Many mind–body techniques emphasize breathing and teach patients that it is better to have slower breathing into the belly as opposed to more rapid chest breathing. This breathing awareness can be incorporated into meditation, which she described as the process of focused attention. Individuals can meditate by focusing on the breath, but they can also meditate by drawing their attention to a word/phrase, a candle or footsteps. No matter the focal point, the goal of meditation is to gently bring the mind back to focus whenever the mind wanders.
Research has shown that meditation changes the way the brain processes information, including pain information. Specifically, one study found that patients who were trained in mindfulness meditation for four days experienced a 57% reduction in pain unpleasantness and a 40% reduction in pain intensity.1 The meditation-induced reductions in pain intensity were associated with increased activity in the anterior cingulate cortex and anterior insula, the regions of the brain involved in the cognitive regulation of pain processing. Thus, although people who meditate continue to feel pain, they are able to live their lives with less disruption from the pain than people who do not meditate.
Guided imagery can also be an effective tool for pain management. It has been shown to decrease postoperative pain, improve fibromyalgia and possibly improve musculoskeletal pain. Dr. Chiaramonte suggested that healthcare providers visit www.healthjourneys.com for a catalogue of effective guided imagery programs.
Moving meditation, such as low-intensity yoga or tai chi, may also help with pain management. Some yoga classes can be very difficult, and hot yoga classes, in particular, should be avoided. However, the right yoga class can improve physical functioning and psychological health in sedentary adults with osteoarthritis and/or rheumatoid arthritis. Specifically, it can improve walking capacity, decrease pain and improve health-related quality of life. Iyengar yoga is one example of a calmer, more restorative form of yoga, and women with rheumatoid arthritis who performed Iyengar yoga had improved health-related quality of life, decreased pain disability, improved mood, decreased fatigue and improved self-efficacy.1
Conclusion
Integrative pain medicine brings many benefits to the patient, including decreased systemic inflammation and improved management of sleep and stress. Dr. Chiaramonte described in detail valuable mind–body techniques, such as guided imagery, MBSR and meditation, and she also reminded the audience that chiropractic care, massage and acupuncture can also be useful tools for pain management. Finally, she suggested that physicians consider recommending that patients try biologically active supplements, such as fish oil, probiotics and vitamin D.
