The Clinically Relevant Value of Meditation

A paper written for Graceland University 

Meditation is a cost effective and clinically proven tool that can benefit a myriad of health disorders. Aftanas and Golosheykin (2005) looked at electroencephalogramsEEGs in a controlled environment to empirically show that meditators have more control over their reactions to stressful situations or “intensity of emotional arousal” (p. 894). According to the studies reviewed by Koopsen and Young (2009), meditation can provide physiological benefits such as a decrease in: oxygen consumption, blood lactate levels, cortisol levels, heart and respiratory rates, blood pressures, muscle tension, and pain and an increase in: skin resistance, alpha waves, and psychological benefits. These emotional and physiological effects have far reaching benefits to the health of a patient as well as the effectiveness of a health care provider if they too engage in conscious awareness.

Astin, Shapiro, Eisenberg, & Forys (2003) review a collection of cumulative clinical evidence that “lends strong support to the notion that medicine should indeed adopt a biopsychosocial rather than exclusively biologic-genetic model of health” (p. 141). They identify meta-analyses and randomized controlled trials that have shown mind-body medicine has effective benefits with: chronic low back pain, coronary artery disease, headache, insomnia, surgical procedure preparation, symptoms of cancer and its treatment, arthritis and urinary incontinence (Astin, et al., 2003). Grossman, Niemann, Schmidt, & Walach (2004) find that improvements in health are consistently seen in a variety of standardized mental health measures and measures of disability with mindfulness-based stress reduction. Other health parameters such as medical symptoms, sensory pain, physical impairment and functional quality of life estimates were also found to have benefits from mindfulness-based stress reduction (Grossman, et al., 2004).

Jung, et al. (2010) give us some clues about the background physiology of these positive effects. They looked at 67 subjects who regularly engaged in mind-body training vs. a control group of 57 healthy subjects and compared their plasma catecholamine (norepinephrine, epinephrine, and dopamine) levels as well as their positive and negative affect scores, and showed: lower stress, higher positive affect, and higher plasma dopamine levels in the meditation group.

A state of heart centered consciousness that can be achieved through meditation or even quick redirection of attention is contagious. A high state of “coherence” affects others in the room to also a achieve a high state of coherence (McCraty, Atkinson, Tomasino & Bradley, 2006). Coherence has been measured with reliable instruments and has shown health benefits in numerous studies over the past 20 years (McCraty, et al., 2006). Practitioners can have positive effects on their patients during a therapeutic encounter if they practice coherence (McCraty, et al., 2006). Nursing literature has examined similar phenomena under the term “presence” and researchers like Zyblock (2010) identify presence as having a sustained therapeutic effect. The Annals of Internal Medicine even has articles on healing skills for physicians that outline themes such as being open, listening, removing barriers and sharing authority (Churchill & Schenck, 2008).

Simple meditations can be easily taught by trained physicians and ancillary staff in a short amount of time and patients can be referred to a growing number of highly trained individuals who specialize in a variety of forms of mindful practices. With so many options and variations, all patients and providers should be able to find some form of mediation that works for them and implement them into daily practice.



References

Aftanas, L., Golosheykin, S. (2005). Impact of regular mediation practice on EEG activity at rest and during evoked negative emotions. International Journal of Neuroscience, 115: 893-909. doi: 10.1080/00207450590897969

Astin, J. A., Shapiro, S. L., Eisenberg, D. M. & Forys, K. L. (2003). Mind-body medicine: State of the science, implications for practice. Journal of the American Board of Family Practice, 16(2), 131-147.

Churchill, L. R. & Schenck, D. (2008). Healing skills for medical practice. Annals of Internal Medicine, 149, 720-724.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindful-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomic Research, 57, 35-43.

Jung, Y. H., Kang, D. H., Jang, J. H., Park, H. Y., Byun, M. S., Kwon, S. J., ... Kwon, J. S. (2010). The effects of mind-body training on stress reduction, positive affect, and plasma catecholamines. Neuroscience Letters, 479(2), 138-42.

Koopsen, C. & Young, C. (2009). Integrative health: A holistic approach for health professionals. Boston, MA: Jones and Bartlett Publishers.

McCraty, R., Atkinson, M., Tomasino, M. & Bradley, R. T. (2006). The coherent heart. Boulder Creek, CA: The Institute for HeartMath

Zyblock, D. M. (2010). Nursing presence in contemporary nursing practice. Nursing Forum, 45(2), 120-124.

Acupuncture for pain

Acupuncture is the oldest continually practiced literate medicine used world wide. With the foundation of thousands of years of recorded biological observation, traditional East Asian medicine has survived and thrived due to the effectiveness of its thorough methods (World Health Organization, 2003).  There are controlled studies showing measurable changes in fMRI, as well as chemical changes such as; local release of adenosin, release of beta-endorphins and other opioid peptides, with acupuncture point stimulation compared to placebo, so it is no surprise that controlled clinical trials show statistically significant changes above placebo in spite of the methodological difficulty of studying a skin-penetrating therapy based on an non-equatable language (Fang, et al., 2004; Goldman, et al., 2010; Hui, 2005; Han, 2004; Zhang, et al., 2003).  

Osteoarthritis of the Knee
Longer trials on knee pain show benefit while shorter trials show conflicting results.  This is congruent with traditional Chinese medicine theory because knee pain can be an indication of chronic overall weakness in some people, which makes resolution more difficult.  This is not always the case, and I find in practice that knee pain can also respond very quickly.  Berman, et al. (2004) showed that a prolonged treatment regime (26 weeks) of frequent acupuncture (starting with 2 treatments a week and tapering to once weekly) for osteoarthritis of the knee in a 570 patient randomized controlled trial was more effective than sham acupuncture and control.  Improvement of function but not pain was seen at 8 weeks, and improvement in pain and function was superior in the acupuncture group compared to the placebo group and control group at longer intervals.  

Suarez-Almazor, et al. (2009) studied acupuncture for osteoarthritis of the knee and included provider communication as a variable for 8 weeks which showed more benefit with communication style than with acupuncture vs. sham acupuncture. This short 8 week trial used a standardized acupuncture treatment, which effectively eliminates traditional East Asian medicine, including the diagnosis and point selection process. The standard treatment was compared to sham acupuncture, which could still stimulate an acupuncture channel no matter where you place a needle, and not surprisingly both groups got some relief from pain. It is fascinating how much communication style can impact a medical encounter but this is hardly evidence against traditional East Asian medicine.

Chronic Shoulder Pain
A German controlled clinical trial of 424 participants recently showed benefit for chronic shoulder pain compared to placebo and conventional orthopedic management alone with 15 treatments over 6 weeks.  Improvement in function (abduction and arm-above-head test) and pain were observed compared to placebo and conventional treatment after the 6 weeks of treatment, and in 3 months, showing the lasting benefits of acupuncture.

Headaches
A 401 participant study of patients with chronic headache, predominantly migraine, showed an overall reduction in headaches of 22 equivalent days per year, as well as 25% fewer visits to practitioners, and 15% fewer sick days in the acupuncture group.  It was concluded that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine (Vickers, et al., 2004).  

A new Duke University systematic review of 31 trials on headache showed that acupuncture had a 62 % effective rate while medications had a 45 % effective rate, with sham acupuncture showing less effectiveness than traditional acupuncture (Sun, Y., Gan, T. J., 2010).

The challenge of studying acupuncture

Most studies compare “acupuncture” to an allopathic diagnosis. Initially, the term “acupuncture” is a misnomer because what is really being studied is a specific set of points rather than an entire system of medicine.  You wouldn’t run a trial on statins and call it “allopathic medicine for heart fire” because you would be comparing two entirely different systems of medicine that do not equate because not only is the language different but also the entire context and framework.  The issue of placebo control in acupuncture is almost as impractical as a placebo massage. The fascial network of nerves is easily stimulated anywhere on the body so no blinded placebo needling will go without effect, which shows in the unusually high placebo effect in these studies.  Yet there are studies showing statistically significant benefit as well as physiological changes when true acupuncture points are used compared to placebo or sham needling. Just think what we might find in well designed trials that attempt to truly harness the diagnostic power of traditional East Asian medicine. 


For more studies on acupuncture and a complete list of conditions effectively treated please visit Sarah's site CascdeWellness.com

References

Berman, M. B., Lao, L., Langenberg, P., Wen, L. L., Gilpin, A. M. K., Hochberg, M. C. (2004). Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. Annals of Internal Medicine, 141, 901-910.

Fang, J. L., Krings, T., Weidemann, J., Meister, I.G., Thron, A. (2004). Functional MRI in healthly subjects during acupuncture: Different effects of needle rotation in real and false acupoints.  Neuroradiology, 46(5), 359-62.

Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., ... Nedergaard, M. (2010). Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture.  Nature Neuroscience, 13, 883-888.

Han, J. S. (2004). Acupuncture and endorphins. Neuroscience Letters, 6;361(1-3), 258-61.

Hui, K. K., Liu, J., Marina, O., Napadow, V., Haselgrove, C., Kwong, K. K., Kennedy, D. N., Makris, N. (2005). The integrated response of the human cerebro-cerebellare and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage, 27(3), 479-96.

Molsberger, A. F., Schneider, T., Gotthardt, H., & Drabik, A. (2009). German randomized acupuncture trial for chronic shoulder pain (GRASP) – A pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. International Association for the Study of Pain, 151, 146-154. doi 10.1016/j.pain.2010.06.036

Suarez-Almazor, M. E., Looney, C., YanFang, L., Cox, V., PietzArthritis Care & Research, 62(9), 1229-36. doi 10.1002/acr

Anesthesia & Analgesia, 107(6), 2038-2047. doi 10.1213/ ane.0b013e318187c76a Retrieved from http://www.anesthesia-analgesia.org/content/107/6/2038.long

World Health Organization (2003). Acupuncture: Review and analysis of reports on controlled clinical trials. Retrieved from http://apps.who.int/medicinedocs/en/d/Js4926e/

Zhang, W. T., Jin, Z., Cui, G. H., Zhang, K.L., Zhang, L., Zeng, Y.W., ... Han, J. S. (2003). Relations between brain network activation and alalgesic effect induced by low vs. high frequency electrical acupoint stimulation in different subjects: A functional magnetic resonance imaging study. Brain Research, 982(2), 168-78.