Altered anterior insula activation during anticipation and experience of painful stimuli in expert meditators
Open accessAbstract
Experientially opening oneself to pain rather than avoiding it is said to reduce the mind's tendency toward avoidance or anxiety which can further exacerbate the experience of pain. This is a central feature of mindfulness-based therapies. Little is known about the neural mechanisms of mindfulness on pain. During a meditation practice similar to mindfulness, functional magnetic resonance imaging was used in expert meditators (>10,000 h of practice) to dissociate neural activation patterns associated with pain, its anticipation, and habituation. Compared to novices, expert meditators reported equal pain intensity, but less unpleasantness. This difference was associated with enhanced activity in the dorsal anterior insula (aI), and the anterior mid-cingulate (aMCC) the so-called 'salience network', for experts during pain. This enhanced activity during pain was associated with reduced baseline activity before pain in these regions and the amygdala for experts only. The reduced baseline activation in left aI correlated with lifetime meditation experience. This pattern of low baseline activity coupled with high response in aIns and aMCC was associated with enhanced neural habituation in amygdala and pain-related regions before painful stimulation and in the pain-related regions during painful stimulation. These findings suggest that cultivating experiential openness down-regulates anticipatory representation of aversive events, and increases the recruitment of attentional resources during pain, which is associated with faster neural habituation.
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Both adept and novice meditators reduced pain intensity ratings during Shamatha practice and noxious heat, with no significant group differences.
“Surprisingly, both adept and novice meditators reduced pain intensity ratings during Shamatha practice and noxious heat, and there were no significant group differences.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [71]
Vipassana-based meditation produced significant pain unpleasantness reductions in adept meditators compared with novices.
“Vipassana-based meditation produced significant pain unpleasantness reductions in the adept meditators when compared with novices.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [71]
Greater meditative experience was associated with greater deactivation of the contralateral anterior insula and rostral midcingulate cortex.
“Furthermore, the greater the meditative experience, the greater the deactivation of said regions.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [71]
Adept meditators exhibited less activation in the contralateral anterior insula and rostral midcingulate cortex during the prestimulus period compared with controls.
“The adept meditators exhibited less activation in the contralateral anterior insula and the rostral aspect of the midcingulate cortex during the prestimulus period when compared with controls.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [71]
Attenuating expectations of impending sensory events by sustaining attention in the present moment is directly associated with facilitating mindfulness-based pain relief.
“Taken together, these mechanistic findings13,71,115 show that attenuating the expectations of impending sensory events by sustaining attention in the present moment are directly associated with facilitating mindfulness-based pain relief.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [71]
Mindfulness meditation reduces pain via several distinct psychological and neural pathways.
“demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [19]
During samatha practice, long-term meditators and novices did not differ in pain intensity ratings.
“Surprisingly, there was no difference between long-term meditators and the novice meditation group on pain intensity ratings during samatha practice.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [19]
Open-monitoring meditation correlated with less anticipatory activity in the anterior insula.
“This form of meditation was associated with reduced anticipatory (before the painful heat stimulus) activation in the anterior insula.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [19]
In expert meditators, open-monitoring meditation significantly lowered pain unpleasantness relative to controls.
“Not surprisingly, open-monitoring meditation produced significant reductions in pain unpleasantness in the expert meditation group when compared to the controls.19”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [19]
Lower baseline activity in the left anterior insula was associated with greater lifetime meditation experience.
“Further, the reduced baseline activation in left anterior insula correlated with lifetime meditation experience.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [19]
In nearly all mindfulness/pain experiments, the unpleasantness aspect of pain is reduced significantly more than pain intensity.
“Furthermore, across almost all mindfulness/pain–focused experiments, the unpleasantness dimension of pain was significantly more attenuated with respect to pain intensity,16–21, 23, 121, 122”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [19]
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- Authors
- Lutz, A., McFarlin, D. R., Perlman, D. M., Salomons, T. V., & Davidson, R. J.
- Affiliations
- University of Wisconsin–Madison (US)
- Venue
- NeuroImage
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 64
- Pages
- 538-546
- ISSN
- 1053-8119 (ISSN-L)
- PMC
- PMC3787201
- OpenAlex
- W2163581406
- Cited by
- 233
- References
- 62
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 16 · 2023: 13 · 2022: 16 · 2021: 17 · 2020: 22 · 2019: 12 · 2018: 26 · 2017: 18 · 2016: 19 · 2015: 20 · 2014: 18 · 2013: 11
- FWCI
- 17.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- NeuroImage (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- CentAUR (University of Reading) (submittedVersion)
- Funders
- National Institute of Child Health and Human Development (P30-HD03352)
- National Institute of Mental Health (P50-MH069315)
- National Center for Complementary and Alternative Medicine (U01-AT002114, P01-AT004952)
- National Institutes of Health (T32-MH018931)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- meditation, pain anticipation, pain unpleasantness, dorsal anterior insula, anterior midcingulate cortex, salience network, amygdala, neural habituation, mindfulness, pain avoidance, meditation experience
- MeSH terms
- Adaptation, Physiological, Cerebral Cortex, Female, Humans, Inhibition, Psychological, Male, Middle Aged, Neuronal Plasticity, Meditation, Pain Perception, Anticipation, Psychological
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