By LUCETTE LAGNADO
Doctors at New York’s Mount Sinai hospital are testing if meditation can reduce patients’ needs for narcotic painkillers after back surgery
Patients who have back surgery, a procedure that can cause severe pain for weeks, may have a new relief option beyond narcotics: meditation.
In a study at Mount Sinai Hospital in New York City, a neurosurgeon has teamed up with a geriatrician who leads meditation classes to test whether the technique can lessen pain in spine-surgery patients and reduce the need for opioid painkillers, which can be highly addictive. The randomized trial trains patients in a simple form of meditation and asks them to practice it starting two weeks before their surgery and for six weeks after, using audiotapes to guide them.
Results of the study might not be available for at least a couple more years, as the researchers have so far signed up about half of the 50 participants they aim to recruit. Some of the patients who have tried meditation say it seems to make their pain more tolerable than they expected.
“We are not hoping to replace the need for pain medication,” says Patricia Bloom, a clinical associate professor of geriatrics at the Icahn School of Medicine at Mount Sinai. “We are trying to understand, can you help people’s pain to resolve faster and can you make their need for narcotics less,” says Dr. Bloom, a co-investigator on the project with colleague Arthur Jenkins, an associate professor of neurosurgery and orthopedic surgery.
David Langer, chairman of neurosurgery at Lenox Hill Hospital, in New York City, says meditation can help reduce anxiety and stress, which can make pain worse. Still, “I would be surprised if it had a large impact on post-operative pain,” in part because many patients will find it difficult to commit themselves to meditate regularly after major surgery, he says.
Meditation has previously been found to benefit patients with a host of medical and psychological issues. Studies have looked at whether it can help control hypertension, assist people suffering from heart disease or help relieve chronic pain, Dr. Bloom says. What makes the Mount Sinai study unusual is its focus on acute post-operative pain—the kind that typically requires opioid drugs to control, she says.
Dr. Jenkins says there has been growing pressure on doctors to reduce reliance on narcotic painkillers because of the dangers of addiction. He says he tried ways to reduce the use of drugs, including performing less-invasive surgeries with smaller incisions and shorter recovery times, but that isn’t always possible. Five years ago, Dr. Jenkins says he had an “epiphany” after reading a scientific study showing meditation could reduce physical pain.
The study, published in 2011 in the Journal of Neuroscience, involved 15 people who were subjected to pain using heated probes. The researchers used an MRI to scan the brains of the volunteers and found that pain intensity was 40% less when they practiced meditation than when they didn’t, says Fadel Zeidan, the study’s lead author and an assistant professor of neurobiology and anatomy at Wake Forest School of Medicine, in North Carolina.
“Wow, that is exactly what I am looking for,” Dr. Jenkins recalls thinking. He says that during his 15 years practicing spine and neurosurgery, he has become increasingly open to other healing options, such as working with chiropractors as a complement or alternative to surgery. “I have evolved to a more holistic approach,” he says.
Dr. Jenkins and Dr. Bloom set about designing a randomized trial to explore whether meditation could help with spine-surgery pain, which can last for six weeks or longer. When patients agree to participate, the researchers use a deck of cards—drawing either red or black—to decide who will practice meditation along with getting painkillers, and who will only get painkillers.
One patient, Clifford Glenn Gualano, 55 years old, had spine surgery several years ago that left him in “excruciating” pain. Ahead of another operation on Sept. 7, he says he was dutiful about listening to the audiotapes and trying to meditate, but was still very skeptical. “I am not a tree-hugger, and this is kind of how this strikes me,” says Mr. Gualano, a police officer in Spring Valley, N.Y. Still, Mr. Gualano was wary of narcotics and decided “to take a shot” at meditation. “If it works and you can sell me, you can sell anybody,” he says.
Since his operation, Mr. Gualano says the meditation exercises don’t reduce the “very severe pain” he has, but they help him relax. He had difficulty waiting the prescribed four hours between doses of hydromorphone, a narcotic. But if he meditated it helped him to hold out until the next dose.
Mr. Gualano recently moved to a rehabilitation facility, where he was given a second painkiller. He has been meditating some but hopes to do it regularly once he gets home. “If it starts hurting, and I need to take a pill, I will try the meditation first,” he says.
Wake Forest’s Dr. Zeidan says it is possible certain forms of meditation can help with the pain from back or neck surgery. His team has published more research, including a 2015 study that found benefits from so-called mindfulness meditation. It “works by teaching you to regulate your response to pain,” Dr. Zeidan says. “People learn to accept the pain as opposed to trying to fight it.”
Mount Sinai’s exercises are a hybrid of mindfulness meditation and a type of mind training called Open Focus to help with relaxation and pain reduction, says Dr. Bloom. In one segment on stress reduction, Dr. Bloom, whose voice is heard on the tape, tells listeners to gently close their eyes and allow “your mind to relax and restore.” She instructs them to focus on different parts of their body and to concentrate on each breath they take.
In another segment devoted to pain, Dr. Bloom tells listeners to “turn your attention to the pain that you feel, seeing if it is possible to visualize the length, width and shape of your pain.” The message: Let “your pain be there, not holding on to it but not pushing it” away, either.
Dr. Bloom acknowledges the meditation techniques aren’t for everyone: “Some people would think it is too woo-woo.”
When Barry Wollner, 63, was scheduled for spine surgery last year, Dr. Jenkins’s team asked him if he believed in meditation. “I said that I don’t not believe in it, but I had never done it,” says Mr. Wollner, a retired housing official for the state of New York.
He diligently set about doing the exercises ahead of his surgery, as often as three times a day, he says. After the operation, he continued meditating and says he found the pain tolerable. He was prescribed oxycodone, a narcotic painkiller, but used very little. Staff at the hospital were surprised. “They would look at me and say, ‘You really didn’t take any?’ and I would say no,” he recalls. “It was the meditation.”