With the opioid epidemic rising precipitously–Prince’s death has now officially been declared a result of fentanyl overdose–various agencies and experts are calling for a vast rethinking of how pain is controlled in this country. Chronic pain is a leading cause of disability, not to mention psychological burden; but we have few effective, non-addictive methods for addressing this global problem.
Earlier this year, in Journal of the American Medical Association (JAMA), the CDC released new guidelines to doctors for prescribing opioids for chronic pain, the first of which is the recommendation to try nonpharmacologic interventions before pharmacologic ones. Also in the journal JAMA last month was an editorial outlining the potential role of mindfulness meditation as an alternative to the opioid over-prescription problem. Though it may not be effective in every case, mindfulness meditation seems to be a promising tool for people who are dealing with mild or moderate pain, or at least as an adjunct for people who are dealing with various types of pain. It's not a panacea, but the research laying out its effects on pain, both in life and in the lab, is growing steadily.
One study earlier this year, for instance, had people with chronic lower back pain take part in either an eight-week mindfulness-based stress reduction (MBSR) course, or as many weeks of cognitive behavior therapy (CBT), which is also known to be effective for managing pain. A control group was made of people receiving “usual care,” which consisted somewhat vaguely of “whatever care participants received.” At the end of the study period, people receiving MBSR and CBT all improved about the same amount–their pain was reduced by about 44% and 45%, respectively, vs. 27% in the control group. So both MBSR and CBT seem to reduce pain significantly over standard care. In another recent study, a similar level of relief was found for older adults experiencing chronic pain and who were assigned to learn MBSR.
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And interestingly, the pain relief that comes from mindfulness meditation doesn’t seem to rely on the opioid pathway. In another study, people who were taught meditation and whose opioid receptors were blocked still had significantly less pain in response to a painful stimulus than those in a control group. “This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain,” said study author Fadel Zeidan. “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.”
Zeidan’s other work has mapped out some of the neural underpinnings of meditation’s effects on the pain response, using MRI. He’s found that meditation, among other things, affects areas of the brain that govern how we contextualize what’s happening in the environment (the orbitofrontal cortex) and our cognitive control and emotional regulation (anterior cingulate cortex), which both are rich in opioid receptors. Meditation was also linked to reduced activity in the thalamus, which is like a relay station for incoming information from the spinal cord to the brain. Zeidan says that subjects who were trained in mindfulness said things like, “I felt the pain was there, but I was able to let it go. I didn’t dwell on it so much.” Part of meditation's beneficial effects may be that it shifts the way we relate to our own perceptions of our pain, which is a lot of what the experience is about.
More research will clearly be needed to figure out who might benefit from meditation as a treatment method–or at least as an adjunct–for chronic pain. For some people it may not work, and some may still need other forms of therapy, with or without medication. But if we can try, as the CDC and others are pushing hard for now, to widen our array of tools in pain management, and not use opioids as a go-to method, then we’ll be in much better shape. Hopefully we'll see fewer addictions and casualties as a result. And given the many other benefits of meditation, for managing chronic pain, too, it's definitely not a bad "drug" to push.
