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Back and Neck Pain

Living More Fully with Chronic Pain Free of Drugs: Cultivating Resilience, Part I

Author| Barry Kerzin, MD

From the Dalai Lama's personal physician

The Complexity of Chronic Pain

We all know the experience of pain, but few of us know what it really is.  Thus our approach to treatment is often one-dimensional -- drugs. Yet pain has many dimensions. There is the sensation of pain, the emotional component, and the cognitive (or thinking) component.

Jon Kabat-Zinn, PhD, developed a meditation treatment program for folks with chronic pain at the University of Massachusetts where he ran the program for decades. His clients had sought relief everywhere without success. He offered a novel approach not using pain medications. Rather he offered meditation. The words ‘medication’ and ‘meditation’ sound similar but in fact, they are quite opposite. The pain medication approach is passive and involves no personal responsibility for inner work and growth. Meditation, on the other hand, trains the mind and heart to be more calm and balanced. It requires self-discipline and personal responsibility. So the former is far away from healing whereas the latter is precisely healing -- healing from the inside.

Kabat-Zinn, recognized as the father of Mindfulness Based Stress Reduction, or as it is popularly known, MBSR, has this to say about the complexity of the experience of pain:

“Physical pain is the response of the body and the nervous system to a huge range of stimuli that are perceived as noxious, damaging, or dangerous.

There are really three dimensions to pain: the physical or sensory component; the emotional, or affective component, how we feel about the sensation; and the cognitive component, the meaning we attribute to our pain” [1].

As we can see “pain” is complex and involves many levels of our life. There are the nerves and brain, the so-called “hard wiring.” Actually, neuroscientists are discovering tremendous plasticity in the brain and nervous system. So the brain’s “hard wiring” is now understood to be malleable and changes throughout our lives in response to experience, environment, and many factors. Thus this plasticity is seen even in the elderly. This is the sensory component or the experienced sensation of pain. The emotional response often involves a variety of fears, anxiety, associated feelings, and deep-seated gut reactions to pain based on our past experience and the experience of others. Lastly, there is the cognitive aspect, our personal library of thoughts and associations we have stored throughout our life regarding the experience of pain. This multidimensional understanding of pain is discussed in Jon Kabat-Zinn’s 1982 paper that referred to Melzack’s chapter in The Skin Senses, from 1968 [see ref. 1] is now being experimentally proven. In November 2015 Zeidan wrote in the Journal of Neuroscience, “This study is the first to demonstrate that mindfulness-related pain relief is mechanistically distinct from placebo analgesia. The elucidation of this distinction confirms the existence of multiple, cognitively driven, supraspinal mechanisms for pain modulation” [2].

This complex multidimensional system we call “pain” requires multidimensional approaches to successfully manage chronic pain. This point cannot be stressed enough. Prescribing an opiate drug, which does not even work for chronic pain, is narrow-minded and outright wrong. Meanwhile the epidemic proportions of opiate abuse are huge. The consequences are possibly bigger than the AID’s epidemic in the 1980’s and 90’s [3]. The Centers for Disease Control and Prevention (CDC) has called this “the worst drug overdose epidemic in history.” Overdose deaths from prescription opioids have quadrupled since 1999, killing more than half a million people, nearly 100 every single day [4]. We must meet this challenge with a new variety of healing methods. The expedient method of over-prescribing opiates got us into this tragedy. The irony is that opiates do not work for chronic pain as they do for acute pain. Thus people continually up their dose, sometimes ending in overdose and death.

  1. Kabat-Zinn, J (1982) An Outpatient Program in Behavioral Medicine for Chronic Pain Patients Based on the Practice of Mindfulness Meditation. General Hospital Psychiatry 1982 Apr; 4(1): 33-47                   note: Kabat-Zinn takes this 3-dimensional view of pain from Melzack’s chapter in Kenshalo’s book, The Skin Senses (1969).
  2. Zeidan, F. (2015) Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia. The Journal of Neuroscience, November 18, 2015  • 35(46):15307–15325 • 15307
  3. https://www.vox.com/science-and health/2017/3/23/14987892/opioid-heroin-epidemic-charts

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Continue to Part II