Mind-body therapies can reduce pain and opioid use

Our ability to feel pain and react to it is both a boon and a curse, simultaneously. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” This means that pain is highly subjective, and it is informed by a mix of past experiences, our current emotional state, and future expectations. Since pain is an emotional and sensory experience it affects our quality of life immensely, and treatment is complex.

Chronic pain management with opioids is not ideal

Opioids are among the most potent medications used to manage pain. Opioids curb pain by blocking pain signals between the brain and the body. This class of medication also relaxes the brain, providing a sense of calm and euphoria, and there is a high risk of addiction. Opioid misuse is more pronounced in people who have had surgery and been given opioids than in people who have not had surgery. The longer a person uses opioids, the greater risk of their misusing these medications. The ongoing opioid epidemic has led physicians to look for adjunct and nonmedication therapies to help people reduce opioid use and still effectively manage pain.

Mind-body therapies for pain management

Mind-body therapies (MBTs) are integrative practices, and they include breathing exercises and/or body movements aimed at achieving relaxation of mind and body. Some MBTs are Isha yoga, vipassana, mindfulness-based stress reduction, integrative body-mind training, tai chi, guided imagery, cognitive behavioral therapy, and others.

Pain and meditation both alter our senses, thinking, and emotional responses

One MBT is mindfulness meditation, which involves practicing attention control, emotional regulation, and self-awareness. There is increased perception and awareness with mindfulness practices, and meditation addresses both the sensory and emotional components of pain. The interoception center in the brain increases and the amygdala shrinks in size with regular mindfulness practices, which explains better emotional regulation and pain control. The brain’s ability to react to painful stimuli with an emotional response decreases, and a person is more likely to respond calmly to a stimulus instead of having a hasty emotional reaction (hurt, pain, anger, etc.). The increased perception and awareness with regular mediation will make a person feel every sensation, including pain; however, they may choose not to react to it, so practicing meditation can help you better manage pain.

New research on MBTs for pain management and reducing opioid use

A recent paper published in JAMA looked into the use of MBTs as potential tools in addressing the opioid crisis. Researchers reviewed 60 randomized clinical trials with 6,404 participants and found that MBTs had a moderate association with reduction in pain intensity and a small but statistically significant association with reduced opioid dose. These findings suggest that MBTs are an effective nonmedication tool in reducing the experience of pain, and using MBTs may have some benefit in reducing opioid use and misuse. MBTs may also help with cravings for opioids if someone is trying to reduce their dose.

However, a closer look into the analysis reveals that the type of MBT used affects therapeutic efficacy. Often combinations of MBTs are used to treat pain, and it is difficult to be certain which type of MBT is most effective. There is also a lack of conclusive evidence for the benefit of using MBTs in certain clinical scenarios (such as following surgery), due to inconsistent reporting of opioid dosing and durations. Lastly, there is currently a gap in our understanding regarding the right time to implement MBTs, and their effectiveness as an adjunct to opioid-treated pain. All these criticisms do not negate the results of the JAMA study; rather, this work highlights a need for future research to determine what types of MBTs could be most effective in helping with pain and reducing opioids.

Routine mindfulness meditation practices can improve your quality of life

As mentioned, MBTs, particularly meditation, play a huge role in transforming our experience of pain. Meditation allows us to recognize the authenticity of distress and not be overwhelmed by it. Learning and practicing mindfulness-based meditation is a means to deal with pain and the inevitable stresses of life, and to improve your quality of life. However, there is no one-size-fits-all approach and no one MBT that works for everyone.

The array of available MBTs means there is flexibility to choose your level of involvement and time spent in these practices. Our personal experience with meditation and its effects on our lives and the well-being of our patients make us strong advocates of MBTs. As always, discuss all medication changes and new lifestyle practices with your doctor.

Comments:

  1. David G Ostrow

    In addition to the specific mind-body practices described in this article, we should keep in mind that empowering patients with significant chronic pain to employ cognitive and other mental coping strategies can always help them manage pain and reduce its negative impact on their quality of life. The concept that total lack of pain is always the desired outcome is one of the myths that encouraged the chronic prescription of ever increasing doses of opioid analgesics, and we all know where that concept led. We also know that the advice given to patients by the prescribing health caregiver can significantly influence the expectations and symptom reduction experienced by the patient. Pain has positive warning and protective functions, and is thus inevitable in life. How we experience and cope with pain involves both conscious and unconscious processes that can oftentimes be enhanced through non-pharmacological interventions.

  2. Dawn McOwen

    It’s unfortunate that doctors do not take meditation, hypnosis, etc. seriously. I had been meditating for five years when I decided to start testing effectiveness by cutting back.

    I had the same doctor 7 years. Every visit was ‘No, the RX doesn’t work, but what can I do?’ “What do you know about acupuncture, stem cells?” Reply: A shrug of the shoulders. No input. I was constantly talking about binaural beats, hypnosis, etc.

    Three months ago, he decided to come whining about test values being too low. I did three hours of research on false positives, false negatives, and went to my appointment with five pages of notes. A month later, after a week of office staff lies, they told me he was refusing my refill. I dropped him as a doctor. Why spend another $500 in a month to be told he wasn’t refilling the other RX either?

    Most important thing I learned is opioids INCREASE pain after you have abstained a few days. I feel sad that recent oral surgery has apparently taken me back to withdrawal day one. I tried to resist, and only had a few days’ worth. But the pain was horrendous.

    Please, Everyone, Try meditation. It often takes a long time to get noticeable results. But if your doctor drops you, or takes away your RX, you will want tools of your own. Too many patients are being dropped. I left my doctor because I wanted to. I had been praying God would set me free for months. Some patients don’t have that choice.

  3. Dentist Brookline

    Our mind have more abilities than what we think. It can help a lot in healing many disease and pain as well. Pain management can be done through mind yoga and meditation. Thank you very much for explaining this topic here. Very helpful for everyone.

  4. Heather Derocher

    Thank you for writing this article. MBTs are immensely helpful for improving day-to-day coping skills, so it makes sense that it can also help with dealing with pain management and the angst of getting off opioids. My father struggled with opioids for 10 years after surgery before the addiction and opioid abuse took his life at 55yrs. MBTs are another tool for people struggling with pain to find relief and a path to better health.

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