Meditation may reduce the brain's reaction to pain and increase pain tolerance.

[Guest guest]

Meditation may reduce the brain's reaction to pain and increase pain

tolerance.

By Andréa R. Vaucher, Special to The Times

October 29, 2007 Los Angeles Times

The 30 or so clinicians and researchers sat cross-legged on cushions

or in chairs, their eyes closed, as their teacher led them through a

guided meditation.

Telling them to relax their bodies and concentrate on their

breathing, author and meditation instructor Sharon Salzberg urged

them to overcome distractions such as sounds, thoughts and emotions

by coming back to the breath each time they found their minds

wandering.

The goal, she said, was to still the mind. For the participants, all

from UCLA's Mattel Children's Hospital Pediatric Pain Program and

many unfamiliar with meditation, it was also an opportunity to

observe, up close and personal, a technique being prescribed at the

hospital to ease physical and emotional pain in their pediatric

patients.

Salzberg, 55, was teaching the group Vipassana -- or mindfulness --

meditation, a centuries-old Buddhist practice she was instrumental

in bringing to the U.S. after a four-year stay in India in the early

1970s. A cofounder of the Insight Meditation Society in Barre,

Mass., Salzberg extols the benefits of a meditation practice, even

if just for minutes a day. " It's a healing process, " she said

later. " A move toward integration. "

It appears to work. In a new study, published in October in the

journal Pain, Natalia Morone, an assistant professor of medicine at

the University of Pittsburgh, tracked the effect of mindfulness

meditation on chronic lower back pain in adults 65 and older. The

randomized, controlled clinical trial found that the 37 people who

participated in an eight-week mindfulness meditation program had

significantly greater pain acceptance and physical function than a

similar size control group. Subsequently, the control group took the

same eight-week program and had similar results.

" When there is pain, the rest of the body tenses up, " Salzberg

said. " Then you have tension plus pain. Or there's judgment: 'I

shouldn't be feeling this way.' Mindfulness allows us to see what

the add-ons are and discover what the actual experience is right

now. "

Increasingly, doctors across the country are recommending meditation

to treat pain, and some of the nation's top hospitals, including

Stanford, Duke and NYU Medical Center, now offer meditation programs

to pain patients.

Dr. Lonnie Zeltzer, the head of Children's pediatric pain program,

didn't need to be convinced of meditation's benefits; she knew from

her own experience as a meditator. Zeltzer organized the recent

training day with Salzberg and Trudy Goodman, a psychotherapist and

founder of the InsightLA meditation community, paying them out of

her own pocket and hosting it at her Encino home so her staff would

be introduced to a tool she is passionate about.

" As a meditator, I learned the value of being present and how that

allows clarity in processing our daily lives, " Zeltzer said. " The

clinical team sees children with chronic pain who are very difficult

to treat and have been to many other specialists and feel

discouraged by the time they come to us. I felt that learning to

meditate would help the team feel a sense of balance and equanimity

in the face of the anxiety and distress brought to them by these

patients and their families. "

Subject of study

SCIENTISTS have studied the effects of meditation on pain for nearly

three decades, ever since 1979, when MIT-trained microbiologist Jon

Kabat-Zinn, professor emeritus and founder of the Center for

Mindfulness at the University of Massachusetts Medical Center, used

mindfulness meditation in a 10-week program to teach chronic pain

patients how to cope. Kabat-Zinn's 1990 bestseller, " Full

Catastrophe Living, " described the technique he used -- mindfulness-

based stress reduction, or MBSR.

Since then, research has suggested that meditation reduces the

brain's reaction to pain and increases pain tolerance. It has an

effect on chronic back pain and can be an effective palliative for

pain associated with fibromyalgia and rheumatoid arthritis, studies

have shown.

Kabat-Zinn's original study was done at the university's Medical

Center's Stress Reduction Clinic, which has since been folded into

the Center for Mindfulness. The 51 patients in the study, which was

published in General Hospital Psychiatry in 1982, suffered from

lower back, neck, shoulder, facial, coronary and GI pain, as well as

headaches. At the end of the study, about two-thirds of the patients

showed a pain reduction of at least 33% and half showed a reduction

of at least 50%. The number of medical symptoms also decreased.

" MBSR's contribution has been to bring the heart of Buddhist

meditation without the Buddhism into the mainstream of Western

medicine, " Kabat-Zinn said. " A referral to the Stress Reduction

Clinic would now be part of the natural progression for anyone who

sees patients with a long-standing pain condition. "

Since 1979, more than 18,000 patients have come through the Stress

Reduction Clinic. There are now more than 250 MBSR programs in

clinics and hospitals around the world.

In Los Angeles, Zeltzer refers patients to Goodman, who taught MBSR

with Kabat-Zinn in the early days of the program, and who continues

to teach the technique through InsightLA. But meditation remained

esoteric to many on Zeltzer's team until they could learn the basics

and ask Salzberg and Goodman questions about the practice.

" Previously, we had talked about meditation in the abstract, "

Zeltzer said. " And a lot of the team members wondered how it was

going to work. "

Zeltzer got interested " in the relationship of mind and body and

health " during her fellowship in adolescent medicine at Los Angeles

Children's Hospital in the 1970s. " What led to the differences in

symptoms and suffering in adolescents who had the same disease? " she

wondered at the time. " Why were some able to endure medical

procedures without too much problem, while others fell apart? "

Realizing that the mind has a powerful effect on the body, Zeltzer

used her first NIH grant in the early 1980s to study the benefit of

hypnotherapy prior to spinal tap operations. " Spending a period of

time each day just sitting and 'doing nothing' was one of the most

important lessons that I learned in my hypnotherapy work, " Zeltzer

said. This journey into silence led to an interest in meditation,

which increased exponentially when Zeltzer began studying the

practice with Goodman in 2002.

Now Zeltzer wants to scientifically measure the effectiveness of

meditation on kids with pain.

PEOPLE who have been helped by meditation, whether physicians or

laypersons, have encouraged the use of meditation in pain management.

" It was life-changing for me, " said Phoebe Larmore, an L.A.-based

literary agent who represents authors Tom Robbins and Margaret

Atwood.

For over two decades, Larmore was plagued with acute back pain and

consulted with top specialists at medical centers such as Stanford

University's and the Mayo Clinic, to no avail. At her worst, she

weighed 80 pounds and was on morphine.

Then a doctor at UCLA gave her a meditation tape.

" I used it over and over and was able to have a few moments in which

I was above the pain and could get my breath and hold onto hope, "

she recalled.

Larmore learned how to pace herself, running her business from her

home. But recently, " the sandpaper of living with chronic pain " got

to her, and she enrolled in an InsightLA MBSR class taught by

Goodman and German physician Wolf.

" The eight-week program was one of the most challenging commitments

I have ever made, " she said. " But I found a new key that enables me

to better accept, embrace and have an instrument with which to

mindfully be with my pain and walk with it with more lightness. "

Though anecdotal experiences about the benefits of meditation are

easy to find, clinical randomized trials on meditation's effects are

rare and in the early stages. And skepticism lurks in the wings of

every study.

" When I submit articles to be reviewed, it feels like they are

picked apart very carefully, and I have to work harder to prove my

findings, " said Dr. Natalia Morone, an assistant professor of

medicine at the University of Pittsburgh who has been studying the

effect of mindfulness meditation on pain in adults. " There's more

intensity to the review comments than if they were about a

conventional subject. "

But despite resistance, Kabat-Zinn is betting on meditation playing

a larger role in medicine in the future.

" We are headed toward development of a new kind of medicine that

honors the profound dilemma of the person who presents to a doctor

with suffering, " he stated with no uncertainty. " Since Buddhism has

a history of understanding suffering, and since nobody goes to a

hospital without some kind of suffering, what better place than a

hospital to be grounded in meditation? "