The role of endogenous opioids in mindfulness and sham mindfulness-meditation for the direct alleviation of evoked chronic low back pain: a randomized clinical trial.
Lora Khatib, Jon G Dean, Valeria Oliva, Gabriel Riegner, Nailea E Gonzalez, Julia Birenbaum, Gael F Cruanes, Jennifer Miller, Marta Patterson, Hyun-Chung Kim, Krishnan Chakravarthy, Fadel Zeidan
Neuropsychopharmacology June 1, 2024 DOI: 10.1038/s41386-023-01766-2 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Placebo-controlled Double-blind Peer reviewed |
|---|---|
| Sample size | 59 |
| Population | Individuals with chronic low back pain |
| Interventions | Mindfulness meditation Sham mindfulness meditation |
| Duration | Four sessions of 20 minutes each |
| Topics | Meditation |
| Citations | 9 |
| Registration | NCT04034004 |
| Key findings | Mindfulness meditation directly reduces evoked chronic pain through non-opioidergic processes, and its effects are more pronounced than sham mindfulness meditation. |
Abstract
Chronic low back pain (cLBP) is the most prevalent chronic pain condition. There are no treatments that haven been found to directly assuage evoked cLBP. To this extent, mindfulness-meditation is a promising pain therapy. Yet, it is unclear if meditation can be utilized to directly attenuate evoked chronic pain through endogenous opioids. A double-blind, randomized, and placebo-controlled clinical trial with a drug crossover design examined if mindfulness-meditation, as compared to sham mindfulness-meditation, attenuated straight leg-raise test evoked chronic pain during intravenous (0.15 mg/kg bolus + 0.15 mg/kg/hour maintenance) naloxone (opioid antagonist) and placebo-saline infusion. Fifty-nine individuals with cLBP (mean age = 46 years; 30 females) completed all study procedures. After the pre-intervention pain testing session, patients were randomized to a four-session (20-min/session) mindfulness (n = 30) or sham mindfulness-meditation (n = 29) intervention. After the interventions, mindfulness and sham mindfulness-meditation were associated with significant reductions in back pain during saline and naloxone infusion when compared to rest (non-meditation) in response to the cLBP-evoking straight leg-raise test. These results indicate that meditation directly reduces evoked chronic pain through non-opioidergic processes. Importantly, after the interventions, the mindfulness group reported significantly lower straight leg-raise induced pain than the sham mindfulness-meditation group during rest (non-meditation) and meditation. Mindfulness and sham mindfulness-meditation training was also associated with significantly lower Brief Pain Inventory severity and interference scores. The pain-relieving effects of mindfulness meditation were more pronounced than a robust sham-mindfulness meditation intervention, suggesting that non-reactive appraisal processes may be uniquely associated with improvements in chronic low-back pain.Trial Registration: ClinicalTrials.gov identifier: NCT04034004.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 5
- Pain, mindfulness, and placebo: a systematic review. Frontiers in Integrative Neuroscience 2024
- Brain mechanisms supporting mindfulness-based chronic pain relief: A randomized, sham-mindfulness meditation controlled mechanistic clinical trial protocol. Contemporary Clinical Trials Communications June 27, 2026
- Mindfulness meditation reduces pain more effectively than slow-breathing meditation: the mediating role of respiration. Pain March 1, 2026
- Heartfulness meditation alters neuroendocrine profiles: A randomized controlled trial on hormones of stress and well-being. Medicine November 21, 2025
- Mindfulness Meditation and Placebo Modulate Distinct Multivariate Neural Signatures to Reduce Pain. Biological Psychiatry 2025
Cites 18
- Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference Social Cognitive and Affective Neuroscience August 13, 2007
- Neural Correlates of Dispositional Mindfulness During Affect Labeling Psychosomatic Medicine July 1, 2007
- Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study ☆ Pain June 4, 2007
- Effects of Brief and Sham Mindfulness Meditation on Mood and Cardiovascular Variables The Journal of Alternative and Complementary Medicine July 28, 2010
- Default mode network connectivity encodes clinical pain: An arterial spin labeling study Pain October 29, 2012
and 13 more in the library