The Neuroscience of Mindfulness Meditation and Pain Relief

Simplicity · Feb 15, 2016

Mindfulness meditation is proven to reduce pain at a neurobiological level
by, Christopher Bergland
Nov 11, 2015

Source: Sebastian Kaulitzki/ShutterstockOver 100 million Americans are impacted by chronic pain, which is the leading cause of disability in the United States. The financial toll of pain is estimated to be $560 to $630 billion annually between the cost of medical expenses and absenteeism.

In 2014, the National Institute of Health(NIH) compiled a report, "Pathways to Prevention: The Role of Opioids in the Treatment of Chronic Pain" to address the silent epidemic caused by the prevalence of chronic pain and the use of highly addictive opioids to treat pain. Ultimately, this report is a call-to-action for more research to find drug-free alternatives for the treatment of pain.

In 1991, doctors wrote 76 million prescriptions for opioids to treat pain. By 2011, this number had almost tripled to 219 million. Unfortunately, according to the NIH report, 40 to 70% of people with chronic pain aren't actually receiving the proper medical treatment for their pain. In cases where opioids are necessary, there is concern by experts about both the over- and under- pharmacological treatment of chronic pain.

A staggering 80% of all opioid prescriptions worldwide are written in the United States. It appears that other countries have found different treatments for chronic pain. What can Americans do to find nonpharmacological treatments for their physical and psychological pain?

Mindfulness Meditation and Nonpharmacological Pain Management
In recent years, a growing body of evidence has found that mindfulness and meditation have the ability to relieve pain by creating structural and functional changes in the brain. I've written a broad range of Psychology Today blog posts on this topic. In this post, I've compiled the latest science-based findings in a retrospective analysis of "The Neuroscience of Mindfulness Meditation and Pain Relief."

Most recently, scientists at Wake Forest Baptist have found new evidence that mindfulness meditation reduces pain more effectively than placebos by activating two specific brain regions associated with self-control, and deactivating the thalamus.

The November 2015 study reports that mindfulness meditation outperforms a placebo in pain reduction. The report was published in the Journal of Neuroscience. These findings are significant because placebo-controlled trials are necessary to demonstrate the efficacy of clinical and pharmacological pain treatments.

The researchers found that mindfulness meditation reduces pain by activating the orbitofrontal cortex (OFC) and anterior cingulate cortex. According to the researchers, these brain areas are associated with the self-control of pain. Mindfulness meditation also deactivated the thalamus, which acts as a type of gateway to determine which sensory information is allowed to reach higher brain centers.

In a press release, lead author Fadel Zeidan, assistant professor of neurobiology and anatomy at Wake Forest Baptist, described the study,

"While we thought that there would be some overlap in brain regions between meditation and placebo, the findings from this study provide novel and objective evidence that mindfulness meditation reduces pain in a unique fashion. This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation."

Orbitofrontal cortex (OFC) in green.
Source: Geoff B. Hall/Wikimedia CommonsThese findings support another study from earlier this year which identified two different brain pathways that contribute to the pain experience and can be self-regulated. The January 2015 Colorado University-Boulder study, “Distinct Brain Systems Mediate the Effects of Nociceptive Input and Self-Regulation on Pain,” was published in the journal PLOS Biology.

Interestingly, a September 2015 study from the University of Illinois at Urbana-Champaign identified that healthy adults who have a larger orbitofrontal cortex (OFC) tend to have less anxiety and are more optimistic. The study, “Optimism and the Brain: Trait Optimism Mediates the Protective Role of the Orbitofrontal Cortex Gray Matter Volume Against Anxiety,” was published in the journal Social, Cognitive and Affective Neuroscience.

Mind-Body Practices Can Help Prevent and Improve Chronic Pain
Chronic pain triggers changes in brain structure that are linked to depression, anxiety, and impaired cognitive function. Brain imaging studies have shown that chronic pain leads to changes in gray matter volume and the integrity of white matter connectivity. Gray matter is home to the neurons in specific brain regions, while white matter creates communication lines between your various brain regions.

In May 2015, Catherine Bushnell, Ph.D., gave a lecture entitled,“Effect of Environment on the Long-Term Consequences of Chronic Pain,” at the American Pain Society's annual meeting in Palm Springs. Bushnell and her colleagues at the NIH are conducting research aimed at discovering non-pharmacological treatments for pain. They've found that chronic pain can be prevented, or reversed, through mind-body practices.

After assessing the impact of brain anatomy on pain reduction, Bushnell concluded that gray matter changes in the insula or internal structures of the cerebral cortex are the most significant players involved in chronic pain.

The researchers used diffusion tensor brain imaging to analyze gray matter volume and the integrity of white matter tracts. Bushnell hypothesizes that increased size and connectivity of the insular cortex is probably the most important brain factor regarding changes in an individual's pain tolerance and thresholds.

Bushnell found that Yoga appears to bulk up gray matter through neurogenesis (the growth of new neurons) and strengthens white matter connectivity through neuroplasticity. "Insula gray matter size correlates with pain tolerance, and increases in insula gray matter can result from ongoing yoga practice," Bushnell said in a press release.

Yoga practitioners have more gray matter than controls in multiple brain regions, including those involved in pain modulation. Other studies have found that regular physical activity is linked to optimizing gray matter volumes and the integrity of your brain's white matter throughout a lifespan.

Conversely, in a series of groundbreaking experiments, Daniela Kaufer, University of California, Berkeley associate professor of integrative biology, and her colleagues discovered that chronic stress and elevated levels of cortisol can disrupt gray matter brain volume and white matter connectivity. In 2014, Kaufer et al. published the study, "Stress and Glucocorticoids Promote Oligodendrogenesis in the Adult Hippocampus," in the journal Molecular Psychiatry.

Could Small Acts of Gratitude and Empathy Help Reduce Pain?

Anterior cingulate cortex in yellow.
Source: Geoff B. Hall/Wikimedia CommonsOne thing that jumped out at me after reading the new study from Wake Forest this morning was the correlation between mindfulness, pain reduction, and the activation of the anterior cingulate cortex.

Last month, I wrote a Psychology Today blog post, "Small Acts of Generosity and the Neuroscience of Gratitude," based on a study led by Antonio Damasio at USC which found that ratings of gratitude correlated with brain activity in the anterior cingulate cortex.

The October 2015 study, “Neural Correlates of Gratitude,” was published in the journal Frontiers in Psychology. Although it is pure conjecture on my part, and an educated guess, it would seem that loving-kindness meditation and nurturing feelings of gratitude could possibly trigger brain changes that activate the anterior cingulate cortex which is also related to pain reduction.

Along these lines, in 2014 neuroscientists in Italy reported that “social pain” activates the same brain regions as physical pain. The researchers also found that witnessing the social pain of another person activated a similar physical pain response of empathy in most test subjects.

The February 2014 study, “Empathy for Social Exclusion Involves the Sensory-Discriminative Component of Pain: A Within-Subject fMRI Study,” was published in the journal Social Cognitive and Affective Neuroscience. This study also found direct links to the posterior insular cortex (also called the insula).

These findings beg the question: Could the triad of empathy, gratitude, and generosity work together to create an analgesic ripple effect and upward spiral for social and physical pain on a neurobiological level? To my knowledge, there is no research that has studied this specific topic—but I will keep my antennae up for any new research in this field.

Conclusion: Mindfulness Meditation as an Opioid Alternative for Treating Pain
The lethal consequences of opioid addiction have been making headlines in recent weeks. The statistics are alarming. Last week, I wrote a Psychology Today blog post, "Why Are So Many Middle-Aged White Americans Dying Young?" that was inspired by a CDC study which found that drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day.

Deaths from heroin have quadrupled since 2013 claiming 8,260 lives. Some experts at the CDC are calling this the worst drug overdose epidemic in U.S. history. A July 2014 study, “The Changing Face of Heroin Use in the United States,” concluded, “Although the ‘high’ produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids.”

Mindfulness meditation is not a silver bullet for ending what the NIH called the 'silent epidemic' caused by the prevalence of chronic pain and the use of highly addictive opioids to treat pain. However, mindfulness meditation and other mind-body practices are science-based interventions that have been proven to help people manage both physical and psychological pain.

Walt Oleksy (RIP 2021) · Feb 15, 2016

Hi, Simplicity, and thanks for sharing this wonderful article about the benefits of mindfulness meditation.

I am almost 86 and healed from severe back pain thanks to learning about TMS. I am not on any medication, do not even walk with a cane,
and this morning used my snow blower to clear 3 inches of snow off my front walk and long driveway. Not bad for an old geezer, huh?

I practiced mindfulness meditation while using the snow blower and it kept me from thinking I might fall or hurt my back. In my mind, I was on a sunny beach with my best friend.

mike2014 · Feb 16, 2016

An excellent article, Simplicity. I've read this a few times, thanks for sharing.

Simplicity · Feb 16, 2016

@Walt Oleksy, @mike2014. Thanks. I'm glad you liked it. ^_^

Forest · Feb 19, 2016

Thanks for sharing this excellent article, @Simplicity . I agree with @mike2014 that it is worth reading a couple of times.

One thing that might make it easier is to recognize that only a couple regions of the brain often show up in articles about pain (about 4). The exact same regions also show up in Dr. Schubiner's book. They are, simplifying a little to keep things manageable:

prefrontal cortex (PFC), which is just the part of the brain right below your forehead. It is heavily involved with conscious rational thought - it's the part of the brain most associated with school learning and thinking about things logically. In terms of pain, it is often the good guy - meditation and TMS treatment involves using this part of your brain to calm the rest of you down. When you see someone in the support forum who is panicking, you want them to use their logical thoughts to calm the other parts of their brain down. This is the "good guy" prefrontal cortex in action. --- The PFC is fairly large so is broken down into several regions. This article talks about the orbital prefrontal cortex, also known as the orbitofrontal cortex. It's right above the "orbs" of your eyes, which is where it gets its name. With meditation, the orbitofrontal cortex is part of the "good guy" in meditation, consciously calming you down and bringing your attention back to mindfulness.

the anterior cingulate cortex (ACC), which is in the surface of the brain between the two lobes, as shown in the picture above. It's often associated with your feelings and can amplify your pain if you feel bad. Obviously that's not good, but this article shows that if you soothe it with gratitude, it may be able to decrease pain as well.

the insula and the thalamus. The thalamus is just a relay station that relays signals, like pain signals or any other sensation, up from your body. It sits at the top of your spinal cord and most sensory information has to pass through it, so it is right at the center of things. This article talked about how mindfulness meditation can cool down your thalamus, which is part of how mindfulness meditation decreases pain. The insula comes after the thalamus and is one of the places where the brain starts to interpret sensory signals from the body, particularly signals that come from inside of the body, such as feeling things stretch or feeling your own heartbeat. As such, it is no surprise that it can grow if you do yoga, as this article states. It also plays a role in emotions, and here's a possible explanation of why: if you know that you are nervous because you can feel butterflies in your stomach, think of the insula. Bodily sensations can be important in understanding how we really feel, so in this sense, the insula can help you better understand some unconscious emotions. We have a number of threads about the insula.

The other part of the brain that has gotten quite famous is the amygdala, which is heavily involved in very quick learned fear reactions, for example if we see a snake. It's not mentioned in this article, but if you know that PFC, the ACC, the insula and the amygala, you know most of the brain regions that you might come across. If you can remember them, it makes articles like this make much more sense.

For 40 years now, ever since Herbert Benson's and Jon Kabat Zinn's pioneering work, there has been an immense amount of research showing that meditation helps a wide variety of conditions. Usually I recommend meditation because it seems to calm people down and help them approach things more philosophically. (Dr. Schubiner and Alan Gordon are both long time meditators and it is amazing how kind and loving they can be, so I feel like I have some personal experience to back it up.)

It's nice to know that this article is suggesting that meditation also decreases pain directly through it's own mechanism. I tend to recommend it to help people "get their head right," because calming themselves down will decrease the tension the fuels the fires of TMS. Based on this article, it sounds like meditation also decreases pain directly.

mike2014 · Feb 20, 2016

@Forest. Thank you for the explanation. I don't suppose you have one decent graphic which illustrates all of the parts of the brain. I really love my visuals.

yb44 · Feb 20, 2016

mike2014 said: ↑

@Forest. Thank you for the explanation. I don't suppose you have one decent graphic which illustrates all of these parts of the brain. I really love my visuals.
Click to expand...

If you have an appropriate device, check out the app, 3D Brain. I have the free version (not the LITE one) but there's also an expanded one for a few pennies. All give you brain visuals at the touch of a button.

mike2014 · Feb 20, 2016

yb44 said: ↑

If you have an appropriate device, check out the app, 3D Brain. I have the free version (not the LITE one) but there's also an expanded one for a few pennies. All give you brain visuals at the touch of a button.
Click to expand...

Thank you YB44, I'll download it right away. It's great to hear from you as always.

Simplicity · Feb 20, 2016

Thanks, @Forest. It's very interesting for sure, to see the mind-body connection like this. That's is my focus now, to practice mindfulness/meditation. - I've definitely seen improvements in my health. Yesterday I was out all day, traveled by car for 10 hours, went for a long hike and had a lovely time. Last year I was happy if I could sit in the car for an hour.

Forest · Feb 20, 2016

yb44, that looks like a great app. I looked into it and it is sponsored by the Cold Spring Harbor Laboratory, which appears to be a respected nonprofit biological research institution in New York State, giving the app a good pedigree. For those who don't have a smart phone or don't want to install an app, they've made the same information available on a web site. It's called "The 3-D Brain," also:
http://www.g2conline.org/2022

The original article talked a lot about the "Anterior Cingulate Cortex," (ACC) and it was one of the four main brain areas that I mentioned. It's an important area for emotional processing because if we feel strongly about something, it often shows up there. Unfortunately, if we have strong negative feelings, it can also act like a gas pedal for our pain, amplifying it. This is why it is one of the main brain regions that Howard Schubiner talks about in his book and why it is so important for people in pain. If your pain ever drops when you are doing something you love or when you get good news, that is the ACC at work.

On a brighter note for the ACC, I found another article that talks about it and how with meditation, the ACC can help us reduce our anxiety. It's that same idea of strong feelings showing up in the ACC, but this time it's on a cheerier note. I'll paste the article below.

Mike, I'll start thinking about how to visualize the different areas of the brain in a way that will help people remember them. In the meantime, as you know, the brain is divided into a left and a right half, known as the left hemisphere and the right hemisphere. Some important stuff happens between those two sides in the brain. Specifically, that's where the ACC lives.

Don't tell anyone, but because of it's location between the two halves, I sometimes refer to the ACC as "the butt crack of the brain."

The following picture ACC. Basically, the following brain has been cut in half from front to back, with the left half completely removed. This allows you to see the inside of the right half, which you normally couldn't see because the left half would be in the way. The cingulate cortex is shown clearly in yellow.

Word roots can be helpful in understanding it. "Cortex" is latin for "bark," so it just refers to the characteristic wrinkled grey surface of the brain. It's where the grey matter is (on the inside of the brain is more white matter). Anterior just means front and posterior means back. The word "cingulate" doesn't show up that often, but it refers to a band of something. Therefore, "Anterior Cingulate Cortex" just means the front of the band of wrinkly surface between the two halves of the brain.

Here's that article I mentioned. It's amazing how powerful our brains are.

Anxious? Activate your anterior cingulate cortex with a little meditation.

Scientists, like Buddhist monks and Zen masters, have known for years that meditation can reduce anxiety, but not how. Scientists at Wake Forest Baptist Medical Center, however, have succeeded in identifying the brain functions involved.

"Although we've known that meditation can reduce anxiety, we hadn't identified the specific brain mechanisms involved in relieving anxiety in healthy individuals," said Fadel Zeidan, Ph.D., postdoctoral research fellow in neurobiology and anatomy at Wake Forest Baptist and lead author of the study. "In this study, we were able to see which areas of the brain were activated and which were deactivated during meditation-related anxiety relief."

The study is published in the current edition of the journal Social Cognitive and Affective Neuroscience.

For the study, 15 healthy volunteers with normal levels of everyday anxiety were recruited for the study. These individuals had no previous meditation experience or anxiety disorders. All subjects participated in four 20-minute classes to learn a technique known as mindfulness meditation. In this form of meditation, people are taught to focus on breath and body sensations and to non-judgmentally evaluate distracting thoughts and emotions.

Both before and after meditation training, the study participants' brain activity was examined using a special type of imaging -- arterial spin labeling magnetic resonance imaging -- that is very effective at imaging brain processes, such as meditation. In addition, anxiety reports were measured before and after brain scanning.

The majority of study participants reported decreases in anxiety. Researchers found that meditation reduced anxiety ratings by as much as 39 percent.

"This showed that just a few minutes of mindfulness meditation can help reduce normal everyday anxiety," Zeidan said.

The study revealed that meditation-related anxiety relief is associated with activation of the anterior cingulate cortex and ventromedial prefrontal cortex, areas of the brain involved with executive-level function. During meditation, there was more activity in the ventromedial prefrontal cortex, the area of the brain that controls worrying. In addition, when activity increased in the anterior cingulate cortex -- the area that governs thinking and emotion -- anxiety decreased.

"Mindfulness is premised on sustaining attention in the present moment and controlling the way we react to daily thoughts and feelings," Zeidan said. "Interestingly, the present findings reveal that the brain regions associated with meditation-related anxiety relief are remarkably consistent with the principles of being mindful."

Research at other institutions has shown that meditation can significantly reduce anxiety in patients with generalized anxiety and depression disorders. The results of this neuroimaging experiment complement that body of knowledge by showing the brain mechanisms associated with meditation-related anxiety relief in healthy people, he said.

Support for the study was provided by the Mind and Life Institute's Francisco J. Varela Grant, the National Institutes of Health grant NS3926 and the Biomolecular Imaging Center at Wake Forest Baptist.

Co-authors are Katherine Martucci, Ph.D., Robert Kraft, Ph.D., John McHaffie, Ph.D., and Robert Coghill, Ph.D., of Wake Forest Baptist.

Story Source:

The above post is reprinted from materials provided by Wake Forest Baptist Medical Center. Note: Materials may be edited for content and length.

Journal Reference:

F. Zeidan, K. T. Martucci, R. A. Kraft, J. G. McHaffie, R. C. Coghill. Neural Correlates of Mindfulness Meditation-Related Anxiety Relief. Social Cognitive and Affective Neuroscience, 2013; DOI: 10.1093/scan/nst041

Wake Forest Baptist Medical Center. "Anxious? Activate your anterior cingulate cortex with a little meditation." ScienceDaily. ScienceDaily, 4 June 2013. <www.sciencedaily.com/releases/2013/06/130604114001.htm>.

Simplicity · Feb 20, 2016

Thanks for all the extra info + article, @Forest. ^_^

Dexy · Feb 22, 2016

Love this entire thread, thanks.

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