Comparing the Effects of Hypnosis, Mindfulness, Meditation, and Spiritual Practices on Experimental Pain
By Dr. Alexandra Ferreira-Valente
There has been an increasing interest in studying the potential benefits of so-called complementary and alternative approaches for pain management, such as hypnosis and mindfulness-based interventions. More recently, researchers have been interested in studying the effects of spiritual practices on pain experience as well. These practices may increase pain tolerance, result in a positive re-appraisal of pain and influence other psychological variables that are known to be associated with pain experience. The purpose of this study is to evaluate and compare the immediate effects of self-hypnosis, mindfulness meditation, and a spiritual intervention relative to a control condition for increasing pain tolerance and reducing pain intensity and pain-related stress, in response to experimental painful stimulation.
Pain is a universal experience.1 It is also a homeostatic and adaptive mechanism, essential for survival.2–4 Without pain, an injury or serious health condition could go unnoticed, potentially leading to the death of the organism.5 6
At the same time, pain is also an unpleasant and distressing experience that can undermine well-being,7 8 and is a primary reason for seeking medical care.9 Although minor acute pain can be readily managed, moderate-to-severe acute pain may require a level of care that may not be available in many treatment settings.10 Even when standard treatments are available, a large number of patients continue to report severe acute pain.11 12 Relatedly, about 20% of patients with acute pain are not satisfied with the pain treatment provided to them.13 If not appropriately treated, severe acute pain is known to contribute to negative cardiovascular, immunological, gastrointestinal, renal, muscular, sleep and psychological complications.10 14 The presence of severe acute pain also puts patients at risk for the development of chronic pain.10 14 All of this evidence supports the importance of patient access to effective acute pain management treatments.
Given its subjective and complex nature, effective pain management frequently requires more than analgesics.14 Pain is a multidimensional experience that cannot be merely explained by the physiological mechanisms that underline its experience.3 15 16 Pain is influenced by a number of biological (eg, physiological aetiology, severity of physical damage), psychological (eg, pain-related beliefs and pain coping responses), social (eg, social support) and spiritual/religious (eg, meaning in life, religiosity) factors.17–25 Not surprisingly, multidisciplinary treatment programmes that address the multifaceted nature of pain, including its psychosocial dimensions, are more effective than unimodal treatments that focus only on biomedical factors.26–28 Given this evidence, multidisciplinary treatments that include instruction and encouragement in the use of psychological, social and spiritual coping may be useful.14 29
Two psychological coping responses that are commonly taught in such programmes are self-hypnosis (SH) and mindfulness meditation (MM). Both SH and MM have evidence supporting their efficacy with acute, chronic and experimentally induced pain.30–40 Both interventions can be used independently or together, and have been shown to: (a) induce brain states that are hypothesised to be associated with a decrease in the processing of nociceptive input as well as adaptive cognitive processes such as acceptance and openness to suggestion; and (b) affect pain-related cognitive content—such as pain-related beliefs and cognitive pain coping responses.37 38 40 41 Both SH and MM have also been shown to have weak-to-strong effects on pain intensity and on pain tolerance,31 32 35 38 39 with the magnitude of the effects varying as a function of: (a) previous experience in using either of these strategies (being a novice vs being a long-term practitioner of MM); (b) outcome expectancies; (c) hypnotic suggestibility (for SH), (d) trait absorption and (e) pretreatment (pain) acceptance.38 40 42–44 It is also possible that, as Tang et al have hypothesised,45 dispositional or baseline mindfulness—that is, a long-lasting and pre-existent tendency towards mindfulness of consciousness—affects brain processing, the ability to practice MM, as well as the effects of MM. In support of this hypothesis, a recent study examined the moderation effect of baseline mindfulness on the effects of MM, cognitive therapy and mindfulness-based cognitive therapy for chronic low back pain.46 The authors found that non-reactivity (ie, a facet of baseline mindfulness that refers to active detachment from negative emotions and thoughts), but not observation (ie, a facet of baseline mindfulness that refers to how one sees, feels, and perceives the internal and external world around oneself and selects the stimuli requiring one’s attention), moderated the effects of both MM and mindfulness-based cognitive therapy. Those participants with lower baseline non-reactivity reported greater improvement in physical function as a result of MM, while those with higher baseline non-reactivity reported greater improvement in mindfulness-based cognitive therapy. However, we are not aware of any other studies that have examined the moderating role of baseline mindfulness on the effects of MM.
Recent research on the role that spirituality (the extent to which an individual searches for meaning and purpose in life, as well as feelings of transcendence and of being connected to a higher power)20 and religiosity (the degree of an individual’s engagement with the belief system and with individual and group practices of a given religion)20 —have on pain experience suggests that at least some individuals spontaneously engage in spiritual and religious practices when experiencing pain as a way to cope.47–49 Moreover, higher levels of spirituality and religiosity (S/R) are hypothesised to have a buffering effect against stressors.47 50 51 Both spiritual (eg, spirituality-based meditation) and religious practices (eg, prayer) that might reduce stress may account for these buffering effects.50 Although there is a growing interest in evaluating the potential benefits of spiritual and religious practices on pain experience,52–57 and on identifying the mechanisms that explain their buffering effects on pain experience,58 to date, only a limited number of studies have focused on these issues. This is especially true for religiosity and for religious practices. Findings from the limited number of studies that have been conducted suggest that S/R and spiritual and religious practices may play a role in influencing pain (eg, pain tolerance and pain intensity) and pain-related outcomes (eg, pain-related distress).19 20 47 50 54–56 59–61 These practices are thought to increase pain tolerance, determine a positive re-appraisal of pain and modulate psychosocial variables (eg, meaning of pain, beliefs and attributions, coping and mood) that are associated with pain experience.22 47 60 62