Studies find meditation rivals oxycodone and other addictive opioids for managing chronic pain 09/11/2017
No topic can be more timely, given America’s epidemic of opioid addiction.
That epidemic began with a physician’s 1980 letter to The New England Journal of Medicine (NEJM).
Dr. Henry Jick was curious about the addictive potential of medical opioids, and examined nearly 12,000 hospital patients who’d received an opiod such as oxycodone at least once.
Surprisingly, their medical records indicated that only four patients later developed an opioid addiction — findings published in the form of a letter from Dr. Jick to the NEJM.
Other researchers began to cite that study, and the idea that opioids don’t cause addiction in pain patients began to take hold.
Dr. Jick's study has been cited more than 600 times, oftten without saying that it focused on short-term use of opioids in hospitalized patients — not long-term use by outpatients.
The maker of OxyContin (which contains oxycodone) cited that study’s limited findings in hospital patients to promote the drug as safe for all pain patients — a position soon echoed by the makers of other opioid drugs.
As Dr. Jick told the AP earlier this year, “I’m essentially mortified that that letter to the editor was used as an excuse to do what these drug companies did. They used this letter to spread the word that these drugs were not very addictive.”
We certainly need good ways to help people break opioid addiction, but — just as importantly — ways to help them avoid taking opioids in the first place.
Fortunately, emerging evidence suggests that "mindful meditation" may enable people to manage pain without using potentially addictive or otherwise-harmful opioids.
What is mindful meditation? Just sit quietly for 15 to 20 minutes, focus on your breathing, and when your attention wanders, refocus on your breathing.
Let's examine three clinical studies that shed light on the effectiveness of mindful meditation, and how it works to manage pain.
Then, we'll look at one way in which meditation might work to ease pain, and potential ways to break opioid addictions with plant medicines.
Trial #1 — Utah, 2017: Meditation rivaled opioids for pain relief
Last July, researchers from the University of Utah published the results of a clinical trial (Garland EL et al. 2017).
And its findings echoed the encouraging results of two earlier studies from North Carolina, described below.
This recent study involved 244 patients at the University of Utah Hospital, all of whom reported pain that they couldn’t manage, resulting from chronic disease, surgery, or an acute illness.
The volunteers were assigned to one of three interventions, which were provided by trained social workers:
- Mindful meditation
- Hypnotic suggestion
- Pain-coping education
All three interventions lowered patients’ anxiety and made them feel more relaxed.
The patients who received pain-coping education reported a 9% reduction in pain.
However, patients given the hypnotic intervention enjoyed a 29% percent reduction in pain, while patients assigned to mindful meditation enjoyed a 23% reduction in pain.
And, the patients assigned to hypnosis or meditation also reported feeling significantly less need for opioid pain medication.
Better yet, following a 15-minute session of hypnotic suggestion or meditation, patients reported immediate reductions in pain, like those expected from opioid painkillers.
According to lead author Eric Garland, “About a third of the study participants receiving one of the two mind-body therapies achieved close to a 30 percent reduction in pain intensity … roughly equivalent to the pain relief produced by 5 milligrams of oxycodone.”
Dr. Garland adds: “It was really exciting and quite amazing to see such dramatic results from a single mind-body session. Given our nation’s current opioid epidemic, the implications of this study are potentially huge.”
Trial #2 — North Carolina, 2015: Meditation rivaled opioids; Scans revealed one reason
A team at North Carolina's Wake Forest Baptist Medical Center measured the effects of meditation using brain imaging scans and the participants' own ratings of pain intensity (Zeidan F et al. 2015).
For this study, 75 pain-free adults were assigned to one of four groups:
- Mindful meditation
- Placebo “sham” meditation
- Placebo analgesic cream (petroleum jelly)
- Control — listening to an audiobook
Because the participants weren’t suffering from chronic pain, the researchers applied heat to a patch of skin, bringing it to a temperature of 120ºF, which is quite painful.
The participants then rated the intensity of the sensation and how it made them feel emotionally.
Before and after each of the interventions, the researchers recorded the participants’ brain activity scanned with a type of MRI scan.
Sham meditation and the control (audiobook) produced little effect, while the placebo cream reduced pain by 11% and the emotional effect of pain by 13%.
In contrast, the “true” mindful meditation group reported that pain intensity was reduced by 27% percent and the emotional effect of the pain was reduced by 44%.
The study’s lead investigator, Fadel Zeidan, Ph.D., expressed pleasant surprise: “While we thought that there would be some overlap in brain regions between meditation and placebo, the findings from this study provide novel and objective evidence that mindfulness meditation reduces pain in a unique fashion.”
Importantly, these MRI scans provided the first evidence that mindful meditation activates brain regions involved in the ability to control pain, and showed that meditation produces brain-activity patterns distinct from those produced by the two placebo treatments.
The scans revealed that the thalamus region of the brain is deactivated by meditation, so the participants’ brains received less input that would normally produce the sensation of pain.
As Dr. Zeidan said, “This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation. Based on our findings, we believe that as little as four 20-minute daily sessions of mindfulness meditation could enhance pain treatment in a clinical setting.”
Trial #3 — North Carolina, 2011: Meditation shows "dose-related" relief
Six years ago, Dr. Zeidan’s Wake Forest University team published a preliminary clinical study that did not employ control groups receiving placebo treatments (Zeidan F et al. 2011).
That study showed that meditation can dramatically reduce people’s perception of pain and pain-related brain activity, and led to the later, placebo-controlled trial.
It involved 15 adults — six men and nine women ranging in age from 22–35 years — who’d never meditated.
The volunteers participated in four 20-minute classes to learn the basic mindful meditation technique: paying attention to breathing and letting go of distracting thoughts and emotions.
Each participants’ brain activity was tracked with a special type of MRI. During the brain scans, they were subjected to the same high-heat pain used in the 2015 trial, for 5 minutes.
The brain images taken after the meditation training confirmed the participants' reports that they experienced less pain, with the reductions in their pain scores ranging from 11% to 93%.
Dr. Zeidan summarized their results this way: “We found a big effect — about a 40 percent [average] reduction in pain intensity and a 57 percent [average] reduction in pain unpleasantness. Meditation produced a greater reduction in pain than even morphine or other pain-relieving drugs, which typically reduce pain ratings by about 25 percent.”
And he made an important point: “… the more that these areas were activated by meditation the more that pain was reduced. One of the reasons that meditation may have been so effective in blocking pain was that it … reduced pain at multiple levels of processing.”
Does meditation cause the body to produce opioids internally?
It’s been proposed that meditation induces the brain to produce naturally occurring opioids.
But two recent studies that attempted to answer this question produced opposite conclusions.
The Wake Forest team behind two of the studies described above tested the effects of the opioid-blocking drug naxalone on the ability of meditation to alleviate heat-induced skin pain (Zeidan F et al. 2016).
They reported that participants who had painful heat applied to their skin still received relief from meditation, despite receiving naxalone.
However, an Israeli team that conducted a very similar trial reported that administration of naxalone greatly reduce the ability of meditation to alleviate pain (Sharon H et al. 2016).
Clearly, more study is needed to answer this important question!
What about people who are already addicted?
To date, there hasn’t been any research designed to see whether meditation can be effective at breaking opioid addiction.
While there are pharmaceutical opioid substitutes — methadone and suboxone — neither is a cure, and they generally must be continued long-term.
But there’s growing evidence that certain traditional plants hold real potential for helping people break opioid addictions, permanently.
The two most promising candidates are plant medicines — iboga and ayahuasca — used in traditional African or Amazonian medicine and shamanic healing.
The active constituent in iboga is an indole alkaloid called ibogaine, while ayahuasca is a mixture of tropical plants that delivers and allows the absorption of dimethyltryptamine (DMT) — traces of which occur naturally in the human brain.
Unlike ayahuasca — which has a generally good safety record, unless combined with certain pharmaceutical drugs — ibogaine can be dangerous if not used under medical supervision.
Regardless of their documented potential, research into these promising plants has been blocked by federal agencies because iboga and ayahuasca produce psychedelic experiences.
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