Meditation for Stress and Pain with Karen Eastman, Ph.D., Lobsang Rapgay, Ph.D., and Lonnie Zeltzer, M.D.

Last Editorial Review: 10/23/2003

Karen Eastman, Ph.D., Lobsang Rapgay, Ph.D., and Lonnie Zeltzer, M.D., will be discussing ways to use meditation for pain and stress relief.

WebMD Live Events Transcript

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Today we will be discussing Meditation for Stress and Pain with Karen Eastman, Ph.D., Lobsang Rapgay, Ph.D., and Lonnie Zeltzer, M.D.

Karen Eastman, Ph.D., is currently the Assistant Director of the University of California Los Angeles/RAND Center for Adolescent Health Promotion. Previously, Dr. Eastman directed a preliminary study in the Department of Pediatrics on the effects of meditation on patients with inflammatory bowel diseases. She assisted the interventionist in the writing of the meditation manual for this project. She has also studied treatment outcomes for depression among Chinese Americans. She has also collaborated on a review of cross-national research on child and adolescent psychopathology, empirical studies of the difference in the behavioral and emotional problems of Thai and American adolescents, and maternal beliefs about common problems and help-seeking behaviors. Dr. Eastman also has extensive clinical experience with adolescents and families, including leading group therapy sessions for parents and adolescents. She has also ... students in the U.S. and Hong Kong.

 Lobsang Rapgay, Ph.D., is an assistant clinical professor in the Department of Psychiatry and Behavioral Sciences at the University of California Los Angeles. He was a clinical instructor in the Mind Body Medical Institute at the Harvard Medical School. He has had major research interests in psychotherapy for patients with life-threatening illnesses focusing on end stage of life issues and the role of meaning, psychotherapy and its application in a hospital setting, and psychotherapy and mind body medicine for medical illnesses.

Lonnie Zeltzer, M.D., is an expert in the field of pediatric pain. She is a former president of the Society for Adolescent Medicine and member of the National Institute of Health's Human Development Study Section. She is currently a Professor of Pediatrics and Anesthesiology at the UCLA School of Medicine. She is Director of the UCLA Pediatric Pain Program and Associate Director of the Patients & Survivors Section, Cancer Prevention and Control Research Branch of the UCLA Jonsson Comprehensive Cancer Center. She has well over one hundred scientific publications, reviews and chapters in medical journals, and has lectured internationally.

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Drs. Eastman, Rapgay and Zeltzer, welcome to WebMD Live.

Dr. Zeltzer: I'm delighted to have Dr. Eastman and Rapgay here. Both have worked independently doing meditation for a long time, as well as the three of us together on a research project. Maybe to start, Dr. Rapgay, what is meditation?

Dr. Rapgay: Meditation is generally described as a simple technique to focus the mind on a single object, whether it's your breath, your body, a picture or a visual object. However, meditation from a traditional eastern perspective has a broader meaning and it covers the whole gamut of developing various states of the mind -- from the sensory, cognitive and imaginative.

Dr. Eastman: I just will add, I think that people conceptualize meditation differently and some people focus on the focus. There are common elements to everyone's conceptualization of meditation.

Dr. Zeltzer: How is meditation, Dr. Rapgay, different from other kinds of things that people do with their mind that help them better, like use of imagery or hypnosis, for example?

Dr. Rapgay: Meditation requires a conscious state of mind and at the same time it requires capacity to focus and totally engage with the objects. So, to some extent it's similar to hypnosis, but there is a difference. In meditation there is not active encouragement to go into a trance-like state. In fact, it's contra-indicated.

Dr. Zeltzer: Does meditation make you socially exclusive and not connected with other people?

Dr. Rapgay: Well, overall, meditation does not seek to do that. It actually tries to help you develop initially internal states of mind which do have for an initial period of time, does isolate you from other people in the sense that it's an internal process done privately within the confines of your own self. However, the goal, once you learned to regulate yourself internally, then meditation, advanced forms of meditation teach you how to engage with other people.

Dr. Zeltzer: Dr. Eastman, did you have something you wanted to add?

Dr. Eastman: The idea that meditation makes you an introvert in some way may, in part, be related to the tradition of people going, or withdrawing really from the world and seeking maybe a connection to some universal spirit or god. But, actually as people have worked and have different conceptualizations, I think meditation has been used among people who are very much in the world and relating to other people. As well, the technique itself can be experiencing and sitting with a feeling of whatever emotion you may have. So, in that capacity you're not disengaging from emotion, but actually sitting with the feeling.

Dr. Zeltzer: I know there are many different types of meditation -- Dr. Rapgay, can you talk about the different types of meditation?

Dr. Rapgay: Generally, you want to talk about meditation in the way it's been used in the west in broad categories, for health purposes and the other is for spiritual or individual development. Traditionally, in eastern religions, meditation is a multi-faceted complex intricate practice and process. You start with meditation designed to help you develop sensory levels, and then to the analytical, and then to the affective or emotional based meditation, and then finally you move on to the imaginative meditation.

Dr. Zeltzer: Dr. Eastman or Dr. Rapgay, how would you use meditation for pain management? If someone came to you in your clinic with severe headaches, and they've tried medication and nothing is working, and want to look for alternative therapies besides drugs to help manage their headaches. How would you help them use meditation for their headaches?

Dr. Rapgay: It will depend on the nature of the pain and the person's coping style. Based on that you can use different types of meditation. For someone who doesn't have extreme pain and has good coping styles you can use what we call a focusing meditation, which is where you help them focus on their breath or the movement of their belly button to the exclusion of every other experience and, in that regard, even with the pain you help them stay engaged completely with the breath. For those with more chronic pain then mindfulness or what we in Tibetan Buddhism called awareness meditation. Others call it mindfulness meditation. In this approach you anchor your mind on the breath. However, a patient is encouraged to gradually incorporate all sensations and experiences and expand his sense of awareness while focused on the breath. That's another technique. Then there is a third where patients can respond to affect and emotional responses. Use of emotions can help them cultivate strong positive emotions and use that as a way to deal with the pain.

Dr. Zeltzer: Dr. Eastman or Dr. Rapgay, how do you think meditation works to reduce pain? What do you think happens when a person with pain begins to learn to meditate, whichever technique you use. What do you think happens to reduce the pain and help them to feel better?

Dr. Rapgay: Well, meditation, the way it appears that meditation works to help pain is that it does help to regulate the stress reactivity that is involved with pain. For instance, it begins to decrease vital body functions such as your breathing goes down and if your breathing rate goes down your metabolism also begins to regulate itself and your tendency to react to pain and discomfort in a fight or flight mode begins to subside. And that, indirectly, helps the pain. But more importantly the benefits are often at the cognitive or emotional levels. You learn how to separate the sensation of pain from the cognitive associations or affective associations and projections on the pain.

Moderator: Do you see an eventual integration between Buddhism and the art of meditation with Yoga and its practices?

Dr. Rapgay: That's one thing. Secondly, you learn how to stay with the sensation of the pain for extended periods of time and then by notating the sensations you begin to have a conceptual sense that this is pain and is awful and is hurting and so forth.

Dr. Zeltzer: So Dr. Rapgay, are you saying that what seems to happen is that you learn to separate out the sensory, sensations, the feeling parts of the pain from the meaning of the pain and the emotion and distress associated with those sensations, and that becomes less distressing as you focus more on yourself and your other feelings and thoughts and sense of self?

Dr. Rapgay: Very much so.

Dr. Eastman: It just makes me think of, back to the example of having a headache, I think about how often if you have a pain like that, most of your body is sort of wanting to avoid and distract against it and you're not even aware of how much you're fighting it. And, one aspect of the techniques described here for just a simple headache, you sit and become aware of and feel the feeling and yes, it hurts, but somewhere in the process of attending to that you become aware of the part of you that is attending, this other part of you that feels and is not exactly the pain. And sometimes in that process there can be tolerance or a reduction.

Dr. Zeltzer: When someone is first learning to meditate, for a pain problem... how often should they be meditating, and for how long? How many times a week or day? And how often should they be going to a teacher to learn and reinforce and learn those next steps?

Dr. Rapgay: Generally, you begin by meditating at least for 20 minutes once a day, or two 10-minute sessions once a day, preferably in the morning before breakfast. And then if it's two sessions then an early evening session would be most appropriate. You should find a quiet place at home which would be used regularly and it's preferable that you sit cross-legged or at least upright. Lying down is discouraged unless you have physical reasons to do so. It's important that you notate or keep record of your experiences because meditation is such a subjective process and to get full benefit you need to record carefully your experiences and share it with your teacher at least once a week at first and then taper it off to once every two weeks.

Dr. Eastman: Sometimes it's hard at the beginning to sit for even 10 minutes. And one of the things that a teacher can help with is to reinforce or encourage you to continue trying even though it may not feel like it's always working initially.

Dr. Zeltzer: Dr. Rapgay or Dr. Eastman... if meditation involves such a sense of being, and does not involve any particular body work, are there any advantages to either receiving or following meditation with body/being types of work like yoga?

Dr. Rapgay: You know, when you use meditation for health or therapeutic purposes, the general finding by researchers is it's best when used in combinations with other interventions. They found that if you sit, you become very immobile and for a lot of patients predisposed to depression, so combining movement and meditation in things like tai chi and certain yoga practices are excellent ways of optimizing the use of meditation for therapeutic purposes. For spiritual purposes, it may not be necessary to supplement meditation with physical activity unless there are mitigating circumstances to do so.

Dr. Zeltzer: If one is using meditation combined with yoga, for example, would it be better sit quietly for twenty minutes and do the meditation and then begin to do the yoga poses? Or should it be the other way around? Or simultaneously?

Dr. Rapgay: Well, it's generally better to do the meditation first and then do the physical activity afterwards. This is because if you do the yoga first the body is in a semi-aroused state and it might take undue time to settle the mind down.

Dr. Eastman: I'll just add, as well, sometimes people in many yoga classes, for instance, now will also incorporate some time at the end because after you have your body going and the flow of energy, the process afterwards can help you to be very aware of your body and the physical parts can help you with relaxation.

Dr. Zeltzer: Can either of you comment on the medical benefits of meditation? I know meditation is being practiced in many cultures regularly; what do we know from Western science about the medical benefits of using meditation regularly?

Dr. Rapgay: There's been several research done over the last three or four decades, much in the early 60s and 70s and then a lull and then in the 80s, Dr. Benson and transcendental meditation people were at the forefront in research in meditation. Basically, what they found was a number of things. They found that meditation was the antithesis of the fight or flight response and, what it did was in other words, your blood pressure and rate of breathing and metabolism and so forth begin to decrease when you begin to meditate because the brain somehow picked up a signal that it needs to slow down activities. In other studies, it was found that during meditation there was significant increase in the alpha and theta waves and even, to some degree, the delta waves which is significant particularly for insomnia patients. Meditation has also been documented for helping women with PMS symptoms and particularly with those with fertility problems due to unknown causes. So, there have been several studies.

Dr. Eastman: Just to add, and I think more studies really need to be done. One of the problems with studying the effects of meditation is that subjects are often super healthy in some way or are already interested in meditation so it's not a random sample and it's hard to control your experiments to show the effects. So, I think it's important that we do more research.

Dr. Zeltzer: For either of you, if somebody has a medical illness, let's say they have a chronic pain problem and they're on medication that might be sedating or effect their mental alertness. Suppose they're on opiates or narcotics... can they still meditate? Will meditation help them get off those medications? Will it make the meditation more effective?

Dr. Rapgay: Generally, many meditators who have been working with pain patients have been trying to increase efforts in meditation to help patients use meditation. Much of the benefits are anecdotal, but there are several cases where meditation done properly, which means the patient has to have a certain degree of consciousness, this can help in pain management. There is a study showing the efficacy of meditation on chronic pain, but generally the consensus is that you do need to try to find a way to reduce the medication for meditation to be effective.

Dr. Zeltzer: In other words, as you're able to use less and less medication, the better the meditation will work for your pain? The easier it will be to learn the meditation and use it to further reduce medication and reduce pain.

Dr. Zeltzer: I would imagine that some people find learning meditation easy, and other people might find meditation quite difficult. I've often heard people say, "How can I possibly learn meditation because so many things keep racing through my mind? Can I possibly have a time when my mind focuses nothingness or is empty?" Are there any ways of finding out or identifying people that learn meditation more readily than others, and can everybody learn it?

Dr. Rapgay: Generally, we would say that meditation can be taught to everybody. The thing is to find the right type of meditation. On the other hand, there are problems for a number of people using meditation. People who have severe pain or are in extreme psychological distress, particularly anxious or depressed people, meditation is difficult for them to engage in. That doesn't mean it can't be used for them. The main thing is to find the right type of meditation. For a depressed person, a focused meditation might not work but a movement meditation might. On the other hand, an anxious person mindfulness meditation might help as well as movement meditation.

Dr. Zeltzer: Are there certain things that people can do to help themselves get in a better place within themselves, and be able to learn meditation? Example, should they learn some relaxation techniques first, or what can people do to help themselves really be in the right state of mind to learn meditation?

Dr. Eastman: I would say one of the first tings they can do is just practicing relaxation. Just very concretely going through the different muscles of the body and being aware if they're tensing or relaxing them and what that feels like. That process can help ready somebody to go further.

Dr. Rapgay: Also, it's good to examine your feelings and your needs. The person must look at their attitude and maturation level and explore whether they've reached a place in their life where they like to learn how to quiet their minds.

Dr. Zeltzer: So Dr. Rapgay, are you saying that learning meditation is more than just learning a technique? That it's learning a whole new way of being, and looking at your emotions, and at your body, health ... your well being?

Dr. Rapgay: Yes. You know, aside from using it for therapeutic purposes, what meditation can teach us is to feel comfortable in the inner landscape of our psyche or our mind and learn to receive it or experience it. And, in that way, learn to first settle the mind which is like letting the mud in a muddy pool first settle down and when the mud settles down the mind becomes clear. And when the mind becomes clear you can explore the water and find what's in the ocean. And that's precisely what we try to do in meditation, settle the mind and this gives us an inner strength and the ability to be still on the inside in the midst of external activity. And there is a peace you get out of doing that. And taking that peaceful state of mind then you can explore the inner landscape of your mind.

Dr. Eastman: I'd say that's a really good question and one I've heard before. In some ways that may be the most common difficulty people have with meditating. One technique that can be used is to start with focusing on the breath and when you notice yourself and as you focus on the breath you may then begin to notice the thoughts start entering about your work. And, eventually you may be able to be aware that you're having the thought and then be able to go back to the breath. It's a process that takes practice. One of the important steps is to recognize that you're having that thought and bring yourself back.

Dr. Rapgay: You could also complement what Dr. Eastman said with first, because this distractive part can be caused by a number of reasons, so you could complement it by first before you meditate try to motivate yourself. Remain in meditation for a specific period of time by identifying the benefits of doing so beforehand and think about how it can help you in your life. Secondly what you could do is this could often be caused by the level of your anxiety . If this is the case you need to relax yourself physically and mentally and for that there are a number of things to help you do that. So, it's important to find out what causes the tendency for distraction and address that as well.

Dr. Zeltzer: So what you're both saying is again, by getting yourself into a relaxed enough state, focusing on your breathing as Karen said, if you begin to wander, to think about your business, step outside the thoughts about the business, and recognize that you're actually doing that. I would ask this of you -- there's the "purple elephant effect" where if you say don't think about purple elephants, then the only thing you think about is purple elephants. So if you start to meditate and say that you won't think about your business, then the only thing you'll think about is your business.

Dr. Rapgay: Well, you know, that's why it's very helpful to relax before you begin to meditate and relaxation can be either passive or active. You need to find out which works for you. And then, secondly, bring motivation, create motivation to meditate by thinking about the benefits.

Dr. Eastman: I might also add to watch, one thing that may happen is that you sit down to meditate, you start focusing on something, your mind wanders to your work or something coming up and you're not even aware that you're particularly anxious about it and then you notice you're thinking about it and there is an element of criticism that you're not doing meditation the way you're supposed to be doing it. And if you can notice that thought as well and simply note that you ARE doing it, the process of going from thinking about your business back to your focusing is all part of the process.

Dr. Zeltzer: When that happens, are there any tools that can be useful so... Karen you mentioned noticing your breast and using it as a focal point. What about saying a single word like "ohm", or listening to chimes or something else that allows you to have a single focus?

Dr. Rapgay: There are a number of techniques that can help you when you have a lot of distraction. One is counting from one to twenty. Counting your breaths up to 21 and then counting it backwards. Another technique is to learn to breathe a little more strongly than your regular breath. There are physiological processes which can help over a long time your tendency to be distracted. Then words can often be helpful. More than simply applying pressure to the ball of your thumb and index finger and using that as a point of focus can be helpful.

Dr. Zeltzer: What about external sounds as opposed to containing words like "ohm?" Are there any certain kinds of music or sounds or chimes that can be useful?

Dr. Rapgay: The sound of bells or chimes would be better than listening to music. Any sound that is kind of repetitive and yet soothing would be better than a sound that has a lot of lyrics or different tonations because that could distract the mind in its own different way. There are a number of risks. Of course, the most glaring one is if you have psychiatric problems like if you have psychosis or are severely depressed, then meditation can be harmful, particularly if it's not done under supervision or if you do the wrong meditating. The key to meditation is that when it's done in its simple form it can be done by anyone. However, a safeguard against harm can be ensured if it's done under the guidance of a teacher or master or someone who at least knows meditation. However, if you get into advanced meditations like kundalini then you should be under the guidance of experts. Advanced meditations like kundalini can lead to other states so it does pose danger when not supervised.

Dr. Eastman: I think, in general, the morning is a preferred time although people nee d to find what works for them. The reason people find the morning better is that you're just waking up and your body isn't in a physical state and you have started the business or getting into those commitments and things you have to do. You're thinking about them, but your body makes the transition from sleep to awakeness and it's a good time to settle in and start a meditation. You can also do it in the morning before things keep you from doing it . The other part of it is the advantages of some of the feelings people have physically and emotionally then get to last the whole day or most of the day so people often prefer it.

Dr. Zeltzer: Where can people learn meditation and other mind-body techniques, especially people who may have health problems and want to learn meditation and learn these things for their health or to reduce their pain?

Moderator: How old is a good age to start learning meditation? Would you recommend it for a hyperactive teenager?

Dr. Rapgay: One place where they could come to not only to learn meditation and Tibetan Yoga, but also other behavioral medicine approaches or mind/body approaches in the form of a comprehensive program is at UCLA. We have clinic that provides a 10-session comprehensive program that integrates a number of mind/body interventions that have been empirically supported and have helped patients to develop skills and set reasonable goals and monitor their progress through these 10 sessions in order to deal with some medical symptoms that don't respond to traditional medical treatments.

Dr. Zeltzer: Do you have a phone number where people can call?

Dr. Rapgay: Yes, I do. The number is (310) 825-5610

Dr. Rapgay: Again, (310) 825-5610

Dr. Zeltzer: So this is for adults who have problems, health problems, emotional problems, where those problems are not responding to conventional medicine or even other alternative therapies they've tried. And this is a new program at UCLA that you are directing, and that's the number they can call to find out more and come in for the program?

Dr. Rapgay: Yes.

Dr. Zeltzer: I would mention that children who have chronic pain can come to our UCLA Pediatric Pain program to learn meditation and other complementary therapies as well as integrated with traditional Western Medicine at 310-825-0731. And certainly Dr. Rapgay, and I, and Dr. Karen Eastman work together in many ways and parents can go to Dr. Rapgay's program and send their children to us.

Moderator: Any last words or closing comments, perhaps some final tips or techniques for our audience?

Dr. Rapgay: Actually, you know, there were concerns several years back whether children could learn meditation. But, there are several studies, particularly done by the transcendental meditation group that show that meditation is very helpful for many children particularly to deal with cognitive functioning and attention problems.

Dr. Zeltzer: I would add that if the parents wants the adolescent to learn meditation but the adolescent has no desire to do so, it would not be a good or successful intervention until the adolescent decided that he/she wanted to learn meditation. Any adolescent should be able to learn if he/she is motivated to do so.

I will just say that meditation has been around for a very long time, and I think Western medicine is just having a re-awakening in terms of learning about a form of awareness and health promotion that other people have known about in other cultures for a long time. And certainly, clinics like Dr. Rapgay's are new, but they're bringing old and traditional therapeutic measures like meditation to modern health practices and I think we're going to learn more and more about health benefits of meditation.

So I encourage people with health problems to contact Dr. Rapgay to find out more about his program.

Moderator: Drs. Eastman, Rapgay and Zeltzer, thank you very much for joining us today. Please join us again tomorrow at 7 p.m. EST here in the World Watch Auditorium when Dr. Lonnie Zeltzer returns, joined by Brenda Bursch, Ph.D., and Paul Zeltzer, M.D. They will be discussing "Difficult Doctors: How To Get the Help You Need."

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