Mindfulness and pain: new research review hints at unique mechanism for pain relief

April 13, 2012

(This article was first published on R Psychologist, and kindly contributed to R-bloggers)


Even though the effectiveness of mindfulness to reduce pain has been
proven in numerous empirical studies its efficacy still remain
unclear. Meaning that the effectiveness of mindfulness could be due to
some other variable than the specific technique. Potential placebo
responses or regression toward the mean could dilute the validity of
research findings. Zeidan et al. (2012) writes that many of the
studies done on mindfulness meditation are either cross-sectional or
case-control designs. As such they are prone to biased conclusions due
to selection bias.

Effectiveness and efficacy… what’s the mechanism?

Mindfulness has been found to attenuate pain through enhanced cognitive
and emotional control, as well as altering the contextual evaluation of
sensory events. In their article Zeidan et al. operationalize meditation
in two overall categories. 1) Focused attention (FA) which includes
techniques like focusing on your breath. And 2) Open monitoring (OM),
sometimes called open awareness, which consist of techniques emphasizing
non-evaluation of any sensory, emotional or cognitive events.

Differences between focused attention and open monitoring for pain relief?

It’s been hypothesized by researchers that different neural processes
underlie the different forms of mindfulness meditation. And it does seem
like a valid hypothesis that FA and OM practices would influence pain in
different ways. Zeidan et al (2010) conclude that OM meditation seem
more suited to analgesia than FA after extensive meditation training
(~2000 hours of practice). However, they continue with stating that
studies suggest that combining FA and OM practices might be able to help
reduce pain even after brief mediation training.

Potential unique mechanism for pain relief?

Based on the studies review by the researchers they conclude that the
findings suggest that mindfulness do operate by unique mechanisms.
Specifically they write that:

“… placebo analgesia is typically preceded by greater activation of
DLPFC [dorsolateral prefrontal cortex] during anticipation of pain, an
effect that predicts reductions in pain perception and activity in
pain-related brain regions. Mindfulness, on the other hand, does not
appear to involve DLPFC activation.”

Moreover they write that placebo effects might work through top-down
modulatory control, whereas mindfulness “seems to reduce the influence
of the expectancy of pain, possibly through decreased elaboration … of
nociceptive information”.

Quality of the evidence

There seem to be some evidence in this research article that mindfulness
alter the contextual evaluation of pain, and that it changed over time
and with meditation experience. However, I would say that this is pretty
weak evidence and that it should be seen as a basis for future

This research article isn’t a systematic review, hence it doesn’t give
any information on studies exclusion or inclusion criteria, nor is there
any information about how they searched for relevant articles. This
makes it impossible for the reader to gage if there’s likely to be any
selection bias in the included studies. Moreover there’s no discussion
about the included studies’ methodological quality.

I’d rather see researchers do well implemented meta-analyses than
reviews, contingent upon that they follow the guidelines in Cochrane
Handbook for Systematic Reviews of Interventions

But as a straightforward summary of some mindfulness research I’d still
recommend readers to look at the review article by Zeidal et al., it
gives a good explanation of current research question regarding
mindfulness meditation.


F, Grant JA, Brown CA, McHaffie JG, & Coghill RC (2012). Mindfulness
Meditation-Related Pain Relief: Evidence for Unique Brain Mechanisms in
the Regulation of Pain. Neuroscience
PMID: 22487846

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