Doctor's orders: Cross your legs and say 'Om'
Interest in meditation grows with evidence it might reduce the brain's reaction to pain and increase pain tolerance.
October 29, 2007|Andrea R. Vaucher, Special to The 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.
Converts meet skepticism
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 Chris 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?"