Wednesday, February 12, 2020

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.

The post Mind-body therapies can reduce pain and opioid use appeared first on Harvard Health Blog.

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