Complementary Medical Therapies for Pain Management
Mindfulness Meditation for Pediatric Pain Management
By Sierra Perez, BS, and Yuan-Chi Lin, MD, MPH
Medical Acupuncture Service
Department of Anesthesiology, Critical Care and Pain Medicine
Boston Children’s Hospital
Department of Anaesthesia
Harvard Medical School
Complementary medicine is defined as a collection of varied medical and healthcare systems, practices, and products that are not routinely considered part of conventional medicine. More than thirty percent of American adults and about twelve percent of children use health care approaches that are not typically part of conventional medical care or that may have origins outside of usual Western practice. While some scientific evidence exists regarding some of these therapies, for most there are still key questions that have yet to be answered through modern scientific studies.
The pediatric population's utilization of CAM is growing rapidly. Meditation has played an important role in the management of chronic pain.1 Pediatric healthcare providers should seek interventions for pain management that will be less impactful for patients on treatment cost, time commitment, and unintentional side effects, while still being an effective and accessible tool for decreasing the disabling characteristics of chronic pain. Provider and patient interest is increasing for Mindfulness Mediation (MM) or Meditation-Based Stress Reduction (MBSR) as a method to decrease pain severity and improve pain coping skills.
While the origin of meditation stems from the traditional practices of Zen Buddhism, Vipassana, and Yoga, meditation in a clinical setting facilitates similar processes without the connection to religion or culture.2 The process of Mindfulness Mediation models the established definition of Focused Attention (FA), or concentrating on a set object, and Open Monitoring (OM), or observation of an experience without reaction.3 MBSR commonly involves an experienced meditation expert to guide patients through training sessions of body scanning, yoga, and different forms of meditation; including mediation while sitting with focused breathing or walking meditation. Mediation focuses attention to ones thoughts, emotions, and present sensations without forcing change to them.4 Other comparable complementary therapies considered by providers include biofeedback, relaxation training, hypnosis, and cognitive-behavioral therapies (CBT).2 A brief review of research in MBSR or MM for the treatment of chronic pain addresses topics related to clinical treatment benefits,2,5 the comparison of MBSR to CBT,4 the feasibility of providing meditation intervention for patients requiring opioid intervention,6 and the brain mechanisms that support the modulation of pain through mediation.5,7
Clinical Benefits of Meditation
When patients were enrolled into a Stress Reduction and Relaxation program with MM for the treatment of chronic pain, patients experienced significant reductions in present-moment pain. After multiple sessions of meditation training, patients experienced long-term improvement to negative body image, reduced inhibition of activity due to pain, and an overall improvement to symptoms, mood, anxiety, and depression.2 Brief MM training had increased patient pain threshold in response to tonic heat sensation.5
Comparing Meditation as a Pain Management Therapy
When providers consider meditation as a pain management strategy, a primary question has been how meditation will be effective when compared or combined with other therapies. One study directly compared the effects of MBSR and CBT for the treatment of chronic back pain for young and middle-aged adults through their usual care. The study concluded the effects MBSR and CBT both separately improved chronic back pain without a significant difference between the two treatment options.4 Research clinicians also wanted to know how meditation can be helpful for patients that require opioids for their pain management. Patients that suffered from chronic lower back pain, to the extent of needing > 30 mg of morphine-equivalent dose (MED) daily for more than three months, expressed a concurrent MM training course to be useful for pain management and for improvement of pain coping skills. This study also suggested that Mindfulness Meditation may be an intervention option for patients with less severe or disabling chronic pain to prevent the introduction or dosage increase of opioids.6
Mechanisms of Pain Modulation by Meditation
Research clinicians have been interested in why Mindfulness Meditation provides pain relief and what mechanisms are involved to produce pain modulation. When Reiner et al. (2016) concluded that MM could increase pain threshold for the pain sensation of tonic heat, their team also concluded the mechanism for pain modulation could be through the restoration of adaptive responses to chronic pain.5 Zeidan et al. studied the brains response to meditation to determine the mechanisms behind pain modulation. This study found OFC activation during MM was directly associated with decreased pain ratings. OFC activation has been supported to be involved in the manipulation of contextual evaluation of sensory events through affective responses.7,8 This study supports the pain-relieving, therapeutic mechanisms experienced through MM are related to the common modulatory pathway used by cognitive manipulation, and is most beneficial when cognitive control is enhanced from meditation and stress reduction training.7
Recommendations for Meditation for Pediatric Pain Management
A systematic review of eight mindfulness based intervention appears to be a promising approach to coping with symptoms related to chronic illness in adolescents.9 A significant portion of meditation for pain management research is directly concerning the adult population. MBSR or MM could potentially provide increased benefits to the pediatric population, such as improved negative body image and mood disorders commonly associated with specific developmental stages. More research regarding meditation for the management of chronic pain in pediatric patients is needed and encouraged.
- Lin YC, Lee AC, Kemper KJ, Berde CB. Use of complementary and alternative medicine in pediatric pain management service: a survey. Pain Med 2005;6:452-8.
- Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 1985;8:163-90.
- Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention regulation and monitoring in meditation. Trends Cogn Sci 2008;12:163-9.
- Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA 2016;315:1240-9.
- Reiner K, Granot M, Soffer E, Lipsitz JD. A Brief Mindfulness Meditation Training Increases Pain Threshold and Accelerates Modulation of Response to Tonic Pain in an Experimental Study. Pain Med 2016;17:628-35.
- Zgierska AE, Burzinski CA, Cox J, et al. Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy. J Altern Complement Med 2016;22:610-20.
- Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci 2011;31:5540-8.
- Rolls ET, Grabenhorst F. The orbitofrontal cortex and beyond: from affect to decision-making. Prog Neurobiol 2008;86:216-44.
- Ahola Kohut S, Stinson J, Davies-Chalmers C, Ruskin D, van Wyk M. Mindfulness-Based Interventions in Clinical Samples of Adolescents with Chronic Illness: A Systematic Review. J Altern Complement Med 2017;23:581-9.