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Pain, Mood, & Meditation- Where does Spirituality fit?

Pain, Mood, & Meditation- Where does Spirituality fit?. Amy Wachholtz, PhD, MDiv UMass Medical School Psychiatry Day, 2009. Outline. Bio-psycho-social-spiritual model of pain What are the mechanisms linking meditation and pain? Who uses Prayer/Meditation to cope with pain?

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Pain, Mood, & Meditation- Where does Spirituality fit?

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  1. Pain, Mood, & Meditation- Where does Spirituality fit? Amy Wachholtz, PhD, MDiv UMass Medical School Psychiatry Day, 2009

  2. Outline • Bio-psycho-social-spiritual model of pain • What are the mechanisms linking meditation and pain? • Who uses Prayer/Meditation to cope with pain? • When do people use Prayer/Meditation for pain? • What does spirituality add to meditation for pain coping?

  3. Question #1 What is Pain?

  4. Typical Pain Cycle

  5. I feel good! Ouch! Gate/Neuromatrix Theory of Pain Thoughts Behaviors Emotions Gate Injury Signals Melzack & Wall, 1965

  6. Influences on Chronic Pain Biological Factors Spiritual Factors Chronic Pain Social Factors Psychological Factors

  7. Question #2: What are the mechanisms linking meditation and pain?

  8. What role does meditation play? • Secular meditation & pain • MBSR (Kabat-Zinn) • Relaxation response (Benson) • Spiritual meditation & pain • TM • Yoga • Loving-Kindness • Beyond the Relaxation Response • Religious Tradition based meditation

  9. Meditation Pathways and Pain Positive Mood Internalized Locus of Control Self-Efficacy Anxiety Distraction from Problems Decreased Focus on the Body Reduced Pain Frequency Increased Pain Tolerance Decreased Pain Sensitivity Meditation

  10. (Adapted from: Wachholtz, Pearce & Koenig, 2007) Spiritual Beliefs and Practices Positive vs. Negative Public vs. Private Intrinsic vs. Extrinsic Existential vs. Religious Possible Unique R/S Factor Spiritual Support Spiritual Growth Spiritual Meaning Making Attributions Additional Efficacy Beliefs Psycho-Social Changes Meaning Making Attributions Self-Efficacy Distraction Social Support Instrumental Support Relaxation Physiological/Neurological Changes Altered neurotransmitter levels Altered sleep Altered HPA activity levels Altered threshold for recognizing distress signals Altered Perceptions Changed Mood Changed Social Interactions Changed Behaviors

  11. Common R/S Coping Tools • Prayer • Spiritual Meditation • Hope • Reading faith-based literature • Finding spiritual role models for coping • Seeking spiritual support/connection • Church attendance • Seeking instrumental support • Religious reappraisal

  12. Question #3: Who uses prayer/meditation to cope with pain?

  13. National Health Interview Survey 2002-2007 (Wachholtz & Sambamthoori, 2009) • Older (>33 years) • Female • More Educated (> High School) • African-American (vs. white) • Have chronic mental or physical health issues: depression, chronic headaches, back and/or neck pain

  14. Pain Question #4: When do people use prayer/meditation to cope with pain?

  15. The initial spiritual pain coping response to acute pain (self-directive), is the least likely spiritual coping response to chronic pain (collaborative) (Dunn & Horgas, 2004) • Terminal stage illnesses with co-morbid pain (Yates, et al., 1981; Ironson, et al, 2002) • Long-term chronic pain (Abraido-Lanza, et al., 2004; Glover-Graf, et al., 2007) • Uncontrollable, intermittent pain (Harrison, et al., 2005) • When other coping mechanisms fail and spiritual coping is efficacious (Keefe, et al., 2001; Pargament, 2002) • Religious/spiritual coping AND secular coping- not either/or

  16. Question #5: What does spirituality add to meditation?

  17. Intervention Studies • Spiritual interventions affect physiological outcomes (Carlson, Bacaseta, and Simanton, 1988; Ironson, et al., 2002, Pargament et al., 2005; Wenneberg, et al., 1997 ) • Increase pain tolerance in healthy, non-chronic pain individuals (Wachholtz & Pargament, 2005) • Doubled pain tolerance to laboratory induced acute pain task • Meditation inherently spiritual?

  18. Intervention Studies • Improved pain tolerance among a chronic pain group (Wachholtz & Pargament, 2008) • 4 weeks • Decreased pain frequency • Greater pain tolerance • Acute- laboratory induced pain • Chronic- decreased rescue medication usage • Limited change in pain sensitivity • Greater decrease in negative mood • Greater decrease in anxiety

  19. Buddhist Loving-Kindness • Cancer patients(Carson, et al, 2008) • Migraineurs Pilot Study(Wachholtz, 2009) • 4 week class, 4 week follow up • Increased spiritual experiences • Elevated pain tolerance • Fewer headaches (n.s.)

  20. Summary • Pain a multi-dimensional disorder including physiological, psychological, social and spiritual components • Prayer and spiritual meditation used by many with chronic pain • Multiple psychological and physiological pathways that support its use • Spiritual meditation may be a useful resource with unique additive components for patients with a spiritual/religious background

  21. Thank You Amy.Wachholtz@umassmemorial.org

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