Mindfulness in Rehabilitation and the Management of Chronic Pain and Stress
What is Mindfulness?
The 21st, a century that has so far been pretty hectic for most of us; even more so since the spread and increased accessibility of the internet. That is why to explain mindfulness, we will start off with a quote that I think many of us will find it easy to relate to: “My mind is like my internet browser, 19 tabs open, 3 of them are frozen, and I have no idea where the music is coming from.” This quote demonstrates the inherent nature of our minds; that is, our minds love to think and multitask. Unfortunately, our attention (and also our internet speeds) are limited - which is why it is crucial to close some tabs, and focus on one tab at a time. This is where mindfulness comes in, it is the answer to tabs for patient and practitioner alike. Mindfulness is the ability to know what is happening in each of your tabs at any given moment, without getting carried away by all of the frozen tabs. In other words, “mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.”
Before we get a little further into what mindfulness is, let’s first talk about what mindfulness is not; here are a few myths about mindfulness:
- It is a mystic practice only meant for Zen masters.
- It is religious and/or hokey-pokey.
- It can be practiced only sitting down and with eyes-closed.
- It is relaxing/passive.
- You must have no thoughts while practicing mindfulness meditation.
Topics of Discussion in the recorded Webinar Include:
- What is mindfulness, its origins, and its journey from the East to the West.
- How do you practice mindfulness?
- Benefits of mindfulness.
- Scientific evidence in support of the effectiveness of mindfulness.
- Practical applications of mindfulness for both practitioners and patients.
- Who mindfulness can (and cannot) benefit.
- Rehabilitative applications of mindfulness (specifically as they relate to chronic pain).
- How to effectively introduce and talk about mindfulness meditation with your patients.
Benefits of Mindfulness:
One in five Canadians suffer from chronic pain, in addition to that, one third of the people in Canada report feeling extreme stress, the latter figure is likely even higher during the current COVID-19 pandemic. Stress is normally a great thing - it is our body’s natural response to something unpleasant - so we can DO something about the situation. Unfortunately, when stress is ‘unchecked’ and lingers for many months to years, it can become extremely problematic - especially in the case of chronic pain. Therefore, anything that can help manage stress could be a shining beacon for these patients.
With mindfulness, the goal is not to eliminate pain, rather it is to teach patients how to become more self-aware of their pain, and how to respond to it in a constructive and healthy way.
Some of the benefits of mindfulness include:
How Do We Practice Mindfulness?
Mindfulness can be practiced through traditional formal practice as well as informal practice; both practices are equally important.
Formal practice is the traditional way of meditating; it generally involves sitting down and going through a structured meditation. Types of formal practice include the body-scan, mindful movements, visualization, and other meditation exercises. Informal practice on the other hand, is the meditative practice that happens during your everyday activities such as washing dishes, eating, talking to someone, etc. To explain the latter a bit further, try to think of a time when you were eating and finished your meal without realizing you had finished it, or talking to someone (especially your significant other), and having no idea what they just said (i.e. you had just zoned out). Both of these present examples of not being mindful, that is, not being present in the moment.
In mindfulness meditation practice (formal or informal), there are three steps that we typically follow:
- Observe: “Just notice” open monitoring.
- Label: Label (not in a negative way - not labelling good or bad, but just acknowledging what you are experiencing) i.e. the sounds you hear, thoughts you have, emotions you feel, any pain or discomfort, without placing any negative connotation on your observations or sensations.
- Non-judgment: Here you practice not reacting to your pain, the thoughts that you are having, or emotions that you are feeling. Ultimately, this leads to a principle of mindfulness known as acceptance.
These three steps can be completed with any meditation practice. Although this sounds easy, you may notice that your mind will wander (this is natural - remember, our minds love to think and open tabs) and that you are no longer focused. But as soon as you notice your mind has wandered, the goal is to gently return your attention to these three steps. However, this is challenging and takes repetition and practice! This is similar to when we are learning a new physical skill (i.e. learning an instrument or playing a sport). Essentially, with enough repetition, you will develop a “muscle memory”, and will undoubtedly reap the benefits of your mindfulness practice. Repeating the above steps leads to attaining calmness, stillness and resilience. With enough practice, you can successfully rewire your brain to become non-reactive and calmer.
The Negative Effects of Stress on the Body:
An injured patient will usually feel pain and stress. If the stress continues unbridled, say 3, 6 months following their injury, without proper stress management that patient may enter a negative stress cycle.
Negative stress cycle:
In the negative stress cycle, the stress the patient is feeling leads to automatic thoughts, which lead to negative moods and emotions, which ultimately result in maladaptive behaviors that then exacerbate the negative physical symptoms.
Where does mindfulness attack in this stress cycle? At the automatic thoughts. Mindfulness grounds patients to the present moment - stopping the chain of endless automatic thoughts.
Watch this short video on the benefits on mindfulness from Shrey Vazir’s webinar, Mindfulness in Rehabilitation and the Management of Chronic Pain and Stress
Some Practical Applications of Mindfulness:
Many patients are resistant to mindfulness meditation due to preconceived notions, lack of information, or other reasons. Oftentimes, if we label things a little differently, patients become instantly curious and want to learn more. While the words mindfulness meditation may elicit a yawn or snore from many patients, a term like active breath techniques and mindset training often piques their interest. In addition to creativity in word choice, below are some steps that you can use to introduce mindfulness to your patients:
- Introduce/ask for permission: First, you must recognize patients who may benefit from mindfulness. Having done so you may now ask for permission: “Can we try something that may help with your pain?” If the answer is yes, you may introduce “Breath/awareness training”.
- Diaphragmatic breathing: Diaphragmatic breathing, also known as belly breathing can be incorporated into clients’ exercise programs.
- Other breathing techniques: 4-7-8 breathing, box breathing.
- Provide handouts to patients: Shrey Vazir, instructor, physiotherapist and certified mindfulness facilitator has created handouts for you to share with your patients. If you feel that you have patients who may benefit from such handouts (or you are just curious), please contact email@example.com to get your copy.
- Mindful breathing meditation: Here is a link to a 3 minute, guided mindful breathing meditation created by Shrey that he uses with his patients: https://www.youtube.com/watch?v=4m1FwImD-gE&t=45s
- Provide a list of mobile apps patients can use: A few quality paid and unpaid apps that your patients may benefit from include InsightTimer (free), Headspace (free and paid versions), Calm (free and paid versions) and Stop Breathe and Think (free). A complete handout of popular mobile applications can be obtained by e-mailing firstname.lastname@example.org.
To learn more about the practical applications of mindfulness for yourself or for your patients, we invite you to check out Shrey’s recorded webinar by clicking on the link below:
How Does Mindfulness Help the Healthcare Practitioner?
We have discussed some of the ways in which mindfulness can help your patients, however, mindfulness can benefit the healthcare practitioner as well.
As a practitioner, compassion fatigue is all too common. Mindfulness is a great item to add to your self-care toolkit to battle compassion fatigue as it improves your resilience, and helps with burnout and personal stress. We would all benefit from remembering that we cannot pour from an empty cup.
As a healthcare practitioner, mindfulness helps you become more non-judgmental and empathetic both to yourself as well as to your patients. It creates a gap between your emotions and your reactions; this could be pivotal in client retention. We may not enjoy working with all patients, some may even be very frustrating and/or challenging to deal with. This is where a non-judgemental and calm approach is crucial.
Think of a time when you had a challenging patient, you might have felt your blood boiling, your heart racing and your whole body tense up. The knee jerk reaction in such cases may be to get away from the patient, or say something that you may regret later, but mindfulness creates that necessary gap to help you keep your cool. Your emotions come up, you can feel them, but you do not have to react to them. Mindfulness gives you a pause, and the pause is what gives us power over our choices.
It is important to note that mindfulness meditation, as well as mindfulness mobile apps are not suitable for patients that are severely depressed, actively suicidal, or have trauma. The introduction of mindfulness in these populations, without appropriate training, can in fact be harmful. As healthcare practitioners, we must stay within our scope of practice.
Mindfulness is a vital tool that can benefit both healthcare practitioners and patients. It is supported by a rapidly growing body of scientific research in many fields. Mindfulness can be used to empower our patients to self-manage their conditions and take ownership of their health. It can reduce the symptoms of stress, depression, and pain, and is an effective approach to chronic pain management. As a practitioner, you may consider using it for yourself as well to manage stress as it will help with compassion fatigue, and promotes calmness and resilience in the face of adversity. These are not easy times my friends, and though we may not be able to change or control the times, with mindfulness, we can surely control our reactions to them.
About the Instructor:
Shrey Vazir MSc (PT), B.Sc.Kin, Applied MPCPM
Shrey is a Registered Physiotherapist and a Mindfulness Meditation Facilitator specializing in chronic pain and stress. Having gone through a personal journey with persistent pain, Shrey has embraced mindfulness into his daily practice – both personally and clinically. With his advanced training in the Mindfulness-Based Chronic Pain Management (MBCPM™) program, he has integrated the principles of mindfulness meditation to teach patients and coworkers on how they can better cope with chronic illnesses such as chronic pain and stress. Shrey has also been a guest presenter at the University of Toronto and is deeply involved in their Physical Therapy Department’s pain curriculum. As a passionate clinician who is well-versed with pain neuroscience and evidence-based rehabilitation practice, Shrey’s mission is to inspire current and future rehabilitation professionals to incorporate mind-body approaches in their own practice.
Blog writer, editor: Nataliya Zlotnikov
References from Webinar:
- Taren, A. A., Gianaros, P. J., Greco, C. M., Lindsay, E. K., Fairgrieve, A., Brown, K. W., . . . Creswell, J. D. (2017). Mindfulness Meditation Training and Executive Control Network Resting State Functional Connectivity: A Randomized Controlled Trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489372/
- Desbordes, G., Negi, L. T., Pace, T. W., Wallace, B. A., Raison, C. L., & Schwartz, E. L. (2012). Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state. Frontiers in Human Neuroscience, 6. doi:10.3389/fnhum.2012.00292
- Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011, January 30). Mindfulness practice leads to increases in regional brain gray matter density. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004979/
- Ardebil, M., & Banth, S. (2015). Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain. International Journal of Yoga, 8(2), 128. doi:10.4103/0973-6131.158476
- Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., . . . Maglione, M. A. (2017). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368208/
- Zeidan, F., Grant, J. A., Brown, C. A., McHaffie, J. G., & Coghill, R. C. (2012, June 29). Mindfulness meditation-related pain relief: Evidence for unique brain mechanisms in the regulation of pain. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580050/
- Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & Clinical Guidelines Committee of the American College of Physicians (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367