DECEMBER 18, 2024
Mindfulness meditation, which has been used for pain management in various cultures for centuries, has long been thought to work by activating the placebo response. Now new research demonstrates that its effectiveness actually comes from engaging distinct brain mechanisms to reduce pain compared with those of the placebo response.
The research, published in Biological Psychiatry (2024: S0006-3223[24]01556-7), was conducted by researchers at the University of California (UC), San Diego School of
Mindfulness meditation, which has been used for pain management in various cultures for centuries, has long been thought to work by activating the placebo response. Now new research demonstrates that its effectiveness actually comes from engaging distinct brain mechanisms to reduce pain compared with those of the placebo response.
The research, published in Biological Psychiatry (2024: S0006-3223[24]01556-7), was conducted by researchers at the University of California (UC), San Diego School of Medicine, who used advanced brain imaging techniques to examine the pain-reducing effects of mindfulness meditation.
“I think we provide the clearest evidence to show that mindfulness meditation is more effective than placebo at reducing pain,” said corresponding study author Fadel Zeidan, PhD, a professor of anesthesiology and an endowed professor in empathy and compassion research at UC San Diego Sanford Institute for Empathy and Compassion.
The study included 115 participants and consisted of two separate clinical trials in healthy participants, who were randomly assigned to receive four interventions: a guided mindfulness meditation, a sham mindfulness meditation that only consisted of deep breathing, a placebo cream (petroleum jelly) that participants were trained to believe reduces pain and, as a control, one group listened to an audiobook. The researchers applied a very painful but harmless heat stimulus to the back of the leg and scanned the participants’ brains before and after the interventions.
To analyze the participants’ brain activity patterns, the researchers used a novel approach called multivariate pattern analysis (MVPA) that was developed by the co-author Tor Wager, PhD, the director of the Brain Imaging Center, Department of Psychological and Brain Science, at Dartmouth College, in Hanover, N.H. MVPA uses machine learning to disentangle the many complex neural mechanisms underlying the experience of pain, including those stemming from specific heat stimulus, negative emotions and pain responses that are driven by the placebo effect. The researchers then were able to identify if mindfulness meditation and placebo engage similar and/or separate brain processes.
The researchers identified a double dissociation in the MVPA signatures supporting pain regulation by mindfulness meditation as compared with placebo cream. Mindfulness meditation produced significantly greater reductions in pain intensity and pain unpleasantness ratings, nociceptive-specific and negative-affective pain signatures compared with placebo cream, sham mindfulness meditation and controls. Placebo cream only reduced the placebo-based signature. “We found that all the techniques were better than the control group at reducing pain; however, mindfulness was more effective than the placebo cream and more effective than sham mindfulness meditation,” Zeidan told Pain Medicine News.
The researchers also found that mindfulness-based pain relief reduced synchronization between brain areas involved in introspection, self-awareness and emotional regulation. These parts of the brain together comprise the neural pain signal (NPS), a documented pattern of brain activity thought to be common to pain across different individuals and different types of pain. In contrast, the placebo cream and sham mindfulness meditation did not show a significant change in the NPS when compared with controls. Instead, these other interventions engaged entirely separate brain mechanisms with little overlap.
“What was really cool was we got closer to appreciating how mindfulness reduces pain,” Zeidan said. “It reduces pain by directly modulating the input coming in from the stimulus—what we call nociception—and it reduces pain by modulating our negative emotional responses to pain. What it didn’t do was it didn’t reduce the brain signature that corresponds to placebo. So, what we see is that there is no overlapping neural mechanisms between placebo and mindfulness.”
He noted that “you don’t need to be a monk to reap the benefits because it’s only four days, 20 minutes of training for individuals who have never meditated before, that we were able to get these folks to practice meditation independently and to dramatically reduce their pain.”
“Pain doctors should be using nonpharmacological approaches as a first path to treat pain. This is something that the CDC has recommended, and it is in our current recommendations for pain treatment,” Zeidan said. “Clinicians should be encouraged by our study that this is not something that is frou-frou, but there is something active occurring, and indeed the technique can be used quiet easily.”
Zeidan said these data provide evidence that mindfulness can be used to particularly counteract the negative emotional component of the pain experience, which can help foster recovery. “What we have shown is that mindfulness meditation can be used immediately to directly reduce one’s own pain. I don’t know of any other pain treatments that can do this,” he said. “Mindfulness can be used to directly assuage an acutely evoked pain experience in real time, and that should be encouraging for clinicians to recommend mindfulness meditation to their patients whenever they experience a pain flare.”
“This study is critical to distinguishing the influence of placebo and mindfulness meditation on pain,” said Bala Subramaniam, MD, MPH, an anesthesiologist and the director of the Sadhguru Center for a Conscious Planet, at Beth Israel Deaconess Medical Center, in Boston, who was not involved in the study. “A significant number of people attribute all physical, mental, emotional and energy changes to a placebo response. [The researchers in this study] objectively address the physical (intensity of stimulus) and perception (mental/emotional) by establishing neuroimaging techniques. Mindfulness meditation can significantly modulate both the intensity and the unpleasantness of a painful stimulus, and these effects are very different from those of a placebo.”
—Kate O’Rourke
Subramaniam and Zeidan reported no relevant financial disclosures.
