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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 (2023)Cite this article

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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

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Fig. 1: Study design.
Fig. 2: Pain ratings in response to lying supine and straight leg-raise test across participants.
Fig. 3: Mindfulness and sham mindfulness-meditation group-based pain ratings in response to lying supine and straight leg-raise test during experimental sessions.

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Funding

This work was supported by the National Center for Complementary and Integrative Health (Zeidan R21-AT010352, R01-AT009693, R00-AT008238) and the UC San Diego Denny T. Sanford Institute for Empathy and Compassion.

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  1. These authors contributed equally: Lora Khatib, Jon G. Dean, Valeria Oliva, Gabriel Riegner.

Authors and Affiliations

  1. Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA

    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

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Contributions

Concept and Design: F.Z. Acquisition of Data: LK, NEG, JGD, GR, JB, VO, GC, KC, JM, MP, H-CK. Statistical Analysis, Interpretation of Data, and Drafting of the Manuscript: LK, JGD, FZ. Critical Revision of the Manuscript: LK, JGD, FZ. Supervision: FZ.

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Correspondence to Fadel Zeidan.

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Khatib, L., Dean, J.G., Oliva, V. et al. 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. Neuropsychopharmacol. (2023). https://doi.org/10.1038/s41386-023-01766-2

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