Change the Brain to Reduce Chronic Pain with Mindfulness
By John M. de Castro, Ph.D.
“While many experts recommend mindfulness-based practices to manage pain, the goal of those practices is typically not to remove pain entirely, but to change your relationship with it so that you are able to experience relief and healing in the middle of uncomfortable physical sensations.” – Jon Kabat-Zinn
We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.
There is an accumulating volume of research findings to demonstrate that mindfulness practices, in general, are effective in treating pain. Pain experiences are processed in the nervous system. So, it’s likely that mindfulness practices somehow alter the brain’s processing of pain. In today’s Research News article “The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728003/), Zeidan and colleagues review and summarize the published research studies on the changes in the brain that accompany the relief of chronic pain by mindfulness-based treatments.
They report that mindfulness appears to reduce pain by increasing attention to the present moment. High levels of mindfulness are associated with lower pain experiences with chronic conditions and that these levels are associated with less activity in the, so called, default mode network in the brain (consisting of the medial prefrontal cortex, posterior cingulate cortex/precuneus, inferior, and lateral temporal cortices). The default mode network is thought to underlie self-referential thinking and mind wandering.
The research also reports that short-term meditation reduces chronic pain and increases communications between cortical areas and the thalamus suggesting top down control of pain sensitivity. On the other hand, long-term meditation practice reduces chronic pain by deactivating prefrontal cortical areas and activating somatosensory cortical regions. This suggests that long-term meditation reduces cognitive appraisals of arising sensory events. Finally, the research suggests that the neural mechanisms of mindfulness-based pain relief are different than opioid pain relief suggesting that there are different mechanisms involved.
Obviously, much more research is needed. But there is an evolving picture of the changes in the brain that occur with mindfulness practices that produce relief of chronic pain. It is different from that of opioid pain relievers and primarily involves high level, cortical, neural systems associated with attention to stimuli and the thought processes that arise evaluating those stimuli. In other words, mindfulness-based practices affect pain processing at the highest levels of attention and thinking.
So, change the brain to reduce chronic pain with mindfulness.
“Chronic pain is frustrating and debilitating. The last thing we want to do is pay more attention to our pain. But that’s the premise behind mindfulness, a highly effective practice for chronic pain.” – Margarita Tartakovsky,
CMCS – Center for Mindfulness and Contemplative Studies
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Zeidan, F., Baumgartner, J. N., & Coghill, R. C. (2019). The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer. Pain reports, 4(4), e759. doi:10.1097/PR9.0000000000000759
The advent of neuroimaging methodologies, such as functional magnetic resonance imaging (fMRI), has significantly advanced our understanding of the neurophysiological processes supporting a wide spectrum of mind–body approaches to treat pain. A promising self-regulatory practice, mindfulness meditation, reliably alleviates experimentally induced and clinical pain. Yet, the neural mechanisms supporting mindfulness-based pain relief remain poorly characterized. The present review delineates evidence from a spectrum of fMRI studies showing that the neural mechanisms supporting mindfulness-induced pain attenuation differ across varying levels of meditative experience. After brief mindfulness-based mental training (ie, less than 10 hours of practice), mindfulness-based pain relief is associated with higher order (orbitofrontal cortex and rostral anterior cingulate cortex) regulation of low-level nociceptive neural targets (thalamus and primary somatosensory cortex), suggesting an engagement of unique, reappraisal mechanisms. By contrast, mindfulness-based pain relief after extensive training (greater than 1000 hours of practice) is associated with deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to reduce appraisals of arising sensory events. We also describe recent findings showing that higher levels of dispositional mindfulness, in meditation-naïve individuals, are associated with lower pain and greater deactivation of the posterior cingulate cortex, a neural mechanism implicated in self-referential processes. A brief fMRI primer is presented describing appropriate steps and considerations to conduct studies combining mindfulness, pain, and fMRI. We postulate that the identification of the active analgesic neural substrates involved in mindfulness can be used to inform the development and optimization of behavioral therapies to specifically target pain, an important consideration for the ongoing opioid and chronic pain epidemic.