Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
Neuropsychopharmacology. 2024 Jun;49(7):1069-1077. doi: 10.1038/s41386-023-01766-2. Epub 2023 Nov 20.
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.
慢性下背痛（cLBP）是最常见的慢性疼痛病症。目前尚无治疗方法被发现可直接缓解诱发的 cLBP。在这种程度上，正念冥想是一种很有前途的疼痛治疗方法。然而，目前尚不清楚冥想是否可以通过内源性阿片类物质直接减轻诱发的慢性疼痛。一项双盲、随机、安慰剂对照的临床试验，采用药物交叉设计，研究了与假正念冥想相比，正念冥想是否能减轻静脉注射（0.15mg/kg 推注+0.15mg/kg/小时维持）纳洛酮（阿片拮抗剂）和安慰剂盐水输注时直腿抬高试验诱发的慢性疼痛。59 名慢性下背痛患者（平均年龄 46 岁；30 名女性）完成了所有研究程序。在干预前疼痛测试阶段后，患者被随机分为四组（20 分钟/组）正念（n=30）或假正念冥想（n=29）干预组。干预后，与休息（非冥想）相比，正念和假正念冥想在直腿抬高试验诱发的盐水和纳洛酮输注期间与直腿抬高试验诱发的慢性疼痛显著减少。这些结果表明，冥想通过非阿片类物质过程直接减轻诱发的慢性疼痛。重要的是，干预后，与假正念冥想组相比，正念组在休息（非冥想）和冥想时直腿抬高引起的疼痛明显更低。正念和假正念冥想训练还与简明疼痛量表严重程度和干扰评分显著降低相关。正念冥想的镇痛效果比强大的假正念冥想干预更为明显，这表明非反应性评估过程可能与慢性下腰痛的改善有独特的关联。试验注册：ClinicalTrials.gov 标识符：NCT04034004。
