March 18

Mindfulness in Rehabilitation Practice

What is mindfulness?

Mindfulness is the practice of achieving a mental state that is focused on the present moment. Born from Buddhism, it is being able to calmly acknowledge and accept ones feelings, thoughts and bodily sensations without judgement. Depression is said to be found when we live in the past, and anxiety is found when we live in the future. Being able to experience our current lived experiences without judgement creates positive outcomes for mental and physical health.

Mindfulness interventions can be used in tandem with physical rehabilitation to assist patients in managing pain, stress and anxiety. In recent decades, literature is becoming more and more suggestive of mindful practice being clinically beneficial for chronic pain, urinary urge incontinence, musculoskeletal pain, and work-related incidents, among many others.

There are many types of mindfulness based interventions – finding the best approach for you will be individually guided by your specific goals and needs. Mindfulness can be movement based, thought based, and may include body scans, guided meditations, affirmations or an awareness movement practice.

Often meditation is mistaken to be synonymous to mindfulness. Mindfulness is a skill you can use throughout your day – where meditation is a practice you do each day. However, meditation is often an excellent gateway to living more mindfully

The Brain in Pain

To understand how mindful practice can impact pain, we first must understand the concept of pain.

Pain is a multidimensional experience that involves cognitive, sensory, and affective (emotional) input. This means that at any one moment, the interaction between these factors can differ and alter the pain experience. Additionally, our cognitive state, mood, pain beliefs, expectations, learned experiences and assigned meaning all impact our pain experience.

At the core, pain is meant to be a protective mechanism, to get our attention and seek care if needed. This is what tells us to lift our foot when we step barefoot on a piece of lego. It provokes an unconscious physical response and serves as a warning that there is the potential for damage. Pain reminds us that we are not invincible and serves to modify our future behavior, however, sometimes we perceive pain disproportionately to the damage done, or long after that damage has healed. In these cases, pain can become more detrimental than helpful.

Unlike our other senses, pain does not come from one specific area of the brain. There is a complex widespread network that is activated during pain, and it is unique to each and every person. Scientists have coined the term neurosignature, implying that the pattern of activation in the brain is peculiar to an individual. Logically then, we can conclude that to retrain our brain and the way it uniquely processes pain should involve the whole mind and body – and not one specific area.

 This is where mindfulness based practice comes in.

How Does Mindfulness Decrease Pain?

Mindfulness is the art of experiencing your world without judgement. You can acknowledge your thoughts, memories and emotions without assigning “good” or “bad” meaning to them. You simply notice them, and then let them go.

A study by Grant and Rainville found that long term mindfulness based meditation practitioners needed significantly higher levels of noxious (painful) stimulation to report pain compared to age-matched control subjects. The study concluded that mindful practice essentially turned down the volume on the network that is associated with pain in the brain.

Don’t worry, you don’t need to move to Nepal, or become a buddhist monk to benefit from mindfulness based pain control. Another study by Zeidan and Vago found that even after four 20-minute sessions of mindful meditation focused on breath sensations, there was a 40% decrease in pain intensity and 57% reduction in pain unpleasantness ratings. The study also looked at brain imaging and noted that mindfulness changes pain in the brain by changing our cognitive conscious state which impacts our subconscious responses to pain and unpleasant stimulus. This means that our body is less likely to enter into a stress response or a state of “fight or flight”.

We know that when we entire fight or flight, the body releases hormones, such as cortisol to get us ready to either flee a situation or fight. But what happens when that threat lives within us? When pain becomes persistent and triggers a continuous stress response it can heighten our awareness of that pain and make us even more vigilant.

Mindfulness leverages our ability to make our own decisions using our executive functioning, to change the level of threat that our subconscious or survivalist brain experiences, and it turn can make our bodies less sensitive to unpleasant experiences, and improve general wellness by “turning” down the areas of the brain that are associated with the pain network. Mindfulness gives us the ability to alter the meaning, and assigned meaning to painful input and can serve as a mechanism to buffer the chronification of pain.

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