Implications for a mindfulness-enhanced positive affect induction: A brief commentary toward acute pain management

Abstract

Over the past decade research has increased on dynamics between mindfulness, positive affect, and pain. While there have been studies examining the direct use of positive psychology for pain management, few have examined the use of a specific mindfulness-enhanced positive affect induction (i.e. a singular brief technique engendering mindfulness and strong positive affect) toward acute pain and pain flare management. This topical commentary discusses the need for such a technique toward bolstered gold-standard interventions, related studies, and possible future directions for acute and post-surgical pain management. Future research is encouraged to build from prior research on loving-kindness meditation and examine novel, brief mindfulness-enhanced positive affect inductions for acute pain management.

Chronic pain impacts approximately 19%–20% of the US and European adult populations (Macfarlane, 2016; Yong et al., 2022). In 2010, it was found to cost approximately $560–$635 billion dollars in annual healthcare and lost productivity in the US alone (Gaskin and Richard, 2011). Meanwhile, acute/post-operative pain has been estimated to impact 101.3 million Americans annually (Gordon et al., 2016). According to two recent reviews, there is a general lack of consistent findings in the management of post-operative pain, for both conventional medicine and psychosocial approaches (Chou et al., 2016; Gordon et al., 2016). Based on multiple reviews over the past decade, a mindfulness-enhanced positive affect induction may be ideal for bolstering psychosocial management of brief pain management (e.g. with pain flares and post-surgical pain) (Finan and Garland, 2015; Goubert and Trompetter, 2017; Hanssen et al., 2017).

In a 2015 review of positive affect and pain, Finan and Garland proposed a model of positive affect, resilience, and pain self-management. The model conceptualizes how psychosocial interventions for chronic pain may be bolstered via targeting positive affect-related coping. While the model is ideal for multi-session psychosocial interventions (Garland et al., 2019), it could also be ideal for strengthening acute pain management techniques. Within the model, mindfulness helps to disengage from pain-related negative affect and cognitions. Subsequent positive affect-related coping and savoring of positive emotions are proposed to then broaden awareness of adaptive prosocial pain management, and self-efficacy in pain management. Within the model, as an individual engages in mindfulness, positive affect-related coping, and other adaptive pain coping methods, pain self-management becomes more efficacious, positive affect builds upon itself, and related resilience increases.

While extant research has examined positive affect inductions and mindfulness separately for brief pain management (Finan and Garland, 2015; McClintock et al., 2019; Ong et al., 2020), to our knowledge, there have not been studies experimentally examining a technique directly based on Finan and Garland’s 2015 model (i.e. a singular brief technique including mindfulness to disengage from negative pain-related thoughts and emotions, as well as a focus on engendering strong positive emotion). Such a technique would ideally be brief and easily implemented for acute pain management. Technique brevity is important, as existing literature shows most mindfulness-based techniques (e.g. breathing mediations and body scans) to require extensive practice and durations over 15 minutes (McClintock et al., 2019; Wachholtz et al., 2019).

Although, not directly based on Finan and Garland’s model, loving-kindness meditation (LKM) does closely follow its concepts. LKM is a mindfulness-based meditation focused on engendering compassion via focusing on compassion phrases toward the self and others. Focus on such phrases is done while maintaining mindful awareness of the breath and utilizing the breath as an anchor for the wondering mind throughout the practice (Graser and Stangier, 2018).

Within the last two decades, there have been pilot studies published on LKM for chronic pain, migraine, and brief pain management (Berry et al., 2020; Carson et al., 2005; Chapin et al., 2014; Day et al., 2023; Robertson et al., 2020; Tonelli and Wachholtz, 2014). Importantly, there is literature showing LKM as effective in pain management with brief instruction and minimal prior practice (Day et al., 2023; Tonelli and Wachholtz, 2014). For example, Tonelli and Wachholtz (2014) found efficacy in migraine pain management with a 20-minute LKM and no prior practice. Despite promising results and further literature showing LKM as efficacious in pain management with multi-session training (Berry et al., 2020; Carson et al., 2005; Chapin et al., 2014; Goerlitz and Wachholtz, 2023), there have yet to be large-scale trials on LKM for pain management, let alone comparative efficacy trials for minimal versus in-depth training. Provided the research gap, such trials are needed and worthwhile.

Another relevant intervention is mindfulness-oriented recovery enhancement (MORE), which incorporates Finan and Garland’s (2015) model. Although MORE primarily focuses on addressing addiction, it has also shown improvements with chronic pain outcomes (Garland et al., 2019). Importantly, MORE and other multi-session interventions have durations of several weeks to months to improve chronic pain and related quality of life. As noted by Chou et al. (2016), such durations are a barrier to realistic implementation and efficacy toward acute pain management. That is a salient consideration for improving psychosocial post-surgical pain and pain flare management.

Given the evidence upholding mindfulness and positive affect in pain management, a brief technique based on Finan and Garland’s (2015) model is ripe for future research and has implications for bolstered acute pain management, as well as addressing risks and obstacles with opioid-based post-surgical pain management and subsequent tapering (Acevedo et al., 2022; Addington et al., 2020; Amanullah et al., 2021; Ashar et al., 2022; Frumkin and Rodebaugh, 2021; Geers et al., 2019; McPhee and Graven-Nielsen, 2022). As noted above, current techniques can take weeks or months of guided practice for efficacy and thus may be improved by a focus on arousing strong positive affect. Beyond LKM, few techniques directly incorporate both mindfulness and strong positive affect. Such a technique should aim to quickly engender strong and enduring positive emotion, in addition to an overall present-moment focused state, toward non-judgmental awareness of pain.

With new headway gained in psychosocial pain management (e.g. with pain reprocessing therapy and emotional awareness and expression therapy) (Ashar et al., 2022; Lumley and Schubiner, 2019), the opportunity for similar expansion on extant techniques cannot go ignored (Chou et al., 2016; Gordon et al., 2016; Wachholtz et al., 2019). Research on mindfulness-enhanced positive affect inductions may prove to be the necessary next frontier for pain flare and other acute pain management. New research is therefore encouraged with large-scale trials on LKM for brief pain management, as well as basic research on novel mindfulness-enhanced positive affect inductions.