The mechanism of mindfulness meditation on pain by functional magnetic resonance imaging method

Abstract

Pain is a subjective feeling having sensory, cognitive and emotional components. Brain regions that cognitively and affectively contribute to pain sensation are the anterior cingulate cortex (ACC), insula, prefontal cortex (PFC) and the default mode network (DMN). Depression and anxiety may accompany pain and they may exaggerate the pain via cognitive and affective disturbance. As a complementary treatment of pain, mindfulness meditation which is a therapeutic technique may be described as “non-judgmental awareness of the present moment”. Mindfulness meditation aims to focus on the experiences of bodily sensations and breathing in a non-judgmental and accepting manner. The functional magnetic resonance imaging (fMRI) is one of the tools that can explain the mechanism of action of mindfulness meditation on pain intensity, pain unpleasantness and the cognitive and affective disorders which accompanying pain. This study compiles studies examining the mechanism of action of mindfulness meditation on pain and pain accompanying pain unpleasantness, depression, anxiety with fMRI.

Keywords

• Pain
• mindfulness meditation
• functional magnetic resonance imaging

References

1. 1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020;161:1976-82.
2. 2. Price DD. Psychological and neural mechanisms of the affective dimension of pain. Science 2000;288:1769-72.
3. 3. Pagé MG, Katz J, Stinson J, Isaac L, Martin-Pichora AL, Campbell F. Validation of the numerical rating scale for pain intensity and unpleasantness in pediatric acute postoperative pain: sensitivity to change over time. J Pain 2012;13:359-69.
4. 4. Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc 2015;90:139-47.
5. 5. Finnerup NB, Otto M, McQuay H, Jensen T, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005;118:289-305.
6. 6. JE H. Guyton ve Hall Tıbbi Fizyoloji (12. Baskı). Nobel Tıp Kitabevleri, İstanbul; 2013: pp. 721-5.
7. 7. Ball EF, Muhammad Sharizan ENS, Franklin G, Rogozińska E. Does mindfulness meditation improve chronic pain? A systematic review. Curr Opin Obstet Gynecol 2017;29:359-66.
8. 8. Song Y, Lu H, Chen H, Geng G, Wang J. Mindfulness intervention in the management of chronic pain and psychological comorbidity: a meta-analysis. Int J Nurs Sci 2014;1:215-23.

9. 9. Lutz A, McFarlin DR, Perlman DM, Salomons TV, Davidson RJ. Altered anterior insula activation during anticipation and experience of painful stimuli in expert meditators. Neuroimage 2013;64:538-46.
10. 10. Harrison R, Zeidan F, Kitsaras G, Ozcelik D, Salomons TV. Trait mindfulness is associated with lower pain reactivity and connectivity of the default mode network. J Pain 2019;20:645-54.
11. 11. Zeidan F, Salomons T, Farris SR, Emerson NM, Adler-Neal A, Jung Y, et al. Neural mechanisms supporting the relationship between dispositional mindfulness and pain. Pain 2018;159:2477-85.
12. 12. Zeidan F, Baumgartner JN, Coghill RC. The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer. Pain Rep 2019;4:e749.
13. 13. Kandel ER, Schwartz JH, Jassel TM, Siegelbaum SA, Hudspeth AJ. Eds., Principles Of Neurosciences, 5th ed. McGraw-Hill Education/Medical, 2013.
14. 14. Weiner RS. Pain management: A practical guide for clinicians: CRC press; 2001.
15. 15. Fuchs PN, Peng YB, Boyette-Davis JA, Uhelski ML. The anterior cingulate cortex and pain processing. Front Integr Neurosci 2014;8:35.
16. 16. Derbyshire SW, Jones AK, Gyulai F, Clark S, Townsend D, Firestone LL. Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain 1997;73:431-45.
17. 17. Thompson JM, Neugebauer V. Cortico-limbic pain mechanisms. Neurosci Lett 2019;702:15-23.
18. 18. Ong W-Y, Stohler CS, Herr DR. Role of the prefrontal cortex in pain processing. Mol Neurobiol 2019;56:1137-66.
19. 19. Roy M, Shohamy D, Wager TD. Ventromedial prefrontal-subcortical systems and the generation of affective meaning. Trends Cogn Sci 2012;16:147-56.
20. 20. Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci 2011;31:5540-8.
21. 21. Baliki MN, Mansour AR, Baria AT, Apkarian AV. Functional reorganization of the default mode network across chronic pain conditions. PloS One 2014;9:e106133.
22. 22. Kucyi A, Moayedi M, Weissman-Fogel I, Goldberg MB, Freeman BV, Tenenbaum HC, et al. Enhanced medial prefrontal-default mode network functional connectivity in chronic pain and its association with pain rumination. J Neurosci 2014;34:3969-75.
23. 23. Donaldson LF, Lumb BM. Top-down control of pain. J Physiol 2017;595:4139-40.
24. 24. Bannister K, Dickenson A. The plasticity of descending controls in pain: translational probing. Journal Physiol 2017;595:4159-66.
25. 25. Chen Q, Heinricher MM. Descending control mechanisms and chronic pain. Curr Rheumatol Rep 2019;21:13.
26. 26. Lépine J-P. The epidemiology of anxiety disorders: prevalence and societal costs. J Clin Psychiatr 2002;63:4-8.
27. 27. de Heer EW, Gerrits MM, Beekman AT, Dekker J, Van Marwijk HW, De Waal MW, et al. The association of depression and anxiety with pain: a study from NESDA. PloS One 2014;9:e106907.
28. 28. Hooten WM. Chronic pain and mental health disorders: shared neural mechanisms, epidemiology, and treatment. Mayo Clin Proc 2016;91:955-70.
29. 29. Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 1985;8:163-90.
30. 30. Germer C. What is mindfulness. Insight Journal 2004;22:24-9.
31. 31. Gordon DJ. A critical history of mindfulness-based psychology. 2009.
32. 32. Dreyfus G. Is mindfulness present-centred and non-judgmental? A discussion of the cognitive dimensions of mindfulness. Contemporary Buddhism 2011;12:41-54.
33. 33. Zeidan F, Vago D. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci 2016;1373:114-27.
34. 34. Kabat-Zinn J. Mindfulness-based stress reduction (MBSR). Construct Hum Sci 2003;8:73.
35. 35. Deng Y-Q, Li S, Tang Y-Y. The relationship between wandering mind, depression and mindfulness. Mindfulness 2014;5:124-8.
36. 36. Rod K. Observing the effects of mindfulness-based meditation on anxiety and depression in chronic pain patients. Psychiatr Danub 2015;27(Suppl 1):S209-11.
37. 37. Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Ann Behav Med 2017;51:199-213.
38. 38. Reiner K, Tibi L, Lipsitz JD. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Med 2013;14:230-42.
39. 39. Heeger DJ, Ress D. What does fMRI tell us about neuronal activity? Nat Rev Neurosci 2002;3:142-51.
40. 40. Gard T, Hölzel BK, Sack AT, Hempel H, Lazar SW, Vaitl D, et al. Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain. Cereb Cortex 2012;22:2692-702.
41. 41. Wang MY, Bailey NW, Payne JE, Fitzgerald PB, Fitzgibbon BM. A systematic seview of pain-related neural processes in expert and novice meditator. Mindfulness 2021;12:799-814.
42. 42. Zeidan F, Emerson NM, Farris SR, Ray JN, Jung Y, McHaffie JG, et al. Mindfulness meditation-based pain relief employs different neural mechanisms than placebo and sham mindfulness meditation-induced analgesia. J Neurosci 2015;35:15307-25.
43. 43. Riegner G, Posey G, Oliva V, Jung Y, Mobley W, Zeidan F. Disentangling self from pain: mindfulness meditation-induced pain relief is driven by thalamic-default mode network decoupling. Pain 2023;164:280-91.
44. 44. Vago DR, Silbersweig DA. Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Front Hum Neurosci 2012;6:296.
45. 45. Seminowicz DA, Burrowes SA, Kearson A, Zhang J, Krimmel SR, Samawi L, et al. Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes. Pain 2020;161:1837-46.
46. 46. Braden BB, Pipe TB, Smith R, Glaspy TK, Deatherage BR, Baxter LC. Brain and behavior changes associated with an abbreviated 4-week mindfulness‐based stress reduction course in back pain patients. Brain Behav 2016;6:e00443.
47. 47. Smith A, Leeming A, Fang Z, Hatchard T, Mioduszewski O, Schneider M, et al. Mindfulness-based stress reduction alters brain activity for breast cancer survivors with chronic neuropathic pain: preliminary evidence from resting-state fMRI. J Cancer Surviv 2021;15:518-25.
48. 48. Mioduszewski O, Hatchard T, Fang Z, Poulin P, Khoo E-L, Romanow H, et al. Breast cancer survivors living with chronic neuropathic pain show improved brain health following mindfulness-based stress reduction: a preliminary diffusion tensor imaging study. J Cancer Surviv 2020;14:915-22.
49. 49. Hatchard T, Mioduszewski O, Khoo E-L, Romanow H, Shergill Y, Tennant E, et al. Reduced emotional reactivity in breast cancer survivors with chronic neuropathic pain following mindfulness-based stress reduction (MBSR): an fMRI Pilot investigation. Mindfulness 2021;12:751-62.
50. 50. Vago DR, Nakamura Y. Selective attentional bias towards pain-related threat in fibromyalgia: preliminary evidence for effects of mindfulness meditation training. Cogn Ther Res 2011;35:581-94.
51. 51. Medina S, O'Daly OG, Howard MA, Feliu-Soler A, Luciano JV. Differential brain perfusion changes following two mind-body interventions for fibromyalgia patients: an Arterial Spin Labelling fMRI Study. Mindfulness (N Y) 2022;13:449-61.