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Dealing with Chronic Pain: The Mind Body SolutionDr. Hilary Tindle is Assistant Professor of Medicine, University of Pittsburgh School of Medicine.
Introduction
When medical professionals talk about "persistent" or "chronic pain," they are referring to debilitating, day-in-and-day-out pain that is difficult or impossible to cure. Persistent and chronic pain affects approximately 30% of the United States population;(1)(2) for a significant portion of them, the pain is centered on the back, joints or other part of the musculoskeletal system. While this kind of pain remains a frustrating and difficult-to-treat condition, our understanding of what pain is and how it works has advanced greatly in recent years, leading to innovative and effective treatments. Many of these are so-called "mind body" therapies that aim to help people to control their own pain response.
The groundbreaking gate control theory of pain helped explain how psychological factors influence pain perception.(3) Put forward in 1962, gate control theory says that physical pain is not a direct result of an assault from the outside on the pain producing neurons, (as is the case when you bang your elbow or break a leg), but rather the result of interaction between different parts of the brain and nervous system. The bottom line is that the brain controls the perception of pain quite directly, and has a proven ability to moderate or even turn on and off certain forms of pain. In earlier theories of neurochemistry, the role of the brain had not been taken into account; pain was thought to be a sort of one-way "alarm system" that always responded in the same way to the same stimuli. Also, in accordance with the biopsychosocial model of disease, a late 20th-century alternative to the traditional ("biomedical") model of disease,(4)(5) in which medical conditions are seen as having biological, psychological and sociological aspects, there is now increasing attention on pain as not only a physiologic, but also a psychological phenomenon. This broader understanding of the complex interaction of mind and body has resulted in new approaches to pain treatment.(6)(7)(8)(9) The Advantages of Mind Body Medicine in Treating Pain
In 1996, the NIH Consensus Panel on the Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia recommended the use of mind body therapies for chronic pain.(10) Since that time, increasing evidence has supported the use of mind body therapies.(11)(12)(13)(14)(15) In addition, many mind body therapies are relatively inexpensive(16)(17)(18) When used appropriately, mind body therapies are generally safe.19 Finally, to the extent that mind body therapies emphasize self-care, they are economical and result in decreased utilization of the health care system.
Definitions
Mind Body Medicine
Mind body medicine, as defined by the National Center for Complementary and Alternative Medicine (NCCAM) "focuses on the interactions among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health."(20) Mind body medicine is one of the five major domains of complementary and alternative medicine,(21) and mind body therapies are some of the most commonly used CAM therapies among US adults.(22)
Mind Body Therapies
Mind body therapies are characterized by NCCAM as "techniques designed to enhance the mind's capacity to affect bodily function and symptoms."(23) ) Common examples include (see also Table 1):
Table 1.
Description of Common Mind Body Therapies.
Relaxation techniques
Relaxation techniques include a variety of practices intended to effect a state of relaxation or reduced sympathetic arousal. The goal of these therapies is to allow patients to perform self-relaxation at will.
Guided Imagery
Guided imagery involves the process of image generation for the purpose of improving health. There are active styles of guided imagery, where the patient mentally creates the image(s), as well as more passive styles in which the guide describes the images using a script, while the patient listens intently.
Biofeedback
Biofeedback utilizes a device to amplify normal physiological processes (e.g., muscle tension) to make them more easily perceptible. Patients then receive feedback regarding their physiologic state (e.g., tension in a given muscle group) and learn to manipulate their own physiology (e.g., decreasing muscle tension), guided by cues.
Hypnosis
Similar to passive style guided imagery, described by expert David Spiegel as "a natural state of aroused, attentive focal concentration coupled with a relative suspension of peripheral awareness."66,67 The hypnotic state includes three main components:
Cognitive Behavioral Therapy
Cognitive behavioral therapy is composed of cognitive and behavioral techniques that address the role of maladaptive cognitions and behaviors in disease. Cognitive therapy emphasizes correcting negative thinking patterns through a process called cognitive restructuring, while behavioral therapy rewards behaviors that are beneficial.(70)
Meditation
When used in clinical settings, meditation is the practice of consciously focusing one's attention on inner experience. It may also be described as the self-regulation of attention. Two main forms of meditation interventions that have been extensively studied for health conditions are transcendental meditation, in which practitioners silently repeat a word or phrase (mantra), and mindfulness meditation, which involves non-judgmental attention to internal events such as thoughts, emotions and physical sensations on a moment-to-moment basis. Like other mind body therapies, meditation often brings about a hypometabolic state, or overall slowing down of bodily systems.(71)
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