Breath Meditation and Pain

We have a lot of scientific evidence that shows mindfulness and meditation reduce pain or the perception of pain. Still, scientists have only recently started to understand how this works. Some people believe mindfulness and meditation must somehow engage the body’s natural pain-relieving system (known as the endogenous opioidergic system). For the sake of brevity, let’s call it the EOS. It naturally produces opioids in the body, such as beta-endorphin, met-enkephalin, and leu-enkephalin. Some time ago, these were thought to create the “runner’s high,” however, recent evidence suggests maybe not.

But I found a recent study that shows mindfulness and meditation are probably not engaging the EOS either. In the March 2020 issue of Pain, Wells and colleagues set up an exquisite way to test this theory using a highly reliable study design (it’s called a double-blind, placebo-controlled crossover study).

They randomly assigned people to three study arms and exposed them to heat (49 degrees Celsius/120.2 degrees Fahrenheit). In one wing, the group used mindfulness meditation to manage pain. The second arm they used “sham-mindfulness,” and the third arm they used slow-paced breathing.

Now, what makes this really interesting is that Wells and colleagues not only applied heat to our fair subjects, but they also infused them with naloxone in one round. This is basically Narcan that is commonly used to reverse an opioid overdose. In this case, it suppressed any opioid action that the body might produce during mindfulness and meditation. Then they used saline (a placebo) in another round to cancel out false reporting. It was double-blind, too, so neither the participants or researchers knew if they were on the naloxone or the placebo.

Scientists asked participants to rate the unpleasantness of pain and the intensity of pain caused by the heat.

Their findings were remarkable.

Wells and colleagues reported that mindfulness appeared to significantly reduce the participants’ perception of the unpleasantness of pain across the board, but not necessarily the pain intensity. Slow-paced breathing significantly reduced both the intensity and the perception of the pain even while the naloxone was flowing. We use slow-pace breathing in meditation! This tells us, however, that mindfulness and meditation were probably NOT activating the body’s own opioids in pain reduction. Sham-mindfulness was ineffective against pain intensity and unpleasantness because they did not focus on the breath. One likely has to focus on the breath (or some other object of meditation) to reduce pain perceptions.

The bottom line is that the Wells et al. study shows attention to the breath lowers pain perception and intensity. Still, the body’s naturally produced opioids are likely not responsible for the effect. That leaves us with the same question, then, how in the world is this happening? At least we some more evidence here that suggests we still do not know why attention to the breath in mindfulness and meditation reduces pain, but it does. The other question is, if our own built-in opioids are not reducing the pain, then maybe there is another chemical in the body doing the work. Or perhaps it is not a chemical at all. The wonders never cease.

If you want to read for yourself, check these links:

Attention to breath sensations does not engage endogenous opioids to reduce pain

The Endogenous Opioid System and Clinical Pain Management