RADIOLOGY TODAY
August 4th, 2003
Imaging CAM: Scientific
Investigations Indicate Efficacy of
Alternative Medicine
By Dan Harvey
We live in an era that witnesses remarkable
scientific and technological achievements on a regular basis. One great
concern among many is that science would demystify the mystical, debunk
the spiritual. However, sometimes the opposite is the case.
Recently, contemporary and alternative medicine
(CAM) techniques have been subjected to careful scientific scrutiny.
Ancient traditions like transcendental meditation (TM), yoga and
acupuncture have not only attracted new adherents, but objective
researchers have placed these practices under the laboratory microscope,
so to speak, and have come up with data that actually validates their
benefits.
“What we are now seeing through science is two
things,” says Alarik Arenander, Ph.D, director of the Brain Research
Institute, which is part of the Institute of Science, Technology and
Public Policy of Maharishi University of Management in Fairfield, Iowa.
“There are great technological advancements in neuroimaging and, at the
same time, there is a great resurgence of interest in these fundamental
states of the brain.”
It’s not so unusual anymore to find seemingly
disparate acronyms such as TM and CAM in the same lead paragraphs with
fMRI, and PET in the mainstream press and scientific journals. For
instance, both Reuters and New Scientist magazine recently
reported how MRI and PET studies reveal that certain areas of the brain
light up constantly in Buddhists, indicating positive states of mind
maintained even beyond the meditative state.
According to these recent reports, researchers at
the University of Wisconsin at Madison and the University Of California
San Francisco Medical Center have demonstrated how parts of the
brain—the left prefrontal lobes, an area linked to emotions and
disposition, and the amygdale, an area linked to fear—are affected by
Buddhists’ spiritual practices. At the same time, yoga and acupuncture
are being combined with western medical treatment throughout the country
to provide more effective patient rehabilitation.
Not only are the scientists and physicians
interested in this direction of research; so are major institutes of
funding such as the National Institutes of Health (NIH). Still, it’s a
whole new frontier of research that has only just opened up, and many
researchers set out on the quest without a map.
“Right now, it’s like the wild, wild west,” says
Arenander, who has been involved in research concerned with applying TM
to the treatment of traumatic brain injury patients and to children with
attention deficit hyperactivity disorder. “Some people are just placing
anyone in a magnet and taking pictures and then publishing. But the work
really doesn’t connect anything up, and few of them really have any
background. There are no rules, and it is not systematic. Everyone has
just got there covered wagon and they’re heading across the prairie.
That’s why we’ve made our grants to the NIH. We have got to come up with
some basics here before we can do some comparative studies, otherwise it
is just mayhem.”
TM and Pain Reaction
Two researchers who have methodically pioneered the
research and systematically scouted the terrain are David Orme-Johnson,
Ph.D, adjunct faculty of the Center for Natural Medicine and
Prevention at Maharishi University of Management and Zang Hee Cho,
Ph.D., professor of radiological sciences and of psychiatry and human
behavior at the Functional Brain Imaging Laboratory at the University of
California at Irvine.
These two researchers, already experienced in
studies on CAM, specifically acupuncture and TM, recently entered into a
collaboration: a pilot study involving the functional neuroimaging of
acute stress responses in TM practitioners. In the ongoing study
conducted at Irvine, Cho and Orme-Johnson, the principal researchers,
are employing fMRI to examine the reaction to pain in TM practitioners
compared to controls inexperienced in meditation. After the initial
imaging, the non-meditating controls learn TM and then are imaged again
after four months of TM practice. The objective is to explore the brain
mechanisms that may mediate the reported beneficial effects of the TM
program on stress and the response of the heart to stress.
“We wanted to make a cross-sectional comparison of
long-term meditators and people interested in learning TM,” explains
Orme-Johnson. “We wanted to find out what was going on in both the heart
and the brain, so we measured heart rate as well as what happens in the
brain in response to pain.”
Both Orme-Johnson and Cho have done similar
previous research separately. While at the University of Texas in El
Paso, Orme-Johnson had conducted a study, also involving TM
practitioners, which measured stress response to noise and revealed that
meditators recovered faster from stress—something that the current study
would appear to collaborate. “There was greater autonomic stability in
the autonomic nervous system in the meditators compared with control,”
he recalls.
Cho had studied acupuncture in relation to the
body’s response to pain—specifically how acupuncture stimulation affects
brain functioning. Appropriately enough, in his research, Cho, who
invented positron emission tomography (PET), employed PET in his
research to measure changes in the brain’s metabolism. The technology
revealed that areas of the brain became activated or deactivated through
the stimulation of certain acupuncture points, or acupoints. As a
result, he concluded that acupuncture, by stimulating brain regulating
mechanisms, or homeostatic mechanisms, could be used to treat different
diseases.
Interestingly, Cho became involved in this
direction of research because of personal experience. In the early
1990s, he went on a rock climbing trip and afterward experienced
soreness excruciating enough to compel him to seek medical attention.
Since he returned on a weekend, immediate regular medical treatment
wasn’t available, so his wife encouraged him to see an acupuncturist
instead. Despite Cho’s skepticism about the procedure, his wife talked
him into it.
As it turned out, the procedure eased his pain
almost immediately. Because he entered the procedure as a skeptic, he
was forced to conclude that its benefits were more than psychosomatic.
With his curiosity provoked, Cho launched a scientific investigation.
Using PET and fMRI, he studied the effects of acupuncture on pain to
determine if an acupoint would induce brain activation.
Cho designed a study that involved subjects placing
their fingers in hot water (hot enough to cause pain but not hot enough
to cause tissue damage). The subjects were imaged twice. First the pain
was measured and the cortical activation was imaged. Next, the subjects
were given acupuncture, then placed their fingers in the hot water a
second time and were imaged again to see the changes in the cortical
area of pain perception. In the second set of images, any evidence of
pain processing had disappeared. Essentially, the subjects weren’t
receiving a pain signal. This led Cho to hypothesize that acupuncture
probably produces an endogenous opiate that blocks the ascending pain
signal somewhere in the spinal chord, and he became convinced that PET
validated the effectiveness of acupuncture. “I believe acupuncture is a
neural effect more than anything else,” he says.
Later, he delivered a presentation on his work at
the Maharishi University. Faculty researchers were fascinated and wanted
to use similar methodology to study TM—and that led to the current
collaboration.
Heated Reactions
Going into the study, Cho and Orme-Johnson
speculated that the brain response to stress in the long-term TM
practitioners would be less than in non-practitioner controls. “Our
working hypothesis is that long-term TM practice develops inner
stability and lower levels of anxiety, so that the reaction to pain is
not amplified by subsequent distress reactions,” says Orme-Johnson.
“This has been shown independently by numerous studies and
meta-analyses.”
The study initially involved only eight subjects 55
to 65 years old: four long-term TM practitioners, who had anywhere from
10 to 40 years of practice, and four non-meditating subjects. As in
Cho’s acupuncture study, hot water (approximately 50 degrees C) was the
pain stressor. The imaging technique employed was fMRI using a Philips
1.5T MRI system. Cho said he opted for fMRI in this study because it is
somewhat easier to use than a PET scan.
“The fMRI allows you to measure the hemodynamics,
or the flow of blood and oxygen, into areas of the brain, or the BOLD
effect,” he says. “PET can also measure blood flow, but it also measures
glucose, or the energy needed to activate the brain, so it is a more
direct measure of what is going on in the brain. It is much more
sensitive and versatile, but you can’t inject too much isotope into the
subject, and it is slow compared to fMRI. So it was convenient to use
fMRI.”
Heart rate measurements were taken simultaneously
with the imaging. The subjects were images twice—once in the evening
then again the next morning. The subjects placed their fingers in the
water for 30 seconds three times over a 7.5-minute period. Orme-Johnson
explained that the MRI component provides background of what the brain
looks like and the fMRI component compares brain activity, measured by
blood flow, between when fingers were in and out of the water. During
the evening sessions, the four TM subjects showed significantly less
response across all brain regions than the four non-practitioners. Heart
rate increased in controls during the pain stimulation in both the
morning and evening sessions but did not increase significantly in the
TM group in either session.
The researchers concluded that these first results
showed that both the brain and heart responded less to pain stimulation
in the TM group than in control group. “The fMRI images show less
activity in the brain of meditators in the pain stimulation than in the
control subjects,” said Orme-Johnson. “We are just at the very
preliminary phases of the study, but initially we are seeing much less
of a reaction.”
Further, they pointed out that the increased heart
rate indicated a defensive reaction of elevated sympathetic arousal—the
fight or flight response—that can cause damage to the body. They also
pointed out that their result concurred with other evidence that
suggests that TM practice changes an individual’s response to stress.
This change, they said, is beneficial to cardiovascular health.
In this way, the experiment was concerned with the
subjects’ physiological response to pain as well as their emotional
response to pain. Orme-Johnson explains that, first, the body tells the
individual that the water is hot and is causing pain. “At first, the
water doesn’t feel particularly hot,” says Orme-Johnson, “but after 10
or 15 seconds the heat builds up and creates a pain sensation.”
That is followed by the distress response, when the
individual becomes emotionally agitated by the pain.
“Pain activation in the brain is very interesting,
as you see a sequential change in various areas,” says Cho. “First the
water is hot, then it becomes very hot, and then it becomes unbearable.
This implied a various sequencing of the pain signal processing.
When you feel the pain, the brain selects the pain
information. After that, the emotional components come into play. You
are distressed because of the pain. When the pain persists, your brain
tells you to do something.”
This distress response was the most significant
aspect of the experiment. The long term meditators demonstrated less of
a distress response. And that is what Cho and Orme-Johnson want to
investigate further. “We’d like to see a particular structure that
lights up in the control subject but not in the long-term meditator,”
says Cho. “But so far, what we’ve seen has been very general.”
TM and the Evolving Mind
Significantly, the experiment wasn’t conducted
during an actual meditation period. Therefore, the researchers explain,
the results suggest that greater relaxation does not occur only during
meditation. “The brain area in the non-meditators was fairly well
activated,” says Cho. “There was a much calmer reaction in the long-term
meditators. The activation was much lower. We thought that was quite
interesting.”
The meditators, it seems, have evolved into less
stressed and more relaxed individuals.
“If you give the brain a certain experience, that
experience changes the brain,” says Arenander. “If you provide the brain
with the experience of transcending, the brain transforms into an organ
that functions more coherently and orderly.”
Moreover, that experience and the resulting
transformation, Arenander says, has a holistically beneficially effect,
as it is manifested by orderly thought processes, behavior and
physiology. That is, meditators are physically and psychologically
healthy individuals.
As the study progresses, Cho and Orme-Johnson are
increasing the number of subjects to gain better statistical
reliability. “I was worried about the statistics so we are repeating
that experiment with 16 subjects,” reports Cho.
In addition, as the study continues, the
researchers are trying to determine what specific regions of the brain
are involved—focusing on the pain response pathways in the thalamus and
limbic system. What they saw in the early part of the study was a
general brain response.
“I’d like to conduct a more sensitive experiment
using a more sensitive high MRI field,” reports Cho. “Right now we have
the 1.5 Tesla MRI system. We’re installing a 3-Tesla system which is
more tuned for fMRI. Hopefully we will be able to look at more specific
areas of the brain and compare.”
Orme-Johnson says he’s particularly interested in
the emotional part of the brain called the anterior singulate gyrus.
“Previous research indicates or suggests this is the part of the brain
that lights up when an individual is distressed about something,” he
says.
Right now, what they know is that the less the
brain lights up the more orderly it seems to function. This all seems in
accordance with finding of other studies, not necessarily involving TM.
But taken all together, what they seem to indicate is a brain the
demonstrated less activation may very well be a higher evolved brain.
“We have shown that in people who have been
practicing TM regularly for some time, their brain actually changes,”
says Arenander, about research done at the Brain Institute. “We actually
have some brain measures which account for some of the variability
[between meditators and non-meditators].”
“There seems to be a pattern now from studies done
at several labs that less of a reaction is associated with greater
efficiency and less agitation,” says Orme-Johnson. “For example,
people with high IQs show less brain activity while solving mental
problems than people with low IQs. A similar result was found
contrasting subjects who are good in math with those who are not.”
Conclusion
Arenander reports that TM is the most widely
applied CAM program in the United States, among both physicians and the
public. It is also the most effective. In fact it has become a growth
industry. There is good reason for that: increasingly, it has been
demonstrated that people who meditate regularly enjoy better overall
health. Now, as Arenander points out, there is a genuine interest in
finding out why.
“If all of these phenomenal things are happening in
peoples’ minds, hearts and physiologies from practicing meditation, then
how is this possible? How do their physiologies change so remarkably?”
he asks. “That is part of our rationale in our [grant applications] to
NIH, and that is why the NIH is so interested in meditation and is
spending a great deal of its money to investigate the efficacy of these
techniques.” |
