Integrative Medicine
Complementary and integrative medicine (CIM) is a holistic, interdisciplinary approach to health, designed to treat the person, not just the disease. It is a partnership between the patient and his or her providers. The goal is to treat the mind, body, and spirit concurrently. CIM combines treatments of conventional medicine and elements of complementary and alternative medicine (CAM) when there is strong evidence of safety and effectiveness. The Osher Center for Integrative Medicine at the University of California, San Francisco, states on its website: “Integrative medicine seeks to incorporate treatment options from conventional and alternative approaches, taking into account not only physical symptoms, but also psychological, social and spiritual aspects of health and illnesses.” CIM encompasses Eastern and Western philosophies, mind and body, and individual and family. Most important, CIM is patient centered. It transforms the current medical model into a personalized, proactive, patient-driven approach, which enables engagement with life in accordance with how an individual wants to live. CIM focuses on empowering the consumer through comprehensive education regarding their health and wellness, thereby encouraging active participation in one’s own well-being. Many practitioners in integrative medicine (IM) talk about a cultural change. The Veterans Health Administration thought this was so important that it created a central (national) office of patient-centered care and cultural transformation in 2011. The cultural change or transformation is on both the patient’s and the provider’s side.
The current model of health care is problem based and disease oriented. The focus is on the identification of current problems associated with the disease process and treating them. It is reactive with sporadic intervention. Care is physician-directed in which the physician makes a diagnosis and offers treatment. The Institute of Medicine (IOM) rules for the twenty-first century health care system describe the current approach to health care as focused on care-based visits, driven by professional autonomy with the control of the care left to the health care professionals. The IOM encourages a new view to include care based on continuous healing relationships and customization according to the needs and values of the patient. Integrative care is wellness oriented. It focuses on the identification of and the minimization of risk and addresses the whole person. It is proactive and patient driven by engaging the patient in making pertinent decisions regarding their health. These decisions are often lifelong commitments to healthy changes.
Key elements within CIM are communication and education. An open dialogue occurs between the provider and the patient to align the patient’s expectations with what can realistically be achieved. Integrative health coaches (IHCs) can be an important part of the health care team. They facilitate change by helping to set realistic goals and, most important, by empowering the patients to take control of their own health and wellness, thus laying the foundation for successful, permanent change.
An IHC meets individually with participants in a supportive partnership to facilitate healthy changes in behavior. The IHC creates a dialogue that encourages discussion while offering insights and clarity that may lead to personal discovery. He or she opens the participant to changes that will include the mind, body, and spirit and assists and supports the participant in making and sustaining, often new, healthy behaviors. A wheel of health that encompasses the mind-body connection, nutrition, spirituality, movement and exercise, relationships, environment, and personal and professional development is frequently used to identify which area or areas are most important to the individual participant. This often includes discussions on complementary methods while encouraging modern medical support, blending the best of both in an individualized patient-centered approach to health. Each participant commits to changes he or she thinks are important to them. They are then held accountable for these changes, through future meetings and discussions. Through this relationship, the IHC is able to empower the participants to follow through on the course set and to identify any obstacles he or she may see while creating a path that will guide them past those obstacles.
Topics, such as sleep hygiene, nutrition, and activity, may be discussed in detail and elaborated on after collecting sleep, nutrition, or activity logs from each participant. This method gives insight into the life of each person and allows for the development of one-on-one patient-centered individualized programs addressing any concerns discovered during the review of the various logs. The interventions place an emphasis on the patient’s responsibility in their own health and well-being.
It is probably more appropriate to refer to patients as “participants” in the CIM approach to medical care. By recognizing the connection among the mind, body, spirit and individuals’ interaction within their community, an interdisciplinary team may offer comprehensive, individualized attention facilitated through dynamic dialogue between the consumer and his or her providers. This in turn can lead to greater satisfaction with services offered, an increase in active participation in one’s own health care, and, most important, lifestyle changes that lead to improved well-being.
Complementary and Alternative Medicine
The National Center for Complementary and Alternative Medicine (NCCAM) uses the term “complementary health approaches” and defines two specific subgroups: natural products and mind-body practices. Natural products are herbs and supplements, such as probiotics, vitamins, and minerals. Mind-body practices include a very diverse, large group of techniques or procedures that include acupuncture, massage, meditation, mindfulness, movement therapies, relaxation techniques, spinal manipulation, traditional Chinese medicine (to include tai chi and qigong), yoga, and others not specifically listed. Complementary medicine involves the use of nonmainstream techniques or treatments in conjunction with conventional medicine. Alternative medicine, by contrast, is the use of CAM in place of conventional medicine.
According to the 2007 National Health Interview Survey, approximately 38% of American adults and 12% of children used some type of CAM in the 12 months before the survey. The most commonly used therapies among adults were nonvitamin, nonmineral (i.e., herbal) natural products (18%); deep-breathing exercises (13%); meditation (9%); chiropractic or osteopathic manipulation (9%); massage (8%); and yoga (6%). Back pain (17.1%), neck pain (5.9%), and joint pain (5.2%) were the most common conditions prompting CAM use.
The one area where CAM and Western medicine treatments differ dramatically is the environment in which care is delivered. Whereas Western medicine settings are almost sterile, CAM surroundings are intended to be comfortable and relaxing, thereby allowing patients to participate fully in their sessions. The atmosphere is established by providing a temperate climate, with dimmer lighting, soft music, warm room decorations, and even a mild pleasant aroma. Many hospitals are beginning to incorporate some of these concepts into their waiting rooms and grounds.
Complementary and Alternative Medicine Practices
Whole Medical Systems
Traditional Chinese medicine is probably the best known of the whole medical systems. It uses specific diagnostic evaluations, such as pulse and tongue assessment, and treatments that include herbal prescriptions and interventions, such as acupuncture.
Ayurveda is a whole medical system from India that aims to provide guidance regarding food and lifestyle to either maintain wellness or improve health. It understands that there are energetic forces (Tridoshas) that influence nature and human beings and that there is a strong connection between the mind and the body.
Homeopathy, developed in Germany in the late eighteenth century, focuses on two theories: “like cures like” (i.e., the disease can be treated or cured by a substance that produces similar symptoms in healthy people) and “law of minimum dose” (i.e., the effect is greater at the lowest dose of the medication). Many homeopathic remedies are so diluted that no molecules of the original substance remain.
Mind-Body Medicine
Research over the past several decades has identified interactions between the brain and the immune system, suggesting that the mind-body connection is real. CIM attempts to address this connection to assist and improve well-being. Many of the CAM modalities mentioned actively engage the mind and body, such as the breathing and mindfulness techniques used in qigong, tai chi, and yoga. Mindfulness-based interventions (MBIs) appear to be some of the most rapidly growing areas within CAM. Yoga, tai chi, and qigong are a few common MBIs, but much of the recent focus has been on the mindfulness-based cognitive therapy and mindfulness-based stress reduction programs, both of which are derived from ancient Buddhist and yoga philosophies. These approaches are being used in psychotherapy and can also be applied in the management of pain.
Manipulative and Body-Based Practices
Osteopathy.
Since its founding in the nineteenth century by Andrew Taylor Still, MD, DO, osteopathic medicine, which includes manual manipulation of the spine, has been at the forefront of IM. Dr. Still stressed the importance of the connection among mental, physical, emotional, and spiritual health and taught that each plays an important role in the patient’s overall health. The evidence for manual therapy, as many refer to it, is not overwhelming. However, there does appear to be a role for osteopathic medicine in the management of pain, particularly if treated early. A 2011 Cochrane review looking at the use of manual therapy in low back pain (LBP) showed improved pain and decreased disability in the short term and decreased pain in the medium term for acute/subacute LBP.
Massage.
Massage is a general term for pressing, rubbing, and manipulating the skin, muscles, tendons, and ligaments to aid in relaxation and recovery from injury. Massage therapists typically use their hands and fingers but may also use their forearms, elbows, and even feet. Swedish massage is primarily used for relaxation and is most common in spa settings. Thai massage uses assisted stretching. Shiatsu is a Japanese technique in which finger pressure, often along meridians that may correspond with acupuncture points, is used. Deep tissue massage is used to target trigger points and release chronic muscle tension. Sports massage can be used before events as part of a warm-up, during the event in cases of cramping, and after the event as part of the cool down. Heat can be added to any of the above treatments via warmed stones, topical ointments, creams, or other emollients to aid in relaxation.
Movement Therapies.
Transitional aquatics use aerobic exercise, stretching, and yoga poses that can be done both in and out of the water. Participants use the buoyancy and support that an aquatic environment provides to begin working out. Once muscle tone, flexibility, and balance improve, they can transition to land-based activities, including gaming systems commonly found in homes, such as the Wii Fit , and eventually to classes offered in the community. Other common forms of movement therapy include tai chi, qigong, and yoga.
Acupuncture.
Acupuncture is a form of energy medicine and is one of the more common and more researched of the CAM modalities. It shares with the others a similar treatment setting and a conceptual framework similar to tai chi or qigong life energy called Qi (pronounced chee) and is thought to circulate through all parts of the body through energy channels called meridians. These meridians connect the exterior to the interior and the organs to each other and the exterior. The classical Chinese explanation is that channels of energy run in regular patterns through the body and over its surface. These energy channels (meridians) are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up in others. Pain and illness are thought to occur when the flow of Qi becomes blocked or unbalanced. Acupuncture is one of the treatments used to reestablish the flow of Qi through the placement of needles at points along the meridians, thus allowing the body to return to a homeostasis and easing the ailment for which it was prescribed. The meridians can be influenced by needling the acupuncture points. The acupuncture needles unblock the obstructions at the dams and reestablish the regular flow through the meridians. Acupuncture treatments can therefore help the body’s internal organs to correct imbalances in their digestion, absorption, and energy production activities and in the circulation of their energy through the meridians.
The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain or will trigger the release of other chemicals and hormones, which influence the body’s own internal regulating system. The physiologic reactions of acupuncture effects are beginning to emerge. Stimulation of acupuncture points has been shown to create signal changes in the amygdala, anterior hippocampus, and subgenual cingulate cortex on functional magnetic resonance imaging (fMRI). Other studies confirm these findings, defining the role of the amygdala in affect, fear, and defensive behavior, as well as the processing of pain and motivation. The hippocampus is thought to link affective states with memory processing. The signal decrease within the amygdala and anterior hippocampus is consistent with past acupuncture fMRI studies at acupoints LI-4 and GB-34, as well as ST-36. Ahsin et al. linked electroacupuncture to functional improvement by the measured rise in endorphins and fall in cortisol levels in individuals given electroacupuncture.
The improved energy and biochemical balance produced by acupuncture results in stimulating the body’s natural healing abilities and in promoting physical and emotional well-being. The anatomy of acupuncture points is not clear; however, a theory proposed by Langevin and Yandow suggests that the meridians are located within tissues planes. Acupuncture points occur at a convergence of these planes and meridian Qi is the biochemical and bioelectrical signaling in the connective tissue. A blockage of Qi may lead to an altered connective tissue matrix composition leading to altered signal transduction and therefore pain or other symptoms.
Clinically, acupuncture does appear to be of benefit in some patients. According to the Journal of Rheumatology , there is sufficient evidence to warrant positive recommendations for osteoarthritis, LBP, and lateral epicondylitis in routine care of patients with rheumatic diseases. Acupuncture has been shown to be effective in the treatment of LBP, lateral epicondylitis, shoulder pain resulting from subacromial impingement, as well as headaches. Nausea and vomiting have also shown to be effectively managed by acupuncture.
Acupuncture is an ancient medical modality, with physiologic changes that appear to suggest neurologic and neurochemical effects that can lead to clinical improvement. Many people may benefit from acupuncture, although it is not a panacea.
Supplements.
The National Center for Health Statistics reported that the use of dietary supplements is common among the U.S. adult population. More than 40% used supplements from 1988 to 1994, and more than 50% from 2003 to 2006. Multivitamins, calcium, folate, and vitamin D were among the most commonly used. The number of adults in the United States that ever used herbs or supplements grew slightly, from 50.6 million in 2002 to 55.1 million in 2007. However, the proportion of adults who reported use of herbs or supplements in the past 12 months dropped significantly: from 18.9% in 2002 to 17.9% in 2007.
Herbs and supplements are used for both health and wellness, and although research does not support many, there is a growing level of evidence for some. It is important for the medical practitioner to ask about herb and supplement use and to know where to look for information on specifics of their use. The Natural Standard is a good resource to provide evidence-based information about CAM, including dietary supplements and integrative therapies. The NCCAM also provides evidence-based information for the health care provider.
Vitamin D is a fat-soluble steroid hormone that is synthesized from 7-dehydrocholesterol through a multistep conversion process in the skin when exposed to ultraviolet light. Vitamin D is also absorbed from dietary sources of innate or fortified food. Research suggests that deficiency of vitamin D has been associated with poor health, diabetes, hyperglycemia, depression, muscle weakness, poor balance, and all-cause mortality. Low vitamin D levels have also been associated with depression. Supplementation with vitamin D may be indicated in preventing falls in the elderly with low vitamin D levels. It has also been associated with decreased pain, improved functional mobility and quality of life, and decreased mortality.
N -Acetylcysteine (NAC) is a precursor to the antioxidant glutathione, which is synthesized in the body. Supplementation with NAC therefore increases the production of glutathione. Research supports NAC supplementation as a potential treatment of chronic obstructive pulmonary disease by improving function of small airways and decreasing exacerbation frequency. A study of a 6-month course of treatment with NAC resulted in reduction of influenza-like episodes and severity. NAC shows promise in the treatment of neuropsychiatric disorders, including the treatment of mood disorders, schizophrenia, addiction, and autism. In a study of mice, NAC was demonstrated to induce analgesia and may be useful in the treatment of inflammatory pain.
S-Adenosyl methionine (SAM-E) is a methyl-donor produced and used in the liver. Studies have shown that SAM-E supplements have comparable antidepressive efficacy as imipramine in patients with major depression. It is promising as an adjunct treatment for antidepressant nonresponders with major depressive disorder, and its use resulted in lower erectile dysfunction when used with antidepressants. Patients with chronic hepatitis C showed an improved response when treated with PEGylated interferon alpha and SAM-E. Controlled clinical studies have also shown that SAM-E is as effective in the treatment of knee osteoarthritis as treatment with nabumetone and celecoxib.
Glucosamine (amino sugar) and chondroitin sulfate (sulfated glycosaminoglycan) have had some controversy and mixed clinical reports regarding efficacy for the treatment of arthritis, and guidelines vary for use of these compounds in the setting of hip and knee arthritis.
Methylsulfonylmethane (MSM) is frequently used in arthritis; however, there is a paucity of studies on MSM. Some trials suggest efficacy in the treatment of osteoarthritis of the knee, decreased muscle damage after exercise, and in animal models of arthritis. Other analyses suggest nonefficacy for human arthritis.
Alpha-lipoic acid (ALA; organosulfur compound derived from octanoic acid) is used as a treatment of diabetic sensory-motor neuropathy. Trial results have been mixed, and case reports suggest a potential for precipitating insulin autoimmune syndrome.
Magnesium is an alkaline earth metal. It is necessary for several hundred cellular enzymatic reactions, such as those synthesizing ATP, DNA, and RNA. Only a very small portion of the body’s magnesium is stored in the extracellular compartment (1%). Sixty percent is in the skeleton, and 39% is in the intracellular compartment (20% in skeletal muscle). Therefore serum magnesium measurements are thought to be a poor reflection of total body magnesium stores. Magnesium deficiency is associated with diverse conditions, such as asthma, diabetes, metabolic syndrome, elevated C-reactive protein, hypertension, atherosclerotic vascular disease, sudden cardiac death, osteoporosis, migraine headache, asthma, and colon cancer. A variety of oral forms of magnesium are available for use in supplementation. Magnesium oxide contains a high level of magnesium by weight but is insoluble in water and not bioavailable, particularly in comparison with magnesium citrate. An important note is that chronic proton pump inhibitor use is associated with hypomagnesemia.
Calcium and strontium contain nearly the same size atomic nucleus. As a result, strontium is readily taken up by bones and tooth enamel. Strontium ranelate is approved as a prescription drug for the treatment of osteoporosis in Europe and other countries but not in the United States. Strontium ralenate is thought to be effective in both women and men. It has been found to be effective in the treatment of knee arthritis. Strontium citrate is available in the United States as a nutritional supplement. Animal studies indicated that strontium citrate is taken up by bone in greater concentration than the ralenate form, although no clinical trials have yet been conducted with the citrate form. The higher atomic number of strontium (38, compared with 20 for calcium) may create difficulty in the assessment of treatment efficacy based on dual-energy x-ray absorptiometry (DXA) scans.
Fish oils contain the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. These fatty acids are precursors of eicosanoids, signaling molecules that control myriad body functions, including those of the central nervous system, inflammation, and immune function. An uncontrolled study suggested efficacy for discogenic pain. Fish oil reduces the need for rescue nonsteroidal antiinflammatory drugs (NSAIDs) in primary dysmenorrhea, decreases dysmenorrhea in adolescents, and increases walking distance in persons with claudication secondary to peripheral arterial disease (PAD). In conjunction with a low arachidonic acid diet, fish oil has an antiinflammatory effect on persons with rheumatoid arthritis, and some patients are able to discontinue taking NSAIDs and concomitant antirheumatic medication. Fish oil also has other important functions in the treatment of depression and attention deficit hyperactivity disorder (ADHD) in children. It is associated with lowered risk of breast cancer, may improve function in patients with heart failure, and may lower triglycerides.
Qigong
Qigong (pronounced chee-gung) is a “moving” mindfulness practice, which uses slow graceful movements often with coordinated breathing to promote the circulation of Qi (“energy flow” or “life force”) within the human body, to enhance overall health, relaxation, and mental focus. There are several forms of qigong, which allow for it to be practiced in standing, sitting, and lying positions; some with little or no movement at all. In its simplest form, the Chinese character for Qi, in qigong, can mean air, breath, or “life force.” Gong means work, so qigong is therefore the practice of “working” with ones’ “life force.”
Qigong is often confused with the Chinese martial art of tai chi. This misunderstanding can be attributed to the fact that most Chinese martial arts practitioners will usually also practice some form of qigong. It is best to think of qigong as the roots and trunk of the tree whose branches form much of the eastern martial arts.
The great appeal of qigong is that anyone can practice it, regardless of their fitness level, age, belief system, income, or life circumstances. Qigong may benefit anyone, from the most physically challenged to the super athlete.
Most physicians in the Western world view qigong as a set of breathing and movement exercises with benefits to health through stress reduction and exercise. One of the more important long-term effects is that qigong is said to reestablish the body-mind-spirit connection. When these three aspects of our being are integrated, it is thought to encourage a positive outlook on life and help eliminate harmful attitudes and behaviors.
Research supports these thoughts in many areas. Metaanalysis and systematic reviews support the use of qigong to improve stress and anxiety, as well as depression. A randomized controlled trial indicated that medical qigong can improve the overall quality of life mood status of patients with cancer and reduce fatigue. Evidence also supports the use of qigong in patients with fibromyalgia, showing significant improvements in pain and sleep, as well as physical and mental function, when compared with the wait list/usual care control group. The benefits extended well past the 8-week study period, with significant changes noted for 6 months.
A review of the scientific literature published in the American Journal of Health Promotion suggests that there is strong evidence of beneficial health effects of both tai chi and qigong, including bone health, cardiopulmonary fitness, balance, and quality of life. Because of the apparent similarities between tai chi and qigong, the researchers reviewed the literature on both practices together. The review, conducted by the Institute of Integral Qigong and Tai Chi (Santa Barbara, California), Arizona State University, and the University of North Carolina, included 77 articles reporting on 66 randomized controlled trials that included 6410 participants of tai chi and qigong. Most of the studies used a nonexercise control group, but some included a control group that practiced other forms of exercise, whereas others included both exercise and nonexercise groups as controls. They concluded that the strongest and most consistent evidence of health benefits for tai chi or qigong is for bone health, cardiopulmonary fitness, balance, and factors associated with preventing falls, quality of life, and self-efficacy (the confidence in and perceived ability to perform a behavior). They went on to suggest that tai chi and qigong are viable forms of exercise with health benefits. Because of the similarities in philosophy and critical elements between tai chi and qigong, they thought that the outcomes could be analyzed across both types of studies.
Tai Chi
Tai chi (TIE-chee) involves performing a series of postures or movements in a slow, graceful manner. It is often referred to as “meditation in motion.” Each posture flows into the next without pause, ensuring that the body is in constant motion. Forms of tai chi include rhythmic patterns of movement synchronized with breathing.
Similar to qigong, most forms are gentle and suitable for everyone, regardless of age or physical ability, as technique is emphasized over speed or strength. It is inexpensive, requires no special equipment, can be done indoors or outdoors, and alone or in a group.
Beyond the study mentioned above, further evidence supports the benefits of tai chi. It has been used for years in patients with Parkinson disease. Studies have shown that tai chi training reduces balance impairments in patients with mild-to-moderate Parkinson disease. Additional benefits included improved functional capacity and reduced falls.
Practicing tai chi with defined goals as part of a rehabilitation program was found to be more effective than the rehabilitation program alone in improving the performance of activities of daily living.
Tai chi practice may exert its effects by changing brain shape. A controlled study compared tai chi practitioners with controls and showed significantly thicker cortex in the precentral gyrus, insula sulcus, and middle frontal sulcus in the right hemisphere, and the superior temporal gyrus, medial occipitotemporal sulcus, and lingual sulcus in the left hemisphere. Greater intensity of tai chi practice was associated with a thicker cortex in left medial occipitotemporal sulcus and lingual sulcus. These findings suggest that committed long-term practice may induce regional structural change, suggesting that tai chi might share similar patterns of neural correlates with meditation and aerobic exercise.
A National Institutes of Health (NIH) comprehensive review of health benefits of qigong and tai chi concluded that research has demonstrated consistent, significant results for a number of health benefits in randomized controlled trials, and suggested a similarity and equivalence of qigong and tai chi.
Tai chi is simply a safe and effective form of physical exercise. As noted, it enhances cardiovascular fitness, muscular strength, balance, and physical function. It also appears to be associated with reduced stress, anxiety, depression, and improved quality of life. Tai chi can be safely recommended to patients with osteoarthritis, rheumatoid arthritis, and fibromyalgia as a CAM approach to affect patient health and wellness.
Yoga.
With many different types of yoga being practiced today, it may be difficult for patients to figure out which style fits them best, and discovering which type of yoga meets their needs. The following is a quick explanation of five of the most common yoga styles practiced.
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Hatha originated in India in the fifteenth century and is slow-paced, gentle, and focuses on breathing and meditation.
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Vinyasa synchronizes breath with movement as one moves through some basic poses. It is a variety of Hatha yoga emphasizing the Sun Salutation, a series of 12 poses in which movement is matched to the breath.
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Ashtanga is a fast-paced and intense form of power yoga that incorporates lunges and push-ups.
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Iyengar covers all aspects of Ashtanga yoga and uses props, such as straps, blankets, and blocks, to assist in strengthening the body while maintaining a focus on body alignment. Standing poses are emphasized and are often held for long periods of time.
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Bikram is a series of 26 poses practiced in a room that is 95° to 100°, which allows for sweating and loosening of tight muscles.
These are only a few of the many styles of yoga.
Research has shown a benefit to yoga practice. In one study, the yoga group significantly improved standing balance, sit-to-stand test, 4-m walk, and one-legged stand with eyes closed compared with a control group.
In another study, the postyoga testing showed a significant decrease in the heart rate and respiratory rate. Maximum changes were seen in autonomic variables and breath rate during the state of effortless meditation (Dhyāna). The changes were all suggestive of reduced sympathetic activity and/or increased vagal modulation.
In a population with traumatic brain injury, one study revealed that the yoga group demonstrated significant longitudinal change on measures of observed respiratory functioning as well as self-reported physical and psychological well-being over a 40-week period. The control group, by contrast, showed marginal improvement on two of the six measures of respiratory health, physical and social functioning, emotional well-being, and general health. The small sample sizes precluded the analysis of between-group differences. This study suggests that breath-focused yoga may improve respiratory functioning and self-perceived physical and psychological well-being of adults with severe traumatic brain injury.
One study of yoga on patients after stroke did not find significant changes in depression or anxiety in those practicing yoga. However, they did report that comparison of individual case results were clinically relevant. Participants reported no adverse events, and the study experienced high retention of participants and high compliance in the yoga program. They concluded that yoga after stroke is a feasible, safe, and acceptable intervention, but additional investigations with larger sample sizes are needed.
Meditation/Mindfulness.
Meditation has been practiced for thousands of years and, today, is commonly used for relaxation and stress reduction. Attention is focused to help control the stream of stressful thoughts, which may result in enhanced physical and emotional well-being. Anyone can practice meditation. It is simple, does not require special equipment, and can be practiced anywhere.
There are numerous types of meditation and ways to meditate. The following are a few examples:
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Guided imagery or visualization allows the practitioner to form mental images of relaxing places or situations, incorporating as many senses as possible.
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Mantra meditation, of which, transcendental meditation is a type, is simply the repeating of a calming word, thought or phrase, often silently, which may prevent distracting or troubling thoughts.
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Mindfulness meditation creates an increased awareness of the present moment, focusing on your experience during meditation, such as breathing, seeing, hearing, smelling, tasting, and touching. Seeing your thoughts and emotions, you let them pass without judgment.
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Prayer is the best known and most widely practiced example of meditation.
Although meditation and mindfulness have been a significant part of the human experience for millennia, modern medicine has recently shown an increased interest in meditation and mindfulness, primarily as a result of Jon Kabat-Zinn’s work on stress reduction. In a 1982 article, he described a 10-week stress reduction and relaxation program to train patients with chronic pain in self-regulation. He reported on 51 patients with chronic pain who had not improved despite modern medical interventions. At the end of the 10 weeks, he noted 65% showed a reduction of 33% or more in mean total pain rating, whereas 50% showed a reduction of 50% or more. He also reported improvement in mood and psychiatric symptoms.
One study used fMRI to assess the neural mechanisms by which mindfulness meditation influences pain in healthy human participants. Each participant underwent a 4-day training period in which they learned mindfulness meditation techniques. A painful stimulus was applied at rest, to establish a baseline, then applied again while they were practicing the mindfulness meditation they were taught. The study found a reduction in pain unpleasantness by 57% and pain intensity ratings by 40% when the participants were practicing mindfulness meditation. The fMRI was then reviewed, and they found that meditation reduced pain-related activation of the contralateral primary somatosensory cortex. In addition, meditation-induced reductions in pain intensity ratings were associated with increased activity in the anterior cingulate cortex and anterior insula, areas involved in the cognitive regulation of nociceptive processing. Reductions in pain unpleasantness ratings were associated with orbitofrontal cortex activation, an area implicated in reframing the contextual evaluation of sensory events. The drop in pain unpleasantness appeared to be associated with thalamic deactivation. They thought this might reflect a limbic gating mechanism involved in modifying interactions between afferent input and executive-order brain areas. This study seemed to show that meditation engages multiple brain mechanisms that may alter the pain experience from the afferent information.
Mantram repetition has been shown in two randomized controlled trials to assist in managing psychological distress in patients with HIV and to reduce symptoms in self-reported and clinician-rated posttraumatic stress syndrome symptom severity.
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