Mindfulness Meditation Provides Pain Relief Without Opioids

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Approximately 100 million Americans suffer from chronic pain at a cost of more than $600 billion for annual treatment. Unfortunately, according to a recent NIH report, 40% to 70% of people with chronic pain are not actually receiving proper medical treatment for their pain. In cases where opioids are necessary, there is growing concern among experts about the over- and under- pharmacological treatment of chronic pain

In 1991, American doctors wrote 76 million prescriptions for opioids to treat pain. By 2012, this number had skyrocketed to 259 million opioid prescriptions. A staggering 80% of all opioid prescriptions worldwide are written in the United States. The uptick in the use of opiate-based painkillers in the past decade created millions of opioid-addicts. Many of these people turned to heroin when they could no longer refill their prescriptions or afford black-market pain pills.

Chronic Pain and Opioid Addictions Are Destroying American Lives

In America today, drug overdoses cause more deaths than car accidents. Opioids such as OxyContin and other pain medications kill about 44 people every day. Deaths from heroin have quadrupled since 2013 claiming 8,260 lives. Experts at the Centers for Disease Control and Prevention (CDC) are calling this the worst drug overdose epidemic in U.S. history.

On March 15, 2016, the CDC issued new guidelines for primary care clinicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The CDC guidelines for prescribing opioids are summarized in a simple checklist.

What can we do to break this cycle of chronic pain, addiction, and overdose deaths? Obviously, there are no easy solutions. That said, it appears that as part of a multi-pronged approach, mindfulness meditation could be a valuable drug-free treatment component to help people cope with chronic pain.

Because opioid and nonopioid mechanisms interact in a synergistic manner to reduce pain, the latest research suggests that a combination of mindfulness-based and pharmacologic, or nonpharmacologic, analgesic strategies (that don't rely on opioid signaling) may be an effective way to treat physical pain.

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A new study from Wake Forest Baptist Medical Center has found that mindfulness meditation can reduce pain without employing the endogenous (self-produced) opioid systems that are typically believed to reduce pain during cognitive-based techniques such as mindfulness and meditation.

The endogenous opioid system has historically been thought of as the central hub for creating pain relief without the use of drugs. The endogenous opioid system self-produces three opioids: beta-endorphin, the met- and leu-enkephalins, and the dynorphins.

The same opioid receptors in our brain respond to both endogenous and exogenous opioids. Endogenous opioids act as neurotransmitters and neuromodulators on three different receptors to produce analgesic pain relief. Exogenous opioid-based painkillers, hijack the opiate receptors that were originally designed for endogenous opioids.

In November 2015, I wrote a Psychology Today blog post, “The Neuroscience of Mindfulness Meditation and Pain Relief,” which references previous research by Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center, and his colleagues.

In their 2015 study, Zeidan et al. reported that mindfulness meditation reduces pain more effectively than placebos by activating two specific brain regions associated with self-control and subsequently deactivating the thalamus.

Mindfulness Meditation Reduces Pain Without Relying on Opioid Receptors

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The March 2016 Wake Forest study, “Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids,” was published today in the Journal of Neuroscience. This study builds on Zeidan’s previous research by identifying that mindfulness meditation does not employ the endogenous opioid system to reduce pain. This is a groundbreaking discovery.

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In their latest study, a team led by Fadel Zeidan set out to identify if mindfulness-meditation-based analgesia is mediated by opioids or if meditation helps reduce chronic pain via a different channel. To solve this riddle, the researchers examined pain reports during meditation in response to painful heat while simultaneously administering the opioid antagonist naloxone.

The mindfulness meditation technique used for this study was a simple cognitive practice of sustaining nonjudgmental awareness of arising sensory events and redirecting one’s thoughts. Until now, experts believed that mindfulness meditation activated multiple brain regions that contain a high number of opioid receptors.

In the latest randomized, double-blind study, 78 healthy, pain-free volunteers were divided into four groups for the four-day (20 minutes per day) trial. The groups consisted of: meditation plus naloxone; non-meditation control plus naloxone; meditation plus saline placebo; or non-meditation control plus saline placebo.

To determine if meditation uses the body's opioids to reduce pain, the Wake Forest Baptist researchers injected study participants with either a drug called naloxone, which blocks the pain-reducing effects of opioids, or a saline placebo.

Pain was induced by using a thermal probe to heat a small area of skin up to 120º F, which is a level of heat most people perceive as being very painful. Then, study participants rated their pain using a sliding scale.

For the meditation group, the participants' pain ratings were reduced by 24 percent from the baseline measurement in the meditation group that received the naloxone. Pain ratings also were comparably reduced by 21 percent in the meditation group that received the placebo-saline injection. On the flip side, the non-meditation control groups reported increases in pain regardless of whether they got the naloxone or placebo-saline injection. In a press release, Zeidan described the study,

“Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain, And now this study shows that meditation doesn't work through the body's opioid system.

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. 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,"

Orbitofrontal Cortex (OFC) in green.

Source: Paul Wicks/Wikimedia Commons

Zeidan and his colleagues have repeatedly shown that greater mindfulness-meditation-induced pain relief is associated with greater activation of the orbitofrontal cortex (OFC).

Interestingly, synaptic projections from the OFC connect onto the thalamic reticular nuclei (TRN) which triggers a chain reaction that inhibits sensory processing in the thalamus. Their latest research illuminates that all feedback connections between the cerebral cortex and thalamus must pass through the TRN in a topographically organized fashion.

Therefore, the researchers surmise that the TRN might operate as a type of “gatekeeper” which regulates the flow of sensory information by suppressing ascending “irrelevant or distracting” sensory inputs from reaching the level of conscious awareness in the cerebral cortex.

How Does Mindfulness-Meditation Minimize Sensory Perceptions of Pain?

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Based on this framework, the Wake Forest researchers propose that mindfulness-meditation triggers the activation of the OFC, which activates the TRN. Then, the TRN inhibits thalamic processing which ultimately derails pain signals from being received at various points throughout the cerebral cortex. It appears that mindfulness meditation may activate the proposed gating mechanism through executive shifts in attention and non-judgmental reappraisal of painful sensations.

In fact, the researchers discovered that mindfulness meditation may redirect sensory perceptions of pain in the cerebral cortex via a chain reaction involving the orbitofrontal cortex (OFC) and the thalamus without requiring the production of endogenous “self-produced” opioids.

As an endurance athlete, I had to figure out various cerebral strategies for coping with excruciating physical pain. These new findings offer a neuroscientific explanation for the underlying brain mechanics involved in mental techniques that I would use to overcome pain during Ironman triathlons and ultramarathons. Similar techniques such as mindfulness training and meditation can be used in daily life to reduce pain.

Conclusion: Meditation-Based Pain Relief Doesn’t Target Opioid Receptors

The most recent Wake Forest study demonstrates that mindfulness meditation facilitates the cognitive ability to acknowledge, and let go of, specific sensory inputs including pain. These findings show that mindfulness meditation reduces pain independently of the opioid-based neurotransmitter mechanisms. The findings also demonstrate that meditation-based pain relief does not require endogenous opioids.

Zeidan concluded, "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." The next step for Zeidan's team is to determine if and how mindfulness meditation can affect a spectrum of chronic pain conditions. The researchers of the study conclude,

"Mindfulness meditation is a complex, cognitive process that likely engages multiple brain networks and neurochemical mechanisms to attenuate pain. 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."

The research suggests that stimulating the OFC creates a domino effect that re-directs pain signals away from your conscious levels of perception via the thalamus. These revolutionary findings offer valuable clues for drug-free alternatives that might help millions of people cope with chronic pain and avoid becoming addicted to opiates or heroin.

To read more on this topic, check out my Psychology Today blog posts:

• "5 Neurocience Based Ways to Clear Your Mind"
• "What Causes Economic Insecurity to Morph Into Physical Pain?"
• "Heroin Addiction Is Destroying the Lives of Young Americans"
• "The Neuroscience of Mindfulness Meditation and Pain Relief"
• "Combining Aerobic Exercise and Meditation Reduces Depression"
• "Mindfulness Meditation and the Vagus Nerve Share Many Powers"
• "Your Brain Can Be Trained to Self-Regulate Negative Thinking"
• "10 Ways Mindfulness and Meditation Promote Well-Being"
• "Neuroscientists Identify How Mindset Alters Pain Perceptions"
• "How Does Yoga Relieve Chronic Pain?"
• "Optimism and Anxiety Change the Structure of Your Brain"
• "How Are Human Traits Linked to Specific Brain Connections?"
• "Is Impaired Neuroplasticity Linked to Chronic Pain?"
• "Chronic Stress Can Damage Brain Structure and Connectivity"
• "The Neurobiology of Grace Under Pressure"
• "Mindfulness: The Power of "Thinking About Your Thinking"
• "The Neuroscience of Savoring Positive Emotions"
• "7 Ways to Create an Upward Spiral of Positive Emotions"

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