Mindfulness meditation: A promising tool to help reduce chronic pain and opioid use


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This month, Optum is a proud partner and supporter of the VA’s Brain Trust: Pathways to InnoVAtion event in Boston, where new solutions to improve brain health for Veterans will be Priority #1. Like other VA partners, Optum is deeply committed to this effort, its innovation, and most important, the resulting actions. We look forward to this unique opportunity and other ways to help ensure exceptional health and quality of life for our Veterans and their families.

Almost daily there seems to be a story in the media about our country’s opioid crisis and the lives tragically lost to the epidemic. From celebrities and promising athletes, to the neighbor down the street who silently struggled with chronic pain for years, more and more are dying from addiction.

The facts are daunting: the United States now consumes almost 100 percent of the world’s total hydrocodone and 81 percent of oxycodone prescriptions1 and 44 Americans die each day from a prescription opioid overdose.2 Since 1999, sales of prescription opioids have nearly quadrupled and so have the total number of drug overdose deaths involving opioids.3

The figures are even more staggering for our nation’s Veterans. While 30 percent of the adult population experiences chronic pain, almost 60 percent of returning Veterans from the Middle East and more than 50 percent of older Veterans in the VA health system report living with some form of chronic pain,4 and many of them turn to opioids for relief. The number of Veterans with opioid-use disorders spiked 55 percent between 2010 and 2015,5 and according to a 2011 study of the VA system, Veterans are almost also twice as likely as non-Veterans to die from accidental opioid overdose.6

There are numerous and well-cited reasons for our national opioid crisis; it is the result of many complex factors and requires a multifaceted approach to treat. For example, often mentioned is that opioids have become alarmingly easy to obtain compared to previous decades when these powerful painkillers were reserved for cancer treatment and end-of-life care.

For our Veterans, addressing and treating chronic pain and opioid-use disorders may be even more complex. Although their stories may not make front-page news, for many of our nation’s Veterans, living with debilitating and chronic pain is a daily reality. In a 2015 testimony to the U.S. Senate Committee on Veterans Affairs, Dr. Carolyn Clancy, then interim under-secretary for health with the Veterans Health Administration, said, “Many of our Veterans have survived severe battlefield injuries, some repeated, resulting in life-long moderate to severe pain related to damage to their musculoskeletal system, and permanent nerve damage, which cannot only impact their physical abilities but also impact their emotional health and brain structures.”4

Adding to the complexity of treating pain in our Veterans, are increasing numbers of Veterans struggling with behavioral and mental health issues related to PTSD and traumatic brain injuries.7

There is no easy answer to curbing the tide of this deadly and tragic epidemic, in the general population or among our Veterans, but there is hope in some integrative and promising evidence-based approaches, including mindfulness meditation.

Mindfulness meditation and pain reduction

In the 1970s, Jon Kabat-Zinn, Ph.D., now professor of Medicine Emeritus at the University of Massachusetts Medical School, was growing increasingly concerned about patients with chronic or severe pain who had access to few, if any, alternatives to nondrug therapies. He designed an innovative intervention called Mindfulness-Based Stress Reduction (MBSR) – a meditative approach that fostered mind-body awareness – initially as a complementary treatment for chronic pain.8

Kabat-Zinn’s early research on chronic pain demonstrated statistically significant reductions in pain and pain-related drug utilization, and increased feelings of self-esteem among patients who participated in MBSR programs.9 Although rooted in ancient Eastern contemplative traditions, mindfulness meditation was adapted by Kabat-Zinn as a secular practice that encourages nonjudgmental awareness of the present moment, fostering wellbeing and increased self-regulation.

Today, MBSR and other mindfulness-based programs are commonplace in hospitals, workplaces and community settings throughout the United States. The growth and interest in mindfulness is due in large part to an impressive body of evidence that suggests mindfulness meditation practices can mitigate a number of physical and mental health issues, ranging from dealing with cancer and depression, to sleep problems and chronic pain.10,11

VA has conducted a number of its own studies in recent years to determine the effectiveness of mindfulness meditation as a tool to assist Veterans suffering from symptoms, including PTSD and chronic pain.12,13 A 2016 study published in Military Behavioral Health suggests mindfulness meditation can help Veterans control their pain. The research, led by Thomas Nassif, Ph.D., of the Washington, DC, VA Medical Center and American University’s Department of Health Studies, found that Veterans who practiced meditation reported a 23 – 42 percent reduction in pain intensity, as well as lowering pain interference with sleep, mood and activity level.13

“Meditation allows a person to accept pain and to respond to pain with less stress and reduced emotional reactivity,” Nassif said. “Our theory is that this process increases coping skills, which in turn can help Veterans to self-manage their chronic pain.”14

He also reported that in many cases, primary care physicians, who are expected to help individuals overcome their chronic pain, often prescribe opioids as part of the treatment. While Veterans in this study, and many who attend meditation sessions, find that opioid medication is a short-term solution, others believe that meditation could be a useful, adjunctive tool to help Veterans manage their pain over the long term.14

The current state of chronic pain and opioid use in the United States may indeed be daunting and require a multifaceted approach; yet, there is promise for our Veterans and the more than 100 million Americans1 who suffer from chronic pain in the age-old and now richly evidence-based practice of mindfulness meditation.


Image of Dawn BazarkoDawn Bazarko is the founder and leader of Moment Health, an innovative new UnitedHealth Group business focused on bringing mindfulness solutions to the work place, to health care workers and into health care delivery to improve the care experience. Over the past nine years, she has been a driving force behind cultivating mindfulness practices in the workplace, offering mindfulness meditation and mindfulness-based stress reduction programs to employees and leaders of major organizations via in-person, telephonic and drop-in formats. She is increasingly seen as an expert in the science of the mindfulness and methods for bringing mindfulness practices into health care and business environments and best practices in mindfulness measurement and evaluation.

 

 

References

  1. Volkow, N. America’s addiction to opioids: Heroin and prescription drug abuse. National Institute on Drug Abuse. http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. Published May 14, 2014. Accessed May 8, 2017.
  2. U.S. Department of Health & Human Services The U.S. Opioid Epidemic. https://www.hhs.gov/opioids/about-the-epidemic/ Published April 26, 2017. Accessed May 8, 2017.
  3. Centers for Disease Control and Prevention. Prescription Opioid Overdose Data . https://www.cdc.gov/drugoverdose/data/overdose.html. Published December 16, 2016. Accessed May 8, 2017.
  4. Clancy, C. Statement of Carolyn Clancy, MD, before the U.S Senate Committee on Veterans Affairs. U.S Senate. http://www.veterans.senate.gov/imo/media/doc/VA%20Clancy%20Testimony%203.26.20151.pdf. Published March 26, 2015. Accessed May 8, 2017.
  5. Childress, S. Veterans face greater risks amid opioid crisis. Frontline. http://www.pbs.org/wgbh/frontline/article/veterans-face-greater-risks-amid-opioid-crisis/. Published March 28, 2016. Accessed May 8, 2017.
  6. Bohnert, AS, Ilgen, MA, Galea, S, McCarthy JF, Blow, FC. Accidental poisoning mortality among patients in the Department of Veterans Affairs Health System. Med Care. 2011; 49(4): 393-396.
  7. Seal KH, Bertenthal D, Barnes DE, Byers AL, Strigo I, Yaffe K. Association of traumatic brain injury with chronic pain in Iraq and Afghanistan Veterans: impact of comorbid mental health conditions. Arch Phys Med Rehabil. 2017; In Press.
  8. Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY. Bantam Dell; 1990.
  9. 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(2): 163-190.
  10. Chiesa A, Serretti A. Mindfulness-based interventions for chronic pain: A systematic review of the evidence. ‎J Altern Complement Med. 2011; 17(1): 83-93.
  11. Kvillemo, P, Bränström, R. Experiences of a mindfulness-based stress-reduction intervention among patients with cancer. Cancer Nurs. 2011; 34(1): 24-31.
  12. Polusny, MA, Erbes, CR, Thuras, P, Moran, A, Lamberty, GJ, Collins, RC, Rodman, JL. Lim, KO. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA. 2015; 314(5): 456-465.
  13. Nassif, TH, Chapman JC, J., Sandbrink, F, Norris, DO, L. Soltes, KL, Reinhard, MJ, & Blackman, M. Mindfulness meditation and chronic pain management in Iraq and Afghanistan veterans with traumatic brain injury: A pilot study. Mil Behav Health. 2015; 4(1), 82-89.
  14. US Department of Veterans Affairs. Meditation and Pain Management. https://www.washingtondc.va.gov/features/A_recent_study_led_by_DCVAMC_Neuroscientist_Dr_T.asp. Published February 22, 2016. Accessed May 8, 2017.

Author

VAntagePoint Contributor

— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. Helen Saltman    

    My husband, a disabled veteran died in 1999. But during the time while he was suffering from myelo fibrosis, he was able to use meditation to control both pain and his need for opiates. Meditation prolonged his life by at least three years and he was able to be with his family.

  2. Vincent Hendren    

    Pain can be controlling if you think about it all the time.
    I avoid thinking about pain just by thinking of the most wonderful images I remember from a very long time ago.
    One such image was in the jungle in Vietnam, the canopy was about a hundred feet high, with an occasional
    beam of sun light beaming through the canopy, with flocks of birds of the same color, like yellow , or blue, flying below
    the canopy.
    I take no pain medication, and try to live a normal life, what ever that is today.
    Vincent

  3. Amy Gable    

    Good article. Wanted to add that the VA has contracted with Take Courage Coaching (TCC) to help veterans with chronic pain. Mindfulness is a big part of the program. I am grateful that I became part of this program. I had tried many different ways in the past, including opioids, to deal with my pain with no real relief. Working with TCC has taught me that while there is no physical cure for my pain, I can deal with the pain in ways that allows me to enjoy a better quality of life. TCC is weekly one on one coaching and group therapy. I have learned something new almost every week and know that I can use mindfulness and other tools to help my situation physically, emotionally and spiritually.

  4. Steven L Vinet    

    I do believe this must be b******* I’ve been on pain medications due to a combat injury since 1991 and I’ve been on pain medications ever since the pain medicine does not take my pain away it only makes it where I can handle it a little easier on a daily basis I’ve tried meditation only by self-taught never had classes and VA never offered it to me. I’ve had 7 back surgery Snice my first injury and nothing seems to help it has only gotten worse and more harder to tolerate there has been many times I’ve wanted to just bite a bullet. I hope the VA gets off for their ass and helps us to better control this because if they don’t more more of us or finding it harder to control. I find smoking marijuana over taking pain medication helps by for. Why won’t VA legalize marijuana over pain medications anyway we don’t want it for the high the high to be taken out of it we just wanted for the pain relief.

  5. Nathan M Thompson Jr.    

    This is the first I have heard of this, but first Steven I feel you brother, and please remember to stay strong, don’t ever ” bite the bullet” I am in and have been in chronic pain for over fifteen long years, and on pain meds 9 of those, and like you they just cut the edge a little. But I for one would love to be pain free and drug free, agree fully that a natural medicine. “Marijuana” should be part of our treatment. It’s a whole hell of a lot safer than pain meds, I will be checking to see if the Atlanta VA has this program. God bless all of us out there, I. Feel truly blessed to be a part of this great group of people.

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