Placebo effects contribute to brief online mindfulness interventions for chronic pain: results from an online randomized sham-controlled trial.
Jonathan N. Davies, Ben Colagiuri, Louise Sharpe, Melissa A Day
Pain October 1, 2023 DOI: 10.1097/j.pain.0000000000002928 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 169 |
| Population | Adults with chronic or recurrent pain |
| Interventions | Mindfulness specific sham mindfulness general sham mindfulness audiobook control |
| Duration | Single 20-minute session |
| Topics | Meditation |
| Citations | 15 |
| Key findings | Mindfulness was not superior to sham conditions for reducing pain intensity or unpleasantness, and improvements were most strongly associated with placebo expectancy. |
Abstract
Mindfulness apps are becoming popular treatments for chronic pain and mental health, despite mixed evidence supporting their efficacy. Furthermore, it is unclear whether improvements in pain are due to mindfulness-specific effects or placebo effects because no trials have compared mindfulness against a sham control. The objective of this study was to compare mindfulness against 2 sham conditions with differing proximity to mindfulness to characterize the relative contributions of mindfulness-specific and nonspecific processes on chronic pain. We assessed changes in pain intensity and unpleasantness and mindfulness-specific and nonspecific pain-related processes in 169 adults with chronic or recurrent pain randomized to receive a single 20-minute online session of mindfulness, specific sham mindfulness, general sham mindfulness, or audiobook control. Mindfulness was not superior to shams for reducing pain intensity or unpleasantness, and no differential engagement of theorized mindfulness-specific processes was observed. However, mindfulness and both shams reduced pain unpleasantness relative to audiobook control, with expectancy most strongly associated with this effect. Sham specificity had no influence on expectancy or credibility ratings, pain catastrophizing, or pain effects. These findings suggest that improvements in chronic pain unpleasantness following a single session of online-delivered mindfulness meditation may be driven by placebo effects. Nonspecific treatment effects including placebo expectancy and pain catastrophizing may drive immediate pain attenuation rather than theorized mindfulness-specific processes themselves. Further research is needed to understand whether mindfulness-specific effects emerge after longer durations of online training.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 7
- Too much or not enough of a good thing? Reconciling differing perspectives on the optimal dose of mindfulness meditation and advancing a dose-response research agenda June 23, 2023
- Pain, mindfulness, and placebo: a systematic review. Frontiers in Integrative Neuroscience 2024
- Evaluating the Effectiveness of Mindfulness Practice Doses in the General Population Through Personalization—A Randomized Controlled Experiment Mindfulness February 12, 2026
- The Impact of Understanding and Openness on State Mindfulness Following a Brief Meditation: A Sham Controlled Study Mindfulness August 1, 2025
- Waiting for pain: effect of a mindfulness intervention during a wait situation on pain intensity. Frontiers in Pain Research 2025
and 2 more in the library
Cites 22
- Using Self-Report Assessment Methods to Explore Facets of Mindfulness Assessment January 27, 2006
- Construct Validity of the Five Facet Mindfulness Questionnaire in Meditating and Nonmeditating Samples Assessment February 29, 2008
- Meta-analytic evidence for effects of mindfulness training on dimensions of self-reported dispositional mindfulness. Psychological Assessment 2016
- Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control Frontiers in Human Neuroscience 2012
- Effects of Brief and Sham Mindfulness Meditation on Mood and Cardiovascular Variables The Journal of Alternative and Complementary Medicine July 28, 2010
and 17 more in the library