June/July 2018 Newsletters (Edited)

June 2018

Does Meditation Block Pain?
This excerpt was sent to me by Marc Rowe, M.D. Underlines and italics are his.

Mindfulness practices have shown promise for managing chronic pain since Jon Kabat-Zinn’s pioneering work in the 1980s, when he developed Mindfulness-based Stress Reduction (MBSR) and applied it to various clinical populations. A recent review and meta-analysis found that for chronic pain patients, mindfulness meditation is associated with a decrease in pain compared to all types of controls in 30 randomized trials. Questions remain, however, as to how this effect may be achieved physiologically. Most pain relief is induced through the body’s natural opioid system, or by artificially activating this system through powerful opioid drugs such as morphine, codeine, or fentanyl. Even cognitive methods of pain relief like placebo or attentional control have been shown to act through the body’s natural opioid system. Does meditation use the same pathways?

Several years ago, Mind & Life funded two separate but complementary Varela Grants that sought to address this question using an elegant pharmacological test. The drug naloxone is often used to treat opioid overdose because it potently blocks opioid receptors. When given fast enough to an overdose victim, it can help prevent death because it blocks the receptors that the opioid would normally interact with. This property of naloxone also means it can be helpful in research studies to tease out which pathways might be active in a given condition.

The two Varela grantees—Fadel Zeidan and Lisa May—both used naloxone to see if it would block meditation-induced pain relief. If it did, they would know that meditation was acting through the body’s natural opioid system, just like other methods of pain relief. If naloxone didn’t block the effect, then some other biological pathway must be involved.

“What drove you to undertake this research?”

FADEL: One of the fundamental questions in pain research is to identify the biological systems that construct and modulate pain. Naloxone was originally approved by the FDA in the 1970s, and has been used to show that placebo analgesia and other cognitive techniques (acupuncture; distraction) are mediated by natural—or what we call endogenous—opioid systems. We know that one of the most promising applications for mindfulness meditation is to treat pain, but exactly how mindfulness works to reduce pain is still unclear. So, examining if mindfulness engages endogenous opioids to reduce pain was a logical next step.

LISA: Also, from a wider lens, examining the neural mechanisms of pain perception allows us to see the impact of mental processes on the physical body. Most people are used to the idea that we can change our experience with chemicals, but sometimes we forget that we can change the chemical activity of our brains depending on how we use our brains. The way we choose to engage our minds—our thoughts, beliefs, attitudes, and practices—shapes our brain chemistry, our habits, and our future experience. I find that inspiring.

“At the Mind & Life Grants Department, we received your two Varela proposals on the same topic a few years ago.. Can you describe how your projects complemented each other, and how your experience has been working together?”

LISA: When you connected me with Fadel, we quickly discovered that we were planning on tackling the same research question with different designs. Fadel was studying people who hadn’t meditated before, and I was recruiting experienced meditation practitioners. In addition, Fadel was comparing separate groups of people (those who received a brief mindfulness training vs. a control group), and I was using repeated measurements on the same participants. So that enabled a really cool approach, what we call a conceptual replication. In this situation, if our findings agree, their validity is strengthened because we show the same basic idea in different populations and different set-ups. And it was wonderful to be able to consult with each other along the way about logistics and details.

FADEL: We collaborated on our study designs, naloxone dosage, and basic psychophysics. My lab examined the effects of brief mindfulness-based mental training on pain and used naloxone to see if the effect was working through the body’s opioid system. Lisa studied long-term mindfulness practitioners, and used naloxone in a similar way, to learn whether it would interfere with mindfulness-induced pain relief. Interestingly, we both found that naloxone didn’t block the effects of mindfulness meditation, which means that mindfulness does not engage endogenous opioids to reduce pain. Together our work offers a more comprehensive account across the meditative training spectrum—from novice to expert. We even presented our work together at the American Psychosomatic meeting in Denver a couple of years ago. Lisa has been great to work with!

“So you both found, in separate studies, that mindfulness meditation reduces pain without activating the body’s natural opioid system. What do you think is most exciting about these combined findings, and how will this be relevant to people’s lives?”

LISA: Both Fadel’s and my research suggests that meditation reduces pain via a non-opioid pathway. This means that meditation could represent a promising pain-reducing intervention for people who don’t want to rely entirely (or perhaps at all) on opioids, or those with compromised natural opioid function associated with opioid use/abuse or other disorders. It’s also likely that meditation impacts other health outcomes via this same non-opioid mechanism.

FADEL: Another angle relates to possibilities for integrated pain treatment approaches. We know that opioid and non-opioid mechanisms of pain relief interact in a synergistic manner in the body. This means that combining mindfulness-based approaches with other pain relief strategies that do use opioid signaling may be particularly effective in the treatment of pain.

Overall, the fact that mindfulness seems to bypass the opioid pathway is a critical finding for the millions of chronic pain patients seeking a non-opioid therapy to reduce pain.

“Lisa, your study had some additional unique findings. Can you describe those?”

LISA: Before this study, we didn’t have any idea of the prevalence of mindfulness-based pain relief in long-term meditation practitioners. We know now that the vast majority of the participants in this study (85 percent) did experience pain reduction during meditation, which means it’s a common and consistent effect. Another finding that was quite unexpected was that for these experienced meditators, giving naloxone actually made the mindfulness-based pain relief even more effective! This is the first study to demonstrate the enhancement of pain relief via a full blockade of opioid receptors, and we’re not quite sure yet how this might be working. This provides new information not just about meditation, but about the function of the brain itself. I’m excited to see how this line of research develops.

“Fadel, what are your next steps for this work, and what new questions have been generated?”

FADEL: This work has led to a whole new avenue of research for me. We just completed another NIH-sponsored naloxone study where we disentangled the pain-relieving mechanisms underlying mindfulness vs. slow breathing vs. sham mindfulness meditation. Data analysis is still underway, but I can tell you that we’ve replicated our original mindfulness findings and have some more insight into the role (or lack thereof) of endogenous systems in the self-regulation of pain.

We still need to do more research, but what is clear is that mindfulness does not use the body’s natural opioid system to reduce pain. It appears that one of the oldest self-regulatory techniques could be employing an as-yet undiscovered pain relieving mechanism. Pretty cool, right? So much interesting work to do!

Interesting Blog Entry
https://www.martialjournal.com/martial-arts-teacher-painter-gardener/

“I may not have gone where I intended to go, but I think I have ended up where I needed to be.” 
― Douglas Adams, The Long Dark Tea-Time of the Soul

July/Early August 2018

Monthly Article
The July article for Premium Subscribers on my website will be Part 2 of Real Life Kenpo. The website is www.kenpotv.com and a yearly subscription is $29, which includes access to all the years of past material along with new monthly issues.

Kudos
Ray Kellison of Missouri has been competing on the national tournament circuit and doing quite well. He’s currently rated as #1 in the Kenpo forms division. You can see video clips of his work on his Facebook page.

A Perspective on Knife Fighting
Submitted without comment.
https://www.usacarry.com/knife-fight/

A man who asks is a fool for five minutes. A man who never asks is a fool for life.      

Chinese Proverb