Mindfulness-based pain management
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Mindfulness-based pain management (MBPM) is a mindfulness-based intervention (MBI) providing specific applications for people living with chronic pain and illness.[1][2] Adapting the core concepts and practices of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), MBPM includes a distinctive emphasis on the practice of 'loving-kindness', and has been seen as sensitive to concerns about removing mindfulness teaching from its original ethical framework.[1][3] It was developed by Vidyamala Burch and is delivered through the programs of Breathworks.[1][2] It has been subject to a range of clinical studies demonstrating its effectiveness.[4][5][6][7][8][9][1]
Origins
MBPM was developed by Vidyamala Burch, growing out of her experience of chronic pain, her practice of Buddhist meditation, and her work with medical experts in pain management. Having suffered several accidents in her early life which, alongside a congenital spine condition, left her with severe long-term pain and partial paraplegia, Burch turned to meditation initially as a way to escape her bodily experience, after having been introduced to visualization practice during a long hospital stay in her mid-20s.[10]: 172 [11] Eventually, after encountering the Triratna Buddhist Community, she became a practicing Buddhist, and moved from New Zealand to the UK to live full-time in a residential Buddhist community.[10]: 173 In the late-1990s she suffered a further collapse in her health, confining her to home for long periods and requiring her to start using a wheelchair, which led her to re-evaluate her meditation practice.[10]: 173 Burch realized that "my approach was out of balance: Too much striving and not enough acceptance."[10]: 173 She read widely about pain management and the emerging secular mindfulness movement, and eventually began teaching a course in meditation for people with chronic pain and illness in Manchester.[12] In 2004, she co-founded the organization Breathworks, which delivers MBPM programs.[13]
Philosophically, the origins of MBPM lie in
The scientific origins of MBPM lie in academic literature on pain and the medical benefits of mindfulness-based interventions (MBIs). In particular, MBPM grows out of new scientific understandings of pain that developed in the second half of the 20th century, which showed the complexity of the experience of pain and "the extent to which it involves the whole person—the mind as well as the body".[10]: 154 The well-established "gate control theory", for instance, suggests that the experience of pain is connected with the operation of neural "gateways" that are affected by "emotional states, mental activity, and where attention is focused".[10]: 156 These become persistently opened in people with chronic pain, even where underlying tissue damage has healed or is absent. Modern pain management draws on these understandings in the biopsychosocial model of pain, which holds that pain is best managed through a multifaceted approach addressing the biological, psychological, and social aspects of a patient's life.[10]: 154 MBPM is intended to form one part of a multifaceted pain management program, based on the understanding that mindfulness and meditation may reduce the experience of pain through calming the "mental, physical, emotional, and nervous systems, allowing them to return to a state of balance."[10]: 154 This is based on extensive research indicating that mindfulness-based interventions (MBIs) including mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) can result in clinically significant reductions in pain, in addition to other health benefits.[15][16][17][18]
Traditional Chinese Medicinal use of Mindfulness Therapy
The origins to mindfulness conception and creation can be traced back thousands of years to traditional approaches from East Asian functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Chinese Buddhist and Traditional Chinese medical texts, doctrine and teachings.[19]
Mindfulness is considered the branch of its root practice meditation and is used extensively in Wuxing heqidao,Taiqi, Qigong, Neigong and by Chinese medicinal physicians as part of an integrative mind/body therapy for the prevention and treatment of injury, pain, disease and suffering.[20][21][22]
Content and delivery
MBPM is delivered primarily through the Breathworks Mindfulness for Health course, which is structured according to a "six stage process" corresponding with practices taught at different stages of the course.[23][3][24] The process is as follows:
Stage | Theme | Meditations/Practices | 8 Week Course |
---|---|---|---|
1 | Awareness: establishing basic awareness | Body scan
Breathing anchor Mindful movement |
Weeks 1–3 |
2 | Acceptance: turning towards the unpleasant | Compassionate acceptance | Week 4 |
3 | Wonder: seeking out the pleasant | Treasure of pleasure | Week 5 |
4 | Equanimity: gaining broader perspective | Open heart | Week 6 |
5 | Connection: connecting with others | Connection | Week 7 |
6 | Choice: responding not reacting | Mindfulness in daily life | Throughout the course |
The course begins by establishing basic meditation skills — in particular the ability to apply focused awareness (
MBPM courses draw many practices and concepts from mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), but provide specific applications for those living with chronic pain, illness, or other forms of suffering.[4][1][2] The three core practices of MBSR – the body scan, breath awareness meditation, and yoga – are all utilized in MBPM, but MBPM meditations are shorter and MBPM movement practice involves cultivating body awareness during simple, non-challenging movements.[4][2] Like MBCT, MBPM places emphasis on working with difficult thoughts and emotions and on mindfulness in daily life, but MBPM incorporates a pacing program drawn from pain management practice, and involves a distinctive emphasis on the concepts of primary and secondary suffering.[4][10]
According to many observers, the most notable distinction between MBPM and other mindfulness-based interventions (MBIs) is its emphasis on loving-kindness, which is manifested in its stress on bringing kindliness and compassion to all forms of meditative awareness, in its teaching of loving-kindness practices utilizing the imagination, and in its six-stage process progressing from the individual to the interpersonal and collective aspects of human experience.[4][1][3] This emphasis has been connected by some observers with a sensitivity to concerns about removing mindfulness teaching from its original ethical framework within Buddhism, while at the same time providing a secular evidence-based approach appropriate for people of all faiths, and none.[1][3][10]: 165
Evaluation of effectiveness
In addition to extensive evidence indicating the effectiveness of mindfulness-based interventions (MBIs) in general for pain management,[15][16][17][18] and further evidence indicating the effectiveness of compassion-based practices for pain,[26][27][28][29][30] a range of studies have specifically supported the effectiveness of Breathworks Mindfulness for Health MBPM programs for the management of chronic pain and other long-term conditions. A 2010 study found that chronic pain patients participating in a Breathworks MBPM program reported significantly higher levels of wellbeing than those in the control group, with significant positive changes in catastrophizing, depression, outlook, pain self-efficacy, and mindful attention, along with particularly large improvements in pain acceptance.[1] (Catastrophizing has been found to be a particularly important predictor of quality of life in those with chronic pain.[31]) A randomized controlled trial in 2013 found that chronic pain patients participating in an MBPM program experienced improvements in their mental health and perceived control of pain symptoms, as well as exhibiting physical changes in brain regions associated with cognitive control and emotional regulation.[9] Long-term qualitative studies with MBPM course participants suffering from chronic pain and other long-term conditions found significant sustained improvements in quality of life, pain acceptance, and self-directed self management, with one study finding benefits sustained up to nine years after course completion.[8][7] 2018 studies conducted in Brazil and Spain found significant lasting improvements in pain and quality of life among musculoskeletal pain and cancer patients.[5][6] A 2018 literature review found that research on Breathworks MBPM courses has shown them "to be very helpful for people with severe chronic pain and illness", while also noting that further randomized controlled trials were needed.[4] In addition to research indicating the effectiveness of MBPM as delivered through the Breathworks Mindfulness for Health course, the effectiveness of MBPM as delivered through the Breathworks Mindfulness for Stress course and online Breathworks courses has also been supported by a number of studies.[3][32][33]
See also
- British Association of Mindfulness-Based Approaches (BAMBA)
- Compassion-focused therapy
- Mindfulness
- Samatha & vipassanā
- Brahmavihara
- Metta
- Self-compassion
- Buddhist meditation
- Buddhism and psychology
References
- ^ PMID 19911432.
- ^ a b c d e "What is Mindfulness based Pain Management (MBPM)?". Breathworks CIC. 22 January 2019. Retrieved 2020-05-22.
- ^ S2CID 59306658.
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- ^ hdl:10017/35501.
- ^ S2CID 4917280.
- ^ S2CID 45682942.
- ^ S2CID 33688569.
- ^ ISBN 978-0-19-968890-6.
- ^ "Interview With Vidyamala Burch". www.everyday-mindfulness.org. Retrieved 2020-05-29.
- ISBN 978-1-909314-28-3.
- ISBN 978-1-60407-637-0.
- ^ "SN 36:6 Sallattha Sutta | The Arrow". www.dhammatalks.org. Retrieved 2020-05-29.
- ^ PMID 24395196.
- ^ PMID 27658913.
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- ^ "Huang di nei jing su wen". Library of Congress, Washington, D.C. 20540 USA. Retrieved 2023-09-27.
- ^ Segal, PhD Zindel (2015). Mindfulness-Based Cognitive Therapy for Depression (Second Edition) (in Chinese) (Second ed.). Xin Ling Gong Fang.
- ISBN 978-0-85701-177-0.
- ISBN 978-1-885246-30-1.
- ^ Guzmari S (2018). "Change the Focus". Community Practitioner. 91: 48–9.
- ^ "The Breathworks approach to mindfulness and compassion". Breathworks CIC. Retrieved 2020-05-31.
- ^ "Mindfulness for Health course". Breathworks CIC. 28 January 2019. Retrieved 2020-05-31.
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Further reading
- Burch V (2010). Living Well with Pain and Illness: the Mindful Way to Free Yourself from Suffering. Boulder, CO: Sounds True.
- Burch V, Penman D (2013). Mindfulness For Health: A Practical Guide To Relieving Pain, Reducing Stress And Restoring Wellbeing. London: Piatkus.
- Burch V (2016). "Meditation and the Management of Pain". In West MA (ed.). The Psychology of Meditation: Research and Practice. Oxford: Oxford University Press.
- Hennessey G (2016). The Little Mindfulness Workbook: Everyday Techniques to Help You Combat Stress and Enhance Your Life. Bath: Crimson Publishing.