(646) 355-8777

Herman & Wallace Blog

Mindfulness and the Descending Modulation of Pain

The following comes to us from Carolyn McManus, PT, MS, MA, our resident expert in the power of mindfulness and it's applications to rehabilitation. Carolyn was recently featured in a video from the Journal of the American Medical Association for her contributions to a newly published research article. Join Carolyn at her course, Mindfulness Based Pain Treatment: A Biopsychosocial Approach to the Treatment of Chronic Pain on May 14th and 15th in California's Bay Area!

Neuroimaging studies show that cortical and sub-cortical brain regions associated with cognitive and emotional processing connect directly with descending pain modulating circuits arising in the brainstem. As diminished nociceptive inhibition by descending pain modulation is a likely contributing factor to the persistence of pain, these cortical and sub-cortical connections to relevant brainstem regions provide a means by which maladaptive cognitive and emotional processing can contribute to the persistence of pain1. It is possible that strategies to help patients self-regulate cognitions and emotions could promote pain reduction through restoring the balance between excitatory and inhibitory mechanisms of the descending pain modulatory system.

To be mindful is to rest the mind in the present moment with stability and acceptance and without additional cognitive or emotional elaboration. Mindful body awareness is a central component. Training in mindful awareness has been shown to improve attention regulation, emotional processing and body awareness and contribute to reduced pain intensity, catastrophizing, depression and anxiety2,3,4,5. Training in mindfulness has also been shown to modulate brain activity in areas associated with body awareness and pain processing6,7. It is possible that the adaptive modulation of cortical and sub-cortical areas engaged with mindful cognitive, emotional and physical self-regulation could contribute to reducing pain through improving the balance between excitatory and inhibitory mechanisms of the descending pain modulatory system.

One of my patients reflected the clinical benefits of mindfulness training when he said, “I needed to learn how to not freak out when my exercises or daily activities increased my pain. Focusing my mind on the present moment was enormously helpful. I would tell myself, “Breathe. Just be here. Calm down.” By breathing and relaxing I could take control of how I was reacting and I immediately saw a difference. My pain did not increase out of control.”

I am thrilled to be sharing my 30+ year experience in mindfulness and patient care in my upcoming course through Herman and Wallace.

1. Ossipov M, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care 2014;8(2):143-151.
2. Holzel BK, Lazar SW, Guard T, et al. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Science. 2011;6: 537–559.
3. Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Med. 2013 Feb;14(2):230-42.
4. Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One. 2013 Aug 26;8(8):e71834.
5. Schutze , Slater H, O’Sullivan P, et al. Mindfulness-based functional therapy: A preliminary open trial of an integrated model of care for people with persistent low back pain. Front Psychol. 2014 Aug 4;5:839.
6. Zeidan F, Martucci KT, Kraft RA, et al. Brain mechanisms supporting modulation of pain by mindfulness meditation. J Neurosci. 2011 Apr 6;31(14):5540-8.
7. Nakata H, Sakamoto K, Kakigi R. Meditation reduces pain-related activity in the anterior cingulated cortex, insula, secondary somatosensory cortex and thalamus. Front psychol. 2014;5:1489.

The Dilemma of the Multifidus
Treat Men As Equals

Upcoming Continuing Education Courses

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Jan 29, 2021 - Jan 30, 2021
Location: Replacement Remote Course

Postpartum Rehabilitation - Remote Course (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Satellite Lab Course

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Oklahoma City, OK Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Oklahoma Physical Therapy

Pelvic Floor Level 1 - Greenville, SC Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Restore Pelvic Health and Wellness

Pelvic Floor Level 1 - Doylestown, PA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Central Bucks Physical Therapy LLC

Pelvic Floor Level 1 - Annapolis, MD Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Encompass PT

Oncology of the Pelvic Floor Level 1 - Remote Course

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Marietta, GA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 1 - Torrance, CA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Women's Advantage Inc

Lumbar Nerve Manual Assessment and Treatment - Remote Course

Jan 30, 2021 - Jan 31, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted

Jan 30, 2021 - Jan 31, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Brooklyn, NY Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: PT of the City

Pelvic Floor Level 1 - New Orleans, LA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: Ochsner Therapy and Wellness/Ochsner Health System

Pelvic Floor Level 1 - Metairie, LA Satellite Location (SOLD OUT)

Jan 30, 2021 - Jan 31, 2021
Location: East Jefferson General Hospital

Sexual Medicine in Pelvic Rehab - Remote Course

Feb 6, 2021 - Feb 7, 2021
Location: Replacement Remote Course

Osteoporosis Management - Remote Course

Feb 6, 2021 - Feb 7, 2021
Location: Replacement Remote Course

Manual Therapy for the Abdominal Wall - Remote Course

Feb 7, 2021
Location: Short Form Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - West Norriton, PA Satellite Location (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 1 - Wallingford, CT Satellite Location (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 1 - Torrance, CA Satellite Location (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: Women's Advantage Inc

Pelvic Floor Level 1 - Bradenton, FL Satellite Location (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: Thrive Integrated Medicine

Pelvic Floor Level 2B - Self-Hosted (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Brooklyn, NY Satellite Course

Feb 20, 2021 - Feb 21, 2021
Location: PT of the City

Coccydynia and Painful Sitting - Remote Course

Feb 20, 2021
Location: Short Form Remote Course

Pelvic Floor Level 1 - San Francisco, CA Satellite Location (SOLD OUT)

Feb 20, 2021 - Feb 21, 2021
Location: St Francis Memorial Hospital

Pelvic Floor Level 2B - Phoenix, AZ Satellite Course

Feb 20, 2021 - Feb 21, 2021
Location: Spooner Physical Therapy

Pudendal Neuralgia and Nerve Entrapment - Remote Course

Feb 21, 2021 - Feb 22, 2021
Location: Replacement Remote Course