Train the brain to manage chronic pain

How do you function when chronic pain is a part of your daily life? The UC San Diego Center for Mindfulness (UCSD CFM) at UC San Diego Health System offers a novel program to help people who are dealing with chronic pain "train their brains" to lessen their experience of discomfort and, in some cases, eliminate it. Called Mindfulness Based Stress Reduction (MBSR), this in-depth eight-week program helps participants learn to better manage their experience of pain through diverse techniques such as guided meditation, gentle yoga, and breathing exercises.

"Cancer patients and those who suffer from chronic conditions, such as Inflammatory Bowel Disease, often deal with cycles of pain that do not respond well to medications," said Steven Hickman, PsyD, director of the Center for Mindfulness and assistant clinical professor in the UC San Diego Department of Psychiatry. "With MBSR, we teach students how to use their brain to work differently with pain and increase mobility."

Hickman suggests that the experience of pain and illness varies widely from patient to patient, for reasons that are not always objective or physically-explainable. The answer, he believes, comes from the emotional distress that is provoked and manifested differently in each person.

"Given two patients with the same disease or type of injury, we know from experience that they may report wildly different levels of pain. If this difference can't be explained by medical reasons, it must be something else," said Hickman. "One person may be angry or afraid, and the other is stoic and reserved, yet each has different amounts of physical pain. Recognizing this difference is crucial to the relief of suffering, because it means that at least part of the perception of pain is how you relate to it."

According to Hickman, the relationship with pain and disease is cultivated and maintained in the mind so the mind is the logical place to go to potentially change that relationship in a healthier direction.

Lorraine Chase decided to try MBSR after her doctor recommended it as a way to manage her tinnitus, a condition involving a chronic ringing in the ears. She was skeptical at first - although familiar with meditation, she wasn't sure why being mindful of pain or ringing in the ears would have any benefit. Six months after going through the training with Hickman, she began to notice the results when she ceased having migraine headaches. Later, when diagnosed with breast cancer, she used what she had learned from MBSR to help her make difficult treatment decisions.

"Instead of wasting energy on being angry about having cancer, I decided to spend my energy on getting well," said Chase.

As many people do when they aren't feeling well, Chase would often get angry when she got sick. Through mindfulness training she came to understand how one chooses to deal with pain can make a difference on how one perceives pain. "Mindfulness helps relieve the suffering of the pain without changing the fact of the pain. I might say to my doctor that I'm in constant pain but when I go into mindfulness, when I really listen to myself, I realize that, yes, I'm in pain but it changes, it moves, it might flare but it's not constant," she added.

Constant pain was something that Bonnie Cohen Rooney was facing after experiencing a series of spinal surgeries in 2000 that included a prolonged stint in the ICU. At 46, Cohen Rooney, a self-described active "high achiever," found herself overwhelmed with pain, fear, and uncertainty about her future. Through MBSR training, she learned several strategies to deal with pain including how to use breath to control it. By imagining her breath as a healing force, Cohen Rooney found she could relax her body and "release pain" while turning down its intensity.

"I close my eyes and turn my attention inward and focus on the breath," said Cohen Rooney. "I visualize that the air being breathed in brings with it healing and calm and the exhaling breath releases the pain and the tension. My body relaxes and a sense of tranquility follows."

Hickman said that the MBSR techniques are helpful in regard to dealing with issues of food and eating, recovering from addiction, attention deficit disorder, anxiety and general stress.