"Noticing the Way that I'm Noticing Pain": A Qualitative Analysis of Therapeutic Progression in Mindfulness-Oriented Recovery Enhancement for Patients with Lumbosacral Radicular Pain.
Ryan S Wexler, Wade Balsamo, Devon J Fox, Danielle Zuzero, Anand Parikshak, Sophia Kwin, Jillian Ramirez, Austin R Thompson, Hans L Carlson, Thomas Kern, Scott D Mist, Ryan Bradley, Heather Zwickey, Courtney K Pickworth, Eric L Garland
Mindfulness 2026 DOI: 10.1007/s12671-026-02782-1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study Peer reviewed |
|---|---|
| Population | Patients with lumbosacral radicular pain (LRP) |
| Intervention | Mindfulness-Oriented Recovery Enhancement (MORE) |
| Topics | Meditation |
| Keywords | Back pain Longitudinal analysis Non-pharmacologic management Qualitative analysis Radiculopathy |
| Key findings | A four-stage progression—Vigilance-Avoidance Metacognition-Reappraisal (VA-MR) framework—describes how participants in MORE develop an adaptive relationship with chronic pain, with attention regulation skills initially used for avoidance before achieving reappraisal. |
Abstract
Mindfulness-Oriented Recovery Enhancement (MORE) aims to foster adaptive attention and pain reappraisal. While research has demonstrated MORE's efficacy, the progression through which participants modify their relationship to pain remains unclear. To understand this process, we conducted a qualitative study with data from a clinical trial of MORE for patients with lumbosacral radicular pain (LRP). Thirty session recordings from MORE were coded. Using thematic analysis, we examined therapeutic processing sessions to understand how participants learned and applied mindfulness to pain. Analysis focused on dialogue resulting from MORE's model of processing, Phenomenology, Utilization, Reframing, Education, Reinforcement (PURER). Four stages and one barrier were identified: (1) Pain Vigilance and Attention Dysregulation, (2) Attention Regulation and its application to Experiential Avoidance, (3) Metacognitive Awareness, and (4) Pain Reappraisal. In addition, some participants engaged in experiential avoidance by using their newfound attention skills to avoid their pain experience. PURER emerged as crucial in facilitating adaptive pain engagement. The four-stage progression pattern identified here - the Vigilance-Avoidance Metacognition-Reappraisal (VA-MR) framework - may help clinicians anticipate challenges in mindfulness training. This study illuminates how MORE participants develop an adaptive relationship with chronic pain, and while attention regulation skills are necessary, they may initially be used for avoidance. Therapeutic benefit appears to require guidance through these stages by a skilled therapist who can navigate initial avoidance tendencies. These findings offer an actionable model for assessing progress and tailoring MBIs to enhance therapeutic outcomes.
Comparable studies
Other qualitative studies on meditation, most cited first.
Citations in the library
Cites 18
- Disentangling self from pain: mindfulness meditation–induced pain relief is driven by thalamic–default mode network decoupling Pain July 7, 2022
- Co-emergence Reinforcement and Its Relevance to Interoceptive Desensitization in Mindfulness and Therapies Aiming at Transdiagnostic Efficacy Frontiers in Psychology December 22, 2020
- The Mindful Reappraisal of Pain Scale (MRPS): Validation of a New Measure of Psychological Mechanisms of Mindfulness-Based Analgesia. Mindfulness 2023
- Mindfulness-integrated Cognitive Behavioral Therapy reduces pain and psychological distress, and improves equanimity, hope and post-traumatic growth during breast cancer treatment: A pilot randomized controlled trial. European journal of oncology nursing : the official journal of European Oncology Nursing Society June 1, 2025
- Virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) reduces daily pain intensity in patients with lumbosacral radiculopathy: a randomized controlled trial. PAIN Reports April 1, 2024
and 13 more in the library