Department of Anesthesiology, University of California San Diego, La Jolla, California.
Department of Psychological and Brain Science, Dartmouth College, Hanover, New Hampshire.
Biol Psychiatry. 2025 Jan 1;97(1):81-88. doi: 10.1016/j.biopsych.2024.08.023. Epub 2024 Aug 30.
Rather than a passive reflection of nociception, pain is shaped by the interplay between one's experiences, current cognitive-affective states, and expectations. The placebo response, a paradoxical yet reliable phenomenon, is postulated to reduce pain by engaging mechanisms shared with active therapies. It has been assumed that mindfulness meditation, practiced by sustaining nonjudgmental awareness of arising sensory events, merely reflects mechanisms evoked by placebo. Recently, brain-based multivariate pattern analysis has been validated to successfully disentangle nociceptive-specific, negative affective, and placebo-based dimensions of the subjective pain experience.
To determine whether mindfulness meditation engages distinct brain mechanisms from placebo and sham mindfulness to reduce pain, multivariate pattern analysis pain signatures were applied across 2 randomized clinical trials that employed overlapping psychophysical pain testing procedures (49 °C noxious heat; visual analog pain scales) and distinct functional magnetic resonance imaging techniques (blood oxygen level-dependent; perfusion based). After baseline pain testing, 115 healthy participants were randomized into a 4-session mindfulness meditation (n = 37), placebo-cream conditioning (n = 19), sham mindfulness meditation (n = 20), or book-listening control (n = 39) intervention. After each intervention, noxious heat was administered during functional magnetic resonance imaging and each manipulation.
A double dissociation in the multivariate pattern analysis signatures supporting pain regulation was revealed by mindfulness meditation compared with placebo cream. Mindfulness meditation produced significantly greater reductions in pain intensity and pain unpleasantness ratings and nociceptive-specific and negative affective pain signatures than placebo cream, sham mindfulness meditation, and control interventions. The placebo-cream group significantly lowered the placebo-based signature.
Mindfulness meditation and placebo engaged distinct and granular neural pain signatures to reduce pain.
疼痛并非是对伤害性刺激的被动反映，而是个体经历、当前认知情感状态和预期相互作用的结果。安慰剂效应是一种矛盾但可靠的现象，它被认为通过与活性治疗共享的机制来减轻疼痛。人们假设正念冥想，通过持续地对出现的感官事件进行无判断的觉察，仅仅反映了由安慰剂引起的机制。最近，基于大脑的多元模式分析已被验证能够成功地区分主观疼痛体验中的疼痛特异性、负性情感和基于安慰剂的维度。
为了确定正念冥想是否通过与安慰剂和假正念冥想不同的大脑机制来减轻疼痛，我们在两项采用重叠的心理物理疼痛测试程序（49°C 有害热；视觉模拟疼痛量表）和不同的功能磁共振成像技术（血氧水平依赖；灌注基础）的随机临床试验中应用了多元模式分析疼痛特征（n = 49）。在基线疼痛测试后，115 名健康参与者被随机分为 4 个疗程的正念冥想（n = 37）、安慰剂乳膏处理（n = 19）、假正念冥想（n = 20）或书籍聆听对照组（n = 39）。在每个干预之后，在功能磁共振成像和每个操作期间都进行了有害热的施加。
与安慰剂乳膏相比，正念冥想在支持疼痛调节的多元模式分析特征中显示出双重分离。正念冥想比安慰剂乳膏、假正念冥想和对照干预显著降低了疼痛强度和疼痛不愉快评分以及疼痛特异性和负性情感疼痛特征。安慰剂乳膏组显著降低了基于安慰剂的特征。
正念冥想和安慰剂通过不同的、精细的神经疼痛特征来减轻疼痛。
