Meditation: A Pathway to Pain Relief
New study finds mindfulness meditation reduces pain intensity through a non-opioid process in the brain.
Cognitive-based approaches found to reduce pain, such as hypnosis, acupuncture, distraction techniques, have been shown to work through the natural production of opioids, also called endogenous opioids or endorphins. But does meditation also use endorphins to reduce pain?
The answer is no. Results from a new study, funded in part by the National Center for Complementary and Integrative Health, demonstrate that mindfulness meditation works on a different pain pathway in the brain, not the one used by opioid pain relievers.1
“Our finding was surprising and could be important for the millions of chronic pain sufferers who are seeking a fast-acting, non-opiate-based therapy to alleviate their pain,” said Fadel Zeidan, PhD, assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center and lead author of the study.
Dr. Zeidan noted that because opioid and non-opioid mechanisms of pain relief interact synergistically, the results of this study suggest that combining mindfulness-based and pharmacologic/nonpharmacologic pain-relieving approaches that rely on opioid signaling may be particularly effective in treating pain.
How the Study Was Conducted
Mindfulness meditation, a practice premised on directing nonjudgmental attention to arising sensory events, reduces pain by engaging mechanisms supporting the cognitive control of pain, noted the study. Previous research has shown that mindfulness meditation helps relieve pain, but researchers have been unclear about how the practice induces pain relief.
"Our subjects had no experience with meditation prior to the study," Dr. Zeidan told Practical Pain Management. "Generally, it doesn’t take much time to get comfortable with practicing meditation. In order not to have the study influence by outside influences, the subjects practiced meditation and the experiment was conducted in Wake Forest Baptist laboratory. "If the subjects had become relaxed due to incense burning, music, or room lighting, then the effects could be attributed to the setting not meditation," he noted
To determine if meditation uses the body’s opioids to reduce pain, the researchers injected study participants with either a drug called naloxone, which blocks the pain-reducing effects of opioids, or a saline placebo.
Researchers recorded pain in 78 healthy adults during meditation (usually 20 minutes) or a non-meditation control in response to painful heat stimuli. The healthy adults were randomized to one of 4 treatment groups:
- Meditation plus naloxone
- Control plus naloxone
- Meditation plus saline
- Control plus saline.
People in the control groups were instructed to “close your eyes and relax until the end of the experiment.”
The researchers found that participants who meditated during naloxone administration had significantly lower pain intensity and unpleasantness. In fact, Dr. Zeidan found that the participants’ pain ratings were reduced by 24% from the baseline measurement in the meditation group that received the naloxone.
This is important because it showed that even when the body’s opioid receptors were chemically blocked, meditation still was able to significantly reduce pain by using a different pathway, he said. Pain ratings also were reduced by 21% in the meditation group that received the placebo-saline injection.
By comparison, the non-meditation control groups reported increases in pain regardless of whether they got the naloxone or placebo-saline injection.
“Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally-induced pain,” Dr. Zeidan said. “The clinical application of the study can be quite large. We showed for the first time that meditation does not use one of the body’s primary pain modulatory systems. Thus, we could be uncovering a novel pathway/mechanism for pain relief that is not dependent on endogenous opioids."
Growing Body of Evidence
“This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain. These findings are especially significant to those who have built up a tolerance to opiate-based drugs and are looking for a non-addictive way to reduce their pain,” he said. Whether this is applicable to chronic pain patients, is still to be determined. "Since we did not conduct this study in patients, its hard to state how much meditation would be beneficial. However, we have seen now across multiple studies that a few sessions of meditation can make healthy participants feel less anxiety and pain."
“The goal of meditation is not to eliminate pain or anxiety, but rather to get patients to focus on breathing and relaxation techniques [focused awareness]. We teach patients to achieve nonjudgmental, self acceptance and to be in the present moment,” said Mel Pohl, MD, who is medical director of the Las Vegas Recovery Center.
Through meditation, Dr. Pohl hopes to reverse some of the negative changes in the brain that can occur with chronic pain. “We have seen a decrease in cortisol and epinephrine levels, an increase in serotonin and gamma-aminobutyric acid levels, which are linked to relaxation and antidepression, and an increase in natural killer cells. With sufficient practice, patients can establish patterns of thought that diminish catastrophization, thus decreasing pain,” he said.
The next step for Dr. Zeidan’s team is to determine if and how mindfulness meditation can affect a spectrum of chronic pain conditions.
“At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without it producing the addictive side effects and other consequences that may arise from opiate drugs,” he said.
The study, conducted by researchers at Wake Forest School of Medicine and Cincinnati Children’s Hospital Medical Center, was published in The Journal of Neuroscience. The study was supported by the National Center for Complementary and Integrative Health K99-AT008238, the Mind and Life Institute and the Wake Forest Translational Science Institute.