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Think Again

Meditation for Pain Management in Hemophilia

By Heather Boerner | 01.20.2012
Originally Published January 2012

When Jaycee McCain, 22, started meditating in the summer of 2010, the arthritis in his ankles and wrists, and the bleeds brought on by his severe hemophilia A were not on his mind. Instead, his mind was focused on his parents’ divorce.

However, meditating 30 minutes in the morning and at night cut McCain’s perception of pain and his stress over it. He found he could take less pain medication. He remembered in the quiet moments of meditation that he needed to do his prophylaxis, leading to better compliance. And, unexpectedly, McCain noticed the number of bleeds he has a month has dropped from three or four to two.

“The pain drops so much that it seems like it just disappears,” says McCain. He recently moved from Jackson, Ohio, to Provo, Utah, for his second year at Utah Valley University, where he’s a business marketing major. “It’s still there a little bit, but it decreases to the point where I’ve had, say, pain that hits six on the pain scale, but after meditation it’s down to a two or three.”

Meditation is a self-directed practice of quiet contemplation and relaxation in which the practitioner usually sits with eyes closed and either attempts to clear his mind or focus it using a mantra—an incantation or prayer that the meditator repeats in his head or aloud. McCain does this by clearing his mind and focusing on his breathing.

In a way, McCain’s experience is all in his head. That’s where research shows meditation can affect the intensity of pain, as well as a person’s perception of it and reaction to it. An April 2011 study in the Journal of Neuroscience found that meditation decreased the perception of pain by 40% and the sense of the pain’s unpleasantness by 57%. Morphine and similar drugs, meanwhile, typically reduce pain by about 25%. Another study, in the October 2011 issue of the Clinical Journal of Pain, found that meditation was as effective as multidisciplinary medical interventions in addressing pain. And while it will never eliminate pain, research shows that meditation is as effective, if not more so, than traditional treatment.

“When you’re in pain all the time, it’s really important to have more options than pain medication,” says Danna Merritt, MSW, LMSW, at the Hemostasis/Hemophilia Thrombophilia Treatment Center at Children’s Hospital of Michigan. “Medication and meditation may not work as well on their own. But, hand in hand, you have a chance of managing it, certainly, but also really conquering it.”

The History of Meditation

Meditation has been around as long as the practice of spirituality, which date back to 3,000 BC. It wasn’t until 1974, however, that meditation went from being a distinctly Eastern religious practice to a Western mind-body medical practice. That year, Herbert Benson, MD, director emeritus of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital in Boston, published the first articles in the journal Psychosomatic Medicine on meditation’s health benefits.

There are two primary kinds of meditation practiced in the US today: mindfulness meditation and concentration meditation. Mindfulness meditation was pioneered in the West by Jon Kabat-Zinn at the Stress Reduction Clinic at the University of Massachusetts Medical School in 1979. It is an outgrowth of the practice of vipassana meditation, which encourages meditators to clear their mind and note nonjudgmentally the thoughts, emotions and sensations that pass through their bodies.

In concentration meditation, meditators choose something to focus their attention on. It can be a sound, word (like “om”), prayer, a photo, candle, or a sensation that keeps the meditator’s mind still. This allows a person to block out distractions and help a wandering mind settle.

Zen meditation, practiced primarily by Zen Buddhists, is a combination of mindfulness and concentration meditation. It starts with concentration, either on the breath, a sound or a mantra, and then moves to a mindful awareness of everything around the person. 

Today, meditation is used to cope with stress, depression and anxiety. It is also practiced by people with an array of disorders ranging from irritable bowel syndrome to diabetes, and chronic pain conditions, such as arthritis from hemophilia joint bleeds.

[Steps for Living: The Pain Facts and Managing Stress]

How Meditation Changes You

Today, there are dozens of studies on meditation and pain, covering everything from the physical structures of the brain and perception of pain, to the effect of meditation on emotional reactions to pain.

What they’ve found is that meditation can do exactly what McCain describes: reduce the experience of pain without having any specific effect on the actual cause of the pain. A 2010 study in the journal Emotion found that long-time meditators actually reduced the intensity of pain. Joshua Grant, PhD, a postdoctoral candidate at the Max Planck Institute in Leipzig, Germany, studied 17 longtime Zen Buddhist meditators, asking them to sit in meditation while researchers applied extreme cold to their skin to study the effect of pain on the meditators. What he found was that meditation may change the structure of the brain. In longtime meditators, the anterior insula—a part of the brain involved in feelings—is thicker, as is the anterior cingulate cortex, a part of the brain with many roles, including attention and emotion.

“What we think happens is meditators disengage regions of their brains that interpret the experience as pain,” Grant says. He conducted the Emotion study. “They still feel it, but it’s somehow disconnected from the notion of hurt or suffering.”

And it’s not just veteran meditators who get results. The April 2011 study in the Journal of Neuroscience found that those who had only received four days of meditation training were able to reduce their perception of pain. “The benefits of meditation seem to be available to everyone,” Grant says.

Meditation has been found effective not only in addressing how our brains process and perceive pain, but also in how we deal with the emotions that chronic pain creates. Diane Dimon, DrRS, calls this “catastrophizing.” She is a doctor of religious studies and founder of Matters of the Mind, a mind-body center in Fresno, California. She speaks on mind-body skills for anxiety, stress reduction and pain management in hemophilia, often at NHF chapter events.

Pain is complex, says Dimon, but our perceptions often influence our experience of it. Pain triggers your “primitive brain”—the fight-or-flight response in the amygdala responsible for assessing threats. When set off, this response shoots the body full of stress hormones and opens pain receptors in the spine, both of which intensify the experience of pain. When a person sits in meditation, he or she can learn to discern whether there’s really any danger, Dimon says.

“As long as there’s no real danger, meditation helps people view pain as a challenge instead of a danger,” she says. In other words, meditators learn to relax, instead of tensing and resisting, which make pain worse. “Depending on their skill level, meditators can short-circuit the stress response.”

Then there’s the effect of meditation on a person’s stress level in general. Chronic pain can wreak havoc on everything from sleep cycles to exercise routines, making it difficult for a person to bounce back. Meditation offers an antidote through what Benson calls the “relaxation response.” The heart rate slows, blood pressure goes down, breathing slows, oxygen intake increases and muscle tension decreases.

“When you meditate you produce the exact physiological opposite of the fight-or-flight response,” Dimon says. “Your heart rhythms, your biochemistry, your whole physiology is changed.”

How to Meditate

Health benefits can result from even regular mini-meditations lasting only three to five minutes, says Merritt—but you have to believe it can work for you.

“A lot of my patients don’t want to try it; they think it’s silly,” she says. She works with pediatric patients on everything from needle phobia to the pain of bleeds caused by growth spurts. “Meditation is like counseling. It works only if you believe it can.”

Once Merritt’s patients are willing to give meditation a shot, she gives them a handout on three meditation techniques. They’re so simple, she says, that a child can practice them himself at home.

The first and easiest meditation technique is to do what she calls the “quick release:” Sit or lay down with your eyes closed and stop what you’re doing. While your eyes are closed, breath in through your nose up to the count of five, taking note of your belly rising up. Then exhale slowly and fully to the count of five. After three repetitions, sit quietly so you can feel your body relax. If needed, repeat the exercise.

She also teaches a full body relaxation in which people lay on their backs and place their hands on their upper bellies, over their diaphragms. They breathe the way she describes above, careful to make sure they are breathing deeply enough that their hand and stomach move up and down with their breath. After three repetitions of this, patients mentally divide their bodies into individual sections: toes, feet, lower legs, upper legs, and so on. Then they imagine all the muscles in their body relaxing one by one, from their toes to their scalps.

After mentally relaxing all these parts of your body, tense all your muscles to the count of 10. Then relax fully, lay quietly, breathing slowly and normally.

And just like exercise, she says, your ability to relax—and manage your pain—grows each time you meditate.

“The more you do it, the better you get at it,” she says. “You start doing it every day, and pretty soon you begin to learn and your body and mind begin to change.”

The important thing to keep up with your meditation is to learn to be nice to yourself even when your brain is running a mile a minute and your body doesn’t seem to be any more relaxed.

“This is simple but not easy,” she says. “It’s about being awake, present and nonjudgmental.”

Positive Results

While McCain says he still struggles with pain at times, he is less anxious about it than he was before he started. That’s partly because he knows that relief is as close as his breath. He is also reassured that he has some control over his experience of pain.

“Hemophilia can tear a person down physically and mentally,” McCain says. “Factor VIII covers the physical needs of hemophilia A, but we need something to cover the mental part of it. Meditation does that.”

Learn More:

  • Steps for Living: The Pain Facts
  • Riley RR, et al. “Assessment and Management of Pain in Hemophilia Patients” Haemophilia. 2011 Nov;17(6):839-45
  • Talk to your Hemophilia Treatment Center about meditation techniques to manage pain.
  • Visit the National Center for Complementary and Alternative Medicine at http://www.nccam.nih.gov/
  • Visit the Evidence-Based Complementary and Alternative Medicine Website for Healthcare Professionals: http://www.camline.ca/