David Patterson, PhD, on Using Mindfulness and Meditation to Reduce Chronic Pain

Opioid addiction is a top public health concern in the United States. In neurology, opioids are commonly used to treat, for example, chronic pain and restless legs syndrome, and taking them out of the treatment plan is not always a viable option.

However, mindfulness and meditation may be a reasonable option for patients with chronic pain who do not want to continue their opioid prescription. David R. Patterson, PhD, ABPP, ABPH, is a professor in the Department of Rehabilitation at the University of Washington School of Medicine in Seattle, Washington, and answered our questions about using mindfulness and meditation in the treatment plan for chronic pain.

NEUROLOGY CONSULTANT: In what ways do mindfulness and meditation reduce pain?

David Patterson: Mindfulness and meditation do not necessarily reduce pain. Meditation, in my view, is a practice in which we train our brains to not attach itself to thoughts or feelings. Thoughts and feelings continue to come and go for effective meditators, but they develop the capacity not to become attached to their pain and made to feel helpless by it. There is a formula in this respect that Suffering = Pain × Resistance. Pain is inevitable, suffering is not, and mindfulness/meditation enable one to suffer less while the pain is still present.

NEURO CON: What techniques have you employed with your patients that others might be able to implement?

DP: I teach many of my patients, as well as those in our research studies, simple meditation techniques in which they focus on their breathing or a mantra (repeating a single word over and over again such as the word “one”). They practice this for 20 minutes, at least once a day, but preferably twice a day. They are trained to focus all of their attention on breathing or the mantra. When their mind wonders, they gently remind themselves to return to their breathing (or mantra). Over time, this enables the patient to return to the present. Patients are trained to return to the present even when they are feeling pain. They are trained to experience the pain rather than avoid it. Training the mind to return to the present moment very much softens the impact of pain, as well as other unpleasant feelings or thoughts.

NEURO CON: What else do neurologists need to know about using mindfulness and meditation to reduce patients’ pain?

DP: Meditation is a discipline rather than a psychological coping technique. Most often, a given meditation session does not make one feel better. The results are seen in neurophysiological studies over a number of weeks and months rather than days. Indeed, there is a cortical shift in brain activity from the right prefrontal cortex (the seat of neurosis) to the left prefrontal cortex (more of a happiness center). Originally this cortical shift was noted in long-term meditators, but now it is being demonstrated (Pierre Rainville’s work, for example) in naïve meditators over a matter of months.

Along the lines of this being a discipline, patients should understand that early attempts at meditation often bring about a sense of boredom, frustration, or even increased pain. The “monkey mind” does not like not being in control and will thwart efforts to focus consciousness in the present. Patients should be encouraged to stay with the process for at least 3 months before expecting results.