A healer’s power stems not from any special ability, but from maintaining the courage and awareness to embody and express the universal healing power that every human being naturally possesses.

-Eric Micha’el Leventhal

How can clinicians help patients tap into the body’s natural inclination to heal itself?

Functional Medicine has a history of early adoption of research ideas for patients. In some instances, benefits have yielded strong results across conditions and types of patients. Mind-body therapies are just one set of interventions whose adoption into the mainstream was accelerated by Functional Medicine clinicians, particularly when used for pain.

For thousands of years, Buddhist monks have speculated that the practice of mindfulness meditation could significantly alter the subjective experience of pain.¹ Now, a study published in November 2019 in the journal JAMA Internal Medicine details the first comprehensive look across the scientific literature at the role of mind-body therapies in addressing opioid-treated pain.² The researchers found that certain therapies including meditation, hypnosis, guided imagery, relaxation and cognitive behavioral therapy may reduce pain as well as opioid use among patients treated with prescription opioids.²

Armed with data from 60 randomized clinical trials including nearly 6,400 study participants, the research team also examined secondary outcomes such as opioid dose, misuse, and craving.² Overall, their work showed that mind-body therapies appear to alleviate pain to a moderate extent and dial back opioid dose by small amounts in patients using opioid analgesics. The evidence also suggests that these therapies may help with opioid-related craving and misuse.²

Eric Garland, PhD, director of the University of Utah‘s Center on Mindfulness and Integrative Health Intervention Development and the study’s corresponding author, told USA News and World Report that the results echo what he has witnessed anecdotally in his clinical practice and in his decade-long research into these techniques.³ They can provide a “useful adjunct to the traditional medical care for patients with opioid-treated pain,” he told the press.³ Notably, all of the mindfulness or meditation studies analyzed showed “significant improvements in pain severity, pain unpleasantness, interference, thermal pain sensitivity and/or cessation of post-surgical pain,” according to the study.²

Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.

– Bessel A. van der Kolk, “The Body Keeps the Score”

What are the neurophysiological processes that support mind-body approaches to treat pain? A 2019 study on mindfulness-based pain relief using functional magnetic resonance imaging gives researchers some insight.⁴ After extensive training (greater than 1,000 hours of meditative practice), mindfulness-based pain relief is associated with deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to blunt the perception of pain at the conscious level.⁴

In other words, mindfulness-based pain relief engages multiple brain mechanisms that are relatively distinct from other cognitive manipulations. It has been shown to enhance cognitive control, emotion regulation, acceptance (i.e. nonreactivity), and improve mood.⁴ Mindfulness meditation-based interventions may improve chronic pain symptomology across a wide range of pain conditions, including fibromyalgia,⁵ headache disorders,⁶ irritable bowel syndrome,⁷ and chronic lower back pain.^8,9

The potential impact of this research on the chronic pain population may be substantial. Whether you’re a clinician specifically treating pain in chronic disease patients, or have a family member or friend struggling with complex pain – one thing is certain – pain is exceedingly pervasive and few people will move through life without being affected by it in some fashion. And, as many clinicians know, opioid medications prescribed for the treatment of chronic pain conditions are controversial and are associated with a significant number of side effects and complications, including addiction.¹⁰

To date, efforts to curb the course of the opioid epidemic have principally focused on restricting the supply of prescription opioid analgesics through prescription drug monitoring programs, opioid prescribing guidelines, dose-limit laws, prescription drug take-back days, and law enforcement approaches.¹¹ But what becomes of the thousands of men and women who, by no fault of their own, rely on these drugs to provide relief so that they can perform the daily functions of living? What are their options? Dr. Garland told US News and World Report that going forward, researchers analyzing the use of mind-body therapies in treating pain should include additional measures of opioid dosing – including the opioid type and duration of use – as well as triangulate data from sources like electronic medical records and prescription drug monitoring programs to solidify evidence of the impact that mind-body therapies can have.³

“There were enough studies to review that you could actually see the statistically significant effect of mind-body therapies on reducing opioid dose, and that’s a positive result. But clearly more research is needed in this area to understand the effects of mind-body therapies on opioid-related issues,” Garland told the press.³

To be sure, the future holds hope for the medical community. Patients also seem receptive to these new approaches. In fact, a 2017 Gallup Poll found that 78% of people would prefer to try other ways to address their physical pain before they take pain medication,¹² and mind-body therapies are ranked among the top 10 complementary and integrative medicine practices used by adults and children.¹²

By focusing on evidence-based fundamentals of care, applying new research in the clinic, and engaging patients to make sustainable changes in lifestyle factors, Functional Medicine can free patients from medications that may not address the root cause of their disease. There is hope. As IFM Certified Practitioner Henri Roca, MD, so eloquently says, “Our challenge is to get [patients] to see that pain is not a thing, it is an experience and it’s unique for each individual. That sets them up for the idea of a Functional Medicine intake, which is going to be highly specific … Once we get [a patient’s] full history and we tell them their story back, it is therapeutic narrative medicine. In doing that, they get to see that there is hope – something they thought didn’t exist – they were on a trajectory that would just cause them to have additional pain throughout the course of their life and now they see that indeed, it could be different. That hope allows them the opportunity to do pieces of work that they choose. We work to help them deepen that process.”

References

1. Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Ann NY Acad Sci. 2016;1373(1):114-27. doi 1111/nyas.13153
2. Garland EL, Brintz CE, Hanley AW, et al. Mind-body therapies for opioid-treated pain: a systematic review and meta-analysis. JAMA Intern Med. 2019. doi 1001/jamainternmed.2019.4917
3. Newman K. Meditation, mindfulness hold promise for pain treatment, curbing opioid use. US News & World Report. Published November 4, 2019. Accessed December 9, 2019. https://www.usnews.com/news/healthiest-communities/articles/2019-11-04/meditation-mindfulness-hold-promise-for-pain-treatment-curbing-opioid-use
4. Zeidan F, Baumgartner JN, Coghill RC. The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer. Pain Rep. 2019;4(4):e759. doi 1097%2FPR9.0000000000000759
5. Davis MC, Zautra AJ. An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Ann Behav Med. 2013;46:273–84. doi 1007/s12160-013-9513-7
6. Wells RE, Burch R, Paulsen RH, Wayne PM, Houle TT, Loder E. Meditation for migraines: a pilot randomized controlled trial. 2014;54:1484–95. doi 10.1111/head.12420
7. Garland EL, Gaylord SA, Palsson O, Faurot K, Douglas Mann J, Whitehead WE. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med. 2012;35:591–602. doi 1007/s10865-011-9391-z
8. Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA. 2016;315:1240–9. doi 1001/jama.2016.2323
9. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study. Pain. 2008;134:310–19. doi 1016/j.pain.2007.04.038
10. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11:S105-20.
11. Chen Q, Larochelle MR, Weaver BS, et al. Prevention of prescription opioid misuse and projected overdose deaths in the United States. JAMA Netw Open. 2019;2(2):e187621.
12. Gallup, Inc. Americans prefer drug-free pain management over opioids. Published September 12, 2017. Accessed December 9, 2019. https://www.palmer.edu/uploadedFiles/Pages/Alumni/Americans%20Prefer%20Drug-Free%20Pain%20Management%20Over%20Opioids%20(002).pdf
13. McClafferty H, Sibinga E, Bailey M, Culbert T, Weydert J, Brown M. Mind-body therapies in children and youth. Pediatrics. 2016;138(3). doi 1542/peds.2016-1896