2017).  Further arguing that when it comes to chronic pain “more well-designed, rigorous, and large-scale RCTs are needed in order to develop an evidence base that can decisively provide estimates of its effectiveness” (p. 211).   Such sentiment was also reflected in a more recent literature review by Goyal and Rush (2020), which argued that there is only moderate evidence that mindfulness meditation-based interventions improve symptoms of pain in general, and low back pain in particular. 

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References

Austin, J. H. (1999). Zen and the brain: Toward an understanding of meditation and consciousness. Cambridge, MA: Mit Press Ltd.

Ball, E. F., Sharizan, E. N., Franklin, G., & Rogozinska, E. (2017). Does mindfulness meditation improve chronic pain? A systematic review. Current Opinion in Obstetrics and Gynecology, 29(6), 359-366. doi:10.1097/GCO.0000000000000417

Bernstein, A., Hadash, Y., Lichtash, Y., Tanay, G., Shepherd, K., & Fresco, D. M. (2015). Decentering and related constructs: A critical review and metacognitive processes model. Perspectives on Psychological Science, 10(5), 599-617. doi:10.1177/1745691615594577

Day, A. M. (2017). Mindfulness-based cognitive therapy for chronic pain. Hoboken, NJ: Wiley-Blackwell.

Dhal, C. J., Lutz, A., & Davidson, R. J. (2015). Reconstructing and deconstructing the self: cognitive mechanisms in meditation practice. Trends in Cognitive Neuroscience, 19(9), 515- 523. doi:10.1016/j.tics.2015.07.001

Goyal, M., & Rush, H. L. (2020). Mindfulness-based interventions in the treatment of physical conditions. The Oxford Handbook of Meditation. doi:10.1093/oxfordhb/9780198808640.013.34

Grant, J. A., Courtemanche, J., & Rainville, P. (2011). A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators. Pain, 152(1), 150-156. doi:10.1016/j.pain.2010.10.006

Hilton, L., Hempel, S., Ewing, B., Apaydina, E., Xenakis, L., Newberry, S., . . . Maglione, M. A. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 55(2), 199-213. doi:10.1007/s12160-016-9844-2

Miura, I., & Sasaki, R. F. (1984). The Zen Koan: Its history and use in Rinzai Zen. New York, NY: Mariner Books.

Taylor, S. (2015). Health psychology (10th ed.). New York, NY: McGraw-Hill Education.

Wager, T. D., Atlas, L. Y., Lindquist, M. A., Roy, M., Woo, C.-W., & Kross, E. (2013). An fMRI-based neurologic signature of physical pain. The New England Journal of Medicine, 368(15), 1388-1397. doi:10.1056/NEJMoa1204471