Attention to breath sensations does not engage endogenous opioids to reduce pain.
Rebecca E Wells, Jason Collier, Grace Posey, Afrayem Morgan, Timothy Auman, Brian Strittmatter, Rossana Magalhaes, Adrienne L Adler-Neal, John G. Mchaffie, Fadel Zeidan
Pain March 9, 2020 DOI: 10.1097/j.pain.0000000000001865 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Double-blind, placebo-controlled crossover study Peer reviewed |
|---|---|
| Sample size | 59 |
| Population | Adults experiencing noxious heat pain |
| Interventions | Mindfulness meditation Sham-mindfulness meditation Slow-paced breathing Naloxone |
| Dose | 0.15 mg/kg bolus + 0.1 mg/kg/hour maintenance infusion |
| Topics | Meditation |
| Keywords | Humans Naloxone Analgesics, opioid Cross-over studies Adult Pain management |
| Key points | Mindfulness meditation and slow-paced breathing reduced pain (unpleasantness and/or intensity) in ways that were insensitive to the opioid antagonist naloxone, whereas sham mindfulness reduced unpleasantness only during saline and this effect was reversed by naloxone. The authors conclude that slow breathing combined with attention to breath reduces pain independent of endogenous opioids. |
Abstract
The endogenous opioidergic system is critically involved in the cognitive modulation of pain. Slow-breathing-based techniques are widely used nonpharmacological approaches to reduce pain. Yet, the active mechanisms of actions supporting these practices are poorly characterized. Growing evidence suggest that mindfulness-meditation, a slow-breathing technique practiced by nonreactively attending to breathing sensations, engages multiple unique neural mechanisms that bypass opioidergically mediated descending pathways to reduce pain. However, it is unknown whether endogenous opioids contribute to pain reductions produced by slow breathing. The present double-blind, placebo-controlled crossover study examined behavioral pain responses during mindfulness-meditation (n = 19), sham-mindfulness meditation (n = 20), and slow-paced breathing (n = 20) in response to noxious heat (49°C) and intravenous administration (0.15 mg/kg bolus + 0.1 mg/kg/hour maintenance infusion) of the opioid antagonist, naloxone, and placebo saline. Mindfulness significantly reduced pain unpleasantness ratings across both infusion sessions when compared to rest, but not pain intensity. Slow-paced breathing significantly reduced pain intensity and unpleasantness ratings during naloxone but not saline infusion. Pain reductions produced by mindfulness-meditation and slow-paced breathing were insensitive to naloxone when compared to saline administration. By contrast, sham-mindfulness meditation produced pain unpleasantness reductions during saline infusion but this effect was reversed by opioidergic antagonism. Sham-mindfulness did not lower pain intensity ratings. Self-reported "focusing on the breath" was identified as the operational feature particularly unique to the mindfulness-meditation and slow paced-breathing, but not sham-mindfulness meditation. Across all individuals, attending to the breath was associated with naloxone insensitive pain-relief. These findings provide evidence that slow breathing combined with attention to breath reduces pain independent of endogenous opioids.
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 16
- Disentangling self from pain: mindfulness meditation–induced pain relief is driven by thalamic–default mode network decoupling Pain July 7, 2022
- Mechanism of Action of Mindfulness-Based Interventions for Pain Relief-A Systematic Review. Journal of Integrative and Complementary Medicine December 1, 2024
- 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. Neuropsychopharmacology June 1, 2024
- Conscious connected breathing with breath retention intervention in adults with chronic low back pain: protocol for a randomized controlled pilot study Pilot and Feasibility Studies January 24, 2023
- Pain, mindfulness, and placebo: a systematic review. Frontiers in Integrative Neuroscience 2024
and 11 more in the library
Cites 19
- 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 training alters cortical representations of interoceptive attention Social Cognitive and Affective Neuroscience June 11, 2012
- 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
and 14 more in the library