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Mindfulness Meditation Modulates Pain Through Endogenous Opioids

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Abstract

Background: Recent evidence supports the beneficial effects of mindfulness meditation on pain. However, the neural mechanisms underlying this effect remain poorly understood. We used an opioid blocker to examine whether mindfulness meditation induced analgesia involves endogenous opioids. Methods: 15 healthy experienced mindfulness meditation practitioners participated in a double-blind, randomized, placebo-controlled, crossover study. Participants rated the pain and unpleasantness of a cold stimulus before and after a mindfulness meditation session. Participants were then randomized to receive either intravenous Naloxone or saline, after which they meditated again, and rated the same stimulus. Results: A (3) x (2) repeated measurements ANOVA revealed a significant time effect for pain and unpleasantness scores (both p<.001) as well as a significant condition effect for pain and unpleasantness (both p<.04). Post-hoc comparisons revealed that pain and unpleasantness scores were significantly reduced after natural mindfulness meditation and after placebo, but not after Naloxone. Furthermore, there was a positive correlation between the pain scores following Naloxone versus placebo and participants' mindfulness meditation experience. Conclusions: These findings show, for the first time, that meditation involves endogenous opioid pathways, mediating its analgesic effect and growing resilient with increasing practice to external suggestion. This finding could hold promising therapeutic implications, and further elucidate the fine mechanisms involved in human pain modulation.

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... This is primarily due to the fact that meditation influences the cerebral processing of physical sensations, emotions, and thoughts (Xu et al., 2014). In such instances, the bodily and perceptual responses that are commonly reported during exercise (e.g., muscle ache and rapid breathing) might be ameliorated during the practice of meditation (Sharon et al., 2016). Meditation routines have the potential to reallocate attentional focus toward environmental sensory signals and reduce processing of internal bodily sensations during light and light-to-moderate exercise intensities. ...
... has the potential to modulate processing of physical sensations (Sharon et al., 2016) and, consequently, optimize the neural control of the musculature. High-intensity exercises tend to force attention toward internal association (e.g., heavy breathing) and reduce processing of external influences (Hutchinson and Tenenbaum, 2007). ...
... Conversely, open monitoring meditation is hypothesized to enhance self-regulatory control and temper the interpretation of interoceptive signals. In such instances, individuals continue to experience the same physical sensations, thoughts, and emotions (i.e., attentional focus is not redirected), but are taught to perceive such signals differently (Lippelt et al., 2014;Sharon et al., 2016). In the Self-Regulatory Model of Exercise proposed in this article, the authors theorize that open monitoring meditation has the potential to prevent negative bodily sensations and emotions from interacting with the activity of the central motor command (i.e., a prophylactic effect). ...
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Some forms of meditation have been recently proposed as effective tools to facilitate the handling of undesired thoughts and reappraisal of negative emotions that commonly arise during exercise-related situations. The effects of meditation-based interventions on psychological responses could also be used as a means by which to increase exercise adherence and counteract the detrimental consequences of sedentariness. In the present article, we briefly describe the effects of meditation on physical activity and related factors. We also propose a theoretical model as a means by which to further understanding of the effects of meditation on psychological, psychophysical, and psychophysiological responses during exercise. The results of very recent studies in the realms of cognitive and affective psychology are promising. The putative psychological mechanisms underlying the effects of meditation on exercise appear to be associated with the interpretation of interoceptive and exteroceptive sensory signals. This is primarily due to the fact that meditation influences the cerebral processing of physical sensations, emotions, and thoughts. In such instances, the bodily and perceptual responses that are commonly reported during exercise might be assuaged during the practice of meditation. It also appears that conscious presence and self-compassion function as an emotional backdrop against which more complex behaviours can be forged. In such instances, re-engagement to physical activity programmes can be more effectively achieved through the implementation of holistic methods to treat the body and mind. The comments provided in the present paper might have very important implications for exercise adherence and the treatment of hypokinetic diseases.
... Furthermore, meditation reduces pain perception (Nakata et al., 2014). A previous study by Sharon et al. (2016) demonstrated that meditation significantly reduces the pain and unpleasantness score of cold stimulus-induced pain in healthy adults. Interestingly, intravenous injection of naloxone, an opioid blocker, reverses this analgesic effect of meditation, suggesting that meditation modulates pain via the endogenous opioid mechanism (Sharon et al., 2016). ...
... A previous study by Sharon et al. (2016) demonstrated that meditation significantly reduces the pain and unpleasantness score of cold stimulus-induced pain in healthy adults. Interestingly, intravenous injection of naloxone, an opioid blocker, reverses this analgesic effect of meditation, suggesting that meditation modulates pain via the endogenous opioid mechanism (Sharon et al., 2016). Moreover, a previous study by Movahedi et al. in 2017 demonstrated that acupressure on specific points 3 times per week for three weeks reduced the severity of chronic low back pain (Movahedi et al., 2017). ...
Article
Objective To investigate the effects of Qigong practice, Guan Yin Zi Zai Gong level 1, compared with a waiting list control group among office workers with chronic nonspecific low back pain (CNLBP). Methods A randomized controlled trial was conducted at offices in the Bangkok Metropolitan Region. Seventy-two office workers with CNLBP were screened for inclusion/exclusion criteria (age 20–40 years; sitting period more than 4 h per day) and were allocated randomly into two groups: the Qigong and waiting list groups (n = 36 each). The participants in the Qigong group took a Qigong practice class (Guan Yin Zi Zai Gong level 1) for one hour per week for six weeks at their workstation. The participants were encouraged to conduct the Qigong exercise at home every day. The waiting list group received general advice regarding low back pain management. The primary outcomes were pain intensity, measured by the visual analog scale, and back functional disability, measured by the Roland and Morris Disability Questionnaire. The secondary outcomes were back range of motion, core stability performance index, heart rate, respiratory rate, the Srithanya Stress Scale (ST-5), and the global perceived effect (GPE) questionnaire. Results Compared to the baseline, participants in the Qigong group experienced significantly decreased pain intensity and back functional disability. No statistically significant difference in these parameters was found in the waiting list group. Comparing the two groups, Qigong exercise significantly improved pain intensity, back functional impairment, range of motion, core muscle strength, heart rate, respiratory rate, and mental status. The Qigong group also had a significantly higher global outcome satisfaction than the waiting list group. Conclusion Qigong practice is an option for treatment of CNLBP in office workers.
... Participants were randomized to receive either intravenous naloxone or saline, after which they meditated again, and rated the same stimulus. The conclusion was that meditation involves endogenous opioid pathways mediating its analgesic effect, which could hold promising therapeutic implications and elucidation for the mechanisms involved in human pain modulation (Sharon et al., 2016). ...
Article
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The endocannabinoid system (ECS) is an important brain modulatory network. ECS regulates brain homeostasis throughout development, from progenitor fate decision to neuro- and gliogenesis, synaptogenesis, brain plasticity and circuit repair, up to learning, memory, fear, protection, and death. It is a major player in the hypothalamic-peripheral system-adipose tissue in the regulation of food intake, energy storage, nutritional status, and adipose tissue mass, consequently affecting obesity. Loss of ECS control might affect mood disorders (anxiety, hyperactivity, psychosis, and depression), lead to drug abuse, and impact neurodegenerative (Alzheimer’s, Parkinson, Huntington, Multiple, and Amyotrophic Lateral Sclerosis) and neurodevelopmental (autism spectrum) disorders. Practice of regular physical and/or mind-body mindfulness and meditative activities have been shown to modulate endocannabinoid (eCB) levels, in addition to other players as brain-derived neurotrophic factor (BDNF). ECS is involved in pain, inflammation, metabolic and cardiovascular dysfunctions, general immune responses (asthma, allergy, and arthritis) and tumor expansion, both/either in the brain and/or in the periphery. The reason for such a vast impact is the fact that arachidonic acid, a precursor of eCBs, is present in every membrane cell of the body and on demand eCBs synthesis is regulated by electrical activity and calcium shifts. Novel lipid (lipoxins and resolvins) or peptide (hemopressin) players of the ECS also operate as regulators of physiological allostasis. Indeed, the presence of cannabinoid receptors in intracellular organelles as mitochondria or lysosomes, or in nuclear targets as PPARγ might impact energy consumption, metabolism and cell death. To live a better life implies in a vigilant ECS, through healthy diet selection (based on a balanced omega-3 and -6 polyunsaturated fatty acids), weekly exercises and meditation therapy, all of which regulating eCBs levels, surrounded by a constructive social network. Cannabidiol, a diet supplement has been a major player with anti-inflammatory, anxiolytic, antidepressant, and antioxidant activities. Cognitive challenges and emotional intelligence might strengthen the ECS, which is built on a variety of synapses that modify human behavior. As therapeutically concerned, the ECS is essential for maintaining homeostasis and cannabinoids are promising tools to control innumerous targets.
... Other studies that included novice subjects have shown that meditation engages brain areas with high concentrations of opioid receptors (prefrontal cortex, anterior cingulate cortex, and insula) which communicate with the descending pain inhibitory system [61]. However, the results of studies using the opiate antagonist naloxone have been inconsistent in that both opioid-dependent [62] and opioid-independent [63] effects of meditation on pain have been reported. Decreased activation of the prefrontal cortex in Zen meditation practitioners and increased activation in novice subjects may indicate different mechanisms underlying pain relief in long-term meditation practitioners compared to those with minimal training. ...
Thesis
Pain is the most common symptom for which people seek medical care. Chronic pain is common worldwide, and often not treated adequately, thereby leading to reduced quality of life and high healthcare costs. Recently, there has been increasing attention toward the complexity and biopsychosocial nature of pain, and the need for multidisciplinary pain management has been increasingly acknowledged. Various mind-body interventions are being used for pain management, and some of them have been found to be effective. Slow, deep breathing is a commonly applied mind-body intervention for the management of pain. Some of the previous experimental studies found an influence of slow, deep breathing on pain outcomes. However, the results have not been consistent across studies and the underlying mechanisms are largely unknown. Some of the proposed mechanisms are emotional and cognitive modulation of pain perception and stimulation of the arterial baroreceptors and pulmonary vagal afferents. The aim of this Ph.D. project was to evaluate the effect of slow, deep breathing on pain perception in healthy subjects and to investigate the underlying psychophysiological mechanisms. To further investigate the arterial baroreceptors and pulmonary vagal afferents as possible mechanisms for the hypoalgesic effects of slow, deep breathing, we first determined whether adding an inspiratory threshold load to slow, deep breathing can enhance its effects on the cardiovascular responses (Chapter 3). We found an increase in the amplitude of blood pressure variation accompanied by an increase in respiratory sinus arrhythmia in response to increasing loads, suggesting that applying inspiratory threshold loads during slow, deep breathing results in stronger stimulation of the arterial baroreceptors. In a complementary study (Chapter 4) we compared four slow, deep breathing techniques (loaded slow, deep breathing, left and right unilateral nostril breathing, and pursed-lips breathing) with regards to psychophysiological responses. We found that loaded slow, deep breathing and pursed-lips breathing techniques are associated with a larger amplitude of blood pressure variation and respiratory sinus arrhythmia, suggesting stronger stimulation of the arterial baroreceptors with these techniques. Moreover, the pursed-lips breathing technique was associated with lower emotional arousal and more pleasantness and a sense of control. Based on these two studies, we investigated the effect of loaded slow, deep breathing and pursed-lips breathing on somatic pain perception (Chapter 5). We found that loaded slow, deep breathing, but not pursed-lips breathing, reduces pain intensity compared with a control condition. However, physiological responses to loaded slow, deep breathing did not mediate its effect on pain perception. Finally, we evaluated the effect of slow, deep breathing on visceral pain perception. We found that slow, deep breathing reduces visceral pain intensity compared with uncontrolled breathing, but the effect is similar to controlled breathing at normal breathing frequency. Physiological and emotional responses to slow, deep breathing did not mediate its effects on visceral pain perception. The studies in this PhD project helped us to better test and understand the role of different psychophysiological mechanisms in somatic and visceral pain modulation by slow, deep breathing. Overall, our studies do not support the role of baroreceptors and vagal afferents stimulation as possible mechanisms mediating the effect of slow, deep breathing on pain perception, suggesting other potential mechanisms, notably attentional modulation may be at play. Further experimental studies are required to better investigate the role of attentional and emotional modulation on pain inhibition by breathing exercises. Also, clinical studies are required to test whether breathing exercises can modulate pain perception in various patient populations and if so, the underlying mechanisms will need elucidation.
... The psychological mechanisms underlying the positive effects of MF on physical activity appear to be associated with the fact that this type of meditation may enhance self-regulatory control (Hölzel et al., 2011). In such instances, individuals continue to experience the same physical sensations, thoughts, and emotions, but they become able to interpret such signals with greater acceptance (Lippelt, Hommel, & Colzato, 2014;Sharon et al., 2016). ...
Article
The aim of the present study was to investigate the effects of an audio-guided mindfulness (MF) single session on psychological and psychophysiological responses during an outdoor walking task. Twenty-four participants (12 females and 12 males; Mage = 23.6, SD = 3.9 years) were required to walk 200 m at a pace of their choosing. Two experimental conditions (mindfulness meditation and mindlessness [ML] meditation) and a control condition (CO) were administered. Electrical activity in the brain was measured by the use of a portable electroencephalography (EEG) system during walking. Fast Fourier Transform was used to decompose the EEG samples into theta (5-7 Hz), alpha (8-14 Hz), and beta (15-29 Hz) frequencies. Brain connectivity analysis between frontal and temporo-parietal electrode sites was conducted to explore functional interactions through the use of spectral coherence. Affective and perceptual responses were measured by the use of single-item scales and questionnaires. The present findings indicate that MF was sufficiently potent to reallocate attention toward task-related thoughts, downregulate perceived activation, and enhance affective responses to a greater degree than the other two conditions. Conversely, ML was sufficient to increase the use of dissociative thoughts, make participants less aware of their physical sensations and emotions, induce a more negative affective state, and upregulate perceived activation to a greater extent than MF and CO. The brain mechanisms that underlie the effects of MF on exercise appear to be associated with the enhanced inter-hemispheric connectivity of high-frequency waves between right frontal and left temporo-parietal areas of the cortex.
... 79 We postulated that expert meditators may have exerted more effort in the presence of naloxone to counteract the effect of naloxone, and that other nonopioidergic systems 10 may have been engaged to compensate for opioid blockade. 89 By contrast, another group used a randomized, crossover design and reported that mindfulness-based pain relief was reversed by naloxone 105 in response to a brief (10 seconds) noxious cold stimulus. In our rebutting commentary of this study, we postulated that the authors' interpretations were not justified because of the significant decrease in pain (ie, ↓19%) during mindfulness and naloxone infusion and the comparable reductions during meditation and saline infusion (ie, ↓25%). ...
Article
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The advent of neuroimaging methodologies, such as functional magnetic resonance imaging (fMRI), has significantly advanced our understanding of the neurophysiological processes supporting a wide spectrum of mind-body approaches to treat pain. A promising self-regulatory practice, mindfulness meditation, reliably alleviates experimentally induced and clinical pain. Yet, the neural mechanisms supporting mindfulness-based pain relief remain poorly characterized. The present review delineates evidence from a spectrum of fMRI studies showing that the neural mechanisms supporting mindfulness-induced pain attenuation differ across varying levels of meditative experience. After brief mindfulness-based mental training (ie, less than 10 hours of practice), mindfulness-based pain relief is associated with higher order (orbitofrontal cortex and rostral anterior cingulate cortex) regulation of low-level nociceptive neural targets (thalamus and primary somatosensory cortex), suggesting an engagement of unique, reappraisal mechanisms. By contrast, mindfulness-based pain relief after extensive training (greater than 1000 hours of practice) is associated with deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to reduce appraisals of arising sensory events. We also describe recent findings showing that higher levels of dispositional mindfulness, in meditation-naïve individuals, are associated with lower pain and greater deactivation of the posterior cingulate cortex, a neural mechanism implicated in self-referential processes. A brief fMRI primer is presented describing appropriate steps and considerations to conduct studies combining mindfulness, pain, and fMRI. We postulate that the identification of the active analgesic neural substrates involved in mindfulness can be used to inform the development and optimization of behavioral therapies to specifically target pain, an important consideration for the ongoing opioid and chronic pain epidemic.
... Neuroimaging studies in adults have provided further support for the mechanisms by which mindfulness meditation practice can lead to change. Specifically, regions of the brain associated with sensory processing and the cognitive modulation of pain (e.g., thalamus, insula, anterior cingulate cortex, orbitofrontal cortex) [74,75] have high concentrations of opioid receptors, [75,76] prompting hypotheses that mindfulness practice may modulate the endogenous opioid system [77]. Other neuroimaging research proposes that mindfulness-induced analgesia is due to a more complex process engaging multiple brain networks and neurochemical mechanisms [78]. ...
Article
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Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.
... Management and regulation of major trigger factors of headache, such as stress, emotional experience and sleep or comorbid psychopathology which interact with headache bidirectionally by psychological treatment might exert preventive effect on headache. Further, physiological changes from psychological treatment, such as modulation of endogenous opioids system, change in sympathetic activity, or modulation of pain-related brain neuroplasticity may also affect headache and pain [62][63][64]. ...
Article
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Background Headache disorder is not only a common complaint but also a global burden. Pharmacotherapeutic and non-pharmacotherapeutic approaches have been developed for its treatment and prophylaxis. The present study included a systematic review of psychological treatments for primary headache disorder accessible in Korea. Methods We included English and Korean articles from EMBASE, MEDLINE, Cochrane library database, SCOPUS, ScienceDirect, Web of Science, CINAHL, PsycArticles and Korean database, KoreaMed and KMBASE which studied primary headache and medication-overuse headache. The primary efficacy measure was the number of headache days per month, while secondary efficacy measures were the number of headache attacks per week, headache index, treatment response rate, and migraine disability assessment. The meta-analysis was performed using R 3.5.1. to obtain pooled mean difference and pooled relative risk with 95% confidence interval (CI) for continuous data and dichotomous data, respectively. Results From 12,773 identified articles, 27 randomized clinical trials were identified. Primary outcome showed significant superiority of psychological treatments (pooled mean difference = − 0.70, 95% CI [− 1.22, − 0.18]). For the secondary outcomes, the number of headache attacks (pooled mean difference = − 1.15, 95% CI [− 1.63, − 0.67]), the headache index (pooled mean difference = − 0.92, 95% CI [− 1.40 to − 0.44]) and the treatment response rate (pooled relative risk = 3.13, 95% CI [2.24, 4.37]) demonstrated significant improvements in the psychological treatment group over the control group. Conclusion Psychological treatments for primary headache disorder reduced headache frequency and the headache index. Future research using standardized outcome measures and strategies for reducing bias is needed.
... Se ha explorado el mindfulness en diversos campos, como el educativo (De la Fuente, Franco, & Mañas, 2010), el de la salud (Carlson & Garland, 2005), el laboral (Shapiro, Astin, Bishop, & Cordova, 2005), el campo social (Franco & Navas, 2009) y el psicofisiológico (Lutz, Brühl, Scheerer, Jäncke, & Herwig, 2016;Tang, Hölzel, & Posner, 2015). Asimismo, se ha reportado beneficios de técnicas promotoras de mindfulness, para tratar la depresión (Baer, 2003;Cebolla & Miró, 2007;Kumar, Feldman, & Hayes, 2008;Segal, Williams, & Teasdale, 2006), la ansiedad (Kabat-Zinn, 1990;Orsillo, Roemer, Block-Lerner, & Tull, 2004;Roemer & Orsillo, 2007;Shapiro, Carlson, Astin, & Freedman, 2006;Vøllestad, 2016), el bienestar general y los síntomas de la percepción de dolor (Majumdar, Grossman, Dietz-Waschkowski, Kersig, & Walach, 2002;Sharon et al., 2016;Williams, Kolar, Reger, & Pearson, 2001;Zeidan et al., 2015;Zeidan & Vago, 2016). ...
Article
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Resumen. El propósito del estudio fue examinar el efecto de la práctica del aikido sobre el mindfulness y el estado de ansiedad, en estudiantes universitarios sin experiencia previa en artes marciales. Se utilizó un diseño cuasi experimental intra sujetos con mediciones Pre y Post tratamiento, con un grupo control activo (estudiantes de Educación Física). Se midió mindfulness con la escala MAAS y la ansiedad con la escala de Hamilton. Se aplicó un entrenamiento centrado en el aprendizaje y práctica de diversas técnicas de aikido (waza) y de la forma en que debían ser recibidas dichas técnicas (ukemi), por 11 semanas (2 sesiones semanales de 2 horas cada una). Grupo experimental: n=12, con edades entre 18 y 62 años. Grupo control: n=12 estudiantes, con edades entre 21 y los 34 años. Resultados: la práctica de aikido mostró tamaños de efecto significativos y de magnitud moderada tanto en mindfulness, como en la ansiedad. La edad no explica estos hallazgos. Se justifican estudios de seguimiento. Abstract. The purpose of the study was to examine the effect of practicing aikido on mindfulness and anxiety state in university students with no previous experience in martial arts. We used an intra-subjects quasi-experimental design with Pre and Post treatment measurements, with an active control group (physical education students). Mindfulness was measured with the MAAS scale, whereas anxiety with the Hamilton scale. A training program focused on learning and practicing various aikido techniques (waza), and the way in which these techniques (ukemi) should be received, was implemented during 11 weeks (2 weekly sessions of 2 hours each). Experimental group: n = 12, with ages between 18 and 62 years old. Control group: n = 12 students, with ages between 21 and 34 years old. Results: the practice of aikido showed significant effect sizes of moderate magnitude in both mindfulness and anxiety. Age does not explain these findings. Follow-up studies are recommended.
... Se ha explorado el mindfulness en diversos campos, como el educativo (De la Fuente, Franco, & Mañas, 2010), el de la salud (Carlson & Garland, 2005), el laboral (Shapiro, Astin, Bishop, & Cordova, 2005), el campo social (Franco & Navas, 2009) y el psicofisiológico (Lutz, Brühl, Scheerer, Jäncke, & Herwig, 2016;Tang, Hölzel, & Posner, 2015). Asimismo, se ha reportado beneficios de técnicas promotoras de mindfulness, para tratar la depresión (Baer, 2003;Cebolla & Miró, 2007;Kumar, Feldman, & Hayes, 2008;Segal, Williams, & Teasdale, 2006), la ansiedad (Kabat-Zinn, 1990;Orsillo, Roemer, Block-Lerner, & Tull, 2004;Roemer & Orsillo, 2007;Shapiro, Carlson, Astin, & Freedman, 2006;Vøllestad, 2016), el bienestar general y los síntomas de la percepción de dolor (Majumdar, Grossman, Dietz-Waschkowski, Kersig, & Walach, 2002;Sharon et al., 2016;Williams, Kolar, Reger, & Pearson, 2001;Zeidan et al., 2015;Zeidan & Vago, 2016). ...
Article
Full-text available
El propósito del estudio fue examinar el efecto de la práctica del aikido sobre el mindfulness y el estado de ansiedad, en estudiantes universitarios sin experiencia previa en artes marciales. Se utilizó un diseño cuasi experimental intra sujetos con mediciones Pre y Post tratamiento, con un grupo control activo (estudiantes de Educación Física). Se midió mindfulness con la escala MAAS y la ansiedad con la escala de Hamilton. Se aplicó un entrenamiento centrado en el aprendizaje y práctica de diversas técnicas de aikido (waza) y de la forma en que debían ser recibidas dichas técnicas (ukemi), por 11 semanas (2 sesiones semanales de 2 horas cada una). Grupo experimental: n= 12, con edades entre 18 y 62 años. Grupo control: n= 12 estudiantes, con edades entre 21 y los 34 años. Resultados: la práctica de aikido mostró tamaños de efecto significativos y de magnitud moderada tanto en mindfulness, como en la ansiedad. La edad no explica estos hallazgos. Se justifican estudios de seguimiento.
... A recent study investigated opioid-mediated meditation analgesia in experienced practitioners, and its authors concluded that Naloxone reduced meditation analgesia (58), an effect that is opposite of what we report here. However, this study's small sample size (N = 14), as well as the report's omission of effect sizes and the critical direct comparisons between Naloxone and saline at baseline and after meditation, make it difficult to evaluate the authors' ...
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Objective: Studies have consistently shown that long-term meditation practice is associated with reduced pain, but the neural mechanisms by which long-term meditation practice reduces pain remain unclear. This study tested endogenous opioid involvement in meditation analgesia associated with long-term meditation practice.Methods: Electrical pain was induced with randomized, double-blind, cross-over administration of the opioid antagonist Naloxone (0.15mg/kg bolus dose, then 0.2mg/kg/hr infusion dose) with 32 healthy, experienced meditation practitioners and a standardized open monitoring meditation.Results: Under saline, pain ratings were significantly lower during meditation (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17) than at baseline (pain intensity: 6.86 ±1.04, t(31) = 2.476, p = 0.019, Cohen’s d = 0.46; pain unpleasantness: 4.96 ±1.75, t(31) = 3.746, p = 0.001, Cohen’s d = 0.68), confirming the presence of meditation analgesia. Comparing saline and Naloxone revealed significantly lower pain intensity (t(31) = 3.12, p = 0.004, d = 0.56), and pain unpleasantness (t(31) = 3.47, p = 0.002, d = 0.62), during meditation under Naloxone (pain intensity: 5.53 ± 1.54; pain unpleasantness: 2.95 ± 1.88) than under saline (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17). Naloxone not only failed to eliminate meditation analgesia, it made meditation analgesia stronger.Conclusions: Long-term meditation practice does not rely on endogenous opioids to reduce pain. Naloxone’s blockade of opioid receptors enhanced meditation analgesia; pain ratings during meditation were significantly lower under Naloxone than under saline. Possible biological mechanisms by which Naloxone-induced opioid receptor blockade enhances meditation analgesia are discussed.
... A recent study investigated opioid-mediated meditation analgesia in experienced practitioners, and its authors concluded that Naloxone reduced meditation analgesia (58), an effect that is opposite of what we report here. However, this study's small sample size (N = 14), as well as the report's omission of effect sizes and the critical direct comparisons between Naloxone and saline at baseline and after meditation, make it difficult to evaluate the authors' ...
Article
Full-text available
Objective: Studies have consistently shown that long-term meditation practice is associated with reduced pain, but the neural mechanisms by which long-term meditation practice reduces pain remain unclear. This study tested endogenous opioid involvement in meditation analgesia associated with long-term meditation practice. Methods: Electrical pain was induced with randomized, double-blind, cross-over administration of the opioid antagonist Naloxone (0.15mg/kg bolus dose, then 0.2mg/kg/hr infusion dose) with 32 healthy, experienced meditation practitioners and a standardized open monitoring meditation. Results: Under saline, pain ratings were significantly lower during meditation (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17) than at baseline (pain intensity: 6.86 ±1.04, t(31) = 2.476, p = 0.019, Cohen's d = 0.46; pain unpleasantness: 4.96 ±1.75, t(31) = 3.746, p = 0.001, Cohen's d = 0.68), confirming the presence of meditation analgesia. Comparing saline and Naloxone revealed significantly lower pain intensity (t(31) = 3.12, p = 0.004, d = 0.56), and pain unpleasantness (t(31) = 3.47, p = 0.002, d = 0.62), during meditation under Naloxone (pain intensity: 5.53 ± 1.54; pain unpleasantness: 2.95 ± 1.88) than under saline (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17). Naloxone not only failed to eliminate meditation analgesia, it made meditation analgesia stronger. Conclusions: Long-term meditation practice does not rely on endogenous opioids to reduce pain. Naloxone's blockade of opioid receptors enhanced meditation analgesia; pain ratings during meditation were significantly lower under Naloxone than under saline. Possible biological mechanisms by which Naloxone-induced opioid receptor blockade enhances meditation analgesia are discussed.
... However, such methods require intensive training (> 2 h per session) in meditation, yoga, and body scanning as well as daily practice [59]. The suggested mechanisms underlying the effects of mindfulness meditation-based analgesia involve alterations in resting state functional connectivity, endogenous opioid pathways (some controversy), or immune functions [60][61][62][63]. In a trial that included patients with CM or CTTH, the intervention group reported lower pain intensity and greater improvements in some quality of life parameters when compared with the control group [64]. ...
Article
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Purpose of review: Although chronic migraine (CM) is a common disorder that severely impacts patient functioning and quality of life, it is usually underdiagnosed, and treatment responses often remain poor even after diagnosis. In addition, effective treatment options are limited due to the rarity of randomized controlled trials (RCTs) involving patients with CM. In the present review, we discuss updated pharmacological, non-pharmacological, and neurostimulation treatment options for CM. Recent findings: Pharmacological treatments include both acute and preventive measures. While acute treatment options are similar between CM and episodic migraine (EM), preventive treatment with topiramate and botulinum toxin A exhibited efficacy in more than two RCTs. In addition, several studies have revealed that behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation techniques are associated with significant improvements in symptoms. Thus, these treatment options are recommended for patients with CM, especially for refractory cases. Neurostimulation procedures, such as occipital stimulation, supraorbital transcutaneous stimulation, non-invasive vagal nerve stimulation, and transcranial direct current stimulation, have shown promising results in the treatment of CM. However, current studies on neurostimulation suffer from small sample size, no replication, or negative results. Although CM is less responsive to treatment compared to EM, recent advance in pharmacological, non-pharmacological, and neurostimulation treatments may provide more chance for successful treatment of CM.
... However, the comparative effects of Tai Chi and PT on mindfulness remain unknown and have not been examined among people with knee OA or other chronic pain diseases (Visted et al. 2015). Because a number of studies found beneficial effects of mindfulness among those with chronic pain (Delgado et al. 2014;Sharon et al. 2016), examining the mindfulnesscultivating effects of Tai Chi, distinct from those of an active comparator like PT, could support mindfulness as an important therapeutic mechanism of Tai Chi mind-body practice. ...
Article
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Tai Chi mind–body exercise is widely believed to improve mindfulness through incorporating meditative states into physical movements. A growing number of studies indicate that Tai Chi may improve health in knee osteoarthritis (OA), a chronic pain disease and a primary cause of global disability. However, little is known about the contribution of mindfulness to treatment effect of Tai Chi practice. Therefore, our purpose was to investigate the effect of Tai Chi mind–body practice compared to physical therapy (PT) on mindfulness in knee OA. Adults with radiographic-confirmed, symptomatic knee OA were randomized to 12 weeks (twice weekly) of either Tai Chi or PT. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) before and after intervention along with commonly used patient-reported outcomes for pain, physical function, and other health-related outcomes. Among 86 participants (74% female, 48% white, mean age 60 years, 85% at least college educated), mean total FFMQ was 142 ± 17. Despite substantial improvements in pain, function, and other health-related outcomes, each treatment group’s total FFMQ did not significantly change from baseline (Tai Chi = 0.76, 95% CI −2.93, 4.45; PT = 1.80, 95% CI −2.33, 5.93). The difference in total FFMQ between Tai Chi and PT was not significant (−1.04 points, 95% CI −6.48, 4.39). Mindfulness did not change after Tai Chi or PT intervention in knee OA, which suggests that Tai Chi may not improve health in knee OA through cultivating mindfulness. Further study is needed to identify underlying mechanisms of effective mind–body interventions among people with knee OA.
... The role of endogenous opioids in mindfulness/meditation is less clear: in a study conducted in healthy meditation practitioners, the analgesic effects of meditation were reversed by the administration of the opioid antagonist naloxone [104]. In contrast, in meditation-naïve healthy participants, a 4-day mindfulness/meditation training protocol resulted in analgesic effects that were naloxone independent [105]. ...
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Chronic pain is a highly prevalent and debilitating condition that is frequently associated with multiple comorbid psychiatric conditions and functional, biochemical, and anatomical alterations in various brain centers. Due to its widespread and diverse manifestations, chronic pain is often resistant to classical pharmacological treatment paradigms, prompting the search for alternative treatment approaches that are safe and efficacious. The current review will focus on the following themes: attentional and cognitive interventions, the role of global environmental factors, and the effects of exercise and physical rehabilitation in both chronic pain patients and preclinical pain models. The manuscript will discuss not only the analgesic efficacy of these therapies, but also their ability to reverse pain-related brain neuroplasticity. Finally, we will discuss the potential mechanisms of action for each of the interventions.
... However, they failed to reverse meditation-induced analgesia by this and yet concluded pain-reducing effects not to be mediated by endogenous opioids. In sharp contrast, Sharon et al. (2016) found that mindfulness meditation-induced analgesia in their trials was reversed by naloxone in an experimental pain model also using the presentation of noxious temperature as pain stimulus (Sharon used cold; Zeidan used heat). They additionally described meditation effects matching placebo physiology. ...
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Background: Research has demonstrated that short meditation training may yield higher pain tolerance in acute experimental pain. Our study aimed at examining underlying mechanisms of this alleged effect. In addition, placebo research has shown that higher pain tolerance is mediated via endogenous neuromodulators: experimental inhibition of opioid receptors by naloxone antagonized this effect. We performed a trial to discern possible placebo from meditation-specific effects on pain tolerance and attention. Objectives: It was proposed that (i) meditation training will increase pain tolerance; (ii) naloxone will inhibit this effect; (iii) increased pain tolerance will correlate with improved attention performance and mindfulness. Methods: Randomized-controlled, partly blinded trial with 31 healthy meditation-naïve adults. Pain tolerance was assessed by the tourniquet test, attention performance was measured by Attention Network Test (ANT), self-perceived mindfulness by Freiburg Mindfulness Inventory. 16 participants received a 5-day meditation training, focusing on body/breath awareness; the control group (N = 15) received no intervention. Measures were taken before the intervention and on 3 consecutive days after the training, with all participants receiving either no infusion, naloxone infusion, or saline infusion (blinded). Blood samples were taken in order to determine serum morphine and morphine glucuronide levels by applying liquid chromatography-tandem mass spectrometry analysis. Results: The meditation group produced fewer errors in ANT. Paradoxically, increases in pain tolerance occurred in both groups (accentuated in control), and correlated with reported mindfulness. Naloxone showed a trend to decrease pain tolerance in both groups. Plasma analyses revealed sporadic morphine and/or morphine metabolite findings with no discernable pattern. Discussion: Main objectives could not be verified. Since underlying study goals had not been made explicit to participants, on purpose (framing effects toward a hypothesized mindfulness-pain tolerance correlation were thus avoided, trainees had not been instructed how to ‘use’ mindfulness, regarding pain), the question remains open whether lack of meditation effects on pain tolerance was due to these intended ‘non-placebo’ conditions, cultural effects, or other confounders, or an unsuitable paradigm. Conclusion: Higher pain tolerance through meditation could not be confirmed.
... Therefore, meditation-induced analgesia was not "reversed" by naloxone as the authors postulated. 1 The placebo-saline þ meditation group exhibited a similar, yet significant reduction in pain (À1.1 VAS; P <.01) and "unpleasantness" (1.4 VAS; P <.01), and "natural meditation" produced a significant decrease in pain (À1.9 VAS; P <.001) and "unpleasantness" (À2.4 VAS; P <.001). ...
... Sharon et al. (56) examined whether mindfulness meditation-induced analgesia involved endogenous opioids. Fifteen healthy experienced mindfulness meditators were asked to rate perceived pain and unpleasantness in response to a cold stimulus before and after a mindfulness meditation session. ...
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Chronic pain is common, and the available treatments do not provide adequate relief for most patients. Neuromodulatory interventions that modify brain processes underlying the experience of pain have the potential to provide substantial relief for some of these patients. The purpose of this Review is to summarize the state of knowledge regarding the efficacy and mechanisms of noninvasive neuromodulatory treatments for chronic pain. The findings provide support for the efficacy and positive side-effect profile of hypnosis, and limited evidence for the potential efficacy of meditation training, noninvasive electrical stimulation procedures, and neurofeedback procedures. Mechanisms research indicates that hypnosis influences multiple neurophysiological processes involved in the experience of pain. Evidence also indicates that mindfulness meditation has both immediate and long-term effects on cortical structures and activity involved in attention, emotional responding and pain. Less is known about the mechanisms of other neuromodulatory treatments. On the basis of the data discussed in this Review, training in the use of self-hypnosis might be considered a viable 'first-line' approach to treat chronic pain. More-definitive research regarding the benefits and costs of meditation training, noninvasive brain stimulation and neurofeedback is needed before these treatments can be recommended for the treatment of chronic pain.
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Mindfulness-based interventions (MBIs) emphasizing a nonjudgmental attitude toward present moment experience are widely used for chronic pain patients. Although changing or controlling pain is not an explicit aim of MBIs, recent experimental studies suggest that mindfulness practice may lead to changes in pain tolerance and pain intensity ratings. The objective of this review is to investigate the specific effect of MBIs on pain intensity. A literature search was conducted using the databases PUBMED and PsycINFO for relevant articles published from 1960 to December 2010. We additionally conducted a manual search of references from the retrieved articles. Only studies providing detailed results on change in pain intensity ratings were included. Sixteen studies were included in this review (eight uncontrolled and eight controlled trials). In most studies (10 of 16), there was significantly decreased pain intensity in the MBI group. Findings were more consistently positive for samples limited to clinical pain (9 of 11). In addition, most controlled trials (6 of 8) reveal higher reductions in pain intensity for MBIs compared with control groups. Results from follow-up assessments reveal that reductions in pain intensity were generally well maintained. Findings suggest that MBIs decrease the intensity of pain for chronic pain patients. We discuss implications for understanding mechanisms of change in MBIs.
A neuroscientific perspective on meditation
  • A Maron-Katz
  • E Ben-Simon
  • H Sharon
  • M Gruberger
  • D Cvetkovic
Maron-Katz A, Ben-Simon E, Sharon H, Gruberger M, Cvetkovic D. A neuroscientific perspective on meditation. In: Singh NN, ed. Psychology of Meditation. New York: Nova Science Publishers; 2014:99-129.