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Brain Mechanisms, Pain Modulation, & Mindfulness Meditation

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Brain Mechanisms, Pain Modulation, & Mindfulness Meditation

  1. 1. Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation Zeidan et al. (2011), J Neuro
  2. 2. What is Mindfulness? • Defined – Present-moment awareness and attention to internal and external experiences – Focused attention: cognitive practice of sustained attention on breath • Psychological and physiological benefits – Increased well-being, decreased psychopathology – Better outcomes in stressed patient populations – Decreased subjective experience of pain
  3. 3. Brain Mechanisms Underlying Mindfulness • Limbic regions – Amygdala: functional and structural changes • Cortical regions – Top-down modulation of limbic regions  attenuated affective response to stress • PASL MRI  measures CBF
  4. 4. Hypotheses 1. Meditation will reduce pain ratings 2. Meditation will modulate activity in brain regions associated with pain processing 1. PFC, ACC, anterior insula 3. Is meditation-related activation associated with pain modulation?
  5. 5. Methods
  6. 6. Stimuli & Measures • 32 5-sec heat stimuli (35-49 C) • Experimental stimuli: 5 min 55 sec – Heat condition: 12 sec 45C/12 sec 35C – Neutral condition: 35 C • Delivered to R calf by thermal stimulator • Other measures: HR, RR, FMI, global CBF • Visual Analog Scale – “No pain sensation” – “Most intense imaginable”
  7. 7. Pain Ratings Across Sessions
  8. 8. • Activations and deactivations pre- training (vs rest) • ATB – Less DMN activation  cognitively engaged • Pain-related activity – Consistent with previous studies – Validates methodology
  9. 9. Post-Training Outcome Measures • After 4 days of meditation training, mindfulness skills increased (FMI) • Respiration Rate – Decreased during meditation in presence of noxious stimuli – Decreased in post-training • Heart Rate – Greater during noxious stimulation
  10. 10. Meditation • SI  nose and throat • Interoceptive attention • ACC, Insula • Pain Modulation • OFC, ventral striatum, vlPFC • PCC, mPFC
  11. 11. Pain • Insula • ACC • SII • Similar to pre- training and previous studies •ACC and AI overlap  pain modulation
  12. 12. SI and SMA: interaction between meditation and noxious stimuli • SI activation during meditation compared to rest in the presence of noxious heat stimulation
  13. 13. • Right AI and bilateral ACC – Greater meditation- induced activation  greater reductions in pain intensity ratings • OFC, thalamus – Greatest meditation- induced activation/deactivation  greater reductions in pain unpleasantness
  14. 14. • Meditation activates self-regulation areas – Cognitive control: ACC – Emotion regulation: OFC – Interoceptive awareness: AI
  15. 15. Pain-related brain activity post-training • Reduced: SI, insula, SII • Increased: frontal pole, thalamus, mPFC, ACC
  16. 16. Proposed Mechanisms for Meditation- Induced Pain Reduction 1) Executive regions  SII, insular cortex, PPC  SI 2) ACC and right AI as pain modulatory regions affected by mindfulness 3) Increased affective regulation and reward processing by OFC 4) Limbic-thalamic gating mechanism activated by meditation
  17. 17. Take-Home Message • Mindfulness is among the cognitive manipulations that can decrease pain perception – Shares common modulatory pathway with attentional control, placebo, reducing expectations of pain • This may occur via changes in signaling between executive regions and subcortical structures
  18. 18. Critique • Small sample size • Didn’t account for other individual trait differences that may influence pain modulation • Long-term effects? Is sustained practice required? • Relation to structural changes?

Editor's Notes

  • Lower salivary cortisol, higher salivary IgA in response to psychological stressor
  • PFC, ACC, and anterior insula  attentional control and affective processing
  • 15 healthy adult subjects, 6 male
    Psychophysical training session: familiarized subjects w/ visual analog scale, thermal stimuli, MRI stimuli
    MRI session 1 (pre-meditation training): 2 blocks of rest (eyes closed) – heat or neutral stimulus. Instructed to start focused attention meditation w/ breath, continued through 2 more blocks of heat/neutral. Pain ratings assessed after each block.
    Meditation training: 4 days of training, 20 min/day. Taught to focus on sensations of breathing, acknowledge intrusive thoughts w/o emotional reaction and let them go, redirecting attention back to breath sensations. MRI scanner sounds in days 3 and 4 of training.
    MRI session 2, post-meditation training: 4 blocks of rest (2 heat, 2 neutral stimuli), then instructed to begin focused attention meditation, then another 4 blocks of meditation with heat or neutral stimuli. Pain ratings assessed after each block.
  • No sig diffs in intensity or unpleasantness ratings between rest and ATB conditions pre-training
    Sig decreases in both intensity and unpleasantness ratings between rest and meditation conditions post-training
  • Pain-related increases in brain activity: ACC, bilateral insula, primary and secondary somatosensory cortex, right putamen
  • Meditation reduces SI activity during noxious heat stimulation
  • How brain activity relates to pain intensity and pain unpleasantness ratings
  • Pre-training vs post-training
  • Executive regions (OFC, ACC, AI) influence pain-related afferent processing in SI via pathways that run through SII, insular cortex, and PPC
    ACC and right AI are regions that modulate pain  overlap in activity during meditation and pain, plus activity correlates w/ reduced pain intensity ratings
    Mindfulness reduces appraisal of negative affective/sensory experiences
    OFC activation during meditation  OFC regulates affective response, processes reward/hedonic benefits of cognitive regulation of pain  pain relief + positive mood induction
    OFC activation was associated with reduced unpleasantness ratings in this study
    Limbic-thalamic gating mechanism activated by meditation: thalamus deactivation during meditation
    PFC projections to thalamic reticular nucleus  modulates sensory nuclei of thalamus  filters transmission of sensory info (e.g. noxious stimuli) back to cortex