Recent research showed that mindfulness meditation is significantly more effective at reducing pain intensity and pain unpleasantness than placebo analgesia, sham mindfulness meditation and other cognitive-based approaches by using distinct neural mechanisms (J Neurosci 2015;35:15307-15325).
“This study is the first to demonstrate that mindfulness-related pain relief is mechanistically distinct from placebo analgesia,” the researchers wrote. “The elucidation of this distinction confirms the existence of multiple, cognitively driven, supraspinal mechanisms for pain modulation.” Specifically, mindfulness meditation–induced pain relief was associated with greater neural activation in higher-order brain regions, including the orbitofrontal and cingulate cortices, the study revealed. In contrast, placebo analgesia was associated with decreased pain-related brain activation.
“We show that mindfulness meditation engages brain regions that are uniquely associated with the ability to change the context of a painful experience from an acceptance-based approach, which is one way of promoting quality of life and reducing the more emotional component of pain,” said Fadel Zeidan, PhD, assistant professor in the Department of Neurobiology and Anatomy at Wake Forest School of Medicine, in Winston-Salem, N.C., and the lead author of the study.
The study randomly assigned 75 healthy, right-handed volunteers (38 men; mean age, 27±6 years) who had never had meditative experience to 20 minutes of mindfulness meditation, placebo conditioning, sham mindfulness meditation or book-listening control intervention for four days. The volunteers were injected with naloxone to block the effects of opioids. A thermal probe of 49 C (120.2 F) was applied to the right calf. Participants could escape the stimuli by lifting their arms. None suffered tissue damage.
The study found that:
mindfulness meditation reduced pain intensity (P=0.032) and pain unpleasantness (P<0.001) ratings more than placebo analgesia; and
mindfulness meditation reduced pain intensity (P=0.030) and pain unpleasantness (P<0.043) ratings more than sham mindfulness meditation.
“Mindfulness-meditation pain relief was associated with greater activation in brain regions associated with the cognitive modulation of pain, including the orbitofrontal, subgenual anterior cingulate and anterior insular cortex,” the study found. “In contrast, placebo analgesia was associated with activation of the dorsolateral prefrontal cortex and deactivation of sensory process regions (secondary somatosensory cortex).”
The study also found that sham mindfulness meditation–induced analgesia was not correlated with significant neural activity, but rather by greater reductions in respiration rate.
The present findings demonstrate that mindfulness meditation is superior in producing pain relief compared with other cognitive training regimens in which nonjudgmental reappraisal is not an integral part of the mental training (the sham mindfulness meditation–relaxation response). The researchers postulated that a broader appreciation of these differences is an integral step in fostering the validity of mindfulness meditation as an adjunct therapy for mitigating pain and resultant suffering.
Building on Previous Work
The Wake Forest researchers had discovered that mindfulness meditation bypasses the endogenous opioid system to reduce pain (J Neurosci 2016;36:3391-3397).
People who have developed resistance to opioids may have an alternate route to pain relief, Dr. Zeidan said. He said he and his fellow researchers are “cautiously optimistic” about the potential of mindfulness meditation to address the opioid epidemic, noting that the study was published the same day the Centers for Disease Control and Prevention (CDC) issued new guidelines for physicians to be more cautious in prescribing opioids.
The CDC, Dr. Zeidan said, “really put an emphasis on developing non–opiate-based pain therapies, and here we have a behavioral intervention that can reliably attenuate acute experimental and chronic pain. Mindfulness meditation has a lot more credibility as an adjunct pain therapy.”
“This study provides evidence for the existence of a nonopioid process in the brain to reduce pain through mindfulness meditation,” said Josephine Briggs, MD, director of the National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH). “Future studies that work to uncover the biochemical pathways of such a nonopioid process could provide us with a new set of molecular targets for pain management and potentially optimize the analgesic effect of mindfulness meditation.”
Mindfulness is nonjudgmental awareness of the present moment. This construct can be developed through the practice of mindfulness-based meditation. There are good, free guided meditations here: http://marc.ucla.edu/?body.cfm?id=22.
This work was funded by the NCCIH and the Mind and Life Institute.
Source: Thomas Rosenthal
http://www.painmedicinenews.com/Complementary-and-Alternative/Article/08-16/Mindfulness-Meditation-Uses-Distinct-Neural-Pathways-To-Reduce-Pain-Better-Than-Placebo/37478
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