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How Mindfulness Can Help Manage Neuropathic Pain

This is an arti­cle by Julie Sin­clair and Salma Ange­linet­ta and was includ­ed in the Feb­ru­ary 2022 issue of Pain Press — The Pain Mat­ters Supplement.

Although it’s not as com­mon as the more gener­ic ‘chron­ic pain’, neu­ro­path­ic pain is thought to affect up to 8% of the pop­u­la­tion in the UK alone. The term is defined by the Inter­na­tion­al Asso­ci­a­tion for the Study of Pain as ‘pain caused by a lesion or dis­ease of the somatosen­so­ry ner­vous sys­tem’, and is essen­tial­ly how we describe any of the unwant­ed sen­sa­tions (e.g., pain, aches, tin­gling, itch­ing, burn­ing, etc.) that can be expe­ri­enced fol­low­ing dam­age to nerves. The prob­lem may lie in the nerves leav­ing the spinal cord (the periph­er­al ner­vous sys­tem) or in the cen­tral ner­vous sys­tem (the brain and spinal cord). This dam­age to nerves can give rise to any num­ber of changes for in indi­vid­ual, from numb­ness, increased sen­si­tiv­i­ty and pain, to expe­ri­enc­ing weak­ness and spasms or changes in tem­per­a­ture and sweating. 

As a form of chron­ic pain, drugs may be pre­scribed as part of the pain man­age­ment, but due to the nature of neu­ro­path­ic pain reg­u­lar painkillers are often inef­fec­tive. Sim­i­lar­ly, peo­ple who have neu­ro­path­ic pain have often not respond­ed well in tra­di­tion­al pain man­age­ment pro­grammes, due to their dif­fi­cul­ty man­ag­ing sud­den increas­es in pain com­mon to sufferers. 

Man­age­ment through mind­ful­ness 

The team at the Pain Man­age­ment Cen­tre at Uni­ver­si­ty Col­lege Lon­don Hos­pi­tals realised a dif­fer­ent approach was need­ed. Based both on their clin­i­cal expe­ri­ence of neu­ro­path­ic pain and feed­back from their patients, they con­clud­ed a tai­lored pro­gramme would be more help­ful and believed some com­mon neu­ro­log­i­cal pain symp­toms might respond well to a mind­ful­ness-based cog­ni­tive ther­a­py approach. They devised a pro­gramme cen­tred around mind­ful­ness and med­i­ta­tion called the Matrix pro­gramme, named after the term ‘pain neu­ro­ma­trix’, which some sci­en­tists use to refer to changes in the ner­vous sys­tem that devel­op in peo­ple liv­ing with chron­ic pain. Salma Ange­linet­ta, a phys­io­ther­a­pist and Julie Sin­clair, a clin­i­cal psy­chol­o­gist, have been part of the team run­ning this programme. 

The med­i­ta­tion prac­tices taught in the pro­gramme encour­age par­tic­i­pants to adopt a dif­fer­ent rela­tion­ship with pain, almost akin to tak­ing an outsider’s view of the sit­u­a­tion, where they prac­tice observ­ing the sen­sa­tions of pain with curios­i­ty, rather than try­ing to stop of reduce it. Grad­u­al­ly, par­tic­i­pants learn to iden­ti­fy and observe the thoughts, emo­tions and phys­i­cal sen­sa­tions asso­ci­at­ed with pain and life in general. 

The skills they devel­op help them to reduce get­ting car­ried away by their thoughts and to focus on present-moment expe­ri­ences, such as their breath or the feel­ing of their feet on the floor. Par­tic­i­pants are encour­aged to notice changes in their thoughts and how the mind reacts to their feel­ings and body sen­sa­tions dur­ing the day and when expe­ri­enc­ing pain flares or dif­fi­cult experiences. 

Julie explains: ‘Whether it is thoughts such as “I can’t cope with this”, “this is killing me” or “I shouldn’t feel like this”, learn­ing to recog­nise the way the mind works makes it pos­si­ble to respond in a more help­ful way, rather than in an auto­mat­ic man­ner.’ Once peo­ple begin to recog­nise and make room for thoughts, emo­tions and body sen­sa­tions as they are and with­out resis­tance, they can begin to let go of them and to focus their atten­tion and ener­gy on things that are of val­ue to them. 

Enter the Matrix 

The Matrix pro­gramme con­sists of eight day-long ses­sions, once a week for eight weeks. The med­i­ta­tion prac­tices taught in the groups can be done lying down (the body scan), sit­ting (mind­ful­ness and breath­ing) and dur­ing activ­i­ties and exer­cise (mind­ful­ness of move­ment). As well as these, there are also infor­ma­tion and edu­ca­tion­al ses­sions on a range of top­ics deal­ing with pain and pain man­age­ment, such as the role of the cen­tral ner­vous sys­tem in pain, sleep and medication. 

The Matrix team con­sists of a psy­chol­o­gist, a phys­io­ther­a­pist and a spe­cial­ist pain nurse to embrace a holis­tic, biopsy­choso­cial approach to chron­ic pain. Patients ini­tial­ly attend a one-hour assess­ment with the phys­io­ther­a­pist and psy­chol­o­gist, where they explore their pain jour­ney, their life val­ues, the impact pain has on their lives, their under­stand­ing of the mind­ful­ness-based approach and ulti­mate­ly their goals for attend­ing the programme. 

Julie states: ‘Par­tic­i­pants have shared with us how often they get caught up in thoughts, dwelling on the past and the future – try­ing to solve things that can’t be solved or avoid­ing things that make them feel bad, instead of con­nect­ing with mean­ing­ful life activities.’ 

Dur­ing the pro­gramme, par­tic­i­pants learn to notice how the mind strug­gles with unpleas­ant thoughts and feel­ings relat­ed to pain. Through med­i­ta­tion prac­tices they are encour­aged to notice the ten­den­cy to push dif­fi­cult events away, a response which can actu­al­ly lead to increas­es in dis­com­fort and occa­sion­al­ly even wors­en­ing symptoms. 

A key part of the pro­gramme comes with its focus on the impor­tance of liv­ing a life based on val­ues, refer­ring back to par­tic­i­pants’ goals, which are defined togeth­er with the Matrix team in order to be spe­cif­ic, mea­sur­able, achiev­able, rel­e­vant and time-spe­cif­ic – and always based on the patient’s val­ues. In this way, patients are encour­aged to move in the direc­tion that mat­ters to them, even in the pres­ence of unwant­ed expe­ri­ences caused by pain. 

Although still ear­ly in its exis­tence, indi­vid­u­als who have already par­tic­i­pat­ed in the pro­gramme have report­ed high lev­els of sat­is­fac­tion from the group inter­ven­tion and have expressed grat­i­tude for the help received. The suc­cess of the approach has meant that while it was ini­tial­ly cre­at­ed specif­i­cal­ly for peo­ple expe­ri­enc­ing neu­ro­path­ic pain, the pro­gramme has since been extend­ed to include any patients who are inter­est­ed in mind­ful­ness-based approach­es to pain management. 

Salma states: ‘We try to deliv­er the pro­gramme in a com­pas­sion­ate, respect­ful and curi­ous man­ner and under the frame­work of self-kind­ness and self-accep­tance. We believe that if par­tic­i­pants can be helped to sep­a­rate the expe­ri­ence of bod­i­ly feel­ings and emo­tions from the thoughts and ‘sto­ries’ that appear in the mind, they are able to man­age their pain more effec­tive­ly and life a fuller, more ful­filled life.’ 

Julie Sin­clair is a Clin­i­cal Psy­chol­o­gist at UCLH Pain Man­age­ment Cen­tre. Salma Ange­linet­ta is a High­ly Spe­cial­ist Phys­io­ther­a­pist in pain man­age­ment and works at the Pain Man­age­ment Cen­tre at UCLH. Both are inter­est­ed in the use of mind­ful­ness-based approach­es to sup­port peo­ple liv­ing with pain. 

Any­one affect­ed by neu­ro­path­ic or chron­ic pain can access a whole host of free resources on, or call the Pain Con­cern Helpline on 0300 123 0789. 

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