Nondual awareness as a novel chronic pain-relieving mechanism.
Kush V. Bhatt, Adam W. Hanley, Chantal Martin-Soelch, Chantal Berna, Eric L Garland
Psychology of Consciousness Theory Research and Practice May 11, 2026 DOI: 10.1037/cns0000474 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of pooled data from two randomized controlled trials Peer reviewed |
|---|---|
| Sample size | 480 |
| Population | Patients receiving long-term opioid analgesic therapy for chronic pain |
| Intervention | Mindfulness-Oriented Recovery Enhancement |
| Duration | 8-week intervention |
| Keywords | Perspective graphical Disease Medline Identification biology |
| Key findings | Nondual awareness mediated the effect of a mindfulness-based intervention (MORE) on reducing chronic pain severity and interference. |
Abstract
Mindfulness-based interventions are efficacious nonpharmacologic treatments for chronic pain, yet the psychological mechanisms mediating the pain-relieving effects of mindfulness-based interventions remain incompletely understood. One potential mechanism may involve nondual awareness, a state of consciousness characterized by attenuation of the subject-object duality, reduced self-referential thinking, and an increased sense of connectedness with others and the world at large. We conducted a secondary analysis of pooled data from two randomized controlled trials (N = 480) investigating the effects of Mindfulness-Oriented Recovery Enhancement (MORE), an 8-week mindfulness-based intervention, in patients receiving long-term opioid analgesic therapy for chronic pain. We tested whether nondual awareness, as measured by the Nondual Awareness Dimensional Assessment, mediated the effect of MORE on chronic pain severity and interference. Results demonstrated that MORE was associated with significantly lower chronic pain severity (p = .014) and pain interference (p < .001) compared with a supportive group therapy control condition. Moreover, participants in the MORE condition exhibited significant increases in nondual awareness compared with the control group (p < .001). Multivariate path analyses revealed that increases in nondual awareness significantly mediated reductions in chronic pain severity (p = .002) and pain interference (p = .01). Nondual awareness outperformed the mindfulness facet of nonreactivity as a mediator of mindfulness' pain-relieving effects. Study findings demonstrate a link between mindfulness-induced nondual awareness and alleviation of chronic pain. Future research should elucidate the neurobiological mechanisms of this relationship. Moreover, studies could identify other potential interventions that produce nondual awareness (e.g., psychedelics) to address chronic pain, possibly in conjunction with mindfulness-based interventions.