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 explained: “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 said: “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 said: “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.”