Brain imaging studies have shown that mindfulness meditation activates different neural pathways than those involved in the placebo effect, indicating that its pain-relieving effects do not stem from placebo responses.
Pain is a complex experience influenced by many factors beyond just physical sensations, including a person’s mindset and their expectations. The placebo effect demonstrates how a person’s belief in a treatment can lead to improvements in symptoms, even when the treatment is inactive. For centuries, mindfulness meditation has been employed across various cultures for pain relief, previously thought to operate mainly by harnessing the placebo effect. However, recent scientific findings reveal a different story.
A new research published in Biological Psychiatry has shown that mindfulness meditation activates unique brain mechanisms for pain reduction, separate from those invoked by a placebo. Conducted by researchers at the University of California San Diego School of Medicine, the study employed advanced brain imaging technology to examine the pain-relieving impacts of mindfulness meditation, a placebo cream, and a “sham” mindfulness meditation in healthy participants.
The results revealed that mindfulness meditation significantly lowered both pain intensity and the unpleasantness associated with pain, while also diminishing brain activity connected to pain and negative emotions. In contrast, the placebo cream merely affected brain activity linked to the placebo effect, leaving the actual experience of pain unchanged.
“The mind holds incredible power, and we’re still discovering how it can be utilized for pain management,” explained Fadel Zeidan, PhD, a professor at UC San Diego Sanford Institute for Empathy and Compassion. “By separating the sensation of pain from your sense of self and avoiding judgment, mindfulness meditation can change how we perceive pain without using drugs, at no cost, and it can be practiced anywhere.”
The study involved 115 participants in two distinct clinical trials. They were randomly assigned to one of four interventions: guided mindfulness meditation, a sham mindfulness meditation that focused solely on deep breathing, a placebo cream (petroleum jelly) that participants were led to believe alleviated pain, or a control group that listened to an audiobook. Researchers applied a painful but harmless heat stimulus to the back of participants’ legs and monitored their brain activity both before and after these interventions.
To assess the participants’ brain activity patterns, researchers employed a cutting-edge method known as multivariate pattern analysis (MVPA), which incorporates machine learning to unravel the complex neural mechanisms associated with pain experiences. This includes elements stemming from the heat stimulus itself, emotional negativity, and responses triggered by placebo effects. This technique allowed researchers to discern whether mindfulness meditation and placebo influenced the same or different brain processes.
While both the placebo cream and sham mindfulness meditation reduced pain, findings revealed that mindfulness meditation was notably more effective than either the placebo cream or the sham meditation, as well as the control group.
Furthermore, the study indicated that mindfulness meditation lowered the synchronization between brain regions engaged in introspection, self-awareness, and emotional regulation. Collectively, these areas represent the neural pain signal (NPS), a well-documented pattern of brain activity associated with pain across individuals and various forms of pain. Unlike the mindfulness approach, neither the placebo cream nor the sham mindfulness meditation showed a significant impact on the NPS compared to control groups, as these interventions recruited different brain mechanisms with minimal overlap.
“There has been a long-held belief that the placebo effect shares some brain mechanisms with active treatments. However, our findings indicate that this may not be the case regarding pain,” stated Zeidan. “Instead, the responses observed in the brain for mindfulness meditation and placebo were entirely distinct, reinforcing the idea of using mindfulness meditation directly as a method for managing chronic pain instead of merely activating the placebo response.”
In contemporary medicine, treatments are generally considered effective if they perform better than a placebo. Given that this study illustrates how mindfulness meditation surpasses the placebo effect and operates through different neurobiological pathways, the implications for developing new chronic pain therapies are significant. However, further research will be needed to validate these effects in individuals suffering from chronic pain, as opposed to healthy participants.
Ultimately, the researchers aspire to leverage knowledge of the unique brain mechanisms involved in mindfulness meditation to create more effective and accessible interventions that capitalize on its benefits for pain management in various health conditions.
“Millions of individuals endure chronic pain daily, and there may be more ways for them to alleviate their suffering and enhance their quality of life than we’ve previously recognized,” commented Zeidan. “We are eager to continue investigating the neuroscience of mindfulness and how to integrate this ancient practice into clinical settings.”
The study’s co-authors include Gabriel Riegner and Jon Dean from UC San Diego School of Medicine, along with Tor Wager from Dartmouth College.
This research was supported by the National Center for Complementary and Integrative Health.
