Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain

Abstract

The cognitive modulation of pain is influenced by a number of factors ranging from attention, beliefs, conditioning, expectations, mood, and the regulation of emotional responses to noxious sensory events. Recently, mindfulness meditation has been found attenuate pain through some of these mechanisms including enhanced cognitive and emotional control, as well as altering the contextual evaluation of sensory events. This review discusses the brain mechanisms involved in mindfulness meditation-related pain relief across different meditative techniques, expertise and training levels, experimental procedures, and neuroimaging methodologies. Converging lines of neuroimaging evidence reveal that mindfulness meditation-related pain relief is associated with unique appraisal cognitive processes depending on expertise level and meditation tradition. Moreover, it is postulated that mindfulness meditation-related pain relief may share a common final pathway with other cognitive techniques in the modulation of pain.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Figures

Fig. 1

Inverse correlations of pain unpleasantness with anticipatory neural activity in mPFC/rACC in meditators and controls. In a study comparing neural responses during anticipation of pain between a group with meditation experience and a control group with no meditation experience, a region in mPFC/rACC was more greatly activated in the meditation group, with greater activation predicting reducing pain unpleasantness ratings. In the control group, the opposite correlation was found with overall lower activity. From Brown and Jones [8].

Fig. 2

Brain areas showing higher and lower activity in meditators compared to controls, during pain, in a non-meditative state. Activation is higher for meditators in pain-related regions such as dorsal anterior cingulate cortex (dACC), insula (INS) and thalamus (Thal) but is dramatically reduced (particularly on inset B) in areas involved in appraisal, emotion and memory: medial prefrontal cortex (mPFC)-orbitofrontal cortex (OFC), amygdala, and dorso-lateral prefrontal cortex (DLPFC).

Fig. 3

Mindfulness meditation significantly reduced pain through a number of brain mechanisms. In the presence of noxious heat, meditation significantly reduced lower level afferent processing in the primary somatosensory cortex (SI) corresponding to the stimulation site (top). Regression analyses revealed that meditation-related pain intensity reductions were associated with greater activity in the rostral anterior cingulate cortex (rACC), an area involved in cognitive control (middle). Greater right anterior insula (aINS) activity also predicted pain intensity reductions during meditation, an area associated with interoceptive awareness (middle). Greater orbitofrontal cortex (OFC) activity was associated with greater decreases in pain unpleasantness ratings (bottom). Moreover, thalamic (Thl) deactivation was associated with reductions in pain unpleasantness (bottom).