Veterans in Minneapolis VA study used mindfulness to combat chronic pain

Don Allen’s left knee has hurt ever since an accident during his Army service in 1981. His right knee has been acting up as well. But the St. Paul man has one surefire way to blunt the pain:

Doing the dishes.

Mindfulness training from the Minneapolis VA Medical Center taught him to stay focused on present moments and activities, distracting from his physical pain as well as his stress and depression. Allen later discovered that cleaning the kitchen helped him stay in that relaxed zone at night.

“My cousins think I’m crazy for this,” he said.

But he’s hardly alone.

VA researchers have been providing mindfulness training to veterans, alone and in groups, and finding it accelerates pain relief when paired with standard treatments such as medication and physical therapy. Their work, honored last week as the Minneapolis VA’s clinical paper of the year, also showed mindfulness training works online, making it easy to provide anywhere.

“Pain is a difficult thing to address in general. We have so many different approaches. Sometimes, they move the needle. Sometimes, they don’t,” said Collin Calvert, a statistician who co-authored the study. “So seeing any kind of improvement with something like this, hey, that’s pretty important.”

Mindfulness uses breathing, movement, listening, visual or other exercises to help people focus on the present moment and surroundings. The discipline has centuries-old roots in Buddhism and eastern philosophy, introduced in U.S. medicine in 1979 as a stress-reduction program. But it has gained traction as the population ages and seeks alternatives to drugs for pain relief.

Negative emotions or panic can cause pain to intensify and radiate beyond the site of a physical injury or disease such as cancer, said Diana Burgess, the lead author of the research and an investigator at the VA’s Center for Care Delivery Outcomes Research.

“There are these mini-mindfulness practices that might be grounding you when your thoughts are spiraling,” she said. “Focus on your breath. Focus on your sensations. A lot of it is trying to tamp down those negative spirals that cause agitation and contribute to chronic pain.”

Researchers from the VA and the University of Minnesota’s Integrative Health & Wellbeing Research Program condensed a standard, eight-session mindfulness training program to focus on pain relief and combine verbal instructions with a mobile app. Veterans either participated in group online discussions or used the app to learn mindfulness techniques on their own, discussing them one-on-one with a study leader. The randomized clinical trial took place during the COVID-19 pandemic, so all instructional sessions were remote.

Compared to veterans only receiving standard pain management, both mindfulness groups self-reported 30% more pain reduction on average through six months, the paper showed.

Allen said he embraced mindfulness as a source of pain relief because he didn’t want to take narcotic painkillers that could make him less sharp during the day when he teaches high school English. He called it “paying attention on purpose” and said his continued focus on the present moment has also helped him manage stress and depression.

The pain relief also helped him keep pace with his two active teenage sons, though he started scheduling more activities together that are easier on his knees, such as swimming.

Allen said he enjoyed the group sessions during the VA study because he learned more about mindfulness. But he also gained other tips, like the one from a Fergus Falls veteran who swore by the use of Epsom salts in a hot tub for his joint pain.

“It worked!” Allen said.

The VA presented new findings from the mindfulness research last week, showing the group approach was a little more helpful for female veterans in addressing pain intensity.

However, it was less helpful for veterans dealing with anxiety or depression on top of physical pain, Calvert said.

“They just didn’t like being in a group setting if they’re anxious, talking about their pain and their experiences,” he said.

Army veteran Bill Roberts said pain has built up from a variety of service-related injuries. He tore his Achilles tendon in one ankle while in Guantanamo Bay and the rotator cuff in one shoulder while in Afghanistan. Pain on a 10-point scale once hovered at nine, he said, keeping him in bed on some days. Mindfulness brought it down to six or seven at worst.

“If you’ve got back pain,” he said, “you can go out and look at the sunlight and imagine how beautiful it is, and the focus comes off of your back. And now you’re looking at your surroundings.”

The 68-year-old veteran participated in the VA research remotely from his home in Spring Hope, N.C. He is now serving as an adviser to Burgess’ next study, which offers online mindfulness training and other therapies to rural veterans who often struggle to access health care and pain management.

Burgess said the group or individual support sessions likely help veterans overcome skepticism about mindfulness and adopt the exercises in useful ways. However, veterans could also choose to simply use a QR code to download the mindfulness app on their phones and do the exercises on their own.

“Not everybody is going to want to do it,” she said, “but it could be a tool that wouldn’t really cost anything because this stuff is already available.”

The study customized the mindfulness app and training sessions so the veterans felt comfortable with them, but U researchers believe others could achieve the results. They have launched a similar study through their Partners4Pain project to see if mindfulness training helps disadvantaged populations who struggle to afford health care and pain management.

The VA study was novel because veterans continued to report less pain after the instructional sessions, said Roni Evans, director of the U’s wellbeing research program, located at the Earl E. Bakken Center for Spirituality & Healing. “The outcomes ... sustained themselves over time, which is very unusual.”