Emerging treatments
Meditation
Depending on patient motivation and skill at meditation, significant reductions in pain can be achieved.[77] Meditation (through any means, including yoga, tai chi, or transcendental meditation) activates the prefrontal cortex and induces a reduction of activity in limbic structures, particularly the anterior cingulate gyrus.[78][79]
Aerobic exercise
Vigorous and prolonged (45 minutes or more) aerobic exercise induces the production of cerebral endorphins, which decrease ascending pain signals. This can be very effective in chronic pain.[80][81]
Focused imagery
This is an experimental version of meditation that is performed within a magnetic resonance imaging (MRI) magnet. Using functional MRI (fMRI) sequences, the activity of the anterior cingulate cortex (ACC) is determined and a proportional, analogous image produced of a bonfire. The patient in the MRI is then shown the image through special video glasses, and she attempts to decrease the size of the bonfire, all while the fMRI continues to calculate the ACC activity. This process relies on prefrontal cortex to directly control the anterior cingulate. Patients require extensive training to accomplish this task, and access to a specially equipped MRI. Preliminary results have been encouraging, but mostly support the use of pharmacotherapy for pain control.[82]
Ondansetron
A small placebo-controlled study demonstrated significant relief with intravenous administration of ondansetron (a selective 5-HT3 receptor antagonist) for patients with chronic pain. This is postulated to work through modulation of limbic serotonin receptors.[83]
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