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NCCIH Research Blog

Can Complementary and Integrative Approaches for Pain Management Engage Brain Circuitry of Endogenous Pain Modulation?

May 10, 2016

Partap S. Khalsa, D.C., Ph.D.

Partap S. Khalsa, D.C., Ph.D.


Division of Extramural Activities

National Center for Complementary and Integrative Health

Wen G. Chen, Ph.D.

Wen Chen, Ph.D.

Branch Chief and Program Director

Basic and Mechanistic Research in Complementary and Integrative Health Branch

National Center for Complementary and Integrative Health

View biographical sketch

The experience of pain is one that is subjective to the individual experiencing it. Pain engages complex interactions between neural and biochemical processes in the peripheral tissues and in the central nervous system. In general, the neural circuits for pain modulation involve the ascending pain pathways, where noxious stimuli are processed by primary afferents and transmitted to the spinal cord and brain to construct the subjective experience of pain. Descending inhibition of pain is facilitated by top-down modulation (i.e., cortical) of ascending nociceptive information to the spinal cord to attenuate pain.

Conventional pharmacologic treatments for pain management have primarily focused on

  • Dampening the ascending pain stimuli by blocking inflammatory events in the tissues with anti-inflammatory medications
  • Eliminating ascending neurotransmission with ion channel blockers (e.g., lidocaine)
  • Enhancing the descending inhibitory pain pathways (e.g., by activating opioid receptor–mediated neural activities with opioids).

However, these treatments, albeit potent, sometimes do not target specific pain pathways and may have undesired side effects. In addition, our physiology may become adapted to these exogenous agents, thereby reducing their therapeutic effects. Consequently, nonpharmacologic therapies that robustly engage the endogenous neural circuits involved in pain processing to achieve analgesic effects may represent effective complementary approaches for pain management.

The upcoming 2016 International Congress on Integrative Medicine & Health (ICIMH) in Las Vegas, Nevada, will feature a National Center for Complementary and Integrative Health (NCCIH)–sponsored symposium to explore innovative research directions, in particular neuroscience research on mindfulness meditation and placebo effects, with the goal to harness and optimize responses in neural circuits to influence endogenous pain modulation. Complementary/integrative approaches that modulate endogenous pain pathways may provide us with powerful noninvasive strategies to manage pain—both acutely and chronically. In addition, the contributions of both specific and nonspecific effects that influence outcomes and the potential exploitation of either or both to improve pain management or general health and well-being will be explored.

As co-moderators, we will begin the symposium with a brief overview on NCCIH priorities and strategies for pain research. Then the first speaker, Dr. Lauren Atlas, will present cutting-edge research related to the neurobiology of pain and pain management. The second speaker, Dr. Luana Colloca, will discuss individual variability of pain modulation by placebo effects and complementary approaches. The third speaker, Dr. Fadel Zeidan, will provide neuroimaging, pharmacologic, and psychological evidence demonstrating that different cognitive manipulations, such as mindfulness meditation, sham-mindfulness meditation, and placebo conditioning, engage distinct mechanisms supporting endogenous analgesia.

The session is scheduled for Wednesday, May 18, 2016 from 2:00 p.m. to 3:00 p.m. PT. We hope that you can join us!


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