For many of us, controlling pain with the mind may bring to mind images of firewalkers on television who endure 600-degree hot coals, yogis who sleep on a bed of nails, or martial arts movies in which the hero survives agonizing tortures by meditating, emerging virtually unscathed. But how much of this is Hollywood fantasy? Just how powerful can the mind be at controlling sickness and pain?

The latter question has been debated for centuries. Western scientists and doctors long thought the body operated like a machine, independent of thought and emotion. Research over the last 50 years, however, shows the mind and body are inextricably connected. Exciting new research also suggests that the mind has far more control over pain than previously thought.

Consider this little-publicized 2006 study.

In an experiment funded by the National Institute of Neurological Disorders and Stroke, researchers studied MRI scans of subjects' brains as they participated in pain research. The volunteers were taught to expect mild, moderate, or severe pain at differently timed specific intervals, using a miniature heat pump controlled by a computer to stimulate the sensation of pain. A seven-second interval meant they would experience mild pain, a 15-second interval signaled a heat level that produced moderate pain, and a 30-second interval meant they would get a heat blast that produced severe pain. (The heat only lasted 20 seconds and didn't generate enough heat to cause burns or skin damage.)

Sounds straightforward enough. But without telling participants, researchers switched the actual level of the painful heat. Now, a third of the time, a study participant expecting a particular shock of heat actually received a lower or higher temperature instead.

The outcome? The researchers found that most of the time, people who expected mild pain experienced mild pain -- regardless of the severity of painful heat they actually received. That is, the volunteers tended to experience the level of pain they anticipated.

Meanwhile, MRI scans of the volunteers' brains confirmed that their experience of pain was what they reported. When subjects expected decreased pain, in fact, the MRI scans showed that activity declined in the part of the brain involved in the processing of pain by the senses and the emotions.

"Our data shows that what you think really changes what you experience," wrote Dr. Robert Coghill, one of the study's researchers. The most effective treatment for chronic pain would be a combination of medical and psychological treatments, he insisted: "Pain needs to be treated with more than just pills…The brain can powerfully shape pain, and we need to exploit its power."

All in all, Coghill found that lower expectations reduced reports of pain by more than 28 percent. "Expectation about pain can affect its intensity at a level of pain reduction comparable to that of a normal dose of the painkiller morphine," he said. In other words, the mind itself has the painkilling power of a powerful narcotic, if only we can learn how to harness it.

Other research suggests that a little control can go a long way when it comes to chronic pain sufferers. Self-care programs, such as the one developed for arthritis patients by Kate Lorig of Stanford University, can dramatically improve the quality of life for patients even while objective measures show the disease worsening. As early as 1993, a study that tracked patients for four years after they completed Lorig's program concluded that those who were educated in self-management techniques reported a 20-percent decline in pain -- even though their physical disability had increased by 9 percent.

One of the most promising programs in helping patients regain a sense of control is the meditation course promoted by Jon Kabat-Zinn, PhD, the author of Full Catastrophe Living, and professor emeritus at the University of Massachusetts Medical School, where he founded its well-known Stress Reduction Clinic. Adapted from centuries-old practices, including yoga and Zen meditation, the core of this stress-reduction program is "mindful" breathing, meditation, and "body scan" techniques, in which students focus awareness on different parts of their anatomy. By simply paying attention to breathing -- to feeling the belly as it moves in and out -- breath can function as an anchor and help calm the body and mind, according to Kabat-Zinn. Gradually, the student learns the basics of mindful meditation, body scans, and relaxation techniques that include simple yoga stretches.

The meditation course is intended to be used in conjunction with Western medicine, not to substitute for it. But the results are striking: In a study by Kabat-Zinn and his colleagues at the University of Massachusetts, 65 percent of the patients in a 10-week meditation course suffering from intractable chronic pain achieved at least a 33 percent reduction in pain symptoms, and 50 percent of the patients experienced at least a 50 percent reduction in pain (as measured by a pain questionnaire called the McGill Melzack Pain Rating Index). They also showed a 30 percent improvement in the extent that pain undermined their daily lives.

"If your doctor suggests that meditation might help you live with your pain, it does not mean that your pain is not 'real,'" writes Kabat-Zinn in Full Catastrophe Living. "It means that your body and your mind are not two separate and distinct entities, and that therefore there is always a mental component to pain. This means you can always influence the pain experience to some extent by mobilizing the inner resources of the mind….Being told that you have to learn to live with pain should not be the end of the road -- it should be the beginning."

"The mindfulness approach involves, above all, a willingness to open up to pain and learn from it," Kabat-Zinn continues. "Some people have difficulty understanding why we emphasize that they try to enter into their pain when they simply hate it and just want it to go away. Their feeling is, 'Why shouldn't I just ignore it or distract myself from it, or grit my teeth and just endure it when it is too great?' One reason is that there may be times when ignoring it or distracting yourself doesn't work. At this point it is very helpful to have other tricks up your sleeve."

With the visionary treatments the National Institutes for Health is now developing -- its budget for pain programs and research has almost tripled in the past decade or so -- new help for pain sufferers may be on the horizon.

The latest research shows that pain is a dynamic process, involving multiple routes, signals, and relays to the brain. Scientists are unraveling other mysteries as well. For example, a 2004 NIH-sponsored study confirmed for the first time the existence of a specific protein receptor in the brain that helps dampen pain. Researchers also discovered that the number of these pain receptors vary from person to person, as does someone's capacity to release anti-pain chemicals.

Advances in gene therapy are also promising. Using genes to boost pain-relieving chemicals -- like endorphins, which naturally occur in humans -- has been effective in reducing pain in animals. Additionally, gene therapy has been used in animals to increase the number of pain-relieving receptors in their bodies. Scientists have found this to not only produce more pain relief, but also to increase the effectiveness of drugs like morphine.

New studies are also redefining decades-old assumptions about the human central nervous system as well. In one case, researchers have recently discovered that a particular kind of cell thought to only play a supportive role in the central nervous system actually plays a crucial one. These cells, called glial cells, release chemicals that increase pain. Stopping neurons -- nerve cells that send and receive electrical signals throughout the body -- from releasing signals to glial cells in animals has resulted in a significant drop in signs of pain.

For physicians trying to help the chronic-pain sufferer, the challenge is to mix and match the best of these drugs, therapies, and approaches with some old-fashioned doctoring. Often, the most important thing a physician can do for long-suffering patients is to take their discomfort seriously -- and then take action quickly.

No one claims that dealing with chronic pain is painless. "Restoring function is more important than restoring comfort," says Richard Chapman, a professor of anesthesiology and director of the Pain Research Center at the University of Utah. "And the road to rehabilitation often goes through terrible discomfort."

But physicians can play a vital role in easing that suffering, says Richard Roberts, past president of the AAFP and a professor of family medicine at the University of Wisconsin-Madison. "I like to remind myself that I don't take care of disease, I take care of patients," says Dr. Roberts. "It's continuing relationships with people through major life events: birth, death, sickness -- and pain."

Thomas Greenly can attest to the rewards of such care. More than a decade after his pain nearly led him to suicide, the ex-cop would just as soon discuss his advocacy work for other pain sufferers, or the memorable trip to watch his son graduate from the Naval Academy. With continued care from Dr. Rose and the drug therapy he feels he needs, Greenly is able to enjoy his family and move about without agony. The pain is not gone, but it's under control. And that's enough, he says, to make his a life worth living.

-- Judith Horstmann is a freelance health reporter who has written for many health and medical publications. Jennifer Biddle is a research editor at Consumer Health Interactive. Part of this story is adapted from an article by Horstmann in Hippocrates magazine.

Resources

Stress Reduction Clinic, University of Massachusetts Medical Center.

Website of the Center for Mindfulness, UMass Medical School (affiliated with Jon-Kabat Zinn).

www.umassmed.edu/fcm

Website of the Mind and Life Institute. www.mindandlife.org

References

First published March 1, 2007
Copyright © 2007 Consumer Health Interactive