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Meditation for Pain Relief Doesn’t Use the Body’s Natural Opioids

meditation for pain reliefResearch 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.”

 

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Learning to Listen & Respond to Your Body’s Needs

I’ve done what journalists call burying the lede in this post. If you want get to the heart of body scans, skip on over to Learning to Listen to Your Body, my latest post on Migraine.com. To understand how listening to your body relates to your life, migraine, chronic illness, and society, keep reading.

Spending time with mothers of young children recently, I’ve been struck by how in tune they are with their children’s needs. Even though the child can’t speak, their mothers know that that a certain squirm means “let me down,” while another indicates a dirty diaper, that a particular squeak means the child is hungry.

Imagine being that in tune with your own body. Think how valuable that knowledge could mean for someone with migraine, whether episodic or chronic, or any other illness, for that matter. If you can identify early warning signs of an impending attack or downturn, you can take appropriate medications or avoid overtaxing yourself, resting when needed rather than only when you’re completely exhausted.

This knowledge is particularly valuable in migraine, since the first phase of an attack, called prodrome, causes physiological changes in the body that many of us are unaware of. Some people yawn a lot, feel tooth sensitivity, have a creative surge, get hyperexcited or depressed, or a host of other symptoms. Unless you’re aware of the minute changes in your body, you may not know a migraine is coming on before it whacks you over the head. Knowing your personal prodrome symptoms are crucial, since migraine abortive medications are more effective the earlier in an attack you can take them.

We are all capable of being as aware of our own bodies’ needs as a parent is of their child’s needs. Living in a culture that prizes busyness and activity over any downtime most of us have never learned how to listen to our bodies or take care of ourselves. When we get sick, we continue ignoring what our bodies have to say — sometimes as a coping mechanism, sometimes because that’s the only way we know how to function. We do so at our own peril and, I fear, ultimately worsen the symptoms of illness.

Fortunately, listening to our bodies is a skill we can learn, just as we can learn to play the piano or bake cookies. Meditating is one way I’ve learned to listen to my body. A body scan, which can be part of a meditation practice or done on its own, is an excellent, clear-cut method for learning to hear what your body is telling you. Learning to Listen to Your Body, my latest article for Migraine.com, walks you through a short body scan and recommends some resources for a guided body scan. Like mastering any skill, it takes practice, but the reward is worth the effort.

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Take the Hamster Off the Wheel: A Practice in Mindfulness

“[I]t’s like your mind is a hamster running on a wheel. Same old thoughts, day in and day out. You don’t really get anywhere except maybe an occasional breakthrough. When I [rock] climb, all there’s room for is the concentration on the gear and the next move. The thoughts stop, the wheel stops . . . the hamster is free.” -Critter (in Jump, by Elisa Carbone)

Sometimes a passage from a novel speaks to you so loudly it screams. Critter, a teenager who is wise beyond his years following a near-death experience, captured the essence of mindfulness so well that I’ve been using his image of a hamster on a wheel since I read it two weeks ago. “Take the hamster off the wheel” has morphed into “hamster, off,” which has the added benefit of making me giggle.

The only trouble is that sometimes I get carried away imaging the hamster curled up on a bed of wood shavings, its little nose twitching as it sleeps. My mental hamster is white with light brown spots and has an adorable pink nose. Although my mind is no longer churning on whatever issue is at hand, it is far from from the present moment as I wonder what the hamster is dreaming about. At this point, I simply think “churning” and try to refocus on the moment I am in.

Whether I mentally say “hamster, off” or “churning,” my shoulder and neck muscles release instantly. (Although thinking doesn’t always feel like stressing, my shoulders seem to think it does.) I relax and experience the present. For a few seconds at least, until the hamster starts running again. Then I gently remove it from the wheel and return to the moment. Again. And again. And again. Because the only sure thing about practicing mindfulness is that your mind will wander.

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The Exhilaration of Irrational Hope: Trying a New Treatment

In a few hours, I’m getting my first occipital nerve block. Sunday I was elated by the possibility for relief, thinking about how, if effective, the treatment would change my life. Yesterday my thoughts changed from “would” to “could” and I became skeptical that it will help. Today I’m just hoping that it doesn’t trigger a migraine attack. This wide range of emotions, from an almost manic excitement to a dread of disappointment, is familiar territory — this is what I feel every time I attempt a new treatment. No wonder trying new treatments is so exhausting.

Mindfulness would eliminate (or at least drastically reduce) this emotional torment, if I could put it into consistent practice. Despite all the wonderful coping skills mindfulness has given me, I resist applying it in this situation. The exhilaration of irrational hope briefly alleviates the difficulties of life with chronic migraine. It counters the pain, nausea, dizziness and distressingly heightened senses of a migraine attack. It provides a glimpse of a glorious (fictional) future that I don’t consciously allow myself to think about, but such indulgence is OK in the context of exploring the outcomes of a possible treatment. Though brief, the high is wonderful.

Like all drugs, irrational hope has a horrible letdown that lasts much longer than the high ever could. Yet, I haven’t been able to break the habit, nor am I sure I want to even though it goes against my general philosophy for how to cope with chronic illness. Any attempt at a new treatment, whatever the outcome comes with a new understanding. For me, that is often the knowledge that yet another treatment has had no positive effect. Even if the treatment works — and I’m speaking from limited experience as I’ve only had two treatments be even slightly successful — there is a period of adjusting to the amount to which it works and the impact it has on one’s life. If I’m going to have to learn to cope anyway, acknowledging that my fantasy of a miracle cure hasn’t materialized isn’t much bother.

As I was procrastinating while writing this post, I saw on Facebook that How to Be Sick author Toni Bernhard shared this apt quote from Brother David Steindl-Rast: “People who have faith in life are like swimmers who entrust themselves to a rushing river. They neither abandon themselves to its current nor try to resist it. Rather, they adjust their every movement to the watercourse, use it with purpose and skill, and enjoy the adventure.” I love the idea of embracing such faith in life as I embark on new treatments. Right now, though, I’m too addicted to the high of irrational hope to entrust myself to the river.

I wasn’t able to edit this piece in time to get it posted before the nerve block this afternoon, which means I can fill you in on how it went. The injections were horrifically painful and I nearly fainted (apparently, this happens to about 10% of people). Good news: the block reduced level 6 pain and to a 3 within 10 minutes. Bad news: it was back to a level 5 within two hours and I’ve spent the rest of the day in level 5 or 6 pain. I’m hopeful that the injections just irritated the nerves and I’ll be better in a day or two.

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Mediation & Self-Compassion: Suffering is Optional

I keep talking about how my migraines have improved, though my migraine diary for December appears to tell a different story. I had at least a level 7 migraine 17 of the first 18 days of the month. Those can be explained by bad weather, Botox injection aftermath, and more bad weather. Just when the weather stabilized, I came down with some lingering low-level virus that has kicked up the migraines, made me nauseated, and drained all my energy. That appears to have finally lifted, so I hope I’m on the upswing. All this and I still say I feel better. Partly this is relative — it doesn’t take much to improve on the migraine hell I was in — but it is more that I have learned how to limit how much I suffer from migraine.

“Pain is inevitable. Suffering is optional.” Through meditation, the simple truth of this statement has woven itself into my life: Suffering is not in the pain itself, but in how we react to pain. Understanding these words and truly embracing their meaning take much practice. I have only just begun this practice, but the relief it has brought me is tremendous.

Since I began meditating in earnest in April, I’ve learned to just be with my illness instead of constantly thinking about it and evaluating it. I’ve learned to turn off the critical internal dialogue that has always accompanied migraines, the one that tells me I’m faking it for attention and letting other people down. I finally learned that I am worthy of the love and understanding I so readily give others; that self-compassion is, in fact, a necessary foundation for caring for others.

To figure all this out, I set aside my aversion to all things spiritual/religious and listened to guided meditations and Buddhist teachings and read about applying Buddhist concepts to chronic illness. (So far, Buddhism feels more like psychology than religion to me.) I’ve culled resources from all over the internet and from multiple libraries. The most accessible and helpful (for me) include:

I recommend the first three as audiobooks. I have listened to each one multiple times, often during a migraine. They are calming and easy to fall asleep to. I like to think that my mind is mulling over the concepts while I sleep. Those are good general approaches to healing. How to Be Sick is an invaluable resource for learning to minimize the suffering of chronic illness. It includes detailed examples of how to apply different principles to particular difficult situations common to people with chronic illness (like losing friends and feeling isolated or dealing with the disappointment of failed treatments).

Have you found meditation to be helpful in dealing with your own migraines or headaches? What other techniques helped you accept your illness?