Wellness Blog

Meditation Reduced The Opioid Dose She Needs To Ease Chronic Pain By 75%

November 11, 20195:05 AM ET

Heard on Morning Edition

To deal with chronic pain, Pamela Bobb’s morning routine now includes stretching and meditation at home in Fairfield Glade, Tenn. Bobb says this mind-body awareness intervention has greatly reduced the amount of painkiller she needs.

There’s new evidence that mind-body interventions can help reduce pain in people who have been taking prescription opioids — and lead to reductions in the drug’s dose.

In a study published this month in JAMA Internal Medicine, researchers reviewed evidence from 60 studies that included about 6,400 participants. They evaluated a range of strategies, including meditation, guided imagery, hypnosis and cognitive behavioral therapy.

“Mindfulness, cognitive behavioral therapy and clinical hypnosis appear to be the most useful for reducing pain,” says study author Eric Garland, a professor at the University of Utah. The reductions in dose were modest overall, he says, but the study is a signal that this approach is beneficial.

And Pamela Bobb, who lives in Fairfield Glade, Tenn., can attest to the benefits. She’s 56 and has endured decades of pain. “Oh, I had been suffering terribly for years,” Bobb tells us.

Bobb was born with a malformation in her pelvis that led to pain. Over the span of two decades, she underwent more than a dozen major surgeries, yet none offered relief. “When you get to that point, you can’t see beyond the pain,” Bobb says. “You’re just surviving.”

She was born with a malformation in her pelvis that led to pain. Over the span of two decades, she underwent more than a dozen major surgeries, yet none of them gave her relief; each procedure left more scar tissue and nerve damage.

“I felt desperate, ” Bobb says. “I didn’t feel like I had any control.”

She couldn’t do basic things such as cook — or take care of her family.

“I was completely debilitated,” Bobb says. “And when you get to that point, you can’t see beyond the pain — you’re just surviving.”

She was put on high doses of opioids to ease the constant pain, but then a few years ago she thought, “There just has to be a better way.” Ultimately, she found help at a clinic that specializes in complementary and alternative medicine.

“We offer a variety of things, explains Wayne Jonas, a physician who treated Bobb at the Fort Belvoir Community Hospital Pain Clinic in Fairfax County, Va.

“We offer physical therapy, behavioral medicine, acupuncture, yoga and mind body practices,” Jonas says. None of these is a cure-all, he adds, but the idea is that there are lots of tools in the toolkit for people to try.

Jonas is a longtime proponent of an integrated, mind-body approach to treating pain and the author of How Healing Works, a book that describes the science behind these approaches.

He says that when someone is in severe pain, their body’s normal defenses are down.


Pamela Bobb harvests some mint from her indoor herb and lemon garden at her home in Fairfield Glade, Tenn. Changes in her diet — lots more greens, fruits, vegetables and herbs and spices that reduce inflammation — are also part of her pain-reduction routine.


“It bumps up a variety of dysfunctions,” Jonas says. Pain increases levels of the stress hormone cortisol and increases inflammatory processes in the body, too. “This starts a continual negative feedback loop that produces more pain,” Jonas explains.

It’s not a surprise, he says, that techniques such as meditation or yoga can be helpful. “If you engage in a deep mindfulness — and relaxation — it will counter those stress responses,” Jonas says.

Think of meditation as a form of mental exercise.

“It’s almost like weightlifting for your brain,” says Garland. Just as curling a dumbbell strengthens the bicep, he says, “meditation is almost a way of, sort of curling the dumbbell of the mind to strengthen the mind’s self control.”

And this can change the way the brain perceives the input from the body. “If you can change the way the brain perceives signals from the body you can actually change the experience of pain,” Garland says.

But there’s a trick here: Learning to meditate takes time, effort and some training. It’s more complicated than swallowing a pill. Pamela Bobb has stuck with it. She has tried a bunch of these alternative mind-body strategies, including acupuncture and biofeedback, and now starts every morning with a meditation practice.

“It’s 4:45 in the morning — and I’ve just awakened,” she says in a recording she made of her practice, so I could listen in. She sounds centered, and calm. “I’m allowing my body to feel as relaxed as it possibly can.”

After several surgeries were unable to alleviate her pain, Bobb couldn’t do basic things such as cook — or take care of her family, she says. “I was completely debilitated.” Incorporating mind-body techniques have completely changed that, she says.

Bobb has also overhauled her diet, now eating a lot more greens, fruits and vegetables and herbs and spices with anti-inflammatory properties. On the day we talk, she’s making a spinach saute with ginger, mint and rosemary.

“I swear you can smell each of those spices. They smell so good!” she says.

Bobb is so at ease now that, just hanging out with her, you’d never guess all that she has endured. And she feels so much better, she says.

“It’s empowering to [have] come all this way,” Bobb says. She says she’s made a fundamental transition in her mind: Instead of waiting for doctors to heal her with surgeries or injections, she now realizes that many of these alternative therapies have empowered her to help herself.

Pamela Bobb still takes medicine to help manage her pain and other health issues, but she cites meditation as key to helping her reduce the opioid dose to 25% of the amount she once took.

Jessica Tezak for NPR

“So much of it does lie within me,” she says.

Bobb accepts that she may never be completely pain-free, but now feels she has control over the discomfort.

She has reduced her opioid dose by 75%. She says she still benefits from a small maintenance dose of the medication. And her doctors say that for her, the benefits of the medicine outweigh potential harms.

In the midst of an opioid epidemic, Bobb’s story may seem unlikely. But many people who have taken opioids for a prolonged period have similar stories. And last month, the Department of Health and Human Services released new guidelines urging doctors to take a deliberate approach to lowering doses of opioids for chronic pain patients.

The guidelines point to the potential harms of forcing patients off the medications.

“The goal is not necessarily to get off of all opioids but to reduce it to a dose [that is] safe,” Adm. Brett P. Giroir, a physician and assistant secretary for health at HHS, told NPR. We asked him about Bobb’s case. He is not her doctor, but after hearing her story he said, “The fact that she’s been able to reduce her opioids substantially is a success story.”

Giroir says this kind of comprehensive approach that includes alternative therapies “could be a model for what we want to do nationwide.” He points out that earlier this year, the Centers for Medicare & Medicaid Services proposed covering acupuncture for Medicare patients who have chronic lower back pain.

Bobb massages her feet with sweet-smelling lavender oil — another part of her morning routine. Successfully mitigating long-term pain, she finds, takes all of the tools in the toolkit.

As the evidence accumulates, Giroir says, there will be more attention placed on covering alternative therapies.

A 2017 Gallup Poll found that 78% of people would prefer to try other ways to address their physical pain before they take pain medication.

And doctors groups such as the American College of Physicians recommend that doctors offer more nonpharmacological treatments to pain patients, such as those who have chronic lower back pain.

Yet, a paper published last year finds that most insurers have not adopted policies that are consistent with these guidelines, and many don’t pay for coverage of these services. An accompanying editorial argues that it’s time for that to change.

It’s clear that when it comes to tackling pain, it takes all of the tools in the toolkit. And when it comes to opioids, the approach needn’t be all or nothing. Bobb says she has learned that, for her, the combination of medicine plus mind-body therapies works best.

Myofascial Release and Yin Yoga

(From DeepRecovery.com)

Is Myofascial Release real?

Myofascial release and deep tissue massage are considered “alternative medicine” and you’ll find people online “debunking” it as quackery… so here’s some welcome new science for people like me who can’t live without it.

Recently, The Journal of the American Osteopathic Association (JAOA) published an article by Manal Zein-Hammoud, PhD and Paul R. Standley, PhD entitled “Modeled Osteopathic Manipulative Treatments: A Review of their in Vitro Effects on Fibroblast Tissue Preparations.” A lengthy title for a potentially groundbreaking bit of science to support the little understood technique of myofascial release.

Technique of what?

spider-webTo understand myofascial release, we must first understand fascia. In keeping this “science lite,” imagine a very strong dew-covered spider web encircling a shrub. And between the gaps in the threads is a clear gel, rather than air. If you can picture this, then you’re on your way to understanding fascia. This three-dimensional complex matrix threads itself throughout our body, surrounding our muscles, organs, nerves, bones, blood vessels and even our cells. Everything is held together and in place by fascia. It is impressively flexible and infinitely adaptable.

And because fascia is a very strong, very connected spider web, when one spot on it gets tugged or pulled or injured, the effects ripple throughout the body. This is why we may have pain in our knee that may have nothing to do with a knee injury, but everything to do with an injury to our lower back. The natural, fluid state of the fascia has been traumatized, causing it to harden and tighten.

muscle anatomyEver pull a thread on a sweater only to find the whole thing bunching up on one side? That bunching is exactly what happens to fascia when our bodies experience stress, whether it’s dehydration, injury, inflammation, repetitive activity—you name it.

Our body reacts to pain of any kind by creating a protection response, that while, initially is a good thing, over time can lead to increased pain, buildup of toxins and reduced blood flow and oxygen to the area. When we experience a slight amount of tissue damage—this can be due to a physical injury, or a psychological one like depression, or even something like an ulcer—pain signals are sent to the spinal cord which then triggers the muscles around the injury to contract in order to provide support and protection for the surrounding tissues.

This response, left unchecked, creates a vicious cycle of pain as more blood flow is restricted to the contracted area. More signals are sent, and more muscles tighten to protect the growing epicenter of pain. What may have started as something small has now grown—that sweater gets more gnarled and bunchy.

Myofascial release (MFR) is designed to go in and smooth out those hard knots, returning the fascia to its normal fluid and adaptable self.

But how?

myofacial release demonstrationIn MFR, a gentle, sustained pressure is applied to points of restriction (those bunched up spots), allowing the connective tissue to release. Picture a stick of cold butter. If you jab your finger into it sharply, you’re just going to hurt your finger, and not even make a dent in the butter. But if you place your finger on the butter, and apply gentle pressure, you’ll find you’re able to slowly sink into the stick of butter, melting your way into it. This is essentially what is happening when an MFR therapist works on the body, or when one performs Self Myofascial Release (SMFR) with tools such as rollersand balls.

But the mechanics behind this technique have been under-studied and difficult to understand, or even explain. Some people brush it off as placebo or ineffective or even “out there,” or too “woo-woo” to be accepted in the academic medical world. Studies trying to illustrate the efficacy of MFR are often poorly designed and executed with little evidence backing their claims.

And this is why the Zein-Hammoud and Standley study is so momentous! Their experiments are not only well designed and controlled, but the results are derived from at least ten years of pertinent research and experimentation based on Standley’s studies of fibroblasts. Their research is the perfect example of how proper research should be performed—the scientific method at its best.

And the findings are not to be ignored. According to a derivative summary of the paper by Michael M. Patterson, PhD, the international associate editor of the JAOA, Standley’s work shows that “fibroblasts respond differently to various strain patterns, secreting various anti-inflammatory chemicals and growth factors, with implications for wound healing and muscle repair, among other physiologic processes.” Standley also experimented with the length of duration and the magnitude of MFR, and how they affect injuries, thus offering future suggestions for therapists on how to treat their patients.

Surprisingly, Standley’s research on non-injured tissue suggests the possibility of MFR aiding in the strengthening of the area.

“Finding the molecular mechanisms of how these therapies work would define the underpinnings of clinical efficacy and could propel OMT (osteopathic manipulative therapy) into evidence-based, first-line therapy,” said the lead author, Paul R. Standley, PhD.

Those of us who have utilized or experienced MFR techniques know that they work. But now we have science finally backing us up—lending credibility to the claims. And now the next time someone brushes off MFR as ineffectual, we can point them toward Standley’s work and tell them, “See? MFR works—it’s science!”

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Give Yourself the Best Day One Drop at a Time

You may have wondered about the “buzz” of essential oils and whether they can make a difference in your life. Looking at a typical day, I’d like to share how using essential oils — one drop at a time — can make each day the best. We know that yoga helps us to feel alive, balanced and strong. Add essential oils to your day, and it’s an all-spa day!

A Morning Ritual

  • Take 3 minutes (yes, just 3 minutes) for a your Morning Meditation.
  • Before breakfast, prepare a glass of warm water with a drop of lemon or peppermint to clear the palette and mental “cobwebs” and bring a feeling of focus and lightness.
  • Create an uplifting aura for greater focus and energy while you prepare breakfast by diffusing a wild orange and peppermint blend or a combination of lavender, rosemary and lemon. 
  • A drop of eucalyptus oil on the throat and chest before a morning shower/bath stimulates the sinuses and lungs while protecting these important passageways from exposure to viral and bacterial infections throughout our day.
  • Apply frankincense before moisturizing your face will stimulate collagen and reduce wrinkles. It gives your skin a certain glow and brightness to start out the day.

Getting Ready to Take on Your Day

  • Apply drops of your favorite balancing oil to your wrists and at the nape of your neck. Lavender is the well-known go-to oil for emotional balance, but you may want to explore some of the special blends designed for what you need at the start of the day. I love the crisp and pure essence of Young Living Oils and here are the blends I found most helpful (in parentheses the single essential oils of each blend are listed).
  • Valor (spruce, blue tansy, frankincense)— an empowering blend for strength, courage, and protection that supports energy alignment. Whether your schedule is daunting or you’re about to undertake a new challenge and negotiations with clients, colleagues and family, it’s the go-to oil blend for everyday.

Other essential oils for your day:

  • Grounding (white fir, spruce, ylang ylang, pine, cedarwood, angelica, juniper) — you’re facing a major decision or having to deal with multiple demands from family, friends and work, this blend helps you cope with reality in a positive manner.
  • Abundance (Orange, frankincense, patchouli, clove, ginger, myrrh, cinnamon and spruce)— when you’re interviewing for a new job, expanding your business or looking for ways to create more meaning in your life, reach for this essential oil blend opens opens us to a wealth of possibilities.

Throughout Your Day

  • Take along a spray atomizer with a purifying essential oil: tree tea, frankincense, myrrh, or eucalyptus. A little spritz will protect you from environmental toxins and those pesky germs that lead to colds and flu. Use it at the gym, in the office, on the subway or anywhere you encounter groups and crowds of people.
  • Keep a small bottle of peppermint in your handbag to refresh your breath. Just place one drop on your tongue and allow the soothing aroma clear your breath and energize your mind.
  • Keep lavender and other stress reduction oils (my favorite is Young Living Stress Away) handy so they can be applied as your day becomes more hectic and you need to renew a sense of peace and well-being.
  • And, when you find yourself dealing with difficult people and situations, reach out for bergamot, ylang ylang or White Angelica to stimulate inner strength while helping to guard against negative energy.

Watch for the next blog posting End of Your Day: Overcome Stress and Sleep Through the Night.

Important links regarding Essential Oils:

Purchase Young Living Oils Online


Wellness Where We Live

Our Habitual “Clean” Selves

Weekend guests were on their way and the house needed a once-over cleaning before they arrived. I grabbed some of the standard household cleaners I’ve used in the past and started off scrubbing the bathroom. I began cleaning the shower stall, spritzing a scum-removal cleaner when I was overcome with nausea and dizziness.

After getting some fresh air, I felt better but found myself wondering what was in this cleaner. After all the press about toxicity of everything from detergents to floor cleaners, I figured responsible cleaning product companies had cleaned up their act. But, I was so wrong.

I looked at the label of the shower cleaner – no listing of ingredients; instead a big warning “harmful if swallowed” and “to be used only in a well ventilated area.” Next I picked up the toilet bowl cleaner – no ingredients listed and a far scarier warning about disposal of the container. This plastic bottle was definitely not a candidate for my recycling bin. What next – the window cleaner for all those mirrors? More warnings but at least the key chemical – ammonia — was identified.

It was definitely time to clean out the cleaning supplies closet.

 The Cleaning Conundrum

I’m an environmentalist who recycles, is adamant about clean air and water and wants to leave a better earth for my grandchildren. I’m a yoga teacher who avoids paraffin candles, cleans mats with tea tree oil and asks students to not use fragrances. How did I get lured into believing that the use of “green” on a label only refers to the color of its liquid and is not a “friend” to us, our families or the earth.

I set out to research the dangers of ingredients in household cleaners. With fervor I began this project while a small part of me hoped to be told to give up cleaning completely. Wrong – even little dust balls are like magnets picking up residue toxins and poisons.

Valuable Resources

Women’s Voices for the Earth (WVE) provides reputable research and a clear message on the challenge having a healthy home. Cleaning product companies are making a fortune as they convince us that we need an army of cleaning and air care products. What these companies are not telling us is that repeated use of these products exposes us and our families to harmful chemicals. From breathing them in to absorbing them through the skin, these toxic chemicals have been linked to serious health problems, including pregnancy complications, breast cancer, birth defects, asthma and allergic reactions.

Women are taking the lead on the challenge to rid our homes and environment of the chemicals that are proving to disrupt our hormonal systems and making our children sick. Safer Chemicals has compiled a set of highly informative – and entertaining — videos aptly entitled Real Housewives of Orange Country. I encourage you to take a moment and hear about their campaign to get tough on toxic chemicals found not only in cleaning products but also in everyday consumer products.

Let me also recommend a visit to WebMD. In collaboration with Healthy Child Healthy World, WebMD offers sensible, doable steps for creating healthy home.

What to Do?

It seems the more fragrant the cleaner, the more deceptive the product often is. The cleaners we use regularly are often the worst culprits: all-purpose cleaners, laundry detergents, dryer sheets, air fresheners, disinfectant sprays, and furniture polish. Each label needs to be evaluated carefully to assess its toxicity. The true telling point is when the ingredients are not listed. In other words, beware!

I love aromas and fully appreciate the sensory experience of walking into a room wafting with lavender or some soothing aroma. Consider essential oils – pure and tested oils – for use in place of commercial cleaners and spays. A touch of lemon, lavender or special blends like Thieves have natural disinfectant properties to give you a germ- and toxin-free home while their soothing aroma lingers.

Take Action

I would be remiss to not mention the impact of chemical toxins on the significant increase of breast cancer. Silent Spring has been leading research efforts that link pesticides, chemicals, fire retardants and everyday toxins to hormonal disruptors that increase our risk of getting breast cancer. More on this in another blog…