1. What is mindfulness in the context of arthritis pain as well as other forms of pain? What is its importance to patients with chronic conditions?

Mindfulness is a state of mind which enables one to step back and simply observe, without judgment, how one’s mind, and body are behaving at the moment. As a consequence, one can separate pain-a purely physiological response to a noxious stimulus, from the suffering, which is an emotional and cognitive response to that stimulus. Suffering is a result of what the pain means to someone, a meaning which is linked to the pain immediately and often unconsciously by the deeper emotional parts of the brain, broadly called the limbic system. For example, pain in a hip might remind someone that they are getting old, fast approaching the age at which their grandmother had a hip replacement because of arthritis, and shortly thereafter died. Chronic pain can lead people to conclude that their life will never be the same; that they cannot enjoy, or be engaged in, their usual pursuits. These types of automatic assumptions cause the pain to have an added dimension, which is what we call suffering–having trouble enduring the pain. In addition, there is a clear and consistent relationship between chronic pain and depression. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain than persons without a depressive or anxiety disorder. One can say that they ‘travel together’. In fact, depression and pain share many of the same pathways and molecules. And, when depression is worse, pain follows suit and visa versa. Additionally many of the treatments for the two conditions overlap, with anti-depressants helping pain, and treatments for rheumatoid arthritis (as one example) actually have antidepressant effects. The molecular link between many types of pain, including arthritis, are cytokines. Cytokines are the ‘hormones of the immune system’, which cause pain, inflammation, and we have recently discovered, depression. This of course has implications for the treatment of depression, i.e., anything that reduces inflammation [mindfulness training] will reduce depression. Finally, mindfulness has recently been shown to reduce levels of some inflammatory molecules, which cause pain. When one engages in mindfulness practices, one can step back and watch the thoughts around the pain, actually notice what the pain is (and is not), and begin to realize that they can choose how they hold the meaning of the pain, rather than allowing their run away mind automatically tagging the pain with a fear based meaning, and worse, begin to identify with their pain (e.g., “I am an arthritic”). As a result, fear of the pain, and anticipation of the pain are reduced. As the suffering is alleviated, and muscles relax and stress systems (e.g., the adrenal glands, the immune system) begin to heal, the pain itself can be reduced to some degree.