“A common but unfortunate saying is that the pain is in your head….this saying implies that it’s not real, but fabricated. This is not true. However, pain is located in your head, within your brain. When you have pain, the brain is very active processing it. How your brain processes it determines the pain you experience. So yes, your pain experience is in your head, but it’s real. It can be measured, and it can be changed for the better.” – Adriaan Louw
Mindfulness practices including meditation have been shown to reduce perceived pain (see http://contemplative-studies.org/wp/index.php/category/research-news/pain/). The studies that examined mindfulness and pain, however, did not include any control conditions to account for the effects of a placebo or participant expectations about the efficacy of the treatment. The placebo effect is powerful and can produce outcomes that are very similar to those produced by different forms of treatment including therapy and drugs. This effect is based upon the psychological tendency of people to produce outcomes that conform to their expectations. So, if the participant believes that a treatment will make him/her better, it will, regardless of whether the particular treatment is actually effective or not.
The placebo effect presents a difficult issue for treatment research and most studies do not include any mechanism for assessing the expectations of the participants. Thus many reported positive results may in fact be due to the placebo effect rather than an actual effect of the treatment. So, it is possible that the reported efficacy for mindfulness training to reduce perceived pain may in fact be due to a placebo effect. Even if a treatment is actually effective, the placebo effect may be so strong that the true effect cannot be distinguished from the placebo effect. It is very difficult to separate the two.
A potential method for examining whether an effect is due to a treatment or a placebo is to look at the neural mechanisms underlying the two. In today’s Research News article “Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms than Placebo and Sham Mindfulness Meditation-Induced Analgesia”
http://jn.sfn.org/press/November-18-2015-Issue/zns04615015307.pdf
Zeidan and colleagues implement this strategy and investigate the neural systems that respond to meditation vs. placebo for pain. They actually implement three control groups, placebo conditioning, sham mindfulness meditation, and book-listening for comparison with meditation and also record functional neuroimaging for each group while responding to an experimental pain condition. The placebo condition involved telling the participant that they were being administered a pain killing cream which was in actuality an inert petroleum jelly. The sham meditation condition only instructed the participant to close their eyes and breath and meditate but without specific instructions as to how to meditate. The experimental pain procedure involved the application of a non-damaging hot probe. During the application of the probe the participants rated their pain and also had their brains scanned with functional MRI.
They found that only the meditation group had an increase in mindfulness and that all groups except the book-listening control group had decreased pain intensity and pain unpleasantness ratings. The meditation group, however, had the largest decrease in perceived pain and pain unpleasantness. They also found that different neural structures were activated with the pain manipulation with the different conditions. Meditation produced a greater activation in brain regions associated with the cognitive processing of pain, including the orbitofrontal, subgenual anterior cingulate, and anterior insular cortex. While the placebo produced increased activity in the dorsolateral prefrontal cortex and deactivation of sensory processing regions. Sham meditation did not produce significant neural activity, but rather greater reductions in the respiration rate.
These results are interesting and important. They demonstrate that meditation is more effective than either a placebo or a sham meditation in reducing perceived pain and pain unpleasantness. In addition, they demonstrate that there were different neural mechanisms involved in the effects of each on pain. The fact that they work differently in the brain indicates that meditation’s effectiveness at relieving pain is not due to a placebo or subject expectancy effect or to the conditions of meditation. Hence, meditation is an effective treatment for pain.
So, meditate and beat pain.
“Your brain plays a major role in controlling your pain. How you are feeling or what you are thinking about your pain has a direct impact on what happens to the pain signal in the spinal cord, and thus has a huge effect on how much pain you feel.”- Charles Argoff
CMCS – Center for Mindfulness and Contemplative Studies
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