Brain scans reveal that mindfulness meditation for pain is not a placebo
Mindfulness meditation engages separate neural pathways from the well-documented “placebo effect”
University of California - San Diego
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These brain scans show different neural signatures associated with pain response: the NAPS (left) is associated with the emotional experience of pain, the SIIPS-1 (center) is related to our expectations of pain and other psychosocial factors, and the NPS (right) is associated with pain intensity. Researchers at UC San Diego found that mindfulness meditation can modulate the NAPS and NPS, but not the SIIPS-1, showing that different parts of the brain are engaged in mindfulness-based pain relief compared to placebo.
view moreCredit: UC San Diego Health Sciences
Pain is a complex, multifaceted experience shaped by various factors beyond physical sensation, such as a person’s mindset and their expectations of pain. The placebo effect, the tendency for a person’s symptoms to improve in response to inactive treatment, is a well-known example of how expectations can significantly alter a person’s experience. Mindfulness meditation, which has been used for pain management in various cultures for centuries, has long been thought to work by activating the placebo response. However, scientists have now shown that this is not the case.
A new study, published in Biological Psychiatry, has revealed that mindfulness meditation engages distinct brain mechanisms to reduce pain compared to those of the placebo response. The study, conducted by researchers at University of California San Diego School of Medicine, used advanced brain imaging techniques to compare the pain-reducing effects of mindfulness meditation, a placebo cream and a “sham” mindfulness meditation in healthy participants.
The study found that mindfulness meditation produced significant reductions in pain intensity and pain unpleasantness ratings, and also reduced brain activity patterns associated with pain and negative emotions. In contrast, the placebo cream only reduced the brain activity pattern associated with the placebo effect, without affecting the person’s underlying experience of pain.
“The mind is extremely powerful, and we’re still working to understand how it can be harnessed for pain management,” said Fadel Zeidan, PhD, professor of anesthesiology and Endowed Professor in Empathy and Compassion Research at UC San Diego Sanford Institute for Empathy and Compassion. “By separating pain from the self and relinquishing evaluative judgment, mindfulness meditation is able to directly modify how we experience pain in a way that uses no drugs, costs nothing and can be practiced anywhere.”
The study included 115 participants, which consisted of two separate clinical trials in healthy participants, who were randomly placed into groups to be given four interventions: a guided mindfulness meditation, a sham-mindfulness meditation that only consisted of deep breathing, a placebo cream (petroleum jelly) that participants were trained to believe reduces pain and, as a control, one group listened to an audiobook. The researchers applied a very painful but harmless heat stimulus to the back of the leg and scanned the participants’ brains both before and after the interventions.
To analyze the participant’s brain activity patterns, the researchers used a novel approach called multivariate pattern analysis (MVPA), which uses machine learning to disentangle the many complex neural mechanisms underlying the experience of pain, including those stemming from specific heat stimulus, negative emotions and pain responses that are driven by the placebo effect. The researchers were then able to identify if mindfulness meditation and placebo engage similar and/or separate brain processes.
Although placebo cream and sham-mindfulness meditation lowered pain, the researchers found that mindfulness meditation was significantly more effective at reducing pain when compared to placebo cream, sham-mindfulness meditation and the controls.
They also found that mindfulness-based pain relief reduced synchronization between brain areas involved in introspection, self-awareness and emotional regulation. These parts of the brain together comprise the neural pain signal (NPS), a documented pattern of brain activity thought to be common to pain across different individuals and different types of pain. In contrast, the placebo cream and sham-mindfulness meditation did not show a significant change in the NPS when compared to controls. Instead, these other interventions engaged entirely separate brain mechanisms with little overlap.
“It has long been assumed that the placebo effect overlaps with brain mechanisms triggered by active treatments, but these results suggest that when it comes to pain, this may not be the case,” said Zeidan. “Instead, these two brain responses are completely distinct, which supports the use of mindfulness meditation as a direct intervention for chronic pain rather than as a way to engage the placebo effect.”
In modern medicine, new therapies are generally deemed effective and reliable if they outperform placebo. As the present study found that mindfulness meditation is more powerful than placebo and does not engage the same neurobiological processes as placebo, the findings have important implications for the development of new treatments for chronic pain. However, it will take more research to demonstrate these effects in people living with chronic pain as opposed to healthy participants.
In the long term, the researchers hope that by understanding the distinct brain mechanisms underlying mindfulness meditation, they can design more effective and accessible interventions that harness the power of mindfulness to reduce pain in people with various health conditions.
"Millions of people are living with chronic pain every day, and there may be more these people can do to reduce their pain and improve their quality of life than we previously understood.” said Zeidan. "We are excited to continue exploring the neurobiology of mindfulness and how we can leverage this ancient practice in the clinic.”
Link to study: Mindfulness meditation and placebo modulate distinct multivariate neural signatures to reduce pain - Biological Psychiatry
Co-authors on the study include Gabriel Riegner and Jon Dean at UC San Diego School of Medicine and Tor Wager at Dartmouth College.
This work was funded by the National Center for Complementary and Integrative Health.
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Journal
Biological Psychiatry
COI Statement
The authors declare no competing interests.
Enhancing the mind-body connection through technology and touch
Reichman University
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THIS GRAPHIC DEPICTS THE VIBRATION DEVICE WHICH PROVIDES HAPTIC STIMULATION WHILE ECG (ELECTROCARDIOGRAM) SIGNAL IS USED TO PROVIDE PRECISE SYNCHRONIZATION.
view moreCredit: IVCHER INSTITUTE FOR BRAIN COGNITION AND TECHNOLOGY, REICHMAN UNIVERSITY
A recent study published in Psychophysiology from a team of researchers at the Ivcher Institute for Brain, Cognition, and Technology (BCT institute) at Reichman University (Herzliya, Israel) showcases how a novel real-time haptic feedback technology can enhance interoceptive awareness and improve mental and physical health.
Interoception refers to the processes which facilitate the perception, interpretation, and integration of various signals which originate from within the body. Abnormal, or impaired interoception is associated with numerous psychological disorders such as depression, anxiety, and eating disorders, as well as neurodegenerative diseases. Enhancing interoceptive abilities however, has shown therapeutic promise for improving mental health outcomes, reducing symptom severity in chronic conditions, and fostering prosocial behaviors.
The study, led by Dr. Olga Dobrushina (MD Phd) investigated the effectiveness of a haptic heartbeat supplementation technology that combines biofeedback and sensory augmentation principles. Users received real-time feedback of their own heartbeats via gentle vibrations delivered to the chest, which closely mimicked the natural sensations of a heartbeat. “The study involved two groups of 30 participants receiving either the haptic or visual feedback of their heartbeats” says Prof. Amir Amedi, founding director of the BCT Institute. “In the haptic condition, we used a custom-built device that provided the vibrations in synchrony with the participants' own heartbeats, and following the wave of the rise in arterial pressure. The visual feedback condition consisted of an animated beating heart on a screen.”
The team analyzed self-reported measures of attentional focus, and assessed the participants in both conditions using a heart rate discrimination task where participants must estimate the timing of their own heart beats, as well as their confidence in their guesses. “What we were able to see is that after a single session of haptic heartbeat feedback participants’ interoceptive accuracy on the heart rate discrimination task improved significantly, as did their confidence in their interoceptive abilities” Dr. Dobrushina explains. “They also found the haptic condition much more pleasant, which suggests that matching the sensory characteristics of wearable technology to our innate, natural bodily sensations can enhance user satisfaction, but also the efficacy of interoceptive training” she adds. The results of the experiment also illustrate that the haptic feedback shifted participants' attention towards their bodily sensations, a crucial aspect of interoception. “This is quite notable as we did not see this shift in the visual feedback condition” Prof. Amedi clarifies. “So it seems that one of the unique benefits of haptic technology is that it might be able to foster a deeper connection between the mind, and the body” he adds.
“Abnormal interoception represents a fairly common vulnerability factor for psychopathology” says Dr. Dobrushina. Some strategies for improving interoception like mindfulness training while effective, can be challenging to engage in regularly. “Using haptic feedback, especially in wearables could overcome these shortcomings” explains Prof. Amedi, “previous studies have shown that visual feedback of heartbeats outperforms mindfulness training in terms of enhancing interoceptive accuracy, and the haptic feedback we used, was able to outperform visual feedback.”
A recent study published in Psychophysiology from a team of researchers at the Ivcher Institute for Brain, Cognition, and Technology (BCT institute) at Reichman University (Herzliya, Israel) showcases how a novel real-time haptic feedback technology can enhance interoceptive awareness and improve mental and physical health.
Interoception refers to the processes which facilitate the perception, interpretation, and integration of various signals which originate from within the body. Abnormal, or impaired interoception is associated with numerous psychological disorders such as depression, anxiety, and eating disorders, as well as neurodegenerative diseases. Enhancing interoceptive abilities however, has shown therapeutic promise for improving mental health outcomes, reducing symptom severity in chronic conditions, and fostering prosocial behaviors.
The study, led by Dr. Olga Dobrushina (MD Phd) investigated the effectiveness of a haptic heartbeat supplementation technology that combines biofeedback and sensory augmentation principles. Users received real-time feedback of their own heartbeats via gentle vibrations delivered to the chest, which closely mimicked the natural sensations of a heartbeat. “The study involved two groups of 30 participants receiving either the haptic or visual feedback of their heartbeats” says Prof. Amir Amedi, founding director of the BCT Institute. “In the haptic condition, we used a custom-built device that provided the vibrations in synchrony with the participants' own heartbeats, and following the wave of the rise in arterial pressure. The visual feedback condition consisted of an animated beating heart on a screen.”
The team analyzed self-reported measures of attentional focus, and assessed the participants in both conditions using a heart rate discrimination task where participants must estimate the timing of their own heart beats, as well as their confidence in their guesses. “What we were able to see is that after a single session of haptic heartbeat feedback participants’ interoceptive accuracy on the heart rate discrimination task improved significantly, as did their confidence in their interoceptive abilities” Dr. Dobrushina explains. “They also found the haptic condition much more pleasant, which suggests that matching the sensory characteristics of wearable technology to our innate, natural bodily sensations can enhance user satisfaction, but also the efficacy of interoceptive training” she adds. The results of the experiment also illustrate that the haptic feedback shifted participants' attention towards their bodily sensations, a crucial aspect of interoception. “This is quite notable as we did not see this shift in the visual feedback condition” Prof. Amedi clarifies. “So it seems that one of the unique benefits of haptic technology is that it might be able to foster a deeper connection between the mind, and the body” he adds.
“Abnormal interoception represents a fairly common vulnerability factor for psychopathology” says Dr. Dobrushina. Some strategies for improving interoception like mindfulness training while effective, can be challenging to engage in regularly. “Using haptic feedback, especially in wearables could overcome these shortcomings” explains Prof. Amedi, “previous studies have shown that visual feedback of heartbeats outperforms mindfulness training in terms of enhancing interoceptive accuracy, and the haptic feedback we used, was able to outperform visual feedback.”
Journal
Psychophysiology
Method of Research
Experimental study
Subject of Research
People
Article Title
Interoceptive training with real-time haptic versus visual heartbeat feedback
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