CHAPTER 21: Mind/Body Interventions in the Management of Chronic Pain

SCIENCE

MECHANISMS OF MIND–BODY THERAPIES

In the field of Western medicine, we still do not fully grasp how and why many pain conditions develop—why a scanner gun dropped on a foot caused complex regional pain syndrome (CRPS) or why an imaging study failed to show structural evidence of lumbar pain. We also do not fully grasp why some develop a pain condition and others do not—surely many scanner guns have been dropped on many feet without the development of CRPS, and there exist many lumbar imaging studies that show deformation with no experienced pain condition.

There remains much that we do not know about many pain conditions, suggesting that there are portions of our explanatory medical model that are either not adequate or not yet clarified. The expanding interest and research findings in mind–body therapies speak to some of the gaps in the model of Western medicine.

To its credit, inductive experimentalism has yielded quite a number of cures and treatments. But the cost of this advancement was a necessary split in conceptualizing body as separate from the mind. In the scientific age, the mind has been considered a source of error for empirical studies, that is, the effects are contaminants to the “real” findings and must be parceled out. But we are beginning to see a reintegration of the mind into experimentalism—the mind as an independent variable in research studies. Whether it is research in the modulation of gene expression by psychosocial cues,¹ children learning to voluntarily increase oxygen perfusion in tissue,² or knowledge of how state-bound memories and experiences manifest somatically,^3,4 it is clear that mind–body therapies represent something real and progressive, even if not completely understood.

In this chapter, we examine some current mind–body therapies that are being used in the treatment of chronic pain. Some are well researched in terms of their efficacy and effects; some are hardly understood in their mechanisms of action. They mark a departure from the norm of medical treatments, and it may be for this reason that they are becoming increasingly popular. More and more, patients are rejecting modern pharmacologic approaches in favor of naturalistic treatments. They are seeking therapies that are holistic and self-empowering.

MIND–BODY THERAPY DEFINED

The National Center for Complementary and Alternative Medicine (NCCAM) defines mind and body medicine as focusing on the interaction among the mind, body, brain, and behavior, with the intent of using the mind to help establish health. Here we are concerned with therapies that can be used to help deal with pain conditions, including hypnosis, biofeedback, meditation, and relaxation, as well as some Eastern therapies such as Tai Chi and Qi Gong.

AVENUES OF ACTION

Mind–body therapies are thought to produce effect in a number of ways. Here we classify ...