Consumption of painkillers in the Western world is massive and increasing.
On average, every Dane takes one to two painkillers every day from infancy to old age. Painkillers are good at relieving pain that has a well-defined physical cause, e.g. postoperative pain, but their effects are modest or small when the pain has a complex, perhaps mainly psychological or stress-related basis. Only a minority of the afflictions for which painkillers are taken have a clear physical cause, and the high levels of consumption reflect how widespread pain and bodily stress are.
Taking tablets does not provide total and reliable pain relief. There is therefore a need for other self-administered treatments, such as meditation or relaxation techniques. But it is easy to swallow a pill, whereas learning and practising meditation involves more input, which may be one of the reasons why relatively few people try it. However, the potential benefits are considerable. Although there is as yet no complete account of the cause-effect relationship between stress and pain, it is clear that even a partial improvement in symptoms has significant implications for quality of life and functioning at work and home. The question is, whether research to date shows that meditation alleviates bodily stress.
Alternatives to medical treatment, such as behavioural therapy, relaxation techniques and meditation, have been introduced in clinics that treat bodily stress and chronic pain. Experiences within the Acem School of Meditation have demonstrated clear reductions in and even elimination of bodily stress in many meditators. This article reviews the scientific evidence.
We searched the international medical databases to identify published data on the effect of meditation on chronic pain, and got 62 results. A closer view, however, revealed that data on meditation was only present in a minority of the studies, which covered a broad spectrum of alternative therapies including music therapy, yoga, healing and acupuncture. In general, the quality of the medical research on meditation was not very high, and the papers dealt with a range of very different techniques. Research from the 1970s was mainly casuistic, reporting data on one or a few individuals. Later articles typically included small groups of patients without a control group of the kind that would be an essential requirement of research today.
Often the participants in the studies were so incapacitated by chronic pain that they had ended up as patients in special clinics treating the most difficult cases. Among these patients, a combination of relaxation, e.g. meditation, with psychotherapy and painkillers or anti-depressants was often reported to be the most effective treatment. This perspective is not directly relevant to individuals with more common, occasional complaints such as headaches, minor sleeping difficulties, poor digestion or muscular pain, who want an alternative to painkillers and expensive treatments in the “grey” market of alternative therapies.
The available literature has obvious weaknesses and deficiencies, but it is not without value. Later in this article we review some of the scientifically soundest studies, which suggest that meditation is efficient in coping with chronic pain, headaches and other physical symptoms of stress.
First, it may be useful to take a closer look at what pain is. We all know the pure, physical pain that arises when you burn yourself on a hot stove. The heat causes damage to tissue, which activates sensory nerves. These send impulses to the spinal cord and the brain, which experiences the pain. The brain activates effector nerves that make you withdraw your hand immediately from the heat. The connection between tissue damage (heat) and the sensation of pain is clear. In patients with damaged sensory nerves, the tissue damage does not cause pain, and these patients only discover that they are burning themselves when it starts to smell! The classical research model of pain is tooth extraction: The cause of pain is clearly identified, the pain is intense, and it is temporary. This is the kind of situation in which acetaminophen and other over-the-counter painkillers are effective.
A recent British study found that meditation leads to an increased pain threshold. Forty-two healthy volunteers were randomised to learn and practise either mindfulness meditation or guided visual imagery (Kingston et al. 2007). Pain tolerance before and after they learned the technique was assessed by measuring how long they could keep one hand in 0.2°C cold water and how much pain it caused. Those who practised meditation increased their hand submersion time, and the pain intensity decreased. These results were not found in the imagery group.
Our sensation of pain is influenced by psychological factors. Anxiety and tension increase the experience of pain – just imagine the fear of the dentist’s drill. Feeling safe and relaxed, on the other hand, reduces it. A good example is the general practitioner who says to the small child waiting to have a vaccination: “Here are some sweets. If you can count them, you may have them.” Many children get completely absorbed in the pleasurable job of counting the sweets and hardly register the injection at all.
Pain may also be elicited by psychological strain without prior physical disease or trauma. Everyday life is full of examples: stomachaches before exams, gynaecological pain resulting from marital problems, pain in the neck and shoulders during stressful times at work. And vice versa: pain may increase the feeling of stress. A bad back or a headache makes you more stressed and irritable than you would otherwise be. Increased stress can start a vicious circle, in which pain and stress amplify each other and lead to chronic pain. Painkillers have limited benefits in this situation, because the pain is the result of a psychological strain (stress), which is not affected by the medication.
For a person with chronic pain, it may be difficult or even impossible to distinguish between physical and psychological causes. It hurts somewhere in the body; the person gets worried and seeks their doctor’s advice. The doctor excludes physical disease and tries a painkilling medication, usually without much success. For some patients the search for an underlying disease becomes an obsession: “When it hurts, something must be wrong with me, and it is the doctor’s job to find out what it is”. This can lead to “doctor shopping” and the use of substantial medical resources without much success.
The interaction between psychological factors and inner and outer stressors with little or no somatic base leads to a complicated picture of temporary or chronic bodily complaints such as muscular tension, irregular heartbeat, sleep disturbances or restlessness. Sometimes these are termed psycho-somatic, an expression that reflects how psychological tensions may present themselves as somatic (bodily) symptoms. Occasionally this is interpreted as implying that nothing is really wrong with a patient – their symptoms are imagined or “all in the mind”.
A more neutral way of describing bodily complaints with no organic origin is to talk about bodily stressors. These may be elicited by personal factors, or by outside factors at home (marital troubles, small children, a close relation’s death or serious illness) or at work (physically demanding or monotonous work, high workload or workplace conflicts). Some individuals are more prone to physical stress than others: the experience of stress is the result of a complex interaction between the demands and pressures that one is exposed to, and one’s ability to cope with these strains.
The close relation between body and mind is obvious in Acem Meditation. A free mental activity (the repetition of the meditation sound in the mind) leads to a physical response, the so-called relaxation response, which was first described by the American professor Herbert Benson (Benson et al. 1974). The relaxation response may be measured physiologically, in decreased oxygen consumption, heart rate, breath volume and muscular tonus. Skin resistance (to conducting electrical impulses) increases because of reduced sweat production. All these changes are indices of a relaxing body.
The relaxation response is central to understanding the impact of meditation on bodily stress. Many bodily symptoms are related to increased muscular tension in one or more parts of the body. Below we discuss two articles which document the effects of meditation and relaxation on two such complaints: muscular infiltrations and tension headaches.
How to measure the benefits? Muscular tension in the neck is a very common complaint arising from psychological stress or monotonous use of the muscles. It often leads to tension headaches and may start a vicious circle in which other groups of muscles are recruited to work inadequately, thereby increasing the pain problem. This is known as muscular infiltration.
A group of Finnish researchers investigated whether muscular infiltrations in the neck responded to meditation (Toivanen et al. 1993). Electromyography (EMG) was used to measure tension in the trapezoid muscle. In EMG, electrodes are inserted above or into the muscle, and electrical impulses reflecting activity in the muscle are registered during rest and work. This is an objective measurement, which is unaffected by the participant’s attitude towards the trial.
Fifty hospital cleaners participated in the study. Half of them were taught a simple relaxation technique (deep inspirations, forced tension and relaxation of the abdominal muscles and 10 minutes of “deep relaxation”, which is not described in further detail in the paper). They were recommended to perform the exercises for 15 minutes per day.
The cleaners’ muscular tension was recorded at rest and while cleaning. Before they learned the relaxation technique, about half of them showed increased muscular activity at rest – i.e. muscular tensions; but after learning relaxation, almost all of them had normal resting levels of muscular activity. The group of controls who did not learn relaxation showed the same amount of tension as previously.
Measurements during work showed that nearly all cleaners who learned relaxation had moderately or severely increased muscular tonus before the course; after the course the muscular tension had normalised in half of them and was only moderately increased in the rest.
In conclusion, the study indicates that regular relaxation results in reduced muscular tension. Elements of the technique resemble meditation, and the results are in agreement with practitioners’ experiences with Acem Meditation: In addition to a general experience of relaxation during meditation, many practitioners find that stiff muscles soften.
Reduction of muscular tension is all very well, but the main problem we are concerned with is pain. To what degree is pain reduced by relaxation? As mentioned previously, headaches are often caused by muscular tensions in the neck and shoulders. In 2001, psychologist Kenneth Holroyd’s groups published a study in the highly regarded journal JAMA in which they investigated the impact of relaxational therapy on chronic headache. The participants had suffered from headaches at least 15 days a month for at least 6 months – which is the international definition of chronic headache. This type of patient is very difficult to treat. Often, the general practitioner does not know how to intervene.
Fifty participants learned exercises (tapes with instructions for relaxation) and received guidance on how to cope with pain (cognitive therapy). Another group received antidepressive medication, which is known to affect the stress response, and a third group received a placebo.
The results are interesting: In one third of those who practised relaxation, headaches were reduced from 14 to 7 days per month. Relaxation was as effective as anti-depressants. Concomitantly, the need for painkillers was reduced, and participants were able to engage in ordinary activities on a larger scale. The impact of relaxation occurred gradually during the 6 months of the study.
Jon Kabat-Zinn in the medical faculty at the University of Massachusetts is doing research on the effect of “mindfulness meditation” on chronic pain, stress disorders and chronic diseases. Mindfulness meditation is a technique based on flexible, non-attached attention, which in some respects resembles the open-mindedness of Acem Meditation. Kabat-Zinn has studied whether mindfulness meditation can break the vicious circle of stress and chronic pain; not through self-control, but through an altered attitude towards the pain (Kabat-Zinn et al. 1985).
He studied 90 persons with chronic pain (such as headaches, back pain, neck- or shoulder pain) over the course of at least six months. The subjects had suffered chronic pain for periods averaging 8 years. They had tried conventional pain treatment, e.g. painkillers, physiotherapy, injections with anti-inflammatory drugs, etc., but to no effect. Thus, the group consisted of patients who were very difficult to treat.
Half of them participated in a 10-week meditation course, and were encouraged to meditate for 45 minutes, 6 days a week. The rest served as a group of controls and received no training.
In contrast to, say, body weight or temperature, pain is difficult to measure. Qualitative measures such as questionnaires are used, or indirect measures like responsiveness to painkillers. In Kabat-Zinn’s study, pain was assessed by various well-established methods of self-reporting. A weakness of this is that participants may have responded positively because they unconsciously wanted the method to help them.
“Present moment” pain (the meaning of this is not explained in the paper) was reduced by more than 50% in a majority of patients, and in half of them the intensity and frequency of the pain was significantly reduced. Negative body image (i.e., how problematically the patient experiences various body parts) was reduced, as was the inhibiting influence of pain on everyday activities. Half of the patients who used painkillers prior to the study either reduced the dose or stopped taking them. In the group of controls, no significant changes in pain or use of painkillers were observed.
At one-year follow-up the results were still present. These observations indicate that meditation may relieve chronic pain and reduce pain-related behaviour in a majority of individuals. The pain may not disappear, but it is easier to cope with and does not have the same impact on everyday life.
Persistent complaints involving diffuse muscular and joint pain (with no sign of inflammation), stiffness, fatigue and sleep disturbances, all in the absence of underlying disease, are known as fibromyalgia or chronic fatigue syndrome. Treatment of this condition is difficult, with anti-depressive medication and physical exercise yielding unsatisfactory results.
An American group of researchers investigated whether meditation relieved symptoms of fibromyalgia. The study was published in General Hospital Psychiatry (Kaplan et al. 1993). Seventy-seven individuals with many years of symptoms participated in a 10-week course of mindfulness meditation, which they were asked to perform 2 x 20 minutes daily, together with other exercises. In half of the patients, better sleep, less fatigue and less pain were observed. Unfortunately, there was no group of controls and no information about long-term results was given.
The Journal of Rheumatology published a study of 128 patients with fibromyalgia in 2003. The research leader, J. A. Astin, has published several papers about the effect of meditation on various diseases. In this study, half of the patients received an 8-week course in mindfulness meditation and Qigong movement therapy (no additional information given); the other half received general education and support. In both groups, good results were observed on various parameters such as pain, and they persisted after 6 months. There was no difference between those who learnt meditation and the group of controls. The authors conclude that meditation and movement therapy were no more effective than patient education and support. We do not know, however, whether the education also included some elements of relaxation, thus making it a less valid group of controls. It is interesting that the level of pain in the meditation group decreased, but we do not know how or in what circumstances.
The latest international recommendations for the treatment of sleep disturbances identify the “goal of meditation” as “the reduction of psychic and muscular tension causing hyper-arousal and interference with sleep onset” (Schenck et al. 2003). This is in accordance with Acem’s experience. If an Acem meditator has sleep problems, he or she is encouraged to postpone the afternoon meditation until bedtime, and meditate sitting in bed immediately before lying down to sleep. The disturbing thoughts, restlessness or tension which may otherwise interfere with sleep will often disappear during meditation. Meditators with normal sleeping patterns should meditate no later than 2 hours before bedtime.
Several studies have shown that various types of cognitive-behavioural therapy may relieve chronic sleep problems. In one study from Germany, mindfulness meditation was incorporated into cognitive group therapy. The patients suffered longstanding insomnia, and had been unsuccessfully treated by sleeping medication and psychological methods (Heidenreich et al. 2006). Total sleep time increased from 5.5 hours to 6.5 hours per night, and the time between lying down to sleep and falling asleep decreased. The number of patients on sleep medication was reduced from 86% to 64%. It is a weakness that there was no control group and that the number of participants was low.
A review of the international literature reveals that there is no systematic research on the impact of meditation on sleep problems. This may reflect the fact that studies tend to involve patients with severe enough sleep disturbances to be receiving psychiatric treatment, whereas individuals with ordinary sleep problems are normally prescribed sleeping medication by their general practitioners, and are therefore not selected for scientific research. There is a need for research into the effects of meditation on ordinary sleep difficulties.
Irritable bowel syndrome is a widespread stress-related disease characterised by abdominal pain and altered bowel habits such as diarrhoea and constipation. Laurie Keefer conducted a study to find out whether meditation affected the course of the disease (Keefer et al. 2001). Sixteen adults with irritable bowel syndrome were allocated to one of two groups at random. One learnt Relaxation Response Meditation (based on Herbert Benson’s principles) and meditated 2 x 15 minutes daily. The other group was put on a waiting list. The method was free of religious or ideological content, so the results can be assigned to a specific, physiological effect.
During the 6 weeks of the study, about two thirds of the meditators experienced less abdominal pain and less diarrhoea and constipation. Afterwards, the group on the waiting list was also taught meditation and achieved similar results. At one-year follow-up the effect was still present and even improved (Keefer et al. 2002).
The study thus indicates that meditation may reduce the signs and symptoms of irritable colon both in the short and longer terms. In addition, other stress symptoms such as headaches, back pain, depression and anxiety were reduced in one third of participants, who experienced better moods, more energy and improved concentration.
Acem Meditation elicits mental and physical relaxation and gives freedom to the impulses of the body and the mind. Everday life often features restlessness, tension or pain. The meditator does not attempt to get rid of these disturbances, but rather tries to move towards greater acceptance. Meeting and containing the challenging parts of life reduces the psychological tension, anxiety and depression that may be causing – or amplifying – physical pain. The physiological mechanisms behind the effect of meditation on bodily symptoms are incompletely understood, but research supports the experience that bodily complaints with a psychological root may be relieved during meditation.