An Outpatient Program in Behavioral Medicine for Chronic by hcj


									An Outpatient Program in Behavioral
Medicine for Chronic pain Patients
Based on the Practice of Mindfulness
meditation: Theoretical Considerations
and Preliminary Results

          By: John Kabat-Zinn, Ph.D.
Stress Reduction & Relaxation Program
 Training in mindfulness or awareness meditation
 Serves as major self-regulatory activity
 Used as an “net” for patients
 Based on development of internal resources of patients
 Alternative to traditional methods
 Self-regulation is promoted and learned via the
  directed attention characteristic of mindfulness
 Transcendental Meditation- involves the
  restriction of attention to a single point or object,
  commonly a mantra, the experience of breathing,
  or a visual object and holding it in the mind for
  extended periods of time.

 Mantra- mental sound

 Based on Indian philosphy
Mindfulness meditation
Mindful Meditation- characterized by the
 specialized use of attention and careful self-
   Emphasizes the detached
   Concentration on one primary object until attention
    is stable
   Allows field of attention to expand to include all
    physical and mental events exactly as they occur
    in time
   No event is considered a distraction
   No mental event is allotted relative or absolute value
Pain is the result of the functioning of a
 normally adaptive neurological pathway.

Chronic Pain- non-adaptive function
   Imposes severe emotional, physical, and economic
Three interactions of pain experience
   Sensory-discriminative
   Motivational affective
   Cognitive- interpretative
Gate Control theory
                       Psychophysiologicial
                        model for explaining
                        the modulating effects
                        that higher nervous
                        system behaviors can
                        have on perception
                        and interpretation of
Pain & Meditation
Meditation practice      Mindfulness requires
 often accompanied by      focusing on unpleasant and
 pain.                     painful sensations and
Pain in meditation        discourages efforts to escape
 periods resemble         De-conditioning of alarm
 chronic pain.             reaction
Traditional meditation
 articles offer
 recommendations for
 achieving detachment
Current Study
Used mindfulness meditation as the basis for a
 self-regulation strategy for chronic pain patients
Uncoupling hypothesis- detaching the sensory
 component of pain from the affective and
 cognitive dimensions.
   Uncoupling is thought to be associated with higher
    brain centers
   Generate descending signals to close or narrow the
    spinal gate, resulting in primary sensory dimensions
    as well.
   “Refinement” of awareness
Current study

 Program was a 10 week course ( 3 cycles)
 Patients attended once per week for 2hrs
 51 participants
    18 male, 33 female
    22 to 75 years old
 Classes of pain
      Lower back pain
      Upper back & shoulder pain
      Cervical pain
      Headaches
 Pre & post interviews were conducted
Mindful Meditation practices
Sweeping- a gradual sweeping
 through the body from feet to head
 with the attentional faculty with
 periodic suggestions of breath
 Mindfulness of breath- practiced
 sitting in chair
Hatha Yoga- introduced meditative
 exercise, developing mindfulness
 during movement
Also taught mindfulness meditation
 using various activities
Hospital sessions taught mindfulness of breath
 and sensations
Sweeping was practiced for 4weeks
   45 minute homework cassette tape
   Once a day, 6 days a week
Hatha yoga introduced next 4 weeks
   Alternate the sweeping with the yoga
   Practiced yoga 35-40 min per day
Allowed to use any form last two weeks
Given material on the physiology of stress and
 methods of coping
Follow up questionnaires ( 2.5, 7, & 11 months )

 Pain Measures                        Non- pain Measures
   Pain Rating Index- scores
    which reflect quality and          MSCL – number of medical
    intensity of clinical pain          symptoms
    experienced ( “right now”)         Profile of Mood States
   Body Parts Problem                  (POMS)- change in
    Assessment (BPPA) –
    measures view of how                emotional affect and mood
    problematic body parts are (       SCL -90R- change in
    “this week)                         psychological
   Three –color Dermatome              symptomatology
    Pain Map (DPM)- visual
    representation of the areas        Multidimensional Health
    and intensities of pain             Locus of Control – change
   Table of Levels                     in health related beliefs
    interference (TLI)-
    frequency with which pain          Outcome questionnaire
    interferes with life activities
                                       Evaluated progress toward
   Daily pain related drug uses
    was monitored                       patient set goals
               Spectrum of meditation
               Group format
               Expectation of relief
               Didactic material
               Non- goal orientation
               Finite duration
               Self responsibility
               Long-term perspective
               High demand
               Advanced program
               Low cost
 65% showed reduction in pain (10 weeks) of ( ≥
50% showed reduction of pain (10 weeks of ( ≥
Large reduction in mood disturbance and
 psychiatric symptoms (26% -49%)
Evidence suggest pain reductions are related to
 changes in attitudes and modes of perception of
 pain (TMD score ↓ 60% )
Some reductions maintained for up to 1.5 years
 follow up
Andes survivors
Pain and suffering similar to that of patients
 with chronic pain.

Rosary for some period of mental relaxation or
 period of thought

Survivors able to endure great physical and
 emotional pain

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