Stop Telling Me To Meditate
Meditation is not a substitute for medication when women are in pain
A few days ago, I asked one of my doctors for a 1-day supply of the NSAID ketorolac, which is a non-narcotic analgesic, similar to (but stronger than) ibuprofen.
She asked if I had tried meditating.
Translation: “I’m not prescribing anything for this.”
I’m now in the postdrome phase of a migraine with brainstem aura that lasted 4 days, and I’m wiped out. I don’t get migraines very often — once a month or so — but when I do, the aura is severe. I get visual disturbances (like this one), aphasia (the loss of ability to speak or to understand speech), and I’m disoriented: I bump into walls, doorways, and furniture if I try to walk. The aura phase is terrible, but at least I know the worst of it will be over in 20–30 minutes.
The headache that comes afterward, however, can last for several days. Tylenol doesn’t work. Ibuprofen doesn’t work. Aspirin doesn’t work. Caffeine doesn’t work.
I’ve only experienced two other things that hurt this badly: giving birth, and endometriosis.
I had an unmedicated birth — no IV, no epidural, no laughing gas, and not even a Tylenol afterward. I remember being told to head to the birthing center when the contractions felt worse than a period. The contractions didn’t feel worse than a period until I was fully dilated. I realized I was fully dilated when my daughter was born in my own hands in the bathroom of the birthing center.
“So, contractions weren’t that bad then!” No — contractions WERE bad. Since I have endometriosis, the contractions just didn’t feel much different from a period until the very end.
Endometriosis pain is severe. It feels different for everyone, but for me, the pain goes all the way down to my feet. I remember laying in a fetal position and sobbing for hours at a time. I would literally be writhing in pain after 800mg of ibuprofen barely took the edge off. I would wait for a break in the pain, and then drag myself to an urgent care center to get a shot of ketorolac. Then: relief.
One time, while waiting to see a doctor, I passed out in the waiting room.
With no options for over-the-counter pain management, I now take progesterone every day to make sure I never have a period again. (Problem solved? Not quite, but I digress.)
My migraines don’t often get as bad as they did the other day. Abortive medications like sumatriptan are usually effective when taken at the first sign of a migraine, but triptans are contraindicated (with conflicting evidence) in migraine with brainstem aura.
Let me be clear: meditation does not relieve this type of pain, and I’m tired of being told to meditate when I ask to medicate.
Meditation is great for a lot of things. It relieves stress. It helps you relax before sleep. It helps you start your morning in a calm and peaceful state of mind. Great! But it isn’t a treatment for severe pain.
For some reason, when women say something hurts, they have to prove it beyond a reasonable doubt. It doesn’t matter if you have a documented history of a painful medical condition. If you aren’t screaming, sobbing, or passing out from pain in the presence of a physician, you’re likely to be sent home with some Tylenol or ibuprofen.
Don’t take my word for it, though. Look at the data.
- The results of this study (1990) showed that men were given pain medication more often than women, and that women were usually given sedatives instead of analgesics.
- This study (2008) concluded that even when men and women reported similar pain scores, women received pain medications — especially opiates — less often than men, and if they did receive them, they had to wait longer than men did for medication.
- In The Girl Who Cried Pain (2001), two professors from the University of Maryland concluded that “women [experience] and [report] both more frequent and greater pain. Yet rather than receiving greater or at least as effective treatment for their pain as men, women are more likely to be less well treated than men for their painful symptoms.”
- Josefina Robertson (2014) concluded that women wait significantly longer than men for treatment in the emergency room, even when the presenting symptoms are the same.
- In addition to the pain bias against women, there are significant racial biases in the treatment of pain (2016). Black patients are “significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room”. Disturbingly, in a study of almost one million children diagnosed with appendicitis, Black patients were less likely to receive any pain medication AT ALL for moderate to severe pain.
Do physicians' implicit views of African Americans affect clinical decision making? - PubMed
1 the Department of Family Medicine and the Department of Psychology, University of Virginia, Charlottesville; and the…
Now — let’s get back to the topic of meditation. After all, that’s what is repeatedly recommended to me, even though I only request pain relief a few times a year at most. Even though I didn’t even ask for pain relief when I had a baby. Even though both migraines and endometriosis are known to be debilitating conditions.
Meditation isn’t ineffective, but it’s not a substitute for medication.
The effects of meditation have been studied extensively. Is it effective? Somewhat… after 8–52 weeks. There’s some evidence that you can spend weeks and weeks training your brain to stop responding to certain types of chronic pain. However, according to Zeidan and Vago, “[w]hile mindfulness meditation practice can improve health and well-being, the active mechanisms supporting mindfulness meditation have yet to be fully characterized. Importantly, a wide range of nonspecific placebo-related effects are likely involved during meditation training.”
They conclude that “[w]hile meditation after brief training (less than 1 week) produces significant reductions in pain intensity and unpleasantness ratings, long-term meditation does not produce changes/differences in pain intensity but rather influences the unpleasantness dimension of self-reported pain.”
Does mindfulness meditation improve chronic pain? A systematic review - PubMed
Women's Health Research Unit, Centre for Primary Care and Public Health, Barts and the London School of Medicine and…
In the article above, Ball et al. conclude that “[m]indfulness meditation has [the] most prominent effect on [the] psychological aspects on living with chronic pain, improving associated depression and quality of life.”
Here’s the thing: I don’t have 8 weeks to practice mindful meditation so that I can trick my brain into thinking that the next episode of severe pain is less unpleasant. Meditation isn’t a substitute for medication.
Pain is pain. It doesn’t matter if you convince yourself that it’s less unpleasant. It still hurts.
With so many non-narcotic analgesic options, it’s inexcusable to look a patient in the eye as they writhe in pain and ask them if they’ve tried meditating. You know damn well that meditation doesn’t treat moderate to severe pain.