Mindfulness as medicine at St. Michael’s

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A straightforward, low-tech treatment offered at St. Michael’s Hospital in Toronto has provided relief to thousands of chronic pain sufferers across Ontario. It’s not a drug, although it does need to be taken regularly – once-a-week for several weeks. It’s not surgery, although it can lead to changes in the brain.

The treatment is a class in mindfulness meditation. Every week, participants gather at the hospital to learn how to think differently about their ailments, and suffer less from them.

In short bursts, pain can be very useful. It’s a signal to our brains that something in the body is weakened or injured and needs to be addressed. Once we’re strong again, the pain lifts, letting us know that we’re ready to return to our normal activities.

But for about one in five Canadians, the pain doesn’t go away. That’s chronic pain. It’s common, debilitating and can be very difficult to treat.

“For some of my chronic pain patients, even the strongest medications didn’t work well,” said Dr. Jackie Gardner-Nix, an associate physician in the St. Michael’s Department of Anesthesia. “But I’ve seen this training reduce, and in some cases even eliminate, many of my patients’ needs for medications and procedures.”

has provided mindfulness-based chronic pain management training at St. Michael’s since 2002. Through meditation, self-reflection and group discussion, participants learn to see the connection between their physiological symptoms and their emotional reactions to those symptoms. Studies have shown that the brain can much better tolerate and quiet painful sensations when it’s not flooded with negative emotions at the same time.

“Even if the training doesn’t reduce patients’ pain sensitivity, the suffering is less,” said Dr. Gardner-Nix. “I like to say that my patients are learning to collaborate with their pain, rather than fight it.”

This kind of collaboration may sound easier said than done. That’s why the intervention is offered through a class: accepting our inner and outer experiences with acceptance, patience and compassion is a skill that must be learned and practiced.

Based on Buddhist principles, the first mindfulness-based stress reduction program was developed by Jon in 1979. His program has since been adapted as a complementary medicine for a wide range of health conditions, from multiple sclerosis to irritable bowel syndrome.

Dr. Gardner-Nix made her own adaptations to Kabat-Zinn’s program after attending one of his workshops in New York.

“It was a life changing experience,” she said. “As soon as I came back, I met with our chief of anesthesiology to tell her about the program. We agreed that it was something that our chronic pain patients should have access to.”

Dr. Gardner-Nix’s tailored program differs from Kabat-Zinn’s in that it focuses specifically on chronic pain management. Courses are offered over a longer term, allowing some flexibility for patients who may need to miss a class when they’re not feeling up to it. However the basic principles are the same, and it’s received Kabat-Zinn’s mark of approval: he wrote the foreward to Dr. Gardner-Nix’s book, The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management.

In response to high demand, Dr. Gardner-Nix now delivers mindfulness-based chronic pain management training through videoconferencing as well as in-person, in collaboration with both the St. Michael’s Hospital and Sunnybrook Health Science’s Telemedicine Programs. Over the past 10 years, thousands of people from more than 40 communities have completed her course. Dr. Gardner-Nix is now training facilitators in how to lead their own programs, to try and address an ever-growing waiting list.

Most participants access Dr. Gardner-Nix’s program through referrals by their physicians. The training is almost completely covered by OHIP. Patients are welcome to repeat courses – and often do – but can access further support at home through Dr. Gardner-Nix’s book. She’s also developed several audio programs with guided imagery and sitting, walking and sleep meditations.

“When traditional treatment fails, chronic pain patients are often told they need to learn to live with the pain,” said Dr. Gardner-Nix. “In a way, that’s true. That’s why this intervention is so important: it’s one of the only ones out there that can actually teach patients how to do that successfully.”