Meditation: mindfulness relieves pain and reduces painkillers

Mindfulness is highly effective in treating opioid abuse in people with chronic pain, clinical trial finds. In the largest trial of its kind to date, researchers found that mindfulness training reduced pain, opioid dosage, and depression in patients with chronic pain.

A randomized clinical trial conducted by Utah researchers compared the effectiveness of mindfulness-based therapy with that of cognitive-behavioral therapy (CBT) in reducing both opioid use and pain in patients with chronic pain. This trial, published in the journal JAMA Internal Medicine in 2022, is the latest in a series of studies that use mindfulness-based techniques to reduce pain and opioid use in people with chronic pain. . The study’s lead author, Eric Garland, PhD, designed the Mindfulness-Oriented Recovery Enhancement (MORE) approach. It combines mindfulness training, changing the course of negative thoughts, relearning to appreciate positive experiences, and positive psychology, which encourages people to focus on their strengths rather than their weaknesses.

The randomized clinical trial involved 250 adults with chronic pain who misused opioids prescribed to them to treat their pain. Half of them met the criteria for opioid use disorder (OUD) when they were recruited for the trial. About half of the patients completed group mindfulness training for eight weeks using MORE. The control group received standard CBT in a group setting. Researchers encouraged patients to do what was good for them and did not force anyone to wean themselves off their medication. For patients who wanted or needed to continue taking opioids, MORE helped reduce the risk of misuse and relieve pain.

Less medication, less pain

Opioid misuse decreased by an average of 45% in the MORE group, twice as much as in the CBT group. Over 35% of people in the MORE group reduced their opioid use by at least half. People in the MORE group also reported decreased pain, opioid cravings, and emotional distress, even though they took fewer painkillers. The effects lasted at least until the researchers’ nine-month follow-up period. And although the effects seemed to stabilize between six and nine months for the MORE group, the effects of CBT actually declined in the control group.

The authors note that “It’s hard to make general statements about chronic pain because it’s so different from person to person, but there seems to be a way to modulate how a person’s relationship person with pain modulates the craving for a drug. This data shows that the more people practice, the more benefits they get.” This new study is the longest and most advanced of trials that have tested the mindfulness intervention specifically designed for patients with chronic pain who abuse opioids. The goal with these patients is twofold: Reduce opioid addiction and continue to manage pain.

What makes the MORE approach unique is that it aims to help people who have used opioids long-term to relearn how to savor pleasure. For the researchers: “Because of opioids, their reward system is completely out of whack. The physiology was altered in such a way that the craving for the drug took over the reward pathways.

Opioids only temporarily relieve pain

Despite relatively high doses of opioids, trial participants still suffered from significant chronic pain. This is explained by the fact that “opioids are not effective against chronic pain. Opiates like morphine can instead relieve acute pain that is temporary, such as post-surgical pain. Chronic pain, on the other hand, is often lifelong. This makes mindfulness a particularly effective modality for helping people cope with chronic pain.

According to research, the immediate effect mindfulness can have is on pain. It’s one of the only techniques that can immediately reduce pain, and we’re only just beginning to understand it. research has so far shown that the effect of mindfulness on pain perception is not just a placebo effect, and unlike other pain relief modalities, it appears to work outside of the internal opioid system of the body. Medications such as prescription opioids, and even over-the-counter painkillers like ibuprofen, work within the body’s opioid system to block signals from reaching the brain, where they are processed and perceived as pain. pain. Mindfulness engages neural and physiological processes that are quite unique. The theory goes that we can’t relieve pain outside of the opioid system using another method.

Chronic pain is not “in your head”

In recent years, the question of whether chronic pain has psychological origins has been the subject of debate. There are certainly psychological factors that influence people’s pain, but people also suffer from medical conditions that are very painful. Even when the pain comes from a purely physiological source, like a herniated disc or an arthritic knee, mindfulness can still be a great way to reduce pain.

The latest MORE trial showed that mindfulness can also lessen the emotional side effects of chronic pain. At the start of the trial, nearly 70% of patients met criteria for major depressive disorder (MDD). At the end of the trial, people treated with MORE had reduced symptoms of depression that were no longer considered major depressive disorder. This effect is just as important as pain relief and reducing opioid addiction.