Research has fairly well established that meditation for pain relief can be a powerful tool, but HOW it helps remains a mystery. One hypothesis is that meditation employs the body’s naturally occurring opioids to control pain. This is what happens when you stub your toe—it hurts at first then it stops hurting when your body produces opioids to block the pain. This opioid theory is incorrect, according to a study published today in the Journal of Neuroscience.
The drug naloxone, which blocks the pain-reduction opioids can provide, was a key part of the study. Researchers divided 78 healthy, pain-free participants into four groups: naloxone plus meditation, naloxone without meditation, saline placebo plus meditation, and saline placebo without meditation. Pain was induced by using a thermal probe to heat a portion of participants’ skin to 120.2 degrees Fahrenheit. Participants used a sliding scale to rate their pain. Each participant established a baseline pain rating before receiving any treatment. The pain ratings after the treatment were 24% lower than baseline in the group that meditated and received naloxone. The ratings were 21% lower than baseline in the meditation group that received the saline placebo. Pain levels were higher than baseline in the groups that did not meditate, whether or not they receive naloxone.
These pain reduction levels are significant because they show that meditation reduced pain even in people whose opioid receptors were chemically blocked. Thus indicating that non-opioid pathways are responsible for pain relief in meditation. Further research is required to determine which pathways might be at work. It will be interesting to see if those pathways (whatever they are) have already been identified as having a role in pain relief.
Although the study included healthy participants who experienced fleeting pain, the lead researcher says the findings could be particularly helpful for people who want to avoid opioids or have built up a tolerance to them—the latter of which implies people with chronic pain. He did not condemn other treatments, but said that meditation can be used to enhance the benefits of other treatments.
Whenever I share anything about pain, I feel the need to clarify that most headache disorders are not just pain. Migraine, cluster headache, and even new daily persistent headache have symptoms that extend beyond pain. Focusing only on the pain diminishes the non-pain symptoms that can be just as, or even more, disabling than the pain. It can also lead to ineffective or even harmful treatment. I’m not worried about that with meditation, but it’s still good to remember that pain isn’t the only symptom for most headache disorders (though I doubt most of you could forget that!). In addition to it’s potential to reduce physical pain, meditation is a great tool for managing the emotional distress that comes with headache disorders. And, as Alicia pointed out in the discussion on acceptance, “the psychological aspect of having migraines can be just as devastating as the physical aspect.”
The Zeiden article found that mindfulness mediates analgesia through a non-opiate pathway, but this article neglects to mention a separate article by Sharon et al. (2016) (linked below) that disputes this, and that mindfulness indeed produces endogenous opioids or endorphins that do reduce pain. These findings are also confirmed through the extensive literature on resting states, that consistently notes the production of endorphins in resting states, and resting or relaxation is a primary result of meditation.
An elaboration of this argument is below, along with linked references.
What Mindfulness Research Neglects
Mindfulness is defined as non-judgmental or choice-less awareness. Choices in turn may be divided into non-perseverative choices (what to have for breakfast, what route to take to go home, or choices with no dilemmas) and perseverative choices (worries, distractions, and rumination, or mental dilemmas wherein every alternative is bad). All meditative procedures, including mindfulness, avoid both.
The consistent avoidance of perseverative choice alone represents resting protocols, wherein the neuro-muscular activity is sharply reduced. In other words, when we want to be relaxed we isolate ourselves from distractive and worrisome events and thoughts. These states in turn correlate with increased levels of endogenous opioids or ‘endorphins’ in the brain. The benefits of this are manifest, as the sustained increase of endogenous opioids down regulates opioid receptors, and thus inhibits the salience or reward value of other substances (food, alcohol, drugs) that otherwise increase opioid levels, and therefore reduces cravings, as well as mitigating our sensitivity to pain. Profound relaxation also inhibits muscular tension and its concomitant discomfort. In this way, relaxation causes pleasure, enhances self-control, counteracts and inhibits stress, reduces pain, and provides for a feeling of satisfaction and equanimity that is the hallmark of the so-called meditative state.
It may be deduced therefore that meditative states are primarily resting states, and that meditative procedures over-prescribe the cognitive operations that may be altered to provide its salutary benefits (that is, you just need to avoid perseverative choices, not all choices), and that meditation as a concept must be redefined.
Finally, the objective measurement of neuro-muscular activity and its neuro-chemical correlates (long established in the academic literature on resting states) is in general ignored by the academic literature on mindfulness, which is primarily based upon self-reports and neurological measures (fMRI) that cannot account for these facts. The problem with mindfulness research is therefore not theoretical, but empirical, and until it clearly accounts for all relevant observables for brain and body, the concept will never be fully explained.
More of this argument, including references, below including a link to the first study (published this year) that has discovered the presence of opioid activity due to mindfulness practice, as well as the 1988 Holmes paper which provided the most extensive argument to date that meditation was rest.
http://www.amjmed.com/article/S0002-9343(16)30302-3/abstract
https://www.scribd.com/doc/284056765/The-Book-of-Rest-The-Odd-Psychology-of-Doing-Nothing
https://www.scribd.com/document/291558160/Holmes-Meditation-and-Rest-The-American-Psychologist