August 2nd, 2022
Written by: Lindsay Ejoh
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Chronic pain is a staggering crisis affecting 50 million adults in the United States, and 1.5 billion individuals worldwide1,2. Opioids have served as a gold standard for the treatment of pain, despite their addictive properties and high risk of abuse. Regardless, chronic pain is highly pervasive, and people often use opioids to ease their suffering, fueling the ongoing opioid epidemic. Thus, there is a crucial need for alternative therapeutic strategies to treat chronic pain disorders and help curb the rising opioid epidemic. Mindfulness meditation is a promising possibility.
Mindfulness meditation is “non-elaborative, non-judgmental awareness” of a present experience or sensation, like the feeling of pain3. There is a rich history of mindfulness meditation being used to alter pain perception. Buddhist monks have known for thousands of years that mindfulness can alter the experience of pain and wrote about this in ancient texts such as Sullatta Sutta (The Arrow)5. They describe the powerful ability of meditation practitioners to fully experience the physical aspect of pain, while letting go of the “evaluation of pain” or the emotions associated with it. Despite this practice being around for so long, modern scientists have only recently systematically studied mindfulness meditation and its ability to produce pain relief, both in experimental settings in healthy individuals, and in the clinic in individuals suffering from chronic pain disorders.
To explore what brain regions are active or calm as mindfulness meditation reduces pain, researchers conducted fMRI brain scans during a mindfulness meditation pain study. In these experiments, healthy participants underwent four sessions of mindfulness meditation before entering the scanner. Then during testing, researchers applied a hot temperature stimulus to the skin and asked participants to rate the intensity of pain and amount of unpleasantness associated with it. Participants that had minfulness training experienced reductions in both the intensity and unpleasantness of the heat stimulus. They also had increases in brain activity in two brain regions known to be involved in reducing negative feelings about pain: the anterior cingulate cortex and anterior insula. Mindfulness meditation has also been found to reduce activity in brain regions critical for processing pain like the periaqueductal gray and the thalamus. This suggests that mindfulness meditation can reduce pain processing, providing modern scientific evidence that the brain can modulate its experience of pain independently of any drugs.
The subjective experience of pain relies on many different factors, such as how much attention is paid to pain, whether pain is expected or not, or how stressed one is while experiencing pain. The brain takes these experiences into account and can induce pain relief on its own. One way that the brain induces pain relief is by releasing natural opioids that quiet regions of the brain that promote pain processing Researchers wondered whether mindfulness meditation follows a similar mechanism. To investigate this, they administered a drug that blocks opioid receptors to subjects that underwent mindfulness meditation therapy for pain and found no change in pain ratings. This indicates that mindfulness meditation might operate via a different mechanism than opioid receptors, which is definitely worth studying further as we try to understand how this therapy influences the brain.
So far, we’ve established that mindfulness meditation can reduce pain in an experimental setting, but is this therapy useful in the clinic? Ultimately, we want to help chronic pain patients, so scientists have also conducted studies assessing the effectiveness of mindfulness meditation in reducing feelings of pain in patients with fibromyalgia and chronic lower back pain4. They found that mindfulness meditation does not change the intensity of pain that these patients feel, though it does help them distinguish between the physical and emotional aspects of pain, reducing negative feelings about their pain and helping them cope.
Though mindfulness meditation is very promising as a therapy for pain, there are several disadvantages worth noting. First, this is a time-intensive practice; sessions can be up to two hours long and go for 8+ weeks. For many people, their pain is constant, so mindfulness practices must be employed outside of the clinic as patients experience everyday pain. Also, mindfulness meditation is administered by highly specialized therapists, limiting this tool’s accessibility. These therapists are found in pain clinics that may be too expensive for the average person, especially someone without health insurance. Lastly, mindfulness does not remove clinical pain entirely, it just serves as a management technique to help change a patient’s relationship with pain.
Regardless, mindfulness meditation may serve as a powerful tool to improve the psychological experience of pain by decreasing negative feelings about pain, enhancing self-compassion and acceptance, and reducing stress. As we move towards finding better therapies for chronic pain disorders, we want to find safe, drug-free interventions with low abuse potential, and mindfulness meditation may be one such alternative.
References
- Jackson, T. P., Stabile, V. S. & McQueen, K. A. K. The Global Burden Of Chronic Pain. ASA Newsletter 78, 24–27 (2014).
- Dahlhamer, J. et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. Morbidity and Mortality Weekly Report 67, 1001–1006 (2018).
- Zeidan, F., & Vago, D. R. (2016). Mindfulness meditation-based pain relief: a mechanistic account. Annals of the New York Academy of Sciences, 1373(1), 114–127. https://doi.org/10.1111/nyas.13153
- McClintock, A. S., McCarrick, S. M., Garland, E. L., Zeidan, F., & Zgierska, A. E. (2019). Brief Mindfulness-Based Interventions for Acute and Chronic Pain: A Systematic Review. Journal of alternative and complementary medicine (New York, N.Y.), 25(3), 265–278. https://doi.org/10.1089/acm.2018.0351
- Sallatha Sutta: The arrow. accesstoinsight.com. (1997). Retrieved July 31, 2022, from https://www.accesstoinsight.org/tipitaka/sn/sn36/sn36.006.than.html
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