美国国家公共电台 NPR Meditation Reduced The Opioid Dose She Needs To Ease Chronic Pain By 75%（在线收听）

NOEL KING, HOST:

Millions of Americans live with chronic pain. Increasingly, the guidance from medical groups and doctors is to experiment with treatments other than opioids - alternative therapies. Now a new study published in the journal JAMA Internal Medicine finds that mind-body interventions can be helpful to reduce pain.

NPR's Allison Aubrey has been looking into all of this. Hi, Allison.

ALLISON AUBREY, BYLINE: Hi, there.

KING: All right. So what is a mind-body intervention, and what did this study find?

AUBREY: Well, this new study has found evidence that treatments other than prescription medications can be beneficial for pain. It was a review of 60 studies involving 6,000 participants. They evaluated a whole bunch of mind-body interventions - everything from hypnosis to guided imagery. And they found that meditation as well as therapy - a type known as cognitive behavioral therapy - were among the most helpful. Overall, people reported reduced levels of pain, and many were able to reduce the dose of their pain medication.

KING: What kind of pain are we talking about?

AUBREY: Well, it could be acute pain following surgery or cancer pain, chronic pain from back pain. And in some cases, we're talking people who've been in pain for decades. That's the story of a woman I met recently. Her name is Pamela Bobb. I want to introduce you to her. She's in her mid-50s. She lives in Tennessee. And I caught up with her in one of her favorite places - her kitchen.

PAMELA BOBB: I swear you can smell each of those spices. They smell so good.

AUBREY: She's now super conscious of what she eats. This stir-fry is full of fresh greens, herbs, spices that have anti-inflammatory properties.

BOBB: I like to add a little bit of ginger and fresh mint and rosemary and - mmm, the ginger - so aromatic.

AUBREY: This diet is one of her strategies to cope with pain. And you know, when you hang out with her, she's so much at ease you would never guess what she's endured.

BOBB: Oh, just - I mean, I had been suffering terribly for years.

KING: Allison, why is Pamela in pain? What's wrong?

AUBREY: Well, she was born with a malformation in her pelvis that led to pain as an adult and required multiple operations over the span of, like, two decades.

BOBB: I've had 14 surgeries, and I really didn't have any relief.

AUBREY: And with each of these procedures, she was left with more scar tissue and nerve damage.

BOBB: I felt desperate. And I would say I actually felt like a victim. I didn't feel like I had any control over it.

AUBREY: It got to the point she couldn't do basic things. She couldn't cook or take care of her family.

BOBB: I was completely debilitated. Sometimes I couldn't even talk. It was just - it was that intense. And when you get to that point - when you can't see beyond the pain, you're just surviving.

AUBREY: She was put on a high dose of opioid medications. But then a few years ago, she thought there had to be another way. And she found help at a clinic that specializes in complementary and alternative medicine. Her doctor is Wayne Jonas, who is a big proponent of the integrated mind-body approach.

WAYNE JONAS: We offer a variety of things. We offer physical therapy and occupational therapy. We offer behavioral medicine. We offer acupuncture, yoga and mind-body practices.

AUBREY: Now, Jonas says none of these things on its own is a cure-all. But the idea is that there are lots of tools in the toolkit. He says the thing about being in pain is that all of your body's normal defenses are down.

JONAS: When you're in pain - when you're in severe pain like this, it bumps up a variety of dysfunctions.

AUBREY: It can increase your cortisol levels - so more stress hormones circulating around the body - and it increases inflammatory processes, too.

JONAS: And that starts in a continual negative feedback loop, which then produces more pain.

AUBREY: Jonas says to get a handle on this, techniques that can get you into a state of deep relaxation - so yoga, mindfulness, meditation - can help to reduce the dysfunction.

JONAS: If you engage in a deep sort of mindfulness component and relaxation component, it will counter those stress responses. And it's not just managing the stress, it's actually improving your brain's capacity to function.

AUBREY: Now, the trick is here - it takes work. People need to be trained and supported. It requires more time and effort than swallowing a pill. Now, Pamela Bobb has stuck with this. She's tried a bunch of these alternative mind-body strategies. She now starts every morning with a meditation practice.

BOBB: It's about 4:45 in the morning, and I've just awakened. I'm allowing my body to feel as relaxed as it possibly can.

AUBREY: Bobb says she feels so much better.

BOBB: It's empowering and - to have come all this way now and to know that this does lie within me. So much of it does

AUBREY: She accepts that she may never be completely pain-free. But now, she says, she feels she has control over it.

KING: Allison, it sounds like she's doing a lot better. Has she managed to get off of opioids then?

AUBREY: Well, she's reduced the amount of opioids she's taking by 75%. That's obviously a lot. But here's the complicated thing, Noel. She will be on this small maintenance dose indefinitely...

KING: OK.

AUBREY: ...Maybe her whole life. And it's a hard thing to say in the midst of this opioid epidemic - right? - I mean, with so many deaths and so much addiction. But her doctors say for her the benefits of this small dose outweigh the potential harms. She does not have an opioid use disorder. She's using them according to prescription. And she says they take the edge off. I mean, basically, she's convinced that these new coping strategies from the mind-body interventions together with the medication is the combination that works for her.

KING: OK. So some people, we should say, just may need to stay on opioids.

AUBREY: Yes. In fact, last month, the Department of Health and Human Services released a new guideline saying this. They say not everyone needs to be taken off prescription opioids. They presented a whole bunch of evidence showing that in the haste to get people off quickly, there's potential harm. And the new guidance is that doctors should aim to taper slowly and carefully, sort of treat each patient as an individual. And they say that Pamela Bobb's story is really a success story.

KING: NPR's Allison Aubrey. Thanks so much, Allison.

AUBREY: Thank you, Noel.

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