Mindfulness meditation: A promising tool to help reduce chronic pain and opioid use

This month, Optum is a proud partner and supporter of the VA’s Brain Trust: Pathways to InnoVAtion event in Boston, where new solutions to improve brain health for Veterans will be Priority #1. Like other VA partners, Optum is deeply committed to this effort, its innovation, and most important, the resulting actions. We look forward to this unique opportunity and other ways to help ensure exceptional health and quality of life for our Veterans and their families.

Almost daily there seems to be a story in the media about our country’s opioid crisis and the lives tragically lost to the epidemic. From celebrities and promising athletes, to the neighbor down the street who silently struggled with chronic pain for years, more and more are dying from addiction.

The facts are daunting: the United States now consumes almost 100 percent of the world’s total hydrocodone and 81 percent of oxycodone prescriptions¹ and 44 Americans die each day from a prescription opioid overdose.² Since 1999, sales of prescription opioids have nearly quadrupled and so have the total number of drug overdose deaths involving opioids.³

The figures are even more staggering for our nation’s Veterans. While 30 percent of the adult population experiences chronic pain, almost 60 percent of returning Veterans from the Middle East and more than 50 percent of older Veterans in the VA health system report living with some form of chronic pain,⁴ and many of them turn to opioids for relief. The number of Veterans with opioid-use disorders spiked 55 percent between 2010 and 2015,⁵ and according to a 2011 study of the VA system, Veterans are almost also twice as likely as non-Veterans to die from accidental opioid overdose.⁶

There are numerous and well-cited reasons for our national opioid crisis; it is the result of many complex factors and requires a multifaceted approach to treat. For example, often mentioned is that opioids have become alarmingly easy to obtain compared to previous decades when these powerful painkillers were reserved for cancer treatment and end-of-life care.

For our Veterans, addressing and treating chronic pain and opioid-use disorders may be even more complex. Although their stories may not make front-page news, for many of our nation’s Veterans, living with debilitating and chronic pain is a daily reality. In a 2015 testimony to the U.S. Senate Committee on Veterans Affairs, Dr. Carolyn Clancy, then interim under-secretary for health with the Veterans Health Administration, said, “Many of our Veterans have survived severe battlefield injuries, some repeated, resulting in life-long moderate to severe pain related to damage to their musculoskeletal system, and permanent nerve damage, which cannot only impact their physical abilities but also impact their emotional health and brain structures.”⁴

Adding to the complexity of treating pain in our Veterans, are increasing numbers of Veterans struggling with behavioral and mental health issues related to PTSD and traumatic brain injuries.⁷

There is no easy answer to curbing the tide of this deadly and tragic epidemic, in the general population or among our Veterans, but there is hope in some integrative and promising evidence-based approaches, including mindfulness meditation.

Mindfulness meditation and pain reduction

In the 1970s, Jon Kabat-Zinn, Ph.D., now professor of Medicine Emeritus at the University of Massachusetts Medical School, was growing increasingly concerned about patients with chronic or severe pain who had access to few, if any, alternatives to nondrug therapies. He designed an innovative intervention called Mindfulness-Based Stress Reduction (MBSR) – a meditative approach that fostered mind-body awareness – initially as a complementary treatment for chronic pain.⁸

Kabat-Zinn’s early research on chronic pain demonstrated statistically significant reductions in pain and pain-related drug utilization, and increased feelings of self-esteem among patients who participated in MBSR programs.⁹ Although rooted in ancient Eastern contemplative traditions, mindfulness meditation was adapted by Kabat-Zinn as a secular practice that encourages nonjudgmental awareness of the present moment, fostering wellbeing and increased self-regulation.

Today, MBSR and other mindfulness-based programs are commonplace in hospitals, workplaces and community settings throughout the United States. The growth and interest in mindfulness is due in large part to an impressive body of evidence that suggests mindfulness meditation practices can mitigate a number of physical and mental health issues, ranging from dealing with cancer and depression, to sleep problems and chronic pain.^10,11

VA has conducted a number of its own studies in recent years to determine the effectiveness of mindfulness meditation as a tool to assist Veterans suffering from symptoms, including PTSD and chronic pain.^12,13 A 2016 study published in Military Behavioral Health suggests mindfulness meditation can help Veterans control their pain. The research, led by Thomas Nassif, Ph.D., of the Washington, DC, VA Medical Center and American University’s Department of Health Studies, found that Veterans who practiced meditation reported a 23 – 42 percent reduction in pain intensity, as well as lowering pain interference with sleep, mood and activity level.¹³

“Meditation allows a person to accept pain and to respond to pain with less stress and reduced emotional reactivity,” Nassif said. “Our theory is that this process increases coping skills, which in turn can help Veterans to self-manage their chronic pain.”¹⁴

He also reported that in many cases, primary care physicians, who are expected to help individuals overcome their chronic pain, often prescribe opioids as part of the treatment. While Veterans in this study, and many who attend meditation sessions, find that opioid medication is a short-term solution, others believe that meditation could be a useful, adjunctive tool to help Veterans manage their pain over the long term.¹⁴

The current state of chronic pain and opioid use in the United States may indeed be daunting and require a multifaceted approach; yet, there is promise for our Veterans and the more than 100 million Americans¹ who suffer from chronic pain in the age-old and now richly evidence-based practice of mindfulness meditation.

Dawn Bazarko is the founder and leader of Moment Health, an innovative new UnitedHealth Group business focused on bringing mindfulness solutions to the work place, to health care workers and into health care delivery to improve the care experience. Over the past nine years, she has been a driving force behind cultivating mindfulness practices in the workplace, offering mindfulness meditation and mindfulness-based stress reduction programs to employees and leaders of major organizations via in-person, telephonic and drop-in formats. She is increasingly seen as an expert in the science of the mindfulness and methods for bringing mindfulness practices into health care and business environments and best practices in mindfulness measurement and evaluation.

References

1. Volkow, N. America’s addiction to opioids: Heroin and prescription drug abuse. National Institute on Drug Abuse. http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. Published May 14, 2014. Accessed May 8, 2017.
2. U.S. Department of Health & Human Services The U.S. Opioid Epidemic. https://www.hhs.gov/opioids/about-the-epidemic/ Published April 26, 2017. Accessed May 8, 2017.
3. Centers for Disease Control and Prevention. Prescription Opioid Overdose Data . https://www.cdc.gov/drugoverdose/data/overdose.html. Published December 16, 2016. Accessed May 8, 2017.
4. Clancy, C. Statement of Carolyn Clancy, MD, before the U.S Senate Committee on Veterans Affairs. U.S Senate. http://www.veterans.senate.gov/imo/media/doc/VA%20Clancy%20Testimony%203.26.20151.pdf. Published March 26, 2015. Accessed May 8, 2017.
5. Childress, S. Veterans face greater risks amid opioid crisis. Frontline. http://www.pbs.org/wgbh/frontline/article/veterans-face-greater-risks-amid-opioid-crisis/. Published March 28, 2016. Accessed May 8, 2017.
6. Bohnert, AS, Ilgen, MA, Galea, S, McCarthy JF, Blow, FC. Accidental poisoning mortality among patients in the Department of Veterans Affairs Health System. Med Care. 2011; 49(4): 393-396.
7. Seal KH, Bertenthal D, Barnes DE, Byers AL, Strigo I, Yaffe K. Association of traumatic brain injury with chronic pain in Iraq and Afghanistan Veterans: impact of comorbid mental health conditions. Arch Phys Med Rehabil. 2017; In Press.
8. Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY. Bantam Dell; 1990.
9. Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985; 8(2): 163-190.
10. Chiesa A, Serretti A. Mindfulness-based interventions for chronic pain: A systematic review of the evidence. ‎J Altern Complement Med. 2011; 17(1): 83-93.
11. Kvillemo, P, Bränström, R. Experiences of a mindfulness-based stress-reduction intervention among patients with cancer. Cancer Nurs. 2011; 34(1): 24-31.
12. Polusny, MA, Erbes, CR, Thuras, P, Moran, A, Lamberty, GJ, Collins, RC, Rodman, JL. Lim, KO. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA. 2015; 314(5): 456-465.
13. Nassif, TH, Chapman JC, J., Sandbrink, F, Norris, DO, L. Soltes, KL, Reinhard, MJ, & Blackman, M. Mindfulness meditation and chronic pain management in Iraq and Afghanistan veterans with traumatic brain injury: A pilot study. Mil Behav Health. 2015; 4(1), 82-89.
14. US Department of Veterans Affairs. Meditation and Pain Management. https://www.washingtondc.va.gov/features/A_recent_study_led_by_DCVAMC_Neuroscientist_Dr_T.asp. Published February 22, 2016. Accessed May 8, 2017.