Pain, Mood, & Meditation- Pain, Mood, & Meditation- Where does Spirituality fit?Where does Spirituality fit?

Amy Wachholtz, PhD, MDivAmy Wachholtz, PhD, MDiv

UMass Medical SchoolUMass Medical School

Psychiatry Day, 2009Psychiatry Day, 2009

OutlineOutline1.1. Bio-psycho-social-spiritual model of painBio-psycho-social-spiritual model of pain

2.2. What are the mechanisms linking meditation What are the mechanisms linking meditation and pain?and pain?

3.3. Who uses Prayer/Meditation to cope with pain?Who uses Prayer/Meditation to cope with pain?

4.4. When do people use Prayer/Meditation for When do people use Prayer/Meditation for pain?pain?

5.5. What does spirituality add to meditation for What does spirituality add to meditation for pain coping?pain coping?

Question #1 What is Pain?Question #1 What is Pain?

Typical Pain CycleTypical Pain Cycle

Gate/Neuromatrix Theory of Gate/Neuromatrix Theory of PainPain

Injury Signals

Gate

ThoughtsEmotions

Behaviors

Ouch!I feel good!

Melzack & Wall, 1965

Influences on Chronic PainInfluences on Chronic Pain

Chronic Pain

Biological Factors

Psychological Factors

Social Factors

Spiritual Factors

Question #2: What are Question #2: What are the mechanisms the mechanisms linking meditation and linking meditation and pain?pain?

What role does meditation What role does meditation play?play?

• Secular meditation & painSecular meditation & pain– MBSR (Kabat-Zinn)MBSR (Kabat-Zinn)– Relaxation response (Benson)Relaxation response (Benson)

• Spiritual meditation & painSpiritual meditation & pain– TMTM– YogaYoga– Loving-KindnessLoving-Kindness– Beyond the Relaxation ResponseBeyond the Relaxation Response– Religious Tradition based meditationReligious Tradition based meditation

Meditation Pathways and Meditation Pathways and PainPain

Meditation

Positive Mood

Internalized Locus of Control

Self-Efficacy

Anxiety

Distraction from Problems

Decreased Focus on the Body

Reduced Pain FrequencyIncreased Pain Tolerance Decreased Pain Sensitivity

Altered Perceptions Changed Mood Changed Social Interactions Changed Behaviors

Physiological/Neurological Changes Altered neurotransmitter levels Altered sleep Altered HPA activity levels Altered threshold for recognizing distress signals

Psycho-Social Changes Meaning Making Attributions Self-Efficacy Distraction Social Support Instrumental Support Relaxation

Possible Unique R/S Factor Spiritual Support Spiritual Growth Spiritual Meaning Making Attributions Additional Efficacy Beliefs

Spiritual Beliefs and Practices Positive vs. Negative Public vs. Private Intrinsic vs. Extrinsic Existential vs. Religious

(Adapted from: Wachholtz, Pearce & Koenig, 2007)

Common R/S Coping ToolsCommon R/S Coping Tools

1.1. Prayer Prayer 2.2. Spiritual Meditation Spiritual Meditation 3.3. Hope Hope 4.4. Reading faith-based literatureReading faith-based literature5.5. Finding spiritual role models for copingFinding spiritual role models for coping6.6. Seeking spiritual support/connectionSeeking spiritual support/connection7.7. Church attendanceChurch attendance8.8. Seeking instrumental supportSeeking instrumental support9.9. Religious reappraisalReligious reappraisal

Question #3: Who Question #3: Who uses uses prayer/meditation to prayer/meditation to cope with pain?cope with pain?

National Health Interview Survey 2002-2007

(Wachholtz & Sambamthoori, 2009)

•Older (>33 years)

•Female

•More Educated (> High School)

•African-American (vs. white)

•Have chronic mental or physical health issues: depression, chronic headaches, back and/or neck pain

Question #4: When do Question #4: When do people use people use prayer/meditation to prayer/meditation to cope with pain?cope with pain?

Pain

• The initial spiritual pain coping response to acute The initial spiritual pain coping response to acute pain (self-directive), is the least likely spiritual pain (self-directive), is the least likely spiritual coping response to chronic pain (collaborative) coping response to chronic pain (collaborative) (Dunn & (Dunn & Horgas, 2004) Horgas, 2004)

– Terminal stage illnesses with co-morbid pain Terminal stage illnesses with co-morbid pain (Yates, et al., 1981; (Yates, et al., 1981; Ironson, et al, 2002)Ironson, et al, 2002)

– Long-term chronic pain Long-term chronic pain (Abraido-Lanza, et al., 2004; Glover-Graf, et al., 2007)(Abraido-Lanza, et al., 2004; Glover-Graf, et al., 2007)

– Uncontrollable, intermittent pain Uncontrollable, intermittent pain (Harrison, et al., 2005)(Harrison, et al., 2005)

• When other coping mechanisms fail and spiritual When other coping mechanisms fail and spiritual coping is efficacious coping is efficacious (Keefe, et al., 2001; Pargament, 2002)(Keefe, et al., 2001; Pargament, 2002)

• Religious/spiritual coping AND secular coping- not Religious/spiritual coping AND secular coping- not either/oreither/or

Question #5: What does Question #5: What does spirituality add to spirituality add to

meditation?meditation?

Intervention StudiesIntervention Studies

• Spiritual interventions affect physiological Spiritual interventions affect physiological outcomes outcomes (Carlson, Bacaseta, and Simanton, 1988; Ironson, et al., (Carlson, Bacaseta, and Simanton, 1988; Ironson, et al., 2002, Pargament et al., 2005; Wenneberg, et al., 1997 ) 2002, Pargament et al., 2005; Wenneberg, et al., 1997 )

• Increase pain tolerance in healthy, non-Increase pain tolerance in healthy, non-chronic pain individuals chronic pain individuals (Wachholtz & Pargament, (Wachholtz & Pargament, 2005)2005)

– Doubled pain tolerance to laboratory induced Doubled pain tolerance to laboratory induced acute pain taskacute pain task

– Meditation inherently spiritual?Meditation inherently spiritual?

• Improved pain tolerance among a Improved pain tolerance among a chronic pain group chronic pain group (Wachholtz & (Wachholtz & Pargament, 2008)Pargament, 2008)– 4 weeks4 weeks– Decreased pain frequencyDecreased pain frequency– Greater pain tolerance Greater pain tolerance

•Acute- laboratory induced painAcute- laboratory induced pain•Chronic- decreased rescue medication Chronic- decreased rescue medication

usageusage– Limited change in pain sensitivityLimited change in pain sensitivity– Greater decrease in negative moodGreater decrease in negative mood– Greater decrease in anxietyGreater decrease in anxiety

Intervention StudiesIntervention Studies

Buddhist Loving-KindnessBuddhist Loving-Kindness

•Cancer patientsCancer patients (Carson, et al, 2008) (Carson, et al, 2008)

•Migraineurs Pilot StudyMigraineurs Pilot Study (Wachholtz, (Wachholtz, 2009)2009)– 4 week class, 4 week follow up4 week class, 4 week follow up– Increased spiritual experiencesIncreased spiritual experiences– Elevated pain toleranceElevated pain tolerance– Fewer headaches (n.s.)Fewer headaches (n.s.)

SummarySummary• Pain a multi-dimensional disorder including Pain a multi-dimensional disorder including

physiological, psychological, social and spiritual physiological, psychological, social and spiritual componentscomponents

• Prayer and spiritual meditation used by many with Prayer and spiritual meditation used by many with chronic painchronic pain

• Multiple psychological and physiological pathways Multiple psychological and physiological pathways that support its usethat support its use

• Spiritual meditation may be a useful resource with Spiritual meditation may be a useful resource with unique additive components for patients with a unique additive components for patients with a spiritual/religious background spiritual/religious background

Thank YouThank You

Amy.Wachholtz@umassmemorial.orAmy.Wachholtz@umassmemorial.orgg