How do placebo effects contribute to mindfulness-based analgesia? Probing acute pain effects and interactions using a randomized balanced placebo design
Jonathan N. Davies, Louise Sharpe, Melissa A Day, Ben Colagiuri
Pain October 1, 2022 DOI: 10.1097/j.pain.0000000000002593 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized balanced placebo design Peer reviewed |
|---|---|
| Sample size | 153 |
| Population | Healthy adults |
| Intervention | Focused attention mindfulness |
| Duration | 6 x 20 minutes |
| Topics | Meditation |
| Key points | Receiving any intervention improved acute heat-pain outcomes relative to no treatment, but actual mindfulness training and instruction had no main effects or interactions on pain. The authors report that believing one received mindfulness predicted increased pain threshold and tolerance, with expectancy fully mediating the tolerance effect, suggesting expectancy and belief may attenuate acute pain more than mindfulness-specific processes in novices. |
Abstract
Abstract: Recent sham-controlled studies suggest placebo effects contribute to acute pain relief after mindfulness interventions. However, the specific effects of mindfulness processes and their interaction with placebo effects remain unclear. This study aimed to characterize the role of mindfulness and placebo processes underlying mindfulness-based pain attenuation. Both treatment (focused attention mindfulness vs sham) and instruction (told mindfulness vs told sham) were manipulated in a balanced placebo design. Changes in acute heat pain were evaluated in 153 healthy adults randomized to receive 6 × 20 minutes of 1 of 4 treatment by instruction interventions or no treatment. Participants receiving any intervention demonstrated improved pain outcomes (unpleasantness, intensity, and tolerance) relative to those receiving no treatment. The instruction manipulation increased expectation for pain relief in those told mindfulness relative to those told sham, but there were no main effects or interactions of treatment or instruction on pain outcomes. However, irrespective of actual intervention received, the belief of receiving mindfulness predicted increased pain threshold and tolerance, with expectancy fully mediating the effect on pain tolerance. These findings suggest a lack of specific effects of mindfulness and instruction on acute pain. Nonetheless, participants' expectancies and beliefs about the treatment they received did predict pain relief. Together with the overall improvement after any intervention, these findings suggest that expectancy and belief may play a stronger role in attenuating acute pain in novices following brief mindfulness interventions than the actual mindfulness-specific processes or instructions delivered.
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 12
- Research in Mindfulness Interventions for Patients With Fibromyalgia: A Critical Review. Frontiers in Integrative Neuroscience July 28, 2022
- Placebo effects contribute to brief online mindfulness interventions for chronic pain: results from an online randomized sham-controlled trial. Pain October 1, 2023
- 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
- The Role of Mindfulness Therapy in the Treatment of Chronic Pain. Current Pain and Headache Reports November 1, 2024
and 7 more in the library
Cites 20
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- Differential effects on pain intensity and unpleasantness of two meditation practices. Emotion 2010
- Does the Five Facet Mindfulness Questionnaire measure what we think it does? Construct validity evidence from an active controlled randomized clinical trial. Psychological Assessment October 13, 2015
- Is mindfulness research methodology improving over time? A systematic review PLoS One October 31, 2017
- The efficacy of mindfulness-based interventions in acute pain: a systematic review and meta-analysis Pain August 1, 2020
and 15 more in the library