The Art and Science of Fitness | Demystifying mindfulness meditation
A recent scientific study showed the importance of mindfulness meditation and its role in managing pain. Here is why these findings are interesting and important:
Meditation has been an integral part of Indian culture for millennia. Religious texts from Hinduism, Buddhism, Sikhism and other religions have numerous stories on how the mind can control bodily aches and pains. Often, science appears to play catch-up with religion and art.
This is why a recent study published in the science journal, Pain, titled Disentangling self from pain, caught my attention. This study also appealed to me because of my long background in running, first competitively, and then my work in mentoring others to pick up running for life. When you run or play any sport at a competitive level, pain often becomes your ally. And some can take on more pain than others. Now, while pain is a complex subject, I’ll keep it simple by focusing primarily on this new study and its key takeaways.
The lead author of the study, Gabriel Riegner, a graduate student at the department of anesthesiology, University of California, San Diego, under the guidance of Fadel Zeidan, an associate professor of anesthesiology there and director of Brain Mechanisms of Pain Health and Mindfulness Laboratory, along with his colleagues studied the interplay between different areas of the brain that are engaged in pain sensation. They shortlisted 40 pain-free people aged 18-65 from the local community, who were new to the idea of meditation.
They were all made aware of how to report the intensity of pain. For this, they used a visual analogue score (VAS) in which ‘0’ refers to ‘no pain sensation’, and ‘10’ to ‘most unpleasant sensation imaginable’. A thermal probe with a temperature ranging from 35-49°C was applied to their forearms. They were asked to report — on VAS — how much pain they feel after a thermal probe was applied to the right calf. This is an important exercise because we all feel pain differently. Once we have this baseline for each individual, we can assess the changes meditation could make.
The participants were divided into two groups: The first was the experiment group, which would do mindfulness meditation, and the second was the control group which would listen to an audiobook titled The Natural History and Antiquities of Selborne, which is known not to improve one's mood. Both groups underwent 4 sessions on different days for 20 minutes.
The mindfulness meditation group was taught by experienced mindfulness instructors how to go about it. They were told to focus on the changing sensation of their breath and to reduce self-referential judgments by acknowledging arising thoughts, feelings, and emotions without judgment or emotional reactions. Participants were encouraged to “simply return their attention to the breath sensations.” The control group listened to the audiobook for the four sessions. To familiarise them with the environment they soon would be in, during the last 10 minutes of the 3rd session, both groups were exposed to audio recordings of an MRI scanner and during the 4th session, both groups were made to lie down flat whether while doing meditation or listening to the audiobook. The meditation group wasn’t given any meditation instructions.
For the experimental session, both groups had their brain activity measured. Participants from both groups were positioned in the MRI scanner with a respiratory transducer around their chest and a pulse oximeter on their left index finger. These would help monitor their breathing and heart rate respectively. Then participants positioned their right calf over the thermal probe. They underwent exposure to painful thermal stimulation, one where they alternated 49°C for 10 seconds and 35°C for 14 seconds for 5 minutes, and the other was continuous exposure to 35°C stimulation. The meditation group was instructed to meditate through the experiment whereas the control group just lay there with their eyes closed. Participants were asked to rate their pains after exposure to each of the heat series.
Now is when the fun begins.
Participants in mindfulness meditation groups reported having experienced a 32% reduction in pain intensity and a 33% reduction in pain unpleasantness. What this study revealed was the change seen in the brain activity of those participants who were trained in mindfulness meditation and then were exposed to a painfully high temperature of 49°C. There was reduced communication between the thalamus, the part of the brain that relays the incoming painful information to the rest of the brain, and parts of the brain that are most active while a person’s mind is wandering all over the place. This reminds me of my psychologist friends who would tell me to stop the chitter-chatter in my mind and to calm it down. Or as the title of this study goes, “disentangling self from pain”.
Zeidan made an interesting point. “We were really excited to confirm that you don’t have to be an expert meditator to experience these analgesic effects. This is a really important finding for the millions of people looking for a fast-acting and non-pharmacological treatment for pain.” He goes on to add, “For many people struggling with chronic pain, what often affects their quality of life most is not the pain itself, but the mental suffering and frustration that comes along with it. Their pain becomes a part of who they are as individuals — something they can’t escape — and this exacerbates their suffering.”
More than two decades ago, my mentor in musculoskeletal medicine, Dr Roderic Macdonald, the then principal at London College of Osteopathic Medicine and also president of the British Institute of Musculo-Skeletal Medicine, used to repeatedly remind me: “Pain is only a messenger. You appreciate it and respect it. But then you need to move on.” This was something I had unknowingly been practising since I was nine years old, when I picked up running.
When I first came across this study, I immediately discussed it with Dr Anurag Mishra, a psychiatrist, psychoanalyst and founder of the Livonics Institute of Integrated Learning and Research, because he happens to be my go-to person for anything related to the mind. He had something interesting to say. “We should avoid glorifying mindfulness. No one knows what it is. It’s almost like mindlessness. We need to quieten the mind down. We all need a safe place to go to when we have physical or psychological pain. While sitting for my MBBS examinations, I would be very anxious. What would work for me was to take a nap for 5-15 minutes, while thinking about cricket, before getting back to my studies with a calm mind. I try to do the same with my excruciating knee pain, which you have very kindly been helping me with. If one doesn’t have pleasant experiences to fall back upon, they need to create a process or go to a place that does that for them. Breathing happens to be an easy one. Breathe in slowly over 5 seconds and then slowly breathe out over 5 seconds. Repeat it for a minute, to begin with and then try to do it for 5 minutes in the morning and 5 minutes in the evening.”
Even though there might be some differences, Zeidan made similar observations to Macdonald and Mishra. “One of the central tenets of mindfulness is the principle that you are not your experiences.” Definitely not your unpleasant experiences. Further, even the slightest exposure to painful stimuli leads to excruciating pain. Zeidan further observes, “You train yourself to experience thoughts and sensations without attaching your ego or sense of self to them, and we’re now finally seeing how this plays out in the brain during the experience of acute pain.” Also, Zeidan like Mishra, focused on breathing. Something that Macdonald ingrained in me a couple of decades ago to remind all the patients I see.
Another thing that works is smiling, or even laughing. When you laugh or smile, it might first be fake, but when others look at you and smile back or burst out laughing, your emotions will soon match your facial expressions. This will reduce the tension in your muscles and also make a similar disassociation that Dr Zeidan and team found with mindfulness meditation.
Mishra adds his pearls of wisdom, “Essentially, Pain (like other emotions) is a bootstrap problem. You need a place to stand on, from which you can strap your boot. Breathing, smiling, etc give you that place. The important thing is to keep it simple.”
The fundamental takeaway is that the fear of pain is often worse than the pain itself. Once we let go of that notion, it’s game on.
Keep miling and smiling.
Dr Rajat Chauhan is the author of The Pain Handbook: A non-surgical way to managing back, neck and knee pain; MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days
He writes a weekly column, exclusively for HT Premium readers, that breaks down the science of movement and exercise.
The views expressed are personal
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