Mindfulness meditation may help combat veterans with traumatic brain injury manage their chronic pain, according to a small but promising pilot study published in the journal Military Behavioral Health.
An estimated 44 percent of U.S. combat veterans and 26 percent of Americans in general suffer from chronic pain, a condition in which pain persists for longer than 12 weeks and in some cases for a lifetime. If the pilot study's results are borne out in future research, the military will have an effective and economical tool to help treat soldiers who return from the field with lifelong pain, says Thomas Nassif, a researcher at the Washington D.C. Veterans Affairs Medical Center and professorial lecturer at American University.
What's more, this mindfulness therapy could apply to civilians with pain problems, providing another way to supplement traditional therapies like pain medication, psychological counseling and surgeries or implants.
Meditation resulted in a 20 percent decrease in pain
Nassif tested a particular mindfulness meditation program called Integrative Restoration Yoga Nidra, or iRest, which focuses on breathing exercises, guided imagery and progressive relaxation. Because of promising but preliminary research on iRest, it is already offered as an "educational class" (read: not official therapy) at VA medical centers and other active-duty military facilities nationwide.
But Nassif’s pilot is the first time it has been tested for its effect on chronic pain. Past research has shown that iRest can help decrease PTSD symptoms and emotional reactivity in vets, but these studies did not have case control groups, he noted.
The participants in Nassif’s study were all male combat veterans of wars in Afghanistan, Iraq, Kosovo and Bosnia. They had all experienced traumatic brain injury during their service and returned to the U.S. with chronic pain. In order to isolate the effects of the meditation, the researchers excluded all men who already seemed to be self-medicating on some level: those who drank a certain amount of alcohol, had used illicit drugs in the past month, relied on prescription medications known to alleviate pain or who were already regular meditators.
That left nine people, who formed two groups. Four of the men spent two months doing at least two hour-long meditations every week, and the five case controls did not participate in the meditation program until after the experiment was over.
After the two month meditation experiment was over, Nassif asked the men to re-assess their pain, where it hurt and how much it hurt. He found that the vets who had meditated reported an at least 20 percent reduction in pain intensity and pain interference, which means whether or not pain can disrupt sleep, mood and activity levels. The control group that didn't meditate did not report any pain improvement.
You can't change pain, but you can change the way you react
Like the tenets of traditional mindfulness meditation, which encourage practitioners to observe their surroundings, thoughts and feelings without judgment, the iRest meditation program encourages practitioners not to avoid their pain but to focus on it from a “nonjudgemental perspective.”
It’s thought that slowly changing a person’s perception of their pain reduces the mental and emotional burden he has to bear, which in turn could help increase their coping skills and minimize the pain’s effect on day-to-day life, explains Nassif. This success could, over time, develop into a sense of empowerment over their pain.
“Our theory is that mindfulness meditation encourages patients to not practice avoidance so much as sustain their attention on painful sensations without judgment and without bringing up any unpleasant cognitions, thoughts or emotions that might accompany these painful sensations,” said Nassif. “The sensations may still be there, but they wont be as bothersome, and we consider that self-management an important process through which mindfulness meditation can help veterans manage their pain better."
A way to complement pain control
Because the pilot study was so small, and conducted among such a homogenous group of participants, Nassif can’t make any generalizations about whether mindfulness meditation can help others living with chronic pain. But he can say that the program is a promising approach to pain control that empowers people to establish a better quality of life for themselves.
Nassif is also clear that he doesn’t see mindfulness meditation as a complete replacement for things like pain medication or therapy. Instead, he explained, it could provide veterans with one more option to help cope with their pain -- especially those who are concerned about the long-term side effects of certain pain medications, or those who find that the pain medications have stopped working for them.
"For many of them, the pain level is sometimes a nine out of 10, or 10 out of 10, every minute of every day," Nassif said, referring to a traditional pain scale. "This is just one example of a tool that may help make the pain more tolerable and may provide some healing, at least on a mental, spiritual or quality-of-life level."
More research is needed on the topic, he concluded.
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