News & Research Archive — Here is a history of past Research for 2010 2009, 2008 or 2007

What does meditation have to do with chronic pain management? I often get this question when my patients see this on a list I give them of potential non-medication based intervention suggestions. I begin answering by first sharing a definition of meditation with them. Below is one definition I use from Wikipedia, the free online encyclopedia © 2001-2010.

Meditation is a mental discipline by which one attempts to get beyond the conditioned, "thinking" mind into a deeper state of relaxation or awareness. Meditation often involves turning attention to a single point of reference. It is recognized as a component of almost all religions, and has been practiced for over 5,000 years. It is also practiced outside religious traditions. Different meditative disciplines encompass a wide range of spiritual and/or psychophysical practices which may emphasize different goals – from achievement of a higher state of consciousness, to greater focus, creativity or self-awareness, or simply a more relaxed and peaceful frame of mind.

The word meditation originally comes from the Indo-European root med-, meaning "to measure." From the root med- are also derived the English words mete, medicine, modest, and moderate. It entered English as meditation through the Latin meditatio, which originally indicated every type of physical or intellectual exercise, then later evolved into the more specific meaning "contemplation."

One popular misconception is that it is a way to make the mind go blank so someone can escape from what they are feeling. However, Dr. Kabat-Zinn maintains that "meditation is an invitation to wake up, to experience the fullness of life and transform a person's relationship with problems, fears, and any pain and stress in life so that they don't wind up being controlled and eroding the quality of their life. It is not about running away or manipulating mental states."

Through the practice of mindfulness, people can learn to develop greater calmness, clarity and insight in facing and embracing all of their life experiences, even the worst of life's trials, and turning them into occasions for learning, growing and deepening their own strength and wisdom. Jody Smith with EmpowerHer.com discusses the use of mindfulness meditation in her post titled Mindfulness Meditation Can Reduce Experience of Pain which is cited below. You can read the original post at EmpowerHer.com.

People who practice mindfulness meditation may be less affected by the presence of pain. For those living with chronic pain, meditation is increasingly popular. Dr. Christopher Brown, who is based in Manchester's School of Translational Medicine, found that people who meditate also showed unusual activity during anticipation of pain in part of the prefrontal cortex, a brain region known to be involved in controlling attention and thought processes when potential threats are perceived.

He also said: "The results of the study confirm how we suspected meditation might affect the brain. Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse."

"Meditation is becoming increasingly popular as a way to treat chronic illness such as the pain caused by arthritis," said Dr. Christopher Brown, who conducted the research. "Recently, a mental health charity called for meditation to be routinely available on the NHS to treat depression, which occurs in up to 50% of people with chronic pain. However, scientists have only just started to look into how meditation might reduce the emotional impact of pain."

The study, to be published in the Journal Pain, found that particular areas of the brain were less active as meditators anticipated pain, as induced by a laser device. Those with longer meditation experience (up to 35 years) showed the least anticipation of the laser pain. Dr Brown said the findings should encourage further research into how the brain is changed by meditation practice. He said: "Although we found that meditators anticipate pain less and find pain less unpleasant, it's not clear precisely how meditation changes brain function over time to produce these effects. However, the importance of developing new treatments for chronic pain is clear: 40% of people who suffer from chronic pain report inadequate management of their pain problem."

Research now shows that meditation can help ease the depression associated with and the pain of fibromyalgia, a condition marked by chronic joint and muscle pain, fatigue, and, in some cases, poor memory and thinking. While meditation doesn't make the pain disappear, it appears to help patients refocus their attention and feel better.

Fibromyalgia is difficult to treat. Doctors normally recommend a combination of exercise and psychosocial interventions, such as learning how to relax. In addition, medications like antidepressants, anti-inflammatories and sleeping pills are often prescribed. The cause of fibromyalgia is unclear, but symptoms often begin after a traumatic experience and worsen during times of stress, said Sandy Sephton, a research psychologist at the University of Louisville. Fibromyalgia affects up to 4 percent of the population of the United States and other industrialized countries. Now researchers have objective evidence to back up patients' claims on the benefits of meditation. Sephton and her colleagues found that meditating appears to lower levels of cortisol, a hormone associated with stress.

Mindfulness Meditation

Sephton and other researchers train patients in a type of meditation called mindfulness meditation. The meditation involves being aware and nonjudgmental of the thoughts that pop into your head while sitting quietly. "We ask people to notice what's going on in your mind," said Paul Salmon, a colleague of Sephton's who trains the study participants in meditation. "Over time, people become more calm and more perceptive of what is happening at the moment," he said in an interview.

One common request we get is about what can be done for Fibromyalgia. Many people have been taking opiates for this condition and they either don’t like the side effects or are afraid of becoming dependent or even addicted. A fairly new option for Fibromyalgia and other chronic pain conditions may be of interest—Infrared Laser Therapy.

One source I often explore for new information on chronic pain management is the online website Medscape Psychiatry and Mental Health. On June 8, 2010 I discovered a new post titled Laser Therapy May Improve Outcomes in Fibromyalgia from which I have posted excerpts below. To read the entire source you’ll need to go to Medscape.com and sign up for a free account.

New data presented here at the American College of Sports Medicine 57th Annual Meeting suggest that the application of class 4 infrared light lasers to fibromyalgia trigger points improves upper body flexibility. This finding is important, investigators noted, because fibromyalgia is often difficult to treat with pharmacologic agents, and patients seek alternative regimens to ease their discomfort.

Kristen Williams, a student at the College of Human Sciences, Florida State University in Tallahassee, presented data on the impact of infrared light therapy on pain, fibromyalgia impact, and function in women diagnosed with fibromyalgia. In all, 39 women (52 ± 11 years of age) were randomly assigned to receive 8 minutes of laser therapy or sham heat therapy twice per week for 4 weeks. Treatment consisted of the application of laser therapy or sham heat therapy to 8 standardized points located across the neck, shoulders, and low back. The impact of laser therapy on upper body flexibility in patients treated with laser therapy was significant, compared with those treated with sham heat therapy. However, there was no improvement in functionality or pain score between the 2 groups. There was an increase in the amount of time between bouts of severe pain in laser-treated patients, compared with sham-treated patients.

These findings are important because patients with fibromyalgia often seek out some form of alternative therapy, like heat or light therapy, to ease their symptoms. Ms. Williams pointed out that 91% of individuals with fibromyalgia use some form of alternative medicine, compared with 42% of the general population. However, the strength of lasers that are used for therapy is widely variable, and there have not been well-designed and documented clinical trials to support the claim that these therapies are beneficial and should be recommended to the larger community.

As I continued to research laser therapy for chronic pain management I discovered Freedom Laser Therapy Inc. This online site has some interesting information on laser therapy for chronic pain management from which I posted some excerpts below.

According to published Medical Reports, Low Level Laser Therapy can improve many acute and chronic conditions such as:

• Relief of hand and wrist pain associated with Carpal Tunnel Syndrome.
• Relief of muscle and joint pain
• Arthritis
• Muscle spasm
• Relief of stiffness
• Promotion of muscle relaxation

How Low-level Laser Therapy Works

Low level laser therapy traces its history back to the early 1960's when researchers discovered that laser light could stimulate a response at the cellular level of tissues in the body, resulting in increased energy levels (ATP, adenosine triphosphate). This increase in energy enables the body's cells to metabolize at a higher rate and speeds its natural ability to heal. In short, the body converts the laser light into a form of energy that it can use (biochemical energy) to repair itself and function at a higher efficiency level. This process is similar to the human body using the sun's energy to manufacture Vitamin D.

FDA Approved

Researchers have experimented for decades to find out which intensities and wavelengths of light work best to promote healing in the body. Laser therapy has been successfully utilized in Europe, Asia, and Canada for over 30 years. In 2002, the Food and Drug Administration (FDA) approved the use of low level laser therapy for pain management use in the United States.

How Low Level Laser Therapy is Used

Low level laser therapy has almost endless applications because of its approach to healing. Its low intensity does not burn or cut tissue like high-powered surgical lasers and there are no known side effects. Laser therapy is effective in treating many conditions that are prominent today, such as chronic arthritis, tendonitis, carpal tunnel syndrome, fibromyalgia, and sports injuries just to name a few. Many professional athletes utilize laser therapy to reduce healing time. People worldwide are experiencing the benefits of laser therapy by eliminating their dependence on pain medications, avoiding surgery, decreasing or eliminating pain, and returning to a healthier lifestyle.

In neuropathic pain the peripheral or central nervous systems are malfunctioning and become the cause of the pain. Neuropathic pain is usually perceived as a steady burning and/or "pins and needles" and/or "electric shock" type of sensations and/or tickling. The difference is due to the fact that "ordinary" pain stimulates only pain nerves, while a neuropathy often results in the firing of both pain and non-pain (touch, warm, cool) sensory nerves in the same area, producing signals that the spinal cord and brain do not normally expect to receive.

Neuropathic pain is produced by damage to, or pathological changes in the peripheral or central nervous systems. This type of pain is often a result of pain signals getting turned on, but not getting turned off. Unfortunately, neuropathic pain frequently responds poorly to standard pain treatments and occasionally pain symptoms may get worse instead of better over time. For some people, this can lead to serious disability and a significantly decreased quality of life.

This is why early recognition and aggressive management of neuropathic pain is critical for successful treatment outcomes. I recommend that multiple treatment modalities be provided through a multidisciplinary pain management team.

There are varied opinions about the “right” type of medication management approaches for treating fibromyalgia. Some health care providers think opiates are a good first line treatment approach, while others think they are not appropriate at all. I discovered one published report at the online Priory Medical Journal titled "The Pharmacological Management of Neuropathic Pain: A Review" by Gary McCleane MD FFARCSI, Consultant Anesthetist, Pain Clinic, Craigavon Area Hospital. Excerpts are below.

Tissue injury is usually accompanied by pain and is described as neuropathic if the initiating injury occurs to neural tissue. After injury occurs, symptoms are initially experienced distal to the site of injury: by contrast in non-neuropathic pain (nociceptive pain) symptoms are apparent, at least initially, at the site of injury. With time the margins between these types become blurred and each may coexist with the other. The consequence of neural injury is change in neural function both at the site of injury and proximal to it with the symptoms produced being manifestations of neural over or under activity. Typical features of neuropathic pain, regardless of the causal injury, include shooting / lancinating pain, burning pain, paraesthesia /dysaesthesia, numbness and allodynia (pain produced by a normally non-painful stimulus).

In addition to differing symptoms experienced with neuropathic and nociceptive pain, there are differences in those therapeutic agents which can produce pain relief. For example, it is accepted that nociceptive pain may be relieved by morphine and non-steroidal anti-inflammatory drugs (NSAIDs). However, with neuropathic pain some studies suggest analgesia with morphine and NSAIDs, while others demonstrate no analgesia with morphine or NSAIDs. The aim of this article is to highlight current therapeutic options for the treatment of neuropathic pain.

Key points

• Neuropathic pain is caused by neural injury
• The symptoms experienced by the patient with neuropathic pain differ to those experienced by the patients with nociceptive pain
• Analgesics that are effective for nociceptive pain have less effect in neuropathic pain
• Tricyclic antidepressants, anticonvulsants, membrane stabilizers and capsaicin can relieve neuropathic pain
• Anticonvulsants have differing modes of action and therefore failure to respond to one does not imply that others may not work

Another source I found on on neuropathic pain is from the U.S. Library of Medicine: National Institute of Health in an article titled "Pharmacologic Management of Neuropathic Pain: Evidence-based Recommendations" by Dworkin RH, O'Connor AB from which I’ve posted the abstract below.

Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered for recommendation if their efficacy was supported by at least one methodologically-sound, randomized clinical trial (RCT) demonstrating superiority to placebo or a relevant comparison treatment. Recommendations were based on the amount and consistency of evidence, degree of efficacy, safety, and clinical experience of the authors. Available RCTs typically evaluated chronic NP of moderate to severe intensity. Recommended first-line treatments include certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel alpha2-delta ligands (i.e., gabapentin and pregabalin), and topical lidocaine.

Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second-line treatments in some circumstances include certain antiepileptic and antidepressant medications, mexiletine, N-methyl-D-aspartate receptor antagonists, and topical capsaicin. Medication selection should be individualized, considering side effects, potential beneficial or deleterious effects on comorbidities, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs examining treatment of central NP are lacking and should be a priority for future research.

News & Research Archive — Here is a history of past Research for 2010, 2009, 2008 or 2007