Mindfulness meditation-based pain relief: a mechanistic account

Abstract

Pain is a multidimensional experience that involves interacting sensory, cognitive, and affective factors, rendering the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms-an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy.

Keywords: fMRI; mindfulness meditation; opioid; pain; placebo.

Conflict of interest statement

Conflicts of interest

The authors declare no conflicts of interest.

© 2016 New York Academy of Sciences.

Figures

Figure 1

Mindfulness meditation–based pain relief is associated with multiple brain mechanisms. Regression analyses corresponding to those in Zeidan et al. revealed that reductions in mindfulness meditation–induced pain intensity were associated with greater activation (depicted in red) in the right anterior insula and rostral aspects of the anterior cingulate cortex (ACC). Greater reductions in pain unpleasantness ratings were associated with greater activation of the orbitofrontal cortex (OFC) and thalamic deactivation (depicted in blue).

Figure 2

The main effects of mindfulness meditation and sham mindfulness meditation involve similar neural processes. Mindfulness meditation and sham mindfulness meditation produced activation (red) in the bilateral putamen and primary somatosensory cortex (SI) corresponding to the nose/face regions and deactivation (blue) of the medial prefrontal cortex (mPFC) and precuneous/poster cingulate cortex (PCC). Mindfulness meditation also activated the right inferior frontal gyrus and produced deactivation of the bilateral thalamus. Conjunction analyses revealed significant overlapping activation in the bilateral putamen, SI representation of the nose/face, and deactivation of the PCC and mPFC.

Figure 3

Psychophysical pain intensity (left graph) and unpleasantness (right graph) ratings (95% confidence intervals). Meditation during saline (meditation + saline) infusion significantly (P < 0.001) reduced pain intensity and unpleasantness ratings compared with rest and the control and saline (control + saline) group. Naloxone did not reverse meditation-induced pain relief. Meditation during naloxone administration (meditation + naloxone) significantly (P < 0.001) reduced pain intensity and unpleasantness ratings compared with rest, the control + saline group, and the control and naloxone (control + naloxone) groups. There were also no significant differences in pain intensity or unpleasantness ratings between the meditation + saline and the meditation + naloxone groups (P > 0.69).