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Mar 17 2016

Mindfulness meditation provides opioid-free pain relief, study says

by My Inner Space

For the millions of individuals suffering from chronic pain, opioid painkillers seem like the only option. But a new study from Wake Forest Baptist Medical Center found that mindfulness mediation may provide drug-free pain relief.

In research published Tuesday in the Journal of Neuroscience, scientists found that mindfulness meditation does not work through the body’s opioid system to reduce pain— meaning there’s no risk of drug addiction or concern for those with a high tolerance to opiate-based drugs.

“We’ve now shown across multiple studies using neuroimaging and pharmacologic intervention with opiate blocking that meditation reduces pain through very unique pathways,” study leader Fadel Zeidan, Ph.D., an assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center, told “We’re able to find a way to cure chronic pain; not necessarily taking pain away, but by diminishing the aspect of chronic pain that really promotes suffering, which is the catastrophizing of pain, the anxiety, depression, and quality of life issues."

Whenever there is pain, the body employs its endogenous opioid system to release opioids that act as potent painkillers. Cognitive-based therapies— which includes hypnosis, acupuncture and distraction— have been shown to relieve pain through use of the opioid system. By bypassing the opioid system, mindfulness meditation could be attractive to those who have built up a tolerance to opioid-based drugs and those looking for non-addictive solutions to their pain.

“All the anesthesiologists we’re working with were blown away,” Zeidan said. “For thousands of years, Buddhist monks have said that meditation reduces pain in a unique fashion. With the advent of neuroimaging and pharmacologic studies, only recently have we been able to examine and potentially verify what they’re saying.”

The study comes on the heels of the Centers for Disease Control and Prevention (CDC)’s release of voluntary guidelines instructing primary care doctors to sharply deter use of medicines for chronic pain. The new guidelines recommend non-opioids, such as acetaminophen and ibuprofen, as preferred therapy. Opioids are to be prescribed in the lowest possible dose and patients should be closely monitored, Reuters reported.

In 2014, nearly two million Americans aged 12 or older either abused or were dependent on prescription opioids, which include heroin, according to the CDC.

“Our medication society is set up to just give somebody pain pills and now we’re seeing problems with that,” Zeidan said.  “Doctors are getting more stringent so individuals are going to the street for drugs that make them feel better and are cheaper. It’s a snowball effect.”

For the double-blind, randomized study, Wake Forest researchers worked with a group of 78 healthy, pain-free participants who were divided in four groups for the four-day trial: meditation plus naloxone, non-meditation control plus naloxone, meditation plus saline placebo; or non-meditation control plus saline placebo. Participants were first tested for baseline pain rating through placement of a hot thermal probe on the skin to 120.2 degrees Fahrenheit, a level of heat most people find very painful.

The meditation group came in for 20 minutes a day and was taught how to practice mindful meditation, which included sitting with a straight posture, closing the eyes and focusing in the changing sensation of breath. If they became distracted, they were taught to acknowledge the distraction, without judgement, and re-focus on their breathing. The control group listened to a book on tape.

All participants then went into the clinic where they were again exposed to the thermal probe and researchers collected their pain ratings. They were given either naloxone— which blocks the effects of opioids— or the placebo via IV and told to either begin meditation or relax. While they were doing so, the researchers exposed them to the heat once more, then took pain ratings.

If meditation worked through the body's opioids, researchers expected to see the pain relief produced by meditation go away for the group using naloxone. They used the highest dose of naloxone possible to completely block opiate receptors.

“The data was clear as day that meditation does not use this powerful opioid system to reduce pain,” Zeidan said.

They observed that the meditation group who used naloxone had a 24 percent reduction of pain from the baseline measurement. The mediation group with saline showed a 21 percent reduction. By comparison, both non-meditation groups reported increases in pain.

Another benefit of meditation that the study found is that the pain-relieving effect kicked in quickly, which may be attractive for chronic pain patients.

“If they experience the benefits of meditation immediately, they will continue to practice and [the benefits] will be more stabilized and long-lasting,” Zeidan said.

The team’s next step is to work with chronic pain patients with a variety of conditions to study which may benefit and how long the pain relief lasts. They hope to use what they learn to specifically target each pain condition with a personalized intervention.

“We’re getting more and more evidence that [mindfulness meditation] seems to have a profound impact on pain physiology, pain psychology and the subjective experience of pain,” Zeidan said. “What we think is happening is that meditators are looking at pain from a different perspective, seeing the pain as momentary, fleeting and using skills to learn to be non-judgmental about the pain.”

As for the challenges of teaching meditation, the team wants to make the intervention readily available to anyone who’s interested. They’re developing web-based interventions, those that use video chatting and an app-based program.

“The first thing’s first is to give a person confidence that they can trust themselves to take on pain,” Zeidan said.

“The most important thing is that you don’t have to be a monk. You don’t have to wear a robe and live in a cave. You can stay at home,” Zeidan said. “It’s markedly consistent with why chronic pain patients suffer— because they don’t know how to deal with it. We think meditators are changing their mindset about [pain.]”


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