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Mindful Meditation and Pain Modulation

Thursday, June 23, 2011

Mindfulness-based meditation can attenuate the subjective experience of pain but remains an underutilized form of therapy in the clinical setting, especially in Headache Medicine.

In a recent study published in The Journal of Neuroscience (PDF of article), Zaidan et al. elegantly demonstrate which brain areas activated by meditation are involved in pain modulation. The authors used partial arterial spin labeling (PASL) MRI, which has several advantages over conventional blood oxygen level-dependent (BOLD) fMRI. Fifteen healthy subjects underwent four sessions: 1) Psychophysical training session to familiarize subjects with the MRI paradigm, thermal stimuli (neutral, 35 oC, and noxious, 49oC, stimuli to posterior calf), and pain rating; 2) First fMRI scan, before meditation training, subjects received neutral or noxious thermal stimuli at rest and then while focusing on the sensations of breathing; 3) Mindfulness-based mental training for 20 min over 4 sessions; 4) Second fMRI scan, after meditation training, subjects received neutral or noxious thermal stimuli at rest and then while meditating.
Meditation significantly reduced rates of pain intensity by 40% and unpleasantness by 57% in comparison to rest. Furthermore, the decrease in pain perception was associated with changes in brain activity in regions involved in pain modulation. Specifically, reduction in pain intensity ratings was associated with activation of the anterior cingulate cortex and anterior insula; whereas, reduction in pain unpleasantness was associated with activation of the orbitofrontal cortex and thalamic deactivation.
Despite some limitations acknowledged by the authors, such as the absence of a sham meditation group, this is a well designed, innovative study.

Overall the findings reveal that mindfulness-based meditation modulates key brain areas associated with the subjective experience of pain. These results provide insight for the development of future pharmacological and non-pharmacological therapies targeting such areas in the management of pain.

This study provides new scientific evidence for the efficacy of meditation in the management of pain and highlights the importance of rigorous research assessing complementary and alternative therapies and their mechanisms of action.

Ana Recober, MD
University of Iowa, Iowa City, IA

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