Exploring the Effects of Peri-Operative Meditation on Patient Well-Being
/By Bijan Mehdizadeh
Image from everydayhealth.com/meditation
Meditation is commonly defined as a technique intended to increase focus and awareness of the present. There have been a vast number of approaches to meditation over the course of centuries, ranging from basic deep breathing exercises centered in mindfulness to more advanced repetition of mantras intended for spiritual benefit. The effects of meditation on various levels of patient experience have been of recent interest due to a more widespread discovery of its general health benefits associated with stress reduction, sleep improvement, and promotion of emotional health. Meditation has long been known to calm down the sympathetic nervous system, thereby decreasing many forms of emotional reactivity (Boynton, 2020). Pre-operative anxiety and post-operative pain have also both been shown to adversely affect the healing process by increasing risks of delayed recovery and chronic pain if left untreated (Grutz & Poch, 2021). Therefore, implementing meditative practices for patients undergoing and recovering from surgery could serve as a way to decrease pre-operative anxiety and post-operative pain, thus improving the overall patient experience.
To explore the merits of meditation in decreasing anxiety, it is necessary to account for multiple types of meditative practice and find an overall negative correlation. Using the Hospital Anxiety and Depression (HADS) scale, scientists were able to compare the effects of guided self-meditation with that of coached meditation, having “no meditation” serve as a control. Scores were not significantly different between those undergoing self-meditation and those undergoing coached meditation for head and neck cancer radiation therapy (Boxleitner et. al, 2017). However, both groups showed scores that indicated less anxiety than that of the control group (Boxleitner et. al, 2017), providing evidence to support a negative correlation between meditation and anxiety levels.
Figure (3): Percentage distribution of the study patients according [to] level of anxiety pre / post zikr meditation & jaw relaxation at day 2” (Soliman & Mohamed, 2013).
Studies measuring correlations between meditation and patient pain levels in addition to anxiety levels are also necessary to better understand the potential merits of meditative practice. In one experiment, patients undergoing abdominal surgery were exposed to Zikr meditation and jaw relaxation techniques before and after said procedure in an effort to observe any significant postoperative anxiety and/or pain. Their anxiety and pain levels were measured using the Hamilton Anxiety Scale and Pain Rating Scale (PRS) respectively (Soliman & Mohamed, 2013). Due to the subjectivity of the responses reported on both scales, physical responses including blood pressure, heart rate, and respiratory rate were also observed to more accurately measure patient experience (Soliman & Mohamed, 2013). The study found no significant difference in physical responses between subjects that were exposed to the spiritual meditative procedure and those that were not exposed, but the post-intervention indices of pain and anxiety were significantly lower for those exposed to intervention than those without (Soliman & Mohamed, 2013), indicating a lower overall report of anxiety and pain after surgery. Although the sample size was limited in focusing mainly on devout Muslims, the trend supporting lower anxiety and pain levels with meditation provides further evidence supporting the fact that meditation in general may have a beneficial effect on patient well-being.
Another form of spiritual meditation that has been studied with respect to its effects on patient anxiety levels is Rajyoga meditation, a Hindu-derived technique that emphasizes mind and body connection (Kiran et. al, 2017) and appears more accessible than Zikr meditation due to the fact that it does not rely on any specific rituals or mantras. In fact, Rajyoga meditative practice more closely resembles basic forms of mindfulness meditation and breathwork exercises as opposed to more specific forms of spiritual meditation. A randomized control study was conducted with 150 patients undergoing coronary artery bypass surgery with one meditation group and one control group (Kiran et. al, 2017). Blood cortisol levels were measured before and after the intervention of meditation, providing another measure of anxiety and stress that had not been previously discussed (Kiran et. al, 2017). In contrast to the previous experiments mentioned, this study focused more on the perioperative patient experience. Serum cortisol levels of participants gathered before surgery and on the first day of surgery were not found to be significantly different between those of the meditation group and those of the control group, but the second day showed significantly lower cortisol levels in the meditation group as opposed to the control group (Kiran et. al, 2017), providing further evidence for a trend of decreased anxiety in a group performing some type of meditative practice.
With technology increasing at an impressive rate, VR and video-based meditation have also become more common. Although not directly related to surgery, the studied impact of VR versus video meditation has provided promising results with regard to decreasing anxiety, leading to overall improved academic performance. With a large effect size, a meditation study with college students showed comparable results with VR and video meditation through t-testing, although VR meditation was shown to be slightly more effective (Kaplan-Rakowski et al, 2021). The results were focused on how meditative techniques affected students’ test scores, so the impact of meditation on anxiety levels specifically is limited as participants may have not had decreased anxiety levels but still had higher scores. It is worth noting, though, that many students expressed skepticism toward any potential benefits of meditation in a posttest survey even though many of those students had significantly improved scores correlated with implementation of said meditative practices (Kaplan-Rakowski et al, 2021).
Figure 2. Graphical display of the primary outcomes of the RCTs. Regarding only primary measurements, the 10 most frequently assessed symptoms or signs (conducted in ≥3 RCTs) are shown. The black square (■) indicates the number of RCTs in which the intervention achieved statistical significance compared to the control (p < 0.05 or Cohen’s d > 0.5) for the primary outcome assessment” (Kim et al, 2022).
These experiments have all shown potential benefits of meditation, but the challenge lies in the limitations of said experiments. Standardization of meditation experiments has provided an obstacle since there are many factors unable to be controlled at this time that can affect one’s emotional state, some of which may include how much rest the patient has been receiving in the days leading up to an experiment and how intensive the patient’s surgery is expected to be in comparison to that of another patient. Still, systematic reviews of randomized controlled trials have shown that meditation had produced a higher ratio of positive outcomes for sleep and fatigue, according to the PubMed database (Kim et al, 2022), providing further evidence to support the idea that applications of meditation are deserving of further evaluation.
While meditation in clinical practice is still a relatively new field of study and remains ongoing, there is no denying that there is promising evidence supporting the fact that different forms of meditative intervention have had significantly positive correlations with anxiety and pain regarding surgery and other invasive forms of medical treatment. The levels of anxiety and/or pain were measured in different ways across multiple experiments and still showed similar correlations, which should increase confidence that there are benefits to clinical implementation of meditative practice. Although this field of study has promise, it requires more attention as to strengthen validity and generalizability in experiments going forward. Only with further studies and better test-retest reliability can we begin to understand and pinpoint the level to which meditation can pose a clinically significant benefit to patient care.
References
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