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Wednesday, April 13, 2016

Mindfulness Meditation and Pain Management: Recent Findings!

by Ram
Branches by Melina Meza
This is part one of two articles that focus on some of the latest findings on meditation and its an amazing variety of neurological benefits. Dhyana or meditation is a state of being where the mind stops wandering, is calmer, and maintains a period of stillness. In this state of mind, an individual no longer possess bodily awareness, the sense organs are not distracted, and the stillness produces few or no thoughts at all (see Yoga Meditation Techniques). One of the original goals of meditation was to quiet the mind. Because our minds are typically busy with thoughts and emotions�many of which disturb our equanimity�quieting the mind and letting go of these daily dramas of life allows us to experience feelings of peace and contentment. Meditation also fosters feelings of compassion, which improve relationships with others. And you can also use meditation to cultivate feelings of gratitude that in turn fosters contentment (Honesty and Contentment in the Yoga Room). There are many different kinds of meditation. Some are designed to help us relax; others are meant to produce altered states of consciousness. 

Mindfulness meditation is one of the techniques where your mind is not only fully aware of the stillness but also keeps observing when your attention starts to wander from the object of the meditation (in most cases the object of meditation is the repetitious breath, flow of thoughts, emotions or feelings). And as you observe these objects with a sense of detachment, you will notice familiar patterns that may seem irrelevant to harbor and you may want to let go these patterns. Detachment or letting go of these patterns helps in cultivating equanimity in your daily life (Meditation and Equanimity). Thus, mindfulness meditation allows you to observe your habitual thought patterns and emotional responses and provides the opportunity to change them to more positive ones. Mindfulness meditation helps us become aware of what is already true at every moment, providing us with an opportunity to become more present with ourselves just as we are. This, in turn, helps us to overcome the unnecessary suffering that results from trying to escape the discomfort and pain that we experience in our daily lives.

Today�s discussion is about mindfulness meditation and its role in alleviating the acute pain response. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and is part of the body�s inherent protective mechanism to motivate the individual to pull out from a damaging situation and prevent further damage to the tissue, allow the damaged tissue to rest and heal, and avoid similar encounters. Thus, the phenomenon of pain is beneficial in a true sense when, for example, your back sustains a blow and the injured tissues need care and protection (Understanding Pain). 

Just like inflammation, the phenomenon of pain is generally transient, and recedes when the stimulus is removed or the damaged tissue has healed (How and Why Yoga Helps with Pain). When your body encounters an acute pain stimulus, your brain releases a large number of pain reducing chemicals called opioids. Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs in the body. The binding of the endogenous opioids to their specific receptors results in reduction of the perception of pain. However, there are certain abnormal pathological conditions where pain is a constant feature and persists for a long time (chronic pain). While in some chronic cases the levels of the endogenous opioids are not sufficient to alleviate the pain response, in most cases the body becomes insensitive to the body�s levels of opioids. Chronic pain that lasts beyond the expected period of healing can interfere with a person's quality of life and general functioning. Unfortunately, chronic pain brings with it other health issues including constant fear, worry, anxiety, depression, and memory deficits and turns out to be the most common reason for individuals to visit their physician (Techniques for Managing Pain with Yoga). 

One of the methods of pain management is the external administration of opioids like vicodin, morphine, codeine, or oxycontin. These external opioids not only blunt the pain response, they also produce a euphoric response since they also affect the brain regions involved in reward. Regular or long-term use or abuse of opioids can lead to physical dependence and, in most cases, addiction. Naloxone is a drug that works as an antidote to the opioids and is mainly used to reverse an opioid overdose. Naloxone works by blocking the analgesic (anti-pain) and the euphoric response of the opioids in the system. Naloxone only works if a person has opioids in their system; the medication doesn't work on other drugs. 

Now what does all this have to do with mindfulness meditation? Well, we know that meditation produces relaxation and the lovely blissful feelings that result from release of tension. The question is: does meditation trigger the release of endogenous opioids which in turn produces the pain relief and the pleasant effects thereafter? This was the premise of a new study Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids in which the researchers set out to ask a simple question, �does mindfulness meditation (MM) produce pain relief and if yes, then does it do so through the release of endogenous opioids�? 

The double blind randomized study involved 78 healthy, pain-free people who were randomly assigned to receive different interventions. The first group was trained in mindfulness meditation for 20 minutes a day for four days. And the second group, which served as a control group, spent the same amount of time listening to a book read aloud. The scientists then exposed all the participants to a pain stimulus by placing a hot probe on the back of their legs. The group that practiced mindfulness meditation experienced significantly reduced pain intensity and pain unpleasantness than the control group. 

The next thing to determine was if the pain reduction in the mindfulness meditation group was due to release of endogenous opioids. One way to test this was to block the release of endogenous opioids (if any) by administering the drug Naloxone, which would then reverse the beneficial analgesic effects of mindfulness meditation. (A control group was given simple saline as a placebo.) To the surprise of the researchers, the meditators who received the drug Naloxone before being subjected to the hot probe continued to experience significantly reduced pain intensity and pain unpleasantness than the control group, suggesting that Naloxone administration failed to reverse the meditation-induced pain relief. There were also no significant differences in pain intensity or pain unpleasantness reductions between the meditation + naloxone and the meditation + saline groups.

The findings clearly demonstrate that mindfulness meditation eases pain through some distinct pathways that are independent of the endogenous opioid mechanisms, suggesting that meditation-based pain relief does not require the role of endogenous opioids. The researchers do not have a clear explanation of the effect of mindfulness meditation on the brain that results in the pain relief. But based on their past results, they believe that meditation activates several regions of the brain that are associated with emotion regulation, focus, and cognitive control. At the same time, meditation also down-regulates the thalamic activity that transmits painful information from and to the body. Thus, the global effect of mindfulness meditation helps to prevent pain and painful information from spreading throughout the brain and body. 

It remains to be determined whether mindfulness meditation would be helpful in the treatment of chronic pain and also be effective in overcoming opiate drug abuse. For now though, mindfulness meditation seems to be a very attractive technique for acute pain relief and for those seeking a non-opiate pain therapy. And, if this is the case, getting hooked on meditation would also be a perfect panacea for pain and other pathological systems some of which we described earlier (Meditation: Effects on Gene Expression). 

This reminds me of an anecdotal report of a senior monk who underwent a complicated surgery without the use of any anesthetics. His years of meditation practice helped him to tide over the pain during and after the surgery. But based on the above-mentioned scientific study, it is also clear that you don�t need to be a monk to reap the benefits of mindfulness meditation. 

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