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Brain Mechanisms, Pain Modulation, & Mindfulness Meditation

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Journal club talk on Zeidan et al. 2011

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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?

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