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

6. Influences on Chronic Pain
Biological Factors
Spiritual Factors
Chronic Pain
Bio-psycho-social model of pain:::Gate control theory (Melzack & Wall, 1965)/ Neuromatrix theory of pain (Melzack, 1999)
New model incorporates spiritual factors as well (McKee & Chappel, 1992; Sulmasy, 2002)
Bio-psycho-social-spiritual model of 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)
Altered Perceptions
Changed Mood
Changed Social Interactions
Changed Behaviors
Physiological/Neurological Changes
Altered neurotransmitter levels
Altered sleep
Altered HPA activity levels
Altered threshold for recognizing distress signals
Psycho-Social Changes
Meaning Making Attributions
Self-Efficacy
Distraction
Social Support
Instrumental Support
Relaxation
Possible Unique R/S Factor
Spiritual Support
Spiritual Growth
Spiritual Meaning Making Attributions
Additional Efficacy Beliefs
Spiritual Beliefs and Practices
Positive vs. Negative
Public vs. Private
Intrinsic vs. Extrinsic
Existential vs. Religious
-Kevin Seybold has done some work on identifying the physiological pathways through which R/S may affect pain.

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
Prayer use study
Studied 2055 nationwide households on use of CAM (including prayer).

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

15. Religious/spiritual coping AND secular coping- not either/or
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
Abraido-Lanza, AF.; Vasquez, E; Echeverria, S E., (2004) En las Manos de Dios [in God's Hands]: Religious and Other Forms of Coping among Latinos with Arthritis. Journal of Consulting and Clinical Psychology, 72,

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?
Comparing spiritual vs. secular interventions on pain

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