Brain Mechanisms Supporting

the Modulation of Pain by

Mindfulness Meditation
By: Zeidan, Martucci, Kraft,
Gordon, McHaffie, and
Coghill

Mindfulness is a state of present awareness. A relaxed
state of mind, in which we are conscious of our
experience, including sensations, thoughts and feelings,
breathing, and surroundings, all with an attitude of
non-resistance, peace and acceptance. This does not
imply passivity or lack of emotion. Mindfulness
engenders faith in the perfection of the moment, and
allows each new experience to be felt fully, without the
reactive, self-critical, controlling mind.



Meditation is not a religion but simply a method of
mental training

You dont have to sit cross legged on the floor.. You can
meditate anywhere

Patience and persistence are required but the practice of
meditation does not take a long time

Meditation is not complicated, nor is it about success or
failure

It will not deaden your mind or turn your into a hippie
but rather it helps cultivate a deep and compassionate
awareness that allows you to assess your goals and find
the optimum path towards realizing your deepest values
Introduction
Our perception of the sensory environment is shaped by our
own unique past experiences, current cognitive state, and
future expectations.

Best example of this is the subjective experience of pain-
while noxious stimuli initiates physiological and
neurophysiological changes within our bodies, its effects are
highly malleable and subject to modification.

The nature of our mental activity can be manipulated through
the practice of mindfulness meditation.





Shamatha (focused attention) is a form of
mindfulness meditation used in this study.

Focused attention is the cognitive practice of
sustaining attention on the changing sensations of
the breath, monitoring changing events as they arise,
disengaging from these events without affective
reaction and redirecting attention back to the breath.

This allows you to observe your thoughts as they
arise in your mind and little by little, to let go of
struggling with them.



The authors believed that given that mindfulness meditation can
reduce the subjective experience of pain, brain regions involved in
meditation must somehow interact with those involved with
nociceptive processing

The specific brain mechanisms associated with mindfulness
meditation were poorly characterized

How the brain mechanisms could potentially influence pain
related brain activity was unknown


Therefore the authors investigated how meditation affects pain
related brain processes using an emerging functional magnetic
resonance imaging technique (FMRI) and pulsed arterial spin
labeled (PASL) MRI
THE STUDY:

Hypothesized that in addition to reducing psychophysical
pain ratings, meditation would modulate brain regions
associated with constructing the pain experience.

Specifically that meditation would engage brain regions
such as the prefrontal cortex, anterior cingulate cortex, and
the anterior insula which are known for their role in
attentional control and affective processing.

They further sought to determine whether meditation
related activation of these brain regions was directly
associated with pain modulation.
Materials and Methods:

Fifteen healthy volunteers, six males and nine females(age
range 22-35) completed the study.

Subjects participated in a psychophysical training session-
initially familiarizing them with 32 5 second duration stimuli
(35-49 degrees C/95- 120.2 degrees F) to provide experience
with the visual analog scales (VAS). They then received 5 min
and 55 seconds of stimulation. A 15 cm plastic sliding VAS scale
was used to quantify pain intensity and unpleasantness. The
minimum rating was represented as no pain sensation/not at all
unpleasant whereas the maximum was most intense
imaginable/most unpleasant imaginable




MRI session 1: Subjects were positioned in the MRI scanner, a pulse
oximeter was attached to a subjects left index finger to assess heart rate
and a transducer was placed around the chest to gauge respiration rate.
Noxious thermal stimuli were delivered to the right calf. The heat
condition consisted of alternating patterns of 49 and 35 degrees C with 12
second durations at each temperature for 5 mins and 55 seconds total. The
neutral series consisted of only 35 degrees C for 5 mins and 55 seconds.

After each series, subjects evaluation of pain intensity and unpleasantness
was acquired with the VAS scale.


In this session four functional series (two heat, two neutral) were
separated by a structural acquisition scan. In the first half of the
experiment, subjects were instructed to keep their eyes closed and restrict
movement (rest). After the image was obtained, they were instructed to
meditate by focusing on breathing (ATB)

Mindfulness based mental training:

Mindfulness based mental training was performed in four
separate, 20 minute sessions conducted by a facilitator with
over 10 years of experience

Subjects were taught to focus on the changing sensations of
the breath. They were also taught that discursive thoughts were
to be acknowledged without affective reaction and to let go by
redirecting their focus back on breath sensations.

In sessions 3 and 4, sounds of the MRI scanner were
introduced to the subjects to familiarize them with the MRI
environment
MRI session 2:

Occurred after successful completion of meditation
training

Session consisted of eight function series (four heat, four
neutral).

After completion of the first four rest series (reduce eye
movement and close eyes) subjects were again instructed to
meditate by focusing on the changing sensations of the
breath at which point the anatomical scan was conducted.
Subjects continued to meditate across blocks of noxious
stimulation and pain ratings were again assessed after each
block.


Results
Before meditation training:

There was no change in pain intensity when subjects attended to
their breathing

There was no significantly greater brain activation when focusing on
breath as contrasted to the rest condition, however there was
significantly greater default-mode- related brain activation (medial
PFC )in the rest condition compared with the ATB condition
suggesting they were actively engaged in a cognitive task when
instructed to focus on breath sensations

When compared with neutral stimulation, pain related brain activity
was detected in the ACC, bilateral insula, secondary Somatasensory
cortex (SII) and SI corresponding to the noxious thermal stimulation
on the leg



Post meditation training/MRI 2:

Meditation produced a 40% reduction in VAS pain intensity
ratings compared with rest. Pain intensity ratings were lower in
MRI session 2 compared with MRI session 1. Meditation also
significantly reduced pain unpleasantness ratings by 57%

Meditation related brain activity:

Meditating produced bilateral activation of the posterior insula,
secondary somatosensory cortex (SII), anterior insula, and the
anterior cingulate cortex which are associated with the cognitive
modulation of pain (these areas were also activated when
compared with neutral stimulation)


Somatosensory cortex activation corresponding to the stimulation site
significantly decreased during mediation when compared with rest

Individuals with the greatest reductions in pain intensity ratings
exhibited the largest meditation induced activation of the right anterior
insula and bilateral anterior cingulate cortex

Individuals with the greatest reductions in pain unpleasantness ratings
exhibited the greatest activation of the orbitofrontal cortex and the
greatest deactivation of the thalamus

After meditation training, brain activity was more pronounced in the
frontal pole, thalamus, medial prefrontal cortex, and the anterior
cingulate cortex compared with before training




Discussion:


In the present investigation, meditation reduced all subjects
pain intensity and unpleasantness ratings with decreases
ranging from 11 to 70% and 20 to 93% respectively.

Meditation related pain relief was directly related to brain
regions associated with the cognitive modulation of pain
providing unique insights into the manner that mediation
alters the subjective experience of pain.



Meditation reduces pain through multiple brain mechanisms

1) Significantly reduced pain related afferent processing in
the somatosensory cortex

2) The magnitude of decreased pain intensity ratings was
associated with anterior cingulate cortex and right anterior
insula activation

3) Orbitofrontal cortex activation was associated with
decreases in pain unpleasantness ratings- may reflect altered
executive level reappraisals to consciously process reward
and hedonic experiences (meditation directly improves
mood and positive mood reduces pain ratings)