Chronic pain is prevalent in the United States, often times leading to opioid addiction. In recent years, there has been a crisis brewing in our nation that has increased awareness of the over prescription of pain medication. A report published in 2014 in The Journal of Pain estimates that 39 million people in the U.S. have persistent or chronic pain. Pain management is described in international law as a basic human right. Healthcare providers all over the world have an ethical obligation to provide pain relief to sufferers. However, because pain is a subjective experience, it makes it very difficult to define, characterize and manage. In addition, anxiety, depression, posttraumatic stress, and abuse are strongly associated with both the development and progression of chronic pain disorders.
The 2010 Global Burden of Disease study reported that low back pain is now the number one cause of years lost to disability worldwide. Veterans that are seeking compensation for a low back disability are limited, most of the time, to a maximum of 40% rating based on the limitation of motion of their spine. A higher rating is granted only if the thoracolumbar or the entire spine is ankylosed, which occurs when the bones fuse and the joints become stiff, basically, there is no range of motion.
Low back pain has a great impact on an individual’s ability to work and manage the daily activities of life. The challenge our nation faces is finding effective treatments outside the opioids realm, which are often time are short-lived, and cause many negative side-effects, and are a path to addiction. Because we can no longer ignore the need for better pain management, in February of 2016 President Obama proposed $1.1 Billion in new funding to address the prescription opioid abuse and heroin use epidemic. Data from the Centers for Disease Control and Prevention shows that prescription pain medications and heroin caused the death of 28,648 Americans in 2014.
To tackle chronic pain and prevent over prescription of opioids, another form of intervention is necessary. For the past two decades, mindfulness stress reduction and cognitive behavioral therapy have been gaining steam as conjunct treatment for chronic pain disorders. It has become widely accepted by the medical community that chronic pain management demands shifting away from the standard model of finding a cure to a biopsychosocial model in which healthcare providers include patient-centered care that emphasizes patient commitment in daily self-management of chronic pain using a range of tools.
A recent study published in the Journal of the American Medical Association, shows that conjunct therapy, such as mindfulness based stress reduction and cognitive behavioral therapy, “resulted in greater improvement in back pain and functional limitations” when compared to usual pharmacological care. In 2014, I posted a blog on the benefits of yoga in the management of posttraumatic stress disorder. Mindfulness meditation and yoga are close cousins and both can assist in the management of chronic pain. Interestingly, our culture prompts us to get rid of the pain, ignore it, and often times you hear the phrase, “try not to think about it”, with hopes that it will magically disappear. Not so in mindfulness stress reduction. In this form of therapy one is introduced to techniques that make the individual more aware of the pain.
Some misconceptions of any type of meditation, but specifically, mindfulness meditation are that you will be made to contemplate your navel, or shave your head and wear a turban, and give away your belongings and move into a monastery – all false. Mindfulness stress reduction prepares your mind to meet the pain head on. It allows you to become more aware of how you feel emotionally and physically and to accept those feelings rather than to react to them. The purpose is for one to be an observer of the sensations, not a participant, in this case, back pain, in a non-judgmental manner.
A critical element of self-management includes home practice and the daily implementation of skills learned. There are a number of health education resources available to Veterans at no cost. Mindfulness based stress reduction (MBSR) programs are still in their infancy stage at the VA, with ongoing studies to determine the efficacy and use for veterans. If you are ready to take an active role in your healing process talk to your VA healthcare provider about the MBSR program. You can also research programs available in your area through MyHealtheVet or contact your Patient Education Center at any VA Medical Center.