Anyone that has experienced chronic musculoskeletal pain can attest to the negative impact it can have on one’s life. Chronic pain is also a significant burden on the US economy. In 2016 alone, the United States Bone and Joint Initiative estimated that the cost for treatment and lost wages was $213 billion due to musculoskeletal disorders alone.
Traditionally musculoskeletal disorders have been treated with a biomedical approach, focusing on damage to tissue and presupposing that this is the key driver of an individual’s pain. This outdated concept has driven excessive utilization of medications, diagnostic imaging, injections, and wasteful surgeries. Over the last 20 years, we have begun to have a better understanding of what drives pain and have developed safer and more effective ways to assist in the management of chronic pain.
Clinicians have begun to understand pain as a much more multidimensional concept than we have in the past. Several aspects contribute to pain including our environment, cognition, culture along with our individual biochemical and neurophysiological makeup. There are also numerous other factors that can negatively impact an individual’s response to pain, including a low level of education, poor family support, dissatisfaction with employment, and alcohol abuse among many other contributors. Armed with this knowledge, expert clinicians have begun to treat patients with more of a biopsychosocial versus biomedical approach.
The biopsychosocial approach emphasizes appropriate communication and messaging to patients, most importantly avoiding unnecessary and unhelpful fear-inducing messages that feed into patient’s perception of pain and tissue damage. Under this premise exercise, manual therapy, pain neuroscience education, and stress reduction techniques are elements of care that are emphasized in order to help patients manage their pain.
How can education and reducing stress positively influence a patient’s perception of pain? There is a significant overlap in our brains in regards to how pain and negative emotional experiences are processed. An experience that may cause little or no pain could be perceived by our brains as much more painful if it occurs when we are in a stressful state of mind. Patients are more likely to experience a negative pain experience or develop chronic pain the more negative psychosocial factors they have occurring. Activities like meditation can assist in reducing these contributing factors and overall reduce painful experiences. In addition to reducing pain, studies have shown that meditation improves mood, our overall sense of well-being and can assist with the symptoms of anxiety and depression. Evidence has shown that meditation can reduce activity in the areas of our brain that drive our emotional responses, which can assist in neutralizing our emotional response to painful situations.
What is meditation and how can it be performed? What is the difference between meditation and mindfulness? In simple terms, meditation is a skill that can be learned through practice, either on your own or through a guided exercise experience. Mindfulness is the actual state or quality of being completely present or engaged in what we are doing, free from distraction along with awareness of our thoughts and actions without getting caught up in them.
Mindfulness meditation is a practice that can activate or deactivate portions of the brain. With continued practice, meditation can cause positive impacts on our brain’s functionality. Our brains have the ability to adapt through a process called neuroplasticity, where the brain can form new neural pathways that can assist with fear, anxiety, and stress, all while potentially improving focus and decision making. These changes allow us to better cope with our pain. Most meditation can be performed in a quiet space by closing our eyes, calming our minds, and focusing on our breathing. As little as ten minutes of meditation a day can make a significant impact. There are numerous resources on how to meditate more effectively, including some phone applications such as Headspace and Calm.
Now that clinicians are continuing to better understand the science of pain and the effectiveness of the biopsychosocial approach, they can continue to recommend safer and more effective methods of treatment. More effective treatments along with better communication and education will help patients achieve better outcomes when dealing with chronic pain while taking fewer risks with more expensive and potentially dangerous treatment options.
Physical Therapists are experts in movement dysfunctions and are very skilled at designing treatment programs consisting of exercise and manual therapy. Physical Therapists that wish to be the most effective should understand the biopsychosocial approach in both how they communicate with patients along with how recommending other interventions like meditation may help their patients mitigate their pain.
