Pain, Mood, & MeditationWhere does Spirituality fit?

Amy Wachholtz, PhD, MDiv UMass Medical School Psychiatry Day, 2009

Outline
1. Bio-psycho-social-spiritual model of pain 2. What are the mechanisms linking meditation
and pain?

3. Who uses Prayer/Meditation to cope with pain? 4. When do people use Prayer/Meditation for pain? 5. What does spirituality add to meditation for pain
coping?

Question #1 What is Pain?

Typical Pain Cycle

Gate/Neuromatrix Theory of Pain

Thoughts Emotions Behaviors

Gate

I feel good! Ouch!

Injury Signals
Melzack & Wall, 1965

Influences on Chronic Pain

Biological Factors Chronic Pain Spiritual Factors

Psychological Factors

Social Factors

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

What role does meditation play?

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

Spiritual meditation & pain

TM Yoga Loving-Kindness Beyond the Relaxation Response Religious Tradition based meditation

Meditation Pathways and Pain

Positive Mood

Internalized Locus of Control

Self-Efficacy Meditation Anxiety Distraction from Problems Decreased Focus on the Body

Reduced Pain Frequency Increased Pain Tolerance Decreased Pain Sensitivity

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

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

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

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

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

Altered Perceptions Changed Mood Changed Social Interactions Changed Behaviors

Common R/S Coping Tools

1. 2. 3. 4. 5. 6. 7. 8. 9.
Prayer Spiritual Meditation Hope Reading faith-based literature Finding spiritual role models for coping Seeking spiritual support/connection Church attendance Seeking instrumental support Religious reappraisal

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

Pain

 The initial spiritual pain coping response to acute pain

(self-directive), is the least likely spiritual coping response to chronic pain (collaborative) (Dunn & Horgas, 2004)
Terminal stage illnesses with co-morbid pain
Ironson, et al, 2002) (Yates, et al., 1981;

Long-term chronic pain

(Abraido-Lanza, et al., 2004; Glover-Graf, et al., 2007)

Uncontrollable, intermittent pain

(Harrison, et al., 2005)

When other coping mechanisms fail and spiritual

coping is efficacious
either/or
(Keefe, et al., 2001; Pargament, 2002)

Religious/spiritual coping AND secular coping- not

Question #5: What does spirituality add to meditation?

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

Increase pain tolerance in healthy, non-chronic

pain individuals
(Wachholtz & Pargament, 2005)

Doubled pain tolerance to laboratory induced acute pain task Meditation inherently spiritual?

Intervention Studies Improved pain tolerance among a chronic

pain group
(Wachholtz & Pargament, 2008)

4 weeks Decreased pain frequency Greater pain tolerance Acute- laboratory induced pain Chronic- decreased rescue medication usage Limited change in pain sensitivity Greater decrease in negative mood Greater decrease in anxiety

Buddhist Loving-Kindness
Cancer patients
(Carson, et al, 2008)
(Wachholtz, 2009)

Migraineurs Pilot Study

4 week class, 4 week follow up Increased spiritual experiences Elevated pain tolerance Fewer headaches (n.s.)

Summary
Pain a multi-dimensional disorder including physiological,
psychological, social and spiritual components

Prayer and spiritual meditation used by many with chronic

pain

Multiple psychological and physiological pathways that

support its use

Spiritual meditation may be a useful resource with unique

additive components for patients with a spiritual/religious background

Thank You
Amy.Wachholtz@umassmemorial.org