Correlations between brain changes and pain management after cognitive and meditative therapies: A systematic review of neuroimaging studies.
Simone S Nascimento, Larissa R Oliveira, Josimari M DeSantana
Complementary Therapies in Medicine August 1, 2018 DOI: 10.1016/j.ctim.2018.06.006 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Peer reviewed |
|---|---|
| Sample size | 280 |
| Population | Adults aged 18-59, including chronic pain patients and healthy subjects with experimental pain |
| Interventions | cognitive behavioral therapy mindfulness meditation transcendental meditation technique |
| Topics | Meditation |
| Keywords | Chronic pain Cognitive behavioral therapy Functional neuroimaging Pain management |
| Key findings | Cognitive and meditative therapies alter brain activity in prefrontal cortex, somatosensory cortices, and limbic system in chronic pain patients, and in anterior cingulate and insular cortex in healthy individuals, while reducing the affective experience of pain. |
Abstract
There are different ways of dealing with pain and cognitive and meditative therapies (CMT) are alternative ways to regulate the emotions associated with pain. Current studies apply neuroimaging techniques trying to elucidate the neural mechanisms of cognitive strategies for pain. This systematic review aimed to summarize the evidence on brain activity changes after CMT, which include cognitive behavioral therapy, mindfulness and/or meditation, for pain management as well as to evaluate clinical pain outcomes. Electronic databases - Pubmed, EMBASE, PsycINFO, Science Direct, Scopus - were searched to find randomized controlled trials (RCTs) examining neuroimaging data of CMT for chronic pain patients or healthy individuals with experimental pain. Two reviewers independently selected the relevant trials, rated for quality assessment and extracted all data using a standardized form. Primary outcome was brain activity changes (activation, deactivation or functional connectivity). Secondary outcomes were pain intensity, self-management, pain coping, quality of life, anxiety and depression. Nine RCTs were included involving 280 adults (18-59 years), 139 chronic pain patients vs. 148 healthy subjects. Three main kinds of intervention were identified: cognitive-behavioral therapy (n = 4), mindfulness meditation (n = 4) and transcendental meditation technique (n = 1). Neuroimaging results revealed distinct patterns of activity, but the main findings were related to increased activation of prefrontal cortex (PFC), specially dorsolateral prefrontal cortex (dlPFC) and ventrolateral prefrontal cortex (vlPFC), orbitofrontal cortex (OBF), somatosensory cortices (SSC) and limbic system in chronic pain population; and increased activation of anterior cingulate cortex (ACC), anterior insular cortex (AI) and decreased activation of thalamus in healthy individuals following CMT. This result means that regulation of pain by CMT can alter functioning of brain regions in an extensive network including non-nociceptive regions. CMT reduced the affective experience of pain, while reductions of pain intensity ratings were less consistent. Brain changes have been demonstrated as a result of the application of psychological measures and may represent the clinical implications of changes in brain activity or morphology.
Comparable studies
Other systematic reviews and meta-analyses on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Meditation Programs for Psychological Stress and Well-being Diverse adult clinical populations | 2014 | Meta-analysis | n = 3,515 |
| Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis Healthy subjects | 2009 | Systematic review and meta-analysis | |
| The psychological effects of meditation: A meta-analysis. Nonclinical groups of adult meditators | 2012 | Meta-analysis | n = 163 |
| Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse Adults with recurrent depression in full or partial remission | 2016 | Meta-analysis of individual patient data from randomized controlled trials | n = 1,258 |
| Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy – a systematic review of randomized controlled trials | 2011 | Systematic review |
Citations in the library
Cited by 9
- Mindfulness-Based Cognitive Therapy in Clinical Practice: A Systematic Review of Neurocognitive Outcomes and Applications for Mental Health and Well-Being. Journal of Clinical Medicine March 3, 2025
- Gray Matter Changes in Adolescents Participating in a Meditation Training Frontiers in Human Neuroscience August 14, 2020
- Oxytocin Modulation in Mindfulness-Based Pain Management for Chronic Pain. Life February 15, 2024
- The Role of Mindfulness Therapy in the Treatment of Chronic Pain. Current Pain and Headache Reports November 1, 2024
- Neural regulation of pain anticipation is associated with mindful behavior change in patients with anxiety or depression: A pilot study. Psychiatry Research Neuroimaging March 1, 2025
and 4 more in the library
Cites 6
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- A systematic review of neurobiological and clinical features of mindfulness meditations Psychological Medicine November 27, 2009
- Pain Attenuation through Mindfulness is Associated with Decreased Cognitive Control and Increased Sensory Processing in the Brain Cerebral Cortex December 15, 2011
- Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia. Journal of Neuroscience November 18, 2015
- Brain mechanisms supporting the modulation of pain by mindfulness meditation. Journal of Neuroscience April 6, 2011
and 1 more in the library