Mindfulness for Physical Pain

A gap between the hype and the actual research 

You may have seen articles claiming that “mindfulness cures headaches” or “meditation is more effective than drugs.” It’s good to be skeptical of such bold claims, which often overlook the complexities of the actual research studies and what they really show.

Mindfulness can be difficult to study because it is hard to measure how mindful someone is being. We also still don’t know how much instruction and practice is enough, or whether different formats (in person or by computer) affect people differently.

As you can see, the research on mindfulness for pain reduction is mixed. This is largely because there has not been enough good research done to make statements about its effectiveness. As more high-quality research is performed, we will continue to learn more about the role mindfulness can play in helping people manage and approach their pain

Mindfulness can improve the psychological experience of pain

Mindfulness Based Stress Reduction, pioneered by Jon Kabat-Zinn, is one of the most widely researched form of mindfulness practices for pain. You’ll notice it’s not called Mindfulness Based Pain Reduction. Rather, Kabat-Zinn found that when patients with chronic pain are able to uncouple their response to pain from the actual physical sensations, they are able to form a healthier response and, in turn, suffer less.

As such, many of the studies that explore mindfulness and pain focus on the ways that mindfulness can improve quality of life and psychological distress associated with pain, rather than the intensity of the sensations of pain itself. Here are some examples of their findings, which constitute a moderate level of evidence:

• A 2011 review found MBSR as effective as cognitive behavioral therapy in reducing depression and anxiety for patients coping with chronic pain (Veehof, et al).
•  A 2013 review demonstrated that while expert meditators report the same pain intensity as non-meditators, they experience reduced unpleasantness (Lutz, et al).
• A 2012 review of people with lower-back pain found limited evidence that MBSR can improve pain acceptance (Cramer, et al).

How mindfulness may help with the psychological experience

Mindfulness may improve the psychological experience of pain by:

1. Decreasing repetitive thinking and reactivity
2. Increasing a sense of acceptance for unpleasant sensations
3. Improving emotional flexibility
4. Reducing rumination and avoidant behaviors
5. Enhancing self-compassion
6. Increasing a sense of acceptance for the present moment
7. Inducing the relaxation response and decreasing stress

Mindfulness practices may reduce pain intensity

There is limited (but perhaps emerging) evidence that there may be a link between mindfulness practice and pain intensity.

Researchers are exploring many ways to test pain sensitivity, from administering electrical shocks or extreme cold before and after mindfulness training, to using neuroimaging studies of the brains of long-term Zen meditators.  

Reiner’s 2013 systematic review reports that most studies do show a positive connection between mindfulness-based practices and a significant reduction of pain intensity, especially among those who are experiencing clinical pain (i.e., pain from a diagnosis, rather than a laboratory-induced electrical shock). However, the research in this area is limited.

Two additional reviews also found moderate evidence that Mindfulness Based Stress Reduction reduces pain severity, although the degree of relief varied and was not considered significant for some conditions (Goyal), and one focused on fibromyalgia specifically (Lakhan).

In short, while a body of evidence that mindfulness has a direct impact on the intensity of the pain experience may be emerging, the research is still somewhat limited.