Disentangling self from pain: mindfulness meditation–induced pain relief is driven by thalamic–default mode network decoupling
Gabriel Riegner, Grace Posey, Valeria Oliva, Youngkyoo Jung, William C. Mobley, Fadel Zeidan
Pain July 7, 2022 DOI: 10.1097/j.pain.0000000000002731 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Preregistered Peer reviewed |
|---|---|
| Sample size | 40 |
| Population | Healthy adults |
| Intervention | Mindfulness meditation |
| Duration | 4-session regimen |
| Topics | Default mode network Meditation |
| Keywords | Decoupling probability Mindfulness meditation Psychotherapist Functional connectivity |
| Citations | 41 |
| Registration | NCT03414138 |
| Key findings | Mindfulness meditation reduces pain through decoupling of thalamus-precuneus connectivity and ventromedial prefrontal deactivation. |
Abstract
ABSTRACT: For millenniums, mindfulness was believed to diminish pain by reducing the influence of self-appraisals of noxious sensations. Today, mindfulness meditation is a highly popular and effective pain therapy that is believed to engage multiple, nonplacebo-related mechanisms to attenuate pain. Recent evidence suggests that mindfulness meditation-induced pain relief is associated with the engagement of unique cortico-thalamo-cortical nociceptive filtering mechanisms. However, the functional neural connections supporting mindfulness meditation-based analgesia remain unknown. This mechanistically focused clinical trial combined functional magnetic resonance imaging with psychophysical pain testing (49°C stimulation and pain visual analogue scales) to identify the neural connectivity supporting the direct modulation of pain-related behavioral and neural responses by mindfulness meditation. We hypothesized that mindfulness meditation-based pain relief would be reflected by greater decoupling between brain mechanisms supporting appraisal (prefrontal) and nociceptive processing (thalamus). After baseline pain testing, 40 participants were randomized to a well-validated, 4-session mindfulness meditation or book-listening regimen. Functional magnetic resonance imaging and noxious heat (49°C; right calf) were combined during meditation to test study hypotheses. Mindfulness meditation significantly reduced behavioral and neural pain responses when compared to the controls. Preregistered (NCT03414138) whole-brain analyses revealed that mindfulness meditation-induced analgesia was moderated by greater thalamus-precuneus decoupling and ventromedial prefrontal deactivation, respectively, signifying a pain modulatory role across functionally distinct neural mechanisms supporting self-referential processing. Two separate preregistered seed-to-seed analyses found that mindfulness meditation-based pain relief was also associated with weaker contralateral thalamic connectivity with the prefrontal and primary somatosensory cortex, respectively. Thus, we propose that mindfulness meditation is associated with a novel self-referential nociceptive gating mechanism to reduce pain.
Comparable studies
Other randomized controlled trials on default mode network, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin Healthy volunteers | 2012 | Within-subjects, placebo-controlled, task-free fMRI study | n = 30 |
| The effects of psilocybin and MDMA on between-network resting state functional connectivity in healthy volunteers | 2014 | Placebo-controlled study | |
| Ketamine Decreases Resting State Functional Network Connectivity in Healthy Subjects: Implications for Antidepressant Drug Action Healthy subjects | 2012 | Randomized, placebo-controlled, double-blind, crossover rsfMRI challenge | |
| Antidepressants Normalize the Default Mode Network in Patients With Dysthymia Subjects with dysthymic disorder and healthy control participants aged 18 to 53 years | 2013 | Randomized controlled trial | n = 41 |
| Functional Connectivity Measures After Psilocybin Inform a Novel Hypothesis of Early Psychosis Healthy volunteers | 2012 | Within-subject, placebo-controlled experimental study | n = 15 |
Citations in the library
Cited by 19
- The Mindful Reappraisal of Pain Scale (MRPS): Validation of a New Measure of Psychological Mechanisms of Mindfulness-Based Analgesia. Mindfulness 2023
- Mindfulness, cognition, and long-term meditators: Toward a science of advanced meditation. Imaging Neuroscience 2025
- The role of endogenous opioids in mindfulness and sham mindfulness-meditation for the direct alleviation of evoked chronic low back pain: a randomized clinical trial. Neuropsychopharmacology June 1, 2024
- fMRI-based explanations for how meditation could modulate pain processing. Frontiers in Neuroscience 2025
- Perspective on salutogenic approaches to persistent pain with a focus on mindfulness interventions. Frontiers in Pain Research 2023
and 14 more in the library
Cites 20
- The Brain's Default Mode Network Annual Review of Neuroscience May 4, 2015
- Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness Frontiers in Human Neuroscience 2012
- Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference Social Cognitive and Affective Neuroscience August 13, 2007
- Functional Reorganization of the Default Mode Network across Chronic Pain Conditions PLoS One September 2, 2014
- Enhanced Medial Prefrontal-Default Mode Network Functional Connectivity in Chronic Pain and Its Association with Pain Rumination Journal of Neuroscience March 12, 2014
and 15 more in the library