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.
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.
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内源性阿片类药物在正念和假正念冥想中的作用，用于直接缓解诱发的慢性腰痛：一项随机临床试验。
DOI：
10.1038/s41386-023-01766-2
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Zeidan,Fadel
中科院分区：
文献类型：
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作者：
Khatib,Lora;Dean,JonG;Oliva,Valeria;Riegner,Gabriel;Gonzalez,NaileaE;Birenbaum,Julia;Cruanes,GaelF;Miller,Jennifer;Patterson,Marta;Kim,Hyun-Chung;Chakravarthy,Krishnan;Zeidan,Fadel
慢性腰痛（cLBP）是最常见的慢性疼痛病症。没有发现直接缓解诱发的cLBP的治疗方法。在这种程度上，正念冥想是一种很有前途的疼痛疗法。然而，目前还不清楚冥想是否可以通过内源性阿片类药物直接减轻诱发的慢性疼痛。一项采用药物交叉设计的双盲、随机和安慰剂对照临床试验，研究了与假正念冥想相比，正念冥想是否会减弱静脉（0.15 mg/kg推注+ 0.15 mg/kg/小时维持）纳洛酮（阿片类拮抗剂）和安慰剂-生理盐水输注期间的直腿抬高试验诱发慢性疼痛。59名cLBP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，患者被随机分为四个阶段（20分钟/阶段）的正念（n= 30）或假正念冥想（n= 29）干预。干预后，与休息（非冥想）相比，正念和假正念冥想与盐水和纳洛酮输注期间的背痛显著减少相关，以响应cLBP诱发的直腿抬高测试。这些结果表明，冥想通过非阿片类药物过程直接减少诱发的慢性疼痛。重要的是，在干预后，正念组在休息（非冥想）和冥想期间报告的直腿抬高引起的疼痛显著低于假正念冥想组。正念和假正念冥想训练也与显着降低简明疼痛量表的严重程度和干扰评分相关。正念冥想的止痛效果比强有力的假正念冥想干预更明显，这表明非反应性评估过程可能与慢性腰痛的改善唯一相关。ClinicalTrials.gov
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