Heart disease, mindfulness and meditation - a literature review

Research has confirmed Dr Dean Ornish’s lifestyle and meditation based program can reverse coronary heart disease cheaply and reliably when compared to ordinary medical care. Yet while endorsed in America for Medicare rebates, in Australia few seem to know of this option, let alone have it offered. 

But what of mindfulness and meditation on their own? This week we examine what they have to offer according to recent research. But first

    Thought for the day

Silence is not empty

It is full of answers

So I encourage you - bow eagerly to love. 

Follow its humble stirrings in your heart. 

Let it guide you in this life 

And it will bring you safely to eternal bliss in the next. 

Love is the essence of all goodness. 

Without it, no kind work is ever begun or finished. 

Simply put, love is a good will, in harmony with God.


                                 The Cloud of Unknowing 


THE BACKGROUND of TRAGEDY

Heart disease remains the leading non-communicable lifestyle related illness in Australia and the US Heart disease, leading to 1 in 4 deaths in both countries. 

Consider how many lives this directly and indirectly affects. 

Tragic. 

Yet heart disease is highly preventable, and much can be done for people diagnosed with heart disease. 


THE SCOPE OF THIS LITERATURE REVIEW

This literature review aims to bring together the research evidence around heart disease, mindfulness and meditation. And given the times we are in, it also examines the evidence base for online programs.

Quite a large body of research has been published in this field, but not surprisingly, it varies in quality. Therefore, while not exhaustive, this review aims to reproduce key research (using many direct quotes) that investigates the efficacy of mindfulness and meditation for people affected by heart disease. 

This review includes direct hyper-links to the original articles as published. The review is in three parts –the role of mindfulness and meditation in the prevention of heart disease, in the management of heart disease and evidence for online programs. On prevention, just the one major review of recent research is quoted.

CONTEXT – THE ORNISH STUDIES

For more than 35 years, Dr. Ornish has championed lifestyle modification as a proven approach for reversing heart disease in patients with pre-existing coronary artery disease. 

Based on in-depth scientific research, Dr. Ornish’s approach actually reverses the progression of cardiovascular disease and reduces the need for interventional revascularizations and costly medications for patients with one of several risk indicators, including a prior acute myocardial infarction, CABG surgery, a PCI procedure or stable angina. 

Recognizing the extraordinary results that Dr. Ornish achieved in reversing heart disease, Congress and the Centers for Medicare and Medicaid Services (CMS) in 2010 provided for Medicare reimbursement for individuals enrolled in The Ornish Program for Reversing Heart Disease. Dr. Ornish and Healthways are now deploying a scalable solution that is unmatched in its impact on outcomes and costs. 

The Ornish program uses the following four core elements equally 

1. A very low-fat, whole foods diet

2.  Moderate aerobic exercise

3. Stress management techniques

4. Support groups

The program has proven results documented in peer-reviewed research journals. In these published studies, CHD patients showed greater changes in diet and lifestyle and better clinical outcomes than have ever before been reported for various lifestyle change interventions. These studies showed, for the first time, that the progression of coronary atherosclerosis could be stopped or reversed by making comprehensive lifestyle changes. 

Specifically, these studies demonstrated the following benefits of the lifestyle modification program

• Regression of coronary artery stenosis using quantitative coronary arteriography

• Decreased size and severity of ischemic myocardial perfusion abnormalities (blood flow to the heart) using cardiac positron emission tomography (PET), exercise thallium scintigraphy, and exercise radionuclide ventriculography

• Safe avoidance of revascularization procedures such as coronary bypass surgery, angioplasty, and intracoronary stents in almost 80% of those who were eligible for these procedures, with comparable clinical outcomes

• Significantly greater exercise capacity

• Substantial cardiac risk factor improvements, e.g., reductions in LDL-cholesterol comparable to what can be achieved with statin drugs without the costs and potential side-effects as well as significant reductions in weight, BMI, blood pressure and fasting blood glucose

• Marked, rapid, and often dramatic decreases in the frequency and severity of angina

• Substantial improvements in quality of life by a variety of measures (including decreased emotional stress and depression and increased vitality, physical function, and well-being)

• 2.5 times fewer cardiac events. In addition, we measured significant improvements in other chronic diseases prevalent in the population, including obesity, diabetes, hypertension, hypercholesterolemia, depression, arthritis, prostate cancer, and related illnesses. 

Follow-up analyses revealed even more reversal after five years than after one year. In contrast, patients in the usual-care randomized control group showed worsening (progression) of coronary atherosclerosis after one year and even more worsening after five years. Also, there was a direct correlation between degree of adherence to this lifestyle 5 modification program and changes in coronary atherosclerosis after one year and also after five years. 

So again, given the Ornish program has stress management based upon meditation and yoga as a key element, what does the research have to say regarding heart disease, mindfulness and meditation on their own?

PART 1  -  MINDFULNESS AND MEDITATION IN THE PREVENTION OF HEART DISEASE

The American Heart Association’s major review from 2017

This review was compiled by a large group of leading researchers under the auspices of the AMA. It systematically reviewed the data on the potential benefits of meditation on cardiovascular risk.

Neurophysiological and neuroanatomical studies demonstrate that meditation can have long‐standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. 

Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease.

Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline‐directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. 

Levine GN et al. Meditation and Cardiovascular Risk Reduction. A Scientific Statement From the American Heart Association; 2017 Journal of the American Heart Association; Vol6: Issue 10.

PART 2  -  MINDFULNESS AND MEDITATION IN THE MANAGEMENT AND TREATMENT OF HEART DISEASE

1. Meditation cuts death risk in half 

From 2012 this 5 year, randomised controlled study of 201 people with coronary disease found those who practiced meditation were 48% less likely to have a heart attack, stroke or die from all causes, compared to a group of study participants who merely attended a health education class over more than five years.

The authors hypothesised reducing stress by managing the mind-body connection would help improve rates of this epidemic disease. They also found the meditators were able to lower their blood pressure and decrease their overall stress and anger.

Schneider RH et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Circ Cardiovasc Qual Outcomes. 2012 Nov;5(6):750-8. 

2. 2019 Major review recommends meditation

In this highly objective paper, the authors screened 3,540 research papers, reducing that number to 45 final papers that met their strict criteria for inclusion in their actual analysis. They point out the quality and quantity of published research in this field is limited and complicated by the different methods taught and studied.

Even so they concluded available data suggest a potential influence of meditation interventions on various factors of cardiovascular disease. The authors state that in clinical practice, meditation as an intervention may be suggested to patients at cardiovascular risk in addition to conservative treatment protocols because of its non-invasive and cost-effective nature. In particular, as recommended by the European Society of Cardiology, treating psychosocial factors can counteract stress, depression and anxiety, and therefore facilitate behaviour change and improve general quality of life. 

The authors reported the quintessence of this expert opinion

• Heterogenous data suggest a link between meditation interventions and cardiovascular disease.

• Meditation can be suggested to patients in addition to conservative treatment or prophylactic protocols.

• In particular, meditation can help to reduce stress, depression and anxiety.

Schnaubelt S et al. Meditation and Cardiovascular Health: What is the Link? European Cardiology Review 2019;14(3):161–4

3. Mindfulness reduces depression and anxiety, improves Quality of life

This review from 2020 searched 7 English and 2 Chinese electronic databases for experimental studies that examined mindfulness-based interventions in adults with heart failure. Five studies involving 467 patients with heart failure met the inclusion criteria. They had weak to moderate quality. 

There were consistent findings that mindfulness-based interventions could significantly reduce depression (three studies) and anxiety (two studies) and improve health-related quality of life (two studies) after intervention. However, the effects on physical symptoms were inconsistent in three studies. 

Zou H et al.  Effects of mindfulness-based interventions on health-related outcomes for patients with heart failure: a systematic review. European Journal of Cardiovascular Nursing. 2020;19(1):44-54.

PART 3  -  ONLINE MINDFULNESS AND MEDITATION PROGRAMS FOR PEOPLE WITH HEART DISEASE

1. Early follow up of online program shows benefits

This study, based upon 12 week follow-up was a pragmatic, randomized, controlled single-blind trial involving 324 patients with heart disease assigned to a 12-week online mindfulness training in addition to usual care (UC) compared to UC alone.

The authors reported mindfulness training showed positive effects on the physiological parameters, exercise capacity and heart rate and concluded it might therefore be a useful adjunct to current clinical therapy in patients with heart disease. Physiological parameters included heart rate, blood pressure, respiratory rate, and NT-proBNP.

Younge JO et al. Web-Based Mindfulness Intervention in Heart Disease: A Randomized Controlled Trial. PLoS One December 7, 2015 : https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143843

2. Online Mindfulness Based Stress Reduction improves outcomes over 12 months

This 2017 paper, evaluated the effect at 12-month follow-up of 324 patients randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. Online delivery of the training was chosen for pragmatic reasons: the training was designed to be self-directed, easily accessible and engaging to a wide audience by keeping practice sessions and lessons short, usually ten to fifteen minutes per exercise. 


Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care.

Gotink RA et al. Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial. PLoS One. 2017;12(5):e0175923. Published 2017 May 9. doi:10.1371/journal.pone.0175923

3. Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

PART 4 - CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by heart disease. These interventions can play a part in prevention and they can reduce the associated symptoms of heart disease such as stress, anxiety and depression, as well as assist in recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.

Multiple Sclerosis, Relaxation, Mindfulness and Meditation - what do they offer? A Literature Review with links to the original articles

In 1978 Neil Sambell wrote me a heartfelt letter of anguish. The half page letter took him 30 minutes to type with the one functional finger he could use; yet that letter changed his life and the lives of many others.

Neil explained he was severely immobilised by MS and wondered if the lifestyle-based, self-help program I had used to overcome my own cancer might help him. This week, what happened to Neil, how his story led to my own involvement helping those with MS and results from a good deal research that has followed, but first

  Thought for the day

      The problem with patience and discipline 

       Is that it requires both of them 

        To develop each of them.

                      Thomas Sterner

My initial reply to Neil was I did not know if what had helped me might help him, and I had no experience at the time with MS. However, I added that my approach involved doing all possible to build a healthy immune system and to gain the best from my capacity to contribute to my own healing. Knowing MS to be an auto-immune-based, chronic degenerative disease, I suggested the same program might be well worth trying. Neil did.

Over 40 years later, Neil is alive and well, writes fluently, has good mobility, a slight, almost imperceptible limp and a big smile. Neil’s outcome inspired me to agree to help others with MS who asked about our program; and then came George Jelinek.

Professor George Jelinek was Head of Emergency Medicine at Sir Charles Gairdner Hospital in Perth when diagnosed with MS in 1999. Being a research based academic clinician, George scoured the literature and discovered there was a lot of support for nutritional intervention along with other lifestyle factors. George gathered the research, added his own experience and published a book for which he asked me to write the Forward. 

From there it seemed a natural fit; George had the MS specific knowledge and personal experience, the MS program that he put together in his book was very similar to the one we used for people with cancer, and we had the experience with running intensive Residential programs. 

George accepted the offer to help establish MS specific programs in 2003 with myself and my wife, Dr Ruth Gawler who has expertise in Mind-Body Medicine. 

A research evaluation of the new program was instigated from day one.

            Prof George Jelinek (R) with myself and Assoc-Prof Craig Hassed at Yarra Junction

All of this is mentioned as it portrays a normal progression. Clinical observations of exceptional results need first to be noticed, and then tested. That is what research does. If we had waited for research to completely validate the MS program before we started, in all likelihood we would still be waiting. In fact, the research George set up provided remarkable results.

THE PURPOSE OF THIS REVIEW

What follows is intended to bring together key research papers investigating the potential role for the practices of relaxation, mindfulness and meditation amongst people with MS. This is not intended as an exhaustive review, rather a good, representative sample of the published research in this field. We start with results of research into the program I helped to establish with Prof Jelinek and my wife, Dr Ruth Gawler.

MS program including meditation shows strong benefits after 2.5 years

Here is the basic issue. According to most measures for people affected by MS, quality of life usually deteriorates around 10% over 5 years. However, George’s investigations found attending the residential retreat promoting lifestyle modification and featuring deep relaxation, mindfulness and meditation had a significant short-medium term positive effect on quality of life for people with MS. 

Participants showed significant improvement in HRQOL at one year and 2.5 year follow-up with significant gains in overall quality of life, physical health composite and mental health composite. 

Li MP, Jelinek GA, Weiland TJ, Mackinlay CA, Dye S, Gawler I. Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis. Qual Prim Care. 2010;18(6):379-89. PMID: 21294980.

MS program benefits continue to improve after 5 years

After 5 years the gains were even better. By then data had been collected on nearly 300 participants. Each completed a standard, well-validated 54-item questionnaire, the MSQOL-54; at 1 and 5 year follow up. The only intervention provided was the 5 day retreat, although each group had group support via regular email after the retreat. 

The results were remarkable! Not only had this group of people with MS stopped deteriorating, they rapidly began to get better as shown by the first data published, and that improvement continued to the five year mark. There was highly significant (p<0.001) improvements at one year in mental health of about 12%, physical health 19%, and quality of life 11%. At five years the benefit continued to accrue, with highly significant (p<0.001) improvements in mental health of about 23%, physical health 18%, and quality of life 20%.

Hadgkiss EJ, Jelinek GA, Weiland TJ, Rumbold G, Mackinlay CA, Gutbrod S, Gawler I. Health-related quality of life outcomes at 1 and 5 years after a residential retreat promoting lifestyle modification for people with multiple sclerosis. Neurol Sci. 2013 Feb;34(2):187-95.

WHERE DOES MEDITATION FIT?   

HOW MIGHT IT HELP THOSE WITH MS?        A LITERATURE SEARCH

In this 2014 paper, the author’s observe MS is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. 

Therefore, a literature search of meditation being used in MS was conducted. Twelve pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The review observed current literature (2014) varies in quality; however common positive effects of meditation include improved quality of life (QOL) and improved coping skills. 

The authors concluded all studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. They suggested additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time.

Levin AB, Hadgkiss EJ, Weiland TJ, Jelinek GA. Meditation as an adjunct to the management of multiple sclerosis. Neurol Res Int. 2014;2014:704691. 

The dramatic benefits from using available resources – huge decreases in depression and fatigue

More recent findings from the ongoing HOLISM study compare health outcomes of people with MS coming to the YVLC retreat programs, with those who did not engage with self-help resources. 

This 2015 study of 2233 participants recruited online compared health-related quality of life, fatigue and depression risk between people who had, or had not, attended a Yarra Valley Living Centre week-long retreat, read the book ‘Overcoming Multiple Sclerosis’ or visited the Overcoming MS website (www. overcomingmultiplesclerosis.org).

The results were remarkable, showing people who attended a retreat program had physical-health quality of life scores 18 per cent higher (on a scale of 0 to 100), and mental-health quality of life scores 14 per cent higher, than those who did not attend.

Even more so, people who attended a retreat program, read the book and accessed the website had 19.5 and 15.6 better physical-health and mental-health quality of life scores, respectively, than those who did not attend.

The research team noted that there had been a “paradigm shift” in the management of chronic diseases, towards a patient-centred approach of self-management and prevention.

“People who are proactive in their health may achieve better outcomes than those more passive,” they said in the paper.

Indeed, the study’s depression outcomes were particularly striking, showing that depression risk among retreat program attendees (8.6 per cent) was around half that of the whole sample. Further analysis showed that no engagement with the retreat program, book or website was associated with tenfold higher odds of depression risk. 

Dr Jelinek said the findings, that people using the three resources had one-tenth the risk of depression, were “astonishing”. “Roughly every second person with MS will have depression and to have such a dramatic fall in incidence of depression is really quite startling.” “No anti-depressant ever achieves that.”

Lack of engagement also found nearly threefold higher odds of clinically significant fatigue. This is a crucial issue for people with MS as 85 per cent report significant fatigue, and for most, it is the most disabling symptom they have. Professor Jelinek said the findings showed that people were one third less likely to suffer fatigue, a significant problem not successfully treated with medication, if they engaged in the three educational resources compared to those who did not.

In the study discussion, researchers noted the role of patient empowerment in dealing with MS. “Rather than the effect of lifestyle modification itself, or perhaps additional to that effect, perceived benefits for health-related quality of life, depression and fatigue may arise from participants’ level of empowerment or self-efficacy,” they said.

“Empowerment is both a process and an outcome—‘‘a process to increase one’s ability to think critically and act autonomously…an outcome when an enhanced sense of self-efficacy occurs as a result of the process’’. “This is distinguished from a patient simply becoming more compliant.”

They added that actively engaged patients may also have a greater understanding of their condition, a better relationship with their doctor, be more likely to attend appointments and stick to their treatments – leading to better outcomes.

“In general, in medicine we significantly underestimate and underutilise people’s own resources in dealing with their illness,” Professor Jelinek said. “We expect people to become compliant.” 

Retreat programs such as those run by the Yarra Valley Living Centre also gave people connectedness by providing a supportive environment, the benefits of which can be profound. “The whole basis of the retreat program is that people become the captain of their own health ship,’’ he said.

Hadgkiss, E.J., Jelinek, G.A., Taylor, K.L. et al. Engagement in a program promoting lifestyle modification is associated with better patient-reported outcomes for people with MS. Neurol Sci 36, 845–852 (2015).


LITERATURE REVIEWS AND META-ANALYSES

1. Mindfulness and its relevance for MS – a 2014 review

Three studies (n = 183 participants) were included in the final analysis. Statistically significant beneficial effects relating to quality of life, mental health, and selected physical health measures were sustained at 3 and 6 month follow up.

The authors concluded from the limited data available, MBIs may benefit some MS patients in terms of QOL, mental health, and some physical health measures. They added further studies are needed to clarify how MBIs might best serve the MS population.

Simpson, R, Booth J et al. (2014). Mindfulness based interventions in multiple sclerosis - a systematic review. BMC neurology. 14. 15. 10.1186/1471-2377-14-15.

2. Mental wellbeing, mindfulness and MS – a 2019 meta-analysis

Twelve RCTs including 744 PwMS were eligible for inclusion in this systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6–9 weeks, delivered individually and via groups, both in person and online. Only three adverse events were reported.

The authors concluded MBIs are effective at improving mental well-being for people with MS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness.

Simpson R, Simpson S, Ramparsad N, et al. Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials. Journal of Neurology, Neurosurgery &Psychiatry 2019;90:1051-1058.

IN PERSON PROGRAMS

1. MS quality of life, depression, and fatigue improve after mindfulness training – a randomized trial

150 adults with relapsing-remitting or secondary progressive MS were randomly assigned to the intervention - a structured 8-week program of mindfulness training.  

This trial provides Class III evidence that MBI compared with UC improved HRQOL, fatigue, and depression up to 6 months postintervention. In addition, the findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL.

Grossman P, Kappos L, Gensicke H, et al. MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology. 2010;75(13):1141-1149. 

2. Progressive Muscle Relaxation effective in MS 

The results of this 2009 study revealed that compared with the control group, patients with multiple sclerosis in the experimental group who practiced the progressive muscle relaxation over eight weeks, experienced higher quality of life in physical and mental dimensions.

Gafari S et al. Effectiveness of applying progressive muscle relaxation technique on quality of life of patients with multiple sclerosis. J Clin Nursing 2009, Vol 8, 2171-2179

EDITOR’S NOTE. The Progressive Muscle Relaxation practice referred to here is the basis for the Deep Relaxation practice on the Allevi8 App. 

3. Progressive Muscle Relaxation and dose dependent benefits in MS

The authors of this 2014 study point out there is a well-established adverse reciprocal relationship between stress and multiple sclerosis (MS). However, stress management in these patients has been parsimoniously studied. In this parallel randomized controlled trial, relapsing-remitting MS patients were randomly assigned to undergo either an 8-week stress management program (n = 31; relaxation breathing and progressive muscle relaxation, twice a day) or not (n = 30). 

In patients in the intervention group, perceived stress and symptoms of depression were significantly decreased after 8 weeks of relaxation. Repeated measures analyses showed significant group-by-time interactions for both the number of weekly symptoms and the mean intensity per symptom. 

Artemios K et al, Stress Management and Multiple Sclerosis: A Randomized Controlled Trial, Archives of Clinical Neuropsychology, Volume 27, Issue 4, June 2012, Pages 406–416,

4. MS, psychological distress, cognitive dysfunctioning and mindfulness - a pilot

Twenty-five MS patients completed the MBSR training and psychological measures, of which 16 patients completed the cognitive tests. Significant improvements were found in depressive symptoms, quality of life, fatigue, mindfulness skills, and self-compassion. Of the cognitive tests, performance on a visual spatial processing test significantly improved after the intervention. Overall, this pilot study showed promising results of the effects of MBSR on reducing psychological distress, and it suggests MBSR might improve cognitive functioning in MS patients. 

Blankespoor, R.J., Schellekens, M.P., et al. The Effectiveness of Mindfulness-Based Stress Reduction on Psychological Distress and Cognitive Functioning in Patients with Multiple Sclerosis: a Pilot Study. Mindfulness 8, 1251–1258 (2017).

5. MS and pain – a cross-sectional survey

Chronic pain is a common symptom in people with multiple sclerosis (MS) and often requires a multimodal approach to care. The practice of mindfulness has been shown to decrease the experience of pain in other conditions, yet little is known about the relationship between mindfulness and pain in people with MS. The objective of this cross-sectional survey of 132 people with any type of MS was to evaluate the association between pain interference and trait mindfulness in people with MS.

The relationship between pain and mindfulness was found to be clinically meaningful and highly significant. These results suggest a clinically significant association between mindfulness and pain interference in MS and support further exploration of mindfulness-based interventions in the management of MS-related pain.These results support further exploration of mindfulness-based interventions in the management of MS-related pain.

Senders A et al. Association Between Pain and Mindfulness in Multiple Sclerosis: A Cross-sectional Survey. Int J MS Care. 2018;20(1):28-34. doi:10.7224/1537-2073.2016-076

6. Level of interest and engagement with meditation

This study aimed to describe website traffic and qualitatively analyse an e-health community discussion forum for people affected by multiple sclerosis visiting the Overcoming Multiple Sclerosis (OMS) website.

This mixed methods study combined descriptive analysis of website traffic over 7 years and 1 month, and qualitative analysis of 1 week of posts in the meditation topic, coded into theme groups using qualitative thematic analysis.

There were 166 meditation topics posted with 21,530 initial views of primary post and 785 sub-post responses. Meditation posts and sub-posts received 368,713 replies. Number of views increased from 4,684 in 2011 to over 80,000 in 2017, a considerably greater rate of increase than overall traffic.

Qualitative analysis of posts on the meditation forum identified themes of barriers and enablers to utilization of meditation resources. Enablement themes dominated, observed across six of the seven theme groups with various forms of positive social and emotional support to learn and practice meditation. One theme, negative emotion, was identified as a barrier.

The OMS peer-to-peer patient online discussion forum serves important functions in encouraging, educating and enabling its growing online community. Our analysis may help improve and innovate online support for lifestyle management in many chronic diseases.

O’Donnell JM, Jelinek GA et al. (2020) Therapeutic utilization of meditation resources by people with multiple sclerosis: insights from an online patient discussion forum, Informatics for Health and Social Care, 45:4, 374-384, 

7. Guided imagery for use in MS

This exploratory efficacy study examined the effects of Healing Light Guided Imagery (HLGI), a novel variant of guided imagery, compared with a wait-list control in patients with relapsing-remitting multiple sclerosis. 

Patients who completed HLGI (N = 9) showed significant reductions in depressed mood and fatigue and showed significant gains in physical and mental quality of life compared with journaling (N = 8). Our results suggest that HLGI can improve self-reported physical and mental well-being in patients with relapsing-remitting multiple sclerosis. 

Case LK et al. Guided Imagery Improves Mood, Fatigue, and Quality of Life in Individuals With Multiple Sclerosis: An Exploratory Efficacy Trial of Healing Light Guided Imagery. J Evid Based Integr Med. 2018 Jan-Dec;23:25 

EDITOR’S NOTE. This Guided Imagery practice is very similar to the Healing Light practice on the Allevi8 App. 

ONLINE MINDFULNESS and MEDITATION PROGRAMS for PEOPLE with MS

1. MS, distress levels, service costs, Skype and mindfulness

This randomised trial assessed the potential effectiveness and cost-effectiveness of a specially adapted Skype distant-delivered mindfulness intervention, designed to reduce distress for people affected by primary and secondary progressive MS.

Forty participants were randomly assigned to the 8-week intervention. Distress scores were lower in the intervention group compared with the control group at postintervention and follow-up. Mean scores for pain, fatigue, anxiety, depression, impact of MS were reduced for the mindfulness group compared with control group at posttherapy and follow-up. There were no differences in quality-adjusted life years, but an 87.4% probability that the intervention saves on service costs and improves outcome. 

Bogosian A, et al. Distress improves after mindfulness training for progressive MS: A pilot randomised trial. Mult Scler. 2015 Aug;21(9):1184-94.

2. MS and online mindfulness – the need for follow-up

139 participants were randomly assigned to an MS-specific online mindfulness meditation intervention or to a psychoeducational (active control) group. Participants were assessed for QOL, depression, anxiety, sleep problems, and fatigue, at three different times: at recruitment, after 2 months, and after 6 months.

In comparison to the control group, the experimental subjects reported higher QOL and lower depression, anxiety, and sleep problems at the end of intervention. However, after 6 months these group differences were no longer significant.

An online MBI could be an effective psychological treatment for the promotion of well-being in MS in short-term. However, the lack of lasting effects requires the development of new strategies to support long-term changes.

Cavalera C, et al. Online meditation training for people with multiple sclerosis: A randomized controlled trial. Mult Scler. 2019 Apr;25(4):610-617. 

3. Online mindfulness leads to significant gains – a 2016 study 

Thirty people with various forms of MS were 2:1 randomized to either active training (one hourly phone session per week) or a control condition of initial instruction only (with no further training) for six weeks. 

Those in the mindfulness training group  showed significant improvement in cognitive measures of information processing, along with greater reduction in fatigue, depressive symptoms and improved sleep quality after the mindfulness training. Fidelity to daily meditation practice was greatest for those who were initially seeking stress reduction training. 

The authors concluded providing instruction and practice through a telemedicine platform greatly improves access and lowers the cost of this symptomatic treatment approach.

Frontario a et al Telehealth Mindfulness Meditation Improves Cognitive Performance in Adults with Multiple Sclerosis (MS); Neurology Apr 2016, 86 (16 Supplement) P3.092;

4. Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

5. App use improves mental health

Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.

“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.

LINK HERE TO THE ARTICLE

CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by Multiple Sclerosis (including their carers). These interventions can reduce the associated symptoms of MS such as fatigue and mobility issues, along with reducing stress, anxiety and depression, as well as assisting in actual recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes increasing the number of guided sessions increases the measured benefits.

Yarra Valley Living Centre is transitioning

Sad news this. So many of us will have happy memories of times well spent on this amazing land, meeting, working with or supporting wonderful people doing truly wonder - full things. 

And as all things change, it seems the conditions created by the pandemic have proven too much to overcome and the Centre will close, with the prospect of morphing into something new. So this week, a few reflections and observations, but first

Thought for the day

The world is a fragile and unpredictable place. 

There are no sacred cows here either :) 

Everything can be turned upside down in a moment. 

That must not be a shock, 

But rather an expectation of an inevitability.  

If we had 1000 lifetimes to live, 

We would pursue every pleasure and adventure. 

Fulfill every wish. 

But after all that, at some point,  

We would choose a life that is a total surprise. 

One where nothing is under control, 

Where you do not know what is going to happen. 

That is the life we are living right now. 

The closer I am to experiencing reality 

Instead of trying to control it, 

The closer I am to God. 

This year is a practice in presence.

Adam Schwartz

Maybe it is worth remembering the work of the Foundation began in 1981 with the inception of the Melbourne Cancer Support Group in rented premises. It was not long before we were conducting wellness groups and meditation programs. Residential programs commenced end of 1983. 

However, it was not until 1984 the land at Yarra Junction was purchased and not until 1991 we had established buildings on that land to enable fully residential programs to be presented there.

So the early history was of many years without a place to call a centre we owned. While it is appropriate to mourn the end of the Living Centre as we know it; it will be interesting to learn what arises in its absence.

Having said that, so many people benefited from that wonderful property. It was selected because of its palpable presence. 

So many people have walked onto those 40 acres and felt a deep, natural peace, along with an atmosphere of healing. Maybe it is because the land is in the heart of the Yarra Valley with all its magnificent tall trees. Maybe it is because the buildings are nestled into the land away from roads and the gaze of others. There is comfort in its solitude. Maybe it is the view from the top of the hill, or the tranquil sounds of the Little Yarra River flowing on through.

Maybe the place had significance for its indigenous ancestors; it certainly has been developed more recently with work, love, prayer, a great deal of meditation and the good-hearted efforts of many, many well motivated people.

Having not been so directly involved for nearly a decade now, I remain acutely aware of all these good people who have contributed. Those who donated time or money, those who worked as staff or as volunteers, those who attended programs and contributed their own learnings and energies. What a remarkable time we all had! And how much good work was accomplished – so many people’s lives transformed for the better.

The first Melbourne Cancer Support Group, the genesis for all this, was held on 16th September 1981. It will be 40 years this September since it all began. Forty years. Wow!

People are beginning to ask me how I feel about the closure. 

It is like this.

I feel deeply saddened that things have changed to a point where the Centre is no longer viable. So many people benefited from what was offered there by an incredible crew of staff and volunteers. And while the MS work is carried forward by Overcoming MS, and there are plenty of people and groups offering meditation and retreats, there is real concern for how the cancer work will continue to be made available. In my view the cancer residential program remains world’s best practice; offering a truly integrated, lifestyle-based, cancer self-help program. 

It is hard to be clear why such a closure should happen; the pandemic was clearly a major and final factor, however, it would be simplistic to say there was no more to it. 

Times change. People change. Foundations change. Some come for a while, do their work and then fold; others morph into something new.

Regarding ownership of land, it always has been clear – we never really own land, we simply serve as its custodians and guardians for a while. My aim with all the places I have lived and worked upon was to leave them better than when I arrived. 

Also, I do not identify too closely with the many and varied roles I have played in this life. 

So - co-Founder of the Foundation, student, teacher, father, son, husband, veterinarian, athlete, football player, gardener, one-legged person – lots of roles. And this by way of saying, I care for what the Foundation has offered and may still offer, but have little attachment to its personal impact upon my own sense of self. 

Hope this sounds close to the way it is intended – not dispassionate; I care deeply for others and to be engaged in how to be more useful, but it is what it is and we have no idea as yet as to what will emerge from it all.

I do feel deeply for those closely involved with the Centre as this unfolds. The Board has difficult decisions to make, staff will need to look for new employment, volunteers lose their connection and all those who relate to the Centre as a place of healing and renewal, a place where they might return to one day, and need time to adjust to the loss.

So in practical terms, I have been informed that the meditation retreat Ruth and I will present end of March will be the last before the doors close and staff cease employment. For those of you who know and care for Dorothy Edgelow, every effort is going into ensuring she can continue to live on the property. 

Apparently discussions are under way with the Board and several groups interested in taking
responsibility for running the Centre going forward, with different models being explored as to how this might work. 

The Board has told me their primary aims are to preserve the legacy of the Foundation and to be of benefit to the community as much as possible. 

So thank you again to all who participated in what was achieved until now, and all best wishes to those who plan to contribute to what transpires. Life goes on… Bon chance to all.

Better sleep – how to enjoy it - and the latest research

Many people are in need of a better night’s sleep. After many requests, we have now added a specific “Better Sleep” section to the Allevi8 App. This is offered with confidence. Having assisted people for over 4 decades to apply relaxation, mindfulness and meditation to manage their sleep disturbances, three things really stand out, and we cover them all in the App with specific techniques many have found transformed their sleep patterns. 

So this week, a guide to better sleep – and the latest research (including links to the original articles) that supports the use of relaxation, mindfulness and meditation to make sleep easier to get to, and easier to stay in, but first

                     Thought for the day

    People often tell me 

   “I cannot sleep because I have pain”. 

   While I understand that, 

   My approach is 

   “Because I have pain, I go to sleep”.

    Good sleep is both a necessity

    And a refuge.

    It makes sense

    To train a little so we sleep better.

                         Ian Gawler 

Three best tips for a better night’s sleep

1. Regular relaxation-based mindfulness and meditation improve sleep patterns significantly

Over the years, many people have reported significant sleep benefits when they practice using the key practices we have included on the Allevi8 App. My sense of this is the deep physical relaxation is very important as a foundation, and then mindfulness and meditation lead to a calmer, more relaxed mind. The two together then combine so that many people, including those dealing with major illnesses like cancer and MS report it is easier to go to sleep, easier to get back to sleep if they do happen to wake, and their quality of sleep feels deeper and more refreshing. 

So in fact, many of the people I have helped sleep better found regular practice was the key. The 3 practices most commonly agreed upon to be helpful have been the Deep Relaxation, the Daily Practice and the Healing Light Imagery practices.

2. Specific techniques for when you need extra help

The best support to use as you are going to sleep, or to use again if you do need help to return to sleep during the night, is the simplified Deep Relaxation exercise. 

As guided in the Sleep section of Allevi8, this exercise has a simple introduction and at the end it fades into silence. 

Many people have told me they fall asleep around half way through when listening to this track in bed, and many have used it repeatedly without ever hearing how it ends!

3. Attitude is important

As we all know, worrying does not help, so do what you can to let go of dwelling on whether you are sleeping or not, how much you are sleeping, or how often you are waking. This approach is actually supported by sleep research that indicates we receive almost as much benefit from simply lying in bed relaxed, as we might from being fully asleep. Maybe this is where the Deep Relaxation exercise comes in again. This exercise does reliably lead to deep relaxation of body and mind, so do what you can to let go of any worry and simply relax into the exercises and the restful nature of simply being in bed.

RELAXATION, MINDFULNESS, MEDITATION AND SLEEP 

The research evidence base

WHAT DOES THE RESEARCH HAVE TO SAY?

1. The size of the problem

Sleep disturbance is widespread with significant adverse consequences on quality of life for the individual and significant economic burden for society. 

Approximately 6% to 20% of adults suffer from an insomnia disorder, characterized as persistent difficulty falling or staying asleep with concomitant waking dysfunction, making it the most prevalent sleep disorder.

Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn,  Sleep Med Rev, 2002, vol. 6 – P97-111

Morin CM et al. Prevalence of insomnia and its treatment in Canada, Can J Psychiatry, 2011, Vol 6- P540- 548.

Roth T et al, Prevalence and perceived health associated with insomnia based on DSM-IV-TR; international statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders, second edition criteria: results from the America insomnia survey, Biol Psychiatry, 2011, Vol 69, P 592 – 600.

2. What might be possible? Early research

Although meditation is about cultivating restful awareness, it can help to significantly improve sleep. Early research indicated meditation to be associated with better sleep quality, being able to go to sleep more easily, longer sleep duration and less use of sleep medications.

Cohen L et al, Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004 May 15;100(10):2253-60.

These benefits may explain why meditation also can be responsible for reducing depression in those with chronic insomnia.

Britton WB, Haynes PL, Fridel KW, Bootzin RR. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med. 2010 Jul;72(6):539-48.

3. Recent relaxation, mindfulness and meditation sleep studies

What follows is a sample of some of the recent individual mindfulness and meditation sleep studies with links to the original articles. While not a definitive research compilation, they provide evidence to support the common clinical experience that both regular relaxation, mindfulness and meditation practice, along with the use of specific techniques, does in fact improve sleep patterns significantly.

i) Alleviating chronic insomnia

This study involving 54 people, found mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia.

Jason C. Ong, PhD, et al, A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia, Sleep, Volume 37, Issue 9, 1 September 2014, Pages 1553–1563,

ii) Deep Relaxation alleviates anxiety and improves sleep for people affected by COVID-19 

The researchers commented that through clinical observation, many COVID-19 patients developed anxiety and sleep disturbances after isolation treatment. Anxiety, as a kind of psychological stress, will trigger a series of physiological events and cause a decrease in immunity. Because the symptoms are mild in the early stage, but can suddenly worsen after a few days, the use of benzodiazepine-type sleep-promoting drugs may cause respiratory depression and delay the observation of the disease.

Therefore the Progressive Muscle Relaxation as used in the Deep Relaxation exercise on Allevi8) was trialled. Fifty one patients who entered a Hospital isolation ward were included in the study and randomly divided into experimental and control groups. The experimental group used progressive muscle relaxation (PMR) technology for 30 min per day for 5 consecutive days. During this period, the control group received only routine care and treatment. 

The study concluded that using the Progressive Muscle Relaxation exercise (as guided during the Deep Relaxation exercise on Allevi8) as an auxiliary method can reduce anxiety and improve sleep quality in patients with COVID-19.

Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complement Ther Clin Pract. 2020;39:101132. 

iii) Reducing depression and fatigue; improving sleep

This randomised clinical trial showed  Mindfulness Awareness Practices led to significant improvement relative to a thorough Sleep Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity. 

Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(4):494–501. 

iii) How does mindfulness improve sleep?

The authors of this study suggested that awareness and acceptance could be the mechanisms of mindfulness interventions in improving sleep quality, partly via reducing psychological stress.

Lau WKW, Leung MK, Wing YK, Lee TMC. Potential Mechanisms of Mindfulness in Improving Sleep and Distress. Mindfulness (N Y). 2018;9(2):547-555. 

iv) Does mindfulness lead in to better sleep?


This research examined whether a brief mindfulness induction immediately prior to sleep following night training might improve athletes’ sleep. University athletes were randomly assigned into experimental group (n = 32) and control group (n = 31). Following night training and just prior to sleep, those in the experimental group received a self-administered brief 6-min mindfulness induction via a video clip, whereas the control group participants viewed a similar 6-min video devoid of mindfulness induction passively. Results showed reduced pre-sleep arousal, and improved level of rest and overall sleep quality, but not sleep duration. These findings suggest that the brief mindfulness induction may be an effective approach for decreasing pre-sleep arousal and improving sleep quality after night training among athletes.

Li C et al; Effect of Brief Mindfulness Induction on University Athletes’ Sleep Quality Following Night Training. Front. Psychol., 12 April 2018  https://doi.org/10.3389/fpsyg.2018.00508

v) Sleep quality - Mindfulness meditation interventions produce significant improvements – a meta- analysis 

From 3303 total records, this study examined 18 trials with a total of 1654 participants. The study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. At posttreatment and follow-up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention and at follow-up. 

These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.

Rusch HL, Rosario M, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019 Jun;1445(1):5-16. 

Pain relief through relaxation, mindfulness and meditation - personal experience and a review of recent research

Before diving into the techniques and the research, please be clear; people can have very different experiences with pain. Growing up, I always seemed very sensitive to pain. Therefore, as an adult, to be able to experience a root canal treatment with a live tooth root and no local anaesthetic as non-hurtful came as a major breakthrough.

Reaching to this point took some mind training, so this week, how it became possible, the latest definition of pain, and what the latest research has to say concerning the use of mind techniques for the management of pain -  it is very positive. This post will be added to the research sections of my own website, as well as that for our Allevi8 meditation App, but first

   

    Thought for the day

           All great spirituality 

           Is about what we do with our pain. 

           If we do not transform our pain, 

          We will transmit it to those around us.

                                  Richard Rohr

A personal experience

My own deep interest in improving my pain management skills was provoked by the extremely painful experience of having my right leg amputated through the hip due to bone cancer, and the knowledge that bone cancer if it was to recur (which it did) is regarded as one of the most painful of all cancer types.

That imperative led me to Dr Ainslie Meares and meditation. 

Dr Meares was a psychiatrist who had a special interest in pain management and a curious mind. 

He travelled widely visiting cultures that used mind control to better manage pain, and eventually came across meditation. 

His worldwide bestseller of 1967, Relief Without Drugs set out a way to use meditation to completely alter our relationship with pain and our perception of pain.

It is to Dr Meares I owe my own remarkable shift in pain management, and his approach informed the way I have been able to help others.

Personal experience helping others to manage their own pain

Having recovered from Osteo-genic sarcoma (bone cancer) secondaries in 1978, I began a lifestyle-based cancer self-help program in 1981. The program was set out in my 1984 book You Can Conquer Cancer (still in print) and pain management was a key part of the program.

Over decades I have been fortunate to observe many, many people transform their own experience of pain. In some this has just made life a little easier, for others it has brought about major relief and the capacity to return to a more normal life.

Pain management techniques

We need to be clear here. Many people who meditate regularly find they seem to manage pain more easily. Pain does not seem so acute, they become more tolerant of it, it does not adversely affect their lives so much. So simply meditating on its own is helpful.

However, the real benefits seem to come from actually training in pain management. 

How to do this is fully set out in You Can Conquer Cancer, and covered more essentially in my latest book on meditation Blue Sky Mind.

The techniques most people have found most helpful are included on the Allevi8 App. They are the basic, but very effective Daily Meditation practice, along with the more specific Pain Relief and Finding Peace exercises. 

There is also an introductory video I recorded.

If you are experiencing pain currently, it is important to know that relief is possible and I do wish you find help like I was so fortunate to do. 

The incidence of pain

Chronic pain is common in Australia. One in 5 Australians aged 45 and over are living with persistent, ongoing pain. Chronic pain affects 1 in 3 adults in the USA. This pain can be disabling and stressful, making it hard for a person to work and do the things they enjoy. In 2018, chronic pain cost an estimated $139 billion in Australia, mostly through reduced quality of life and productivity losses.

The definition of pain

The International Association for the Study of Pain (IASP) revised its definition of pain in July 2020. This definition followed lengthy consultation and is widely accepted. 

Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

This definition is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.

• Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.

• Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.

• Through their life experiences, individuals learn the concept of pain.

• A person’s report of an experience as pain should be respected.

• Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.

• Verbal description is only one of several behaviours to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.

Definition reference : Raja, Srinivasa N et al. International Association for the Study of Pain definition of pain: concepts, challenges, and compromises, PAIN: September 2020 - Volume 161 - Issue 9 - p 1976-1982.

Acute Pain

Pain that is acute, or short-term, is a response to damaged tissue and usually disappears once the tissue has healed.

Chronic Pain 

Chronic pain is pain that lasts beyond normal healing time after injury or illness—generally 3 to 6 months. It is a common and complex condition, and the pain experienced can be anything from mild to severe. The defining characteristic of chronic pain is that it is ongoing and experienced on most days of the week. Chronic pain can result from injury, surgery, musculoskeletal conditions such as arthritis, or other medical conditions such as cancer, endometriosis or migraines. In some cases, there may be no apparent physical cause.

Chronic pain is more complex than acute pain and may result from damage to body tissue from an acute or chronic condition, or changes in the nerves or nervous system that result in the nerves continuing to signal pain after the original condition has healed. 

Chronic pain can affect a person’s use of health care and ability to work, exercise and socialise. People with chronic pain are more likely than those without chronic pain to experience mental health conditions, including depression, anxiety, sleep disturbance and fatigue.

There may also be a two-way relationship between chronic pain and mental health disorders. Many people with chronic pain report psychological distress, and psychological symptoms may be associated with increased risk of chronic pain.

Chronic Pain in Australia, Australian Institute of Health and Welfare, 2020

Clearly, chronic pain is a major public health problem. Based on the alarming prevalence, enormous cost to society, and current limitations with conventional treatment approaches, the Institute of Medicine  has called for a cultural transformation in the way pain is viewed and treated.

Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. PMID: 22553896.

THE RESEARCH into relaxation, mindfulness, meditation and pain – a summary

In simple terms, mindfulness meditation does offer a fundamental shift in view and a path of transformation in its own right. While studies have provided varying results, there is now ample evidence mindfulness meditation-based interventions can have a positive impact on individuals suffering from chronic pain of various kinds. By teaching the core self-regulation skills of bare attention, detached awareness, self-compassion, and uncoupling, mindfulness meditation offers a new way of seeing, and a new way of being, which holds potential to relieve pain, reduce suffering, and restore wholeness, hope, and functionality. 

Again, speaking personally, the results observed in our own groups seem way more consistent and strong than those reported in the literature, and this reflects why I am so confident in advocating the techniques on Allevi8. 

Significantly, in both my personal and clinical experience, the Progressive Muscle Relaxation technique (Deep Relaxation on Allevi8) plays a significant part in long-term effective pain relief and is well worth practicing regularly.

KEY RESEARCH STUDIES 

EXAMINING RELAXATION, MINDFULNESS, MEDITATION AND PAIN

This is not intended as an exhaustive review, rather a representative sample of the published research in this field, with a number of key meta-analyses included.

EARLY RESEARCH

1. Mindfulness alleviates chronic pain syndromes

Early research found mindfulness meditation to be associated with a significant reduction in pain, fatigue, and sleeplessness along with improved function, mood and general health for people with chronic pain syndromes.

Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985 Jun;8(2):163-90.

Singh BB, Berman BM, Hadhazy VA, Creamer P. A pilot study of cognitive behavioral therapy in fibromyalgia. Altern Ther Health Med. 1998 Mar;4(2):67-70.

Astin JA, Berman BM, Bausell B, Lee WL, Hochberg M, Forys KL. The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. J Rheumatol. 2003 Oct;30(10):2257-62. 

2. Deep Relaxation and pain relief

This review reported positive findings for relaxation interventions in 8 of the 15 studies reviewed. The most frequently supported technique was Progressive Muscle Relaxation (PMR – and the basis of the Deep Relaxation exercise in Allevi8), particularly for arthritis pain.

Most of the studies reviewed had weaknesses in methodology, which limited the ability to draw conclusions about interventions. The authors recommended further research is needed to confirm positive findings related to PMR, jaw relaxation, and systematic relaxation, to address questions related to the dose-response relationship and the individual differences that might influence response to relaxation interventions. These and other relaxation techniques require testing in carefully designed and conducted trials.

Kwekkeboom K, Gretarsdottir E. Systematic review of relaxation intervention for pain. J Nurs Scholarsh. 2006;38: 269–277.

RECENTLY PUBLISHED STUDIES

1. Mindfulness and Pain – a meta-analysis

This systematic review was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. Six studies met the search criteria. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. 

Study outcomes include reduced pain severity, anxiety, stress, depression, and improved quality of life. 

Ngamkham S, Holden JE, Smith EL. A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia Pac J Oncol Nurs. 2019;6(2):161-169. 

2. Mindfulness and chronic pain – a systematic review

In this review of both randomized and nonrandomized controlled trials of mindfulness -based interventions (MBI) for chronic pain, the authors note MBIs were generally associated with greater psychological and physical symptom reduction than wait-list control groups (i.e., comparing MBI to no treatment at all), but did not consistently demonstrate greater efficacy when compared to active control groups (i.e., comparing MBI to alternative treatments). However, a preponderance of evidence suggests MBIs are effective for reducing both physical and psychological symptoms among individuals with chronic pain.

Chiesa A, Serretti A. Mindfulness-based interventions for chronic pain: a systematic review of the evidence. J Altern Complement Med. 2011 Jan;17(1):83-93.

3. Mindfulness meditation and pain management - is it effective? A major review

This study from Johns Hopkins University’s Evidence-based Practice Center in Baltimore, examined 18,753 studies. Only randomized clinical trials with active controls for placebo effects were selected. Next the strength of evidence was graded using risk of bias, precision, directness, and consistency, and then the group determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. Forty seven trials (with 3515 participants) met the criteria to be included in the final analysis. 

The results? Mindfulness meditation programs had moderate evidence of reduced anxiety at 3-6 months, depression at 8 weeks and at 3-6 months, and pain; and low evidence of improved stress/distress and mental health-related quality of life. 

Among the 9 RCTs evaluating the effect on pain, moderate evidence was found that mindfulness-based stress reduction reduces pain severity to a small degree when compared with a nonspecific active control. 

It is worth noting most studies only evaluated short-term effects, and there may well be significant differences between different techniques and different times people spend practicing these techniques.

Goyal, M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68. 

4. Online mindfulness program effective for pain relief

This study investigated 99 people with chronic pain. Those who attended in person, and those who used videoconferencing achieved similar gains in mental health and pain catastrophizing levels relative to controls. However, those who attended in person obtained significantly higher scores on the physical dimension of quality of life and lower usual-pain ratings than the online group. The results suggest that videoconferencing is an effective mode of delivery for the Mindfulness course and may represent a new way of helping chronic pain patients.

Gardner-Nix J, Backman S, Barbati J, Grummitt J. Evaluating distance education of a mindfulness-based meditation programme for chronic pain management. J Telemed Telecare. 2008;14(2):88-92. 

5. Mindfulness and pain relief – a meta-analysis

Researchers reviewed more than 200 studies of mindfulness among healthy people and amongst other benefits, found mindfulness can help treat people with specific problems including pain. For example, mindfulness may reduce pain, fatigue and stress in people with chronic pain. 

Mindfulness meditation: A research-proven way to reduce stress. Mindfulness meditation can improve both mental and physical health. Creswell JD and Khoury B. American Psychological Association website, 2019

6. Mindfulness does reduce pain intensity

This review examined articles published from 1960 to 2010. Only studies providing detailed results on change in pain intensity ratings were included. Sixteen studies were included in this review (eight uncontrolled and eight controlled trials). In most studies (10 of 16), there was significantly decreased pain intensity in the MBI group. Findings were more consistently positive for samples limited to clinical pain (9 of 11). In addition, most controlled trials (6 of 8) reveal higher reductions in pain intensity for MBIs compared with control groups. Results from follow-up assessments reveal that reductions in pain intensity were generally well maintained. The authors concluded MBIs do decrease the intensity of pain for chronic pain patients.

Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity ? A critical review of the literature. Pain Med. 2013;14: 230–242. pmid:23240921

7. Acceptance, mindfulness and chronic pain – a meta-analysis

This meta-analysis examined 25 Randomised Controlled Trials totalling 1285 patients with chronic pain that compared acceptance and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up.

Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KMG. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review. Cogn Behav Ther. 2016;45: 5–31. pmid:26818413

CONCLUSION

There is a solid evidence base for deep relaxation, mindfulness and meditation being used to help people alleviate their experience of pain.