NRSC 4132 Blog

Recent consensus numbers indicate that roughly 20 million, or about 10%, of the current U.S. population reported practicing meditation in the last year! To many of us at CU, the practice of meditation is all too familiar - Boulder, CO is one of the most yoga- and meditation- active cities in the U.S.

A recent study in the Journal of Neuroscience by Zeidan et. al (http://www.jneurosci.org/content/31/14/5540.abstract) analyzes an interesting application of meditation: modulation of pain. In particular, the Shamantha model of meditation was examined, one which involves sustaining attention on the "changing sensations of breath, monitoring discursive events as they rise, disengaging from those events without affective reaction, and redirecting attention back to breath". In this study, the discursive event was pain, and subjects were assessed for their ability to dissociate cognition of the pain stimulus from pain response.

The study employs a novel form of fMRI called pulse arterial spine labeled (PASL) MRI, a form of imaging that quantifies cerebral blood flow (CBF). Blood oxygen-level dependent (BOLD) fMRI, the conventional form of fMRI, is useful for monitoring short spurts of activity, but it is susceptible to slow drifts in signal intensity over extended periods of time. Because the practice of meditation often requires ample time, PASL MRI is better suited than BOLD fMRI.

The experiment consisted of 15 healthy volunteers. Three groups were sampled: a control group that received no training, an experimental group that only received directions to focus attention to breathing (ATB), and an experimental group that was taught Shamantha meditation. Each group was brought into a neutral environment and was presented with a 6 min. noxious heat stimulus (at 49 deg Celsius), during which the control group was instructed to rest, the ATB group to focus on breathing, and the meditation group to meditate. Two MRI readings were taken on all groups during presentation of noxious stimuli: pre- and post-meditation training. Additionally, test subjects were asked to rate unpleasantness of pain through the Freiburg Mindfulness Inventory (FMI) shortform.

Interestingly, the results show that attention to breath alone has no effect on modulating pain response; ratings of pain intensity and unpleasantness were identical between the control and ATB groups prior to meditation training. After meditation training, the experimental groups exhibited a 57% decrease in pain unpleasantness ratings and a 40% decrease in pain intensity ratings relative to the control group. Statistical analysis shows that meditation-induced reductions in pain were associated with increased activity in the anterior cingulate cortex and anterior insula, areas involved in the cognitive recognition of pain. This may seem paradoxical at first, as a majority of past studies have reported increased activity of these areas increases pain experience.

It is important to note that Zeidan et. al clarify the increased activity of these areas with the concurrent reduction of activity in the orbitofrontal cortex (OFC), an area of the brain associated with emotional evaluation and response. Grant et. al (http://www.ncbi.nlm.nih.gov/pubmed/21055874) report a similar de-coupling of the dorsolateral prefrontal cortex (DLPFC) and the cingulate, suggesting that the DLPFC (like the OFC) functions to generate emotional response after the cingulate receives afferents from pain stimuli. Given this novel model of pain, it is not surprising that the anterior cingulate cortex and anterior insula were active in meditating individuals; the heightened activity of these areas allowed them to be aware of discursive events (pain stimuli), but the reduced activity of the OFC allowed them to dissociate their pain response and refocus their attention to breathing.

These results show that meditation may be a powerful, natural way of dealing with pain. In an era where opiates and pain relievers are often relentlessly abused, meditation may be the perfect solution. Maybe one day, we'll see NFL athletes meditate at the end of practices and games, or physical rehabilitation patients meditate daily to overcome the pain of a healing injury. Only time, and more research, can tell.

Focus on your breathing. As thoughts and emotions come to you, simply observe without judgment and dismiss them, as if they were just passing by outside your car window. Return to the sensations of air passing in through your nostrils, down your trachea and filling your lungs...

Sound like a yoga class? Hypnosis? Close, but even better. It's a trick you can keep up your sleeve to pull out the next time your body screams "Ouch!" And it works, according to a study published in the April, 2011 issue of the Journal of Neuroscience. (https://cuvpn.colorado.edu/content/31/14/,DanaInfo=www.jneurosci.org+5540.full.pdf+html)

Researchers took 15 young healthy volunteers, and applied a painful stimulus to their calves for about 6 minutes while instructing them to simply pay "attention to breath." Brain activity was recorded using fMRI before and during the noxious stimulus. Afterwards, the subjects also rated their subjective pain intensity and pain unpleasantness on a standard visual analog scale.

Subjects were then given instruction in Shamatha, a type of "mindfulness meditation" that involves focused attention on the sensations of the breath, while disengaging from intrusive thoughts or emotions. Subjects spent merely 20 minutes a day, for 4 days, learning the technique. The fMRI sequences were then repeated, with the subjects meditating as taught during the application of noxious stimulus.

Meditation has long been thought to modify our sensory experiences, but the specific brain mechanisms were mysterious. As expected by the researchers, the subjects' ratings of pain intensity and pain unpleasantness were lower during meditation than before the training. In fact, subjects rated their pain lower by 40% and 57% respectively!

New information also emerged. Several different brain mechanisms seemed to be working at once. fMRI showed that distinct brain regions were significantly more active during meditation, some of them associated with the cognitive modulation of pain; some related to emotion regulation; some tasked with reframing the contextual evaluation of sensory events; and others involved in interoceptive awareness (attention to sensations inside the body). Additionally, some areas such as the thalamus were deactivated during meditation, acting as a sort of gatekeeper for afferent nociceptive signals.

Thanks to these brain mechanisms, you can handle the pain - if you make friends with Shamatha. For a relatively small time investment (just 20 minutes a day for 4 days), you can acquire a skill that will last you a lifetime, and hone it with practice. By extension, the pain-reducing benefits of Shamatha could be used to brave a variety of "painful" circumstances, like speaking in front of a crowd or meeting your boyfriend's parents. Further, a host of other benefits of increased interoceptive awareness await, like "trusting your gut" or knowing when you need some exercise, or knowing when you've had enough pizza.

Try it; it can't hurt.

In case you don't know what they are, throat lozenges are those chalky, powdery tablets primarily composed of zinc that you take to alleviate sore throat pain. Similar to a cough drop, they've been around for years and seem to be part of many people's remedy regimen to treat such symptoms of the common cold. Pain is one of those feelings that not many of us like to deal with or even think about. Whether you are taking aspirin, acetaminophen, or throat lozenges to manage throat pain, it is known that many options are abound in the marketplace.

Pain is an unpleasant sensory and emotional reaction that usually motivates us to seek some sort of "pain-killer." Sometimes it even gets to the point where we don't care to know or what extent we have to go to alleviate our pain--symptoms of such "pain-killers" disregarded. An extensive amount of funding and research has gone into the clinical aspects of pain management drugs including not only over-the-counter pain medications such as Tylenol and Advil, but chronic pain anesthetics with detrimental side effects. Such drug categories include neurolytic blocks, narcotics, opiates, and other analgesics. Side effects from all of these drugs, acute and severe, range from topical rashes and swelling to addiction and cardiac arrest. Holistic healing, be it through ?mind over matter? or ingesting natural antidotes, may be a way to avoid pain killers that bring severe side effects with them. According to comprehensive research involving zinc in last month's issue of Nature Neuroscience, perhaps there are some natural treatment methods of pain management.

Zinc, as previously mentioned, is a metallic chemical element that is readily available and affordable throughout the marketplace. In fact, it is so copious, that it is the 24th most abundant element in the Earth's crust, and the second most prevalent trace element in the body according to Nozaki's et al. investigation. Not only is it essential for life and crucial for cellular metabolism, but Nozaki et al. have discovered a role for zinc in brain functions such as neurological disorders and pathological pain management. The trouble with studying this element is the myriad of potential zinc targets on the molecular basis. Nozaki et al. noted that NMDA receptors are one of the potential synaptic targets for zinc effects of excitatory transmission and have key roles in both the physiology and pathology of the nervous system. Notably, these receptors contribute to pain transmission and the development of chronic pain.

As we understand, there are various subunits that comprise the NMDA receptor (NR1 and NR2 subunits). In particular, the NR2A subunit, which is widely expressed in the adult nervous system, has an intense sensitivity for extracellular zinc, or zinc taken in the body beyond endogenous levels of zinc. Using knock-in NR2A-H128S mice, they found that high affinity zinc binding to the NR2A subunit is enough to dampen NMDA receptor function in pain pathways throughout the central nervous system. Though Nozaki et al. have not found the precise location of the site where zinc diffuses in the vicinity of NMDA receptors, they did find that NMDA-dependent spinal long-term potentiation, a well-known substrate for hyperalgesia, is blocked by exogenous zinc.

This is an enormous discovery in terms of future experimentation and the potential role of the natural element zinc in place of dangerous pain-management pharmaceuticals. It's absolutely incredible to me how technology is unveiling Mother Nature's organic remedy for so many of the problems and illnesses in today's society. Not that I doubt the use of western medication and synthetic pharmaceuticals as treatment options for various illnesses, but I strongly condone taking natural elements found on this planet with a far shorter list of side effects. A lesson to consider: keep on sucking on those zinc throat lozenges when you have a sore throat!

Presently, we live in a society that has become increasingly dependent of pharmaceuticals as the great panacea for our discomforts and diseases. Treatment of neurological disorders is most commonly mediated through trial and error dosing of medication. This trend has steadily increased since the 1950s with the use of antidepressants and accompanied the closing of most of America?s mental hospitals. The emphasis on personal treatment and therapy has lost ground to the administration of singular chemicals (or combinations) that alter pathways with predicted but not completely understood chemical results (due to the highly interconnected nature of these chemical pathways.) This method can work wonders, many patients with severely debilitating neurological disorders such as schizophrenia often find great relief in their treatments and are able to live without or with minimal assistance. Drugs are also often a cheaper solution to the problem (compared to high levels of therapy or institutionalization.)
Unfortunately though this practice of pharmaceutical treatment has many limits; Many antidepressants that have been prescribed over the years have been found later to increase suicidal tendencies. Some people have genetic or environmentally caused dispositions that increase or decrease the drug potency or its negative side effects. Some drugs are sought out not for curing disorders or diseases but for recreational or ability enhancing uses (like the highly prevalent the misuse of adderall among students.) Then, of course, there are disorders or injuries which impair the nervous system for which there is no known treatment or specific biochemical pathway on which to act upon. For these reasons many scientists and clinicians are using nonpharmacological treatments, especially the utilization of sensory input, to help ease and heal their patients.
A great leader in this movement towards alternative forms treatment is Dr. V. S. Ramachandran. Dr. Ramachandran is a neuroscientist at the University of California San Diego and has helped people suffering with a strange neurological disorder known as phantom limb syndrome without surgery or drugs. Phantom limb syndrome is the experience of feeling of the presence of an amputated limb, it can be quite painful and is believed to be caused by lack of feedback inhibition (the brain tells the missing hand to clench but the hand cannot clench so the brain tells the hand to clench harder etc.) By using a ?mirror box? Ramachadran has found that he can use external sensory input (the patient ?seeing? his missing hand clench by using the reflection of his present hand) to override the jammed signal.
Another example of novel drug-free therapies has been the use of electrodes to serve as external sensory devices in both the treatment of vestibular malfunction and to return sight to the blind. A grid of electrodes is used in both cases and can be used as a sort of balancing meter for vestibular treatment or as a sort of low resolution black and white television (with an on electrode being white and an off electrode being black.) These treatments have shown success for many patients and may become more popular as technology advances.
These exciting and alternative therapies are of course limited, but may open the door to other forms of treatment for difficult to medicate neurological disorders.

Those of us in dating in high school in the late 80′s can attest to the stinging truth revealed in Def Leppard?s song, ?Love Bites? shortly after a nasty break-up. But it was only recently that scientists employing state-of-the-art brain imaging fMRI technology have been able to view the similarities between the biting pain of rejection from a lover and physical pain.

A study published in the April 12 issue of Proceedings of the National Academy of Science (PNAS) has provided the most direct evidence showing a common brain circuit underlying the pain of rejection and physical pain.

In their study, the researchers at Columbia University, University of Michigan and University of Colorado, Boulder studied 40 subjects who had experienced rejection and break-up with a lover within the past six months. They tested each subject on two tasks, a social rejection task and a physical pain task, while imaging their brains.

In the scanner, subjects looked at the faces of their ex and thought about how it felt during their split and a snapshot of their brain was taken. Next they were shown a headshot of a friend of the same sex as their former partner and thought about a recent positive experience they shared. This provided the social rejection condition.

To compare the social rejection experience to the experience of ?physical pain? they attached a thermal device to the volunteers? forearms and set it to produced a ?painful?, but not harmful level.

In both men and women, rejection and painful heat activated brain circuits underlying distress (e.g. Anterior Cingulate cortex) and the sensation of pain e.g. somatosensory cortex).

Although this seems seems intuitive from centuries of poetry, tragic plays and lyrics, knowledge at a mechanistic level showing the same circuits are activated gives scientists new ways to deal with both. It makes one wonder if taking pain-killers shortly after a break-up might be a treatment option.

The common mechanism between social rejection and physical pain may be one reason why heroin and alcohol, both analgesics for pain, are irresistible amongst country and grunge musicians whose melodic ruminations center on tragedy, angst and painful relationships. Kurt Cobain comes to mind when he said, ?Thank you for the tragedy. I need it for my art.?

Last year the British pop group ironically named, ?The Wanted?, brilliantly connected the idea that pain from being unwanted/rejected and searing physical pain were one and the same in their popular song ?Lose My Mind?. Here are the lyrics and the video

They say that time
Heals everything
But they don?t know you
And the scars you bring

?Cos you left a jagged hole
And I can?t stand it anymore

If heartache was a physical pain
I could face it I could face it
But you?re hurting me
From inside of my head
I can?t take it I can?t take it

I?m gonna lose my mind
I?m gonna lose my mind

I?d erase my thoughts
If only I knew how
Fill my head with white noise
If it would drown you out
Kill the sound

If heartache was a physical pain
I could face it I could face it

But you?re hurting me
From inside of my head
I can?t take it I can?t take it

I?m gonna lose my mind
I?m gonna lose my mind

And I?d rather be crazy
I?d rather go insane
Than having you stalk
My every thought
Then having you here inside my heart

If heartache was a physical pain
I could face it I could face it
But you?re hurting me
From inside of my head
I can?t take it I can?t take it

I?m gonna lose my mind
I?m gonna lose my mind