Abstract ID: 2259

Primary Topic: State of the science/evidence base for integrative modalities
Secondary Topic: Mind-body (including meditation and yoga)

Mindfulness-oriented Approaches to Pain and Opioid Misuse: Mechanistic Considerations and Clinical Applications
David Vago, PhD, Osher Center for Integrative Medicine, Nashville, TN, United States; Eric L Garland, PhD, LCSW, Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, UT, United States; Fadel Zeidan, PhD, Center For Integrative Medicine, Winston-Salem, NC, United States

Late Breaker: No

Overview

The development, testing, and validation of non-pharmacological approaches to treat pain are critically important today as the national epidemic of opioid use and misuse has led to adverse clinical outcomes and failure in symptom management. Mindfulness meditation and other integrative health modalities have been found to significantly reduce pain in both experimental and clinical settings, with additional possible therapeutic benefit for opioid-related outcomes. Yet, neither the mechanisms, nor the appropriate prescriptive protocols remain clear in scaling treatment of heterogeneous populations of patients with acute and chronic pain seeking a narcotic-free, self-facilitated form of pain therapy. Here we discuss the extant literature identifying the mechanisms of action that provide preliminary evidence for the utility of mindfulness-based modalities in attenuating pain and opioid misuse practices. We will delineate the prospects of its use in integrative health care settings in an audience-integrated discussion.

Rationale

There has been a need to develop and identify low-cost, non-invasive and non-addictive alternatives to opiates for the treatment of chronic pain. Mindfulness and other mind-body interventions have shown great promise in subserving this clinical population. In fact, in early 2017, the American College of Physicians developed a guideline providing evidence and clinical recommendations to use such integrative mind-body methods for first-line treatment of low back pain. Yet, it remains unclear what aspects of pain are affected, which populations (e.g., low back pain) are best served, which interventions are most effective, and the biological and physiological mechanisms by which such mind-body interventions may predict clinical outcomes. This proposed symposium is in alignment with the theme of the 2018 International Congress on Integrative Medicine and health – specifically to advance integrative health through the discussion of extant research in this field with experts studying and implementing such modalities in both controlled research and in clinical contexts that focus on pragmatic clinical trials and implementation science.

Objectives

As a result of this session, participants will be able to:

  • Understand the current literature on the effects of mindfulness on acute and chronic pain
  • Examine in detail the underlying physiological and neurobiological mechanisms by which mindfulness and other mind-body health practices support clinical outcomes for experience of pain
  • Investigate best research and clinical practices as well as a prescriptive agenda for future research

Methods/Session Format

Each of the 3 speakers will be allotted 30 minutes for a presentation on their research and clinical perspective on pain. Each speaker will address the psychobiological mediation of nociception and pain, as well as the clinical applications of their treatment modalities.

  • Eric Garland, Ph.D., LCSW will present research on the clinical effectiveness and mechanisms of Mindfulness-Oriented Recovery Enhancement for chronic pain and prescription opioid misuse
  • Fadel Zeidan, Ph.D. will present research identifying the neural mechanisms supporting mindfulness-based analgesia from a longitudinal perspective (i.e., dispositional mindfulness; novice and adept meditators).
  • David Vago, Ph.D. will moderate the session. He will first present an overview of the neuroanatomic and neurochemical systems underlying cognitive, emotional, and behavioral factors central to the pain experience. Second, he will provide data suggesting further mechanisms by which pain is modulated by mindfulness and other mind-body health treatment modalities.

Outline

  • Pain is a multidimensional experience that involves sensory, cognitive and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and often a financial burden.
  • Recent studies that demonstrate that mindfulness meditation significantly attenuates pain and opioid-related problems through multiple, unique mechanisms
  • Implementation of Mindfulness in an integrative medical model can have various forms and research has yet to demonstrate which treatment modalities are most effective for specific forms of chronic pain
  • Best practices for research and pragmatic applications in integrative health care will be discussed