Insular cortex mediates increased pain tolerance in yoga practitioners
Open accessAbstract
Yoga, an increasingly popular discipline among Westerners, is frequently used to improve painful conditions. We investigated possible neuroanatomical underpinnings of the beneficial effects of yoga using sensory testing and magnetic resonance imaging techniques. North American yogis tolerated pain more than twice as long as individually matched controls and had more gray matter (GM) in multiple brain regions. Across subjects, insular GM uniquely correlated with pain tolerance. Insular GM volume in yogis positively correlated with yoga experience, suggesting a causal relationship between yoga and insular size. Yogis also had increased left intrainsular white matter integrity, consistent with a strengthened insular integration of nociceptive input and parasympathetic autonomic regulation. Yogis, as opposed to controls, used cognitive strategies involving parasympathetic activation and interoceptive awareness to tolerate pain, which could have led to use-dependent hypertrophy of insular cortex. Together, these findings suggest that regular and long-term yoga practice improves pain tolerance in typical North Americans by teaching different ways to deal with sensory inputs and the potential emotional reactions attached to those inputs leading to a change in insular brain anatomy and connectivity.
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Learning to read bodily signals through contemplative training can enhance the ability to understand one's emotions.
“Studies have shown that learning to read bodily signals through contemplative training can enhance the ability to understand one’s emotions (Villemure et al., 2014; Bornemann et al., 2015; Bornemann and Singer, 2016; Garcia-Cordero et al., 2017).”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Villemure et al., 2014
The paper’s Discussion (page not available in our copy) reports that yoga practitioners used interoceptive awareness and focused on bodily sensations without reacting. The Introduction discusses possible control over affective reactions to pain, but neither passage shows that contemplative training improves the ability to understand one’s emotions. (LLM, conf=0.82)
Experimental — accuracy not yet measuredA number of contemplative practices, such as yoga, tai chi, and all types of meditation, have shown to modulate the insula and enhance IA by simply attending to the body without specifically attending in a traditionally mindful way.
“This is a reasonable conclusion as a number of contemplative practices, such as yoga or yoga-based practices (YBPs; Froeliger et al., 2012a; Villemure et al., 2014; Schmalzl et al., 2015), tai chi (Kerr et al., 2008), and all types of meditation (see Fox and Cahn, 2017), have shown to modulate the insula and enhance IA by simply attending to the body without specifically attending to the body in a”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Villemure et al., 2014
The Discussion reports insular differences in yoga practitioners and their use of strategies involving interoceptive awareness, supporting the yoga-related part of the claim. It does not show that yoga enhanced interoceptive awareness or that simply attending to the body caused the insular differences; the study was cross-sectional. The mental-strategies section describes the practitioners’ nonjudgmental attention to sensations as reminiscent of mindfulness, rather than distinct from it. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn a healthy population, simply attending to the body from a variety of contemplative practices appears to increase IA with its associated benefits.
“To be clear, in a healthy population, simply attending to the body from a variety of contemplative practices appears to increase IA with its associated benefits (Gibson, 2014; Villemure et al., 2014; Bornemann et al., 2015; Schmalzl et al., 2015), but increasing IA in a clinical population can be problematic.”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Villemure et al., 2014
The Results section on pain-coping strategies (page unavailable) reports that yoga practitioners focused on breathing and bodily sensations more often than controls; the Discussion links these interoceptive strategies to greater pain tolerance. The paper studies yoga practitioners, not a variety of contemplative practices, and does not establish that simply attending to the body increases interoceptive awareness. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThese practices (body scan meditation and yoga) increase IA as evidenced by neuroplasticity changes in the insula/interoceptive network, leading to outcomes identified in the literature.
“It is also plausible, and this is the central thesis of this article, that these practices (e.g., body scan meditation and yoga) increase IA as evidenced by the neuroplasticity changes in the insula, interoceptive network (Villemure et al., 2014; Schmalzl et al., 2015) leading to the outcomes identified in the extant literature.”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Villemure et al., 2014
The Discussion (page not supplied) reports insular anatomical differences in yoga practitioners and their use of interoceptive-awareness strategies to tolerate pain. It does not establish that yoga increases interoceptive awareness, and the authors say their cross-sectional findings cannot establish causation. The cited study did not test body scan meditation. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMore accurate perception of body signals may facilitate more adaptive responses to pain, healthier eating habits, improvements in social relationships, better stress management, and other adaptive behaviors.
“More accurate perception of body signals may facilitate more adaptive responses to pain (Villemure et al., 2014), healthier eating habits (Herbert et al., 2013), improvements in social relationships (Porges, 2011; Gibson, 2014), better stress management (Bornemann et al., 2015), and other adaptive behaviors.”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Villemure et al., 2014
Yoga-based practices may promote pain tolerance.
“Several studies have indicated that YBP may promote a more “mindful” approach to emotionally based stimuli (Gard et al., 2012; Froeliger et al., 2012b) and pain tolerance (Villemure et al., 2014).”
From Mindfulness, Interoception, and the Body: A Contemporary Perspective (2019) · cites this paper as Villemure et al., 2014
Individuals with extensive experience with yoga have been shown to tolerate induced pain about twice as long as controls without a yoga practice.
“individuals with extensive experience with yoga have been shown to tolerate induced pain about twice as long as controls without a yoga practice [22].”
From A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery (2021) · cites this paper as [22]
The Villemure et al. [22] study showed greater pain tolerance associated with yoga practice.
“which showed greater pain tolerance associated with yoga practice”
From A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery (2021) · cites this paper as Villemure et al. [22]
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“This has been demonstrated in a laboratory setting; individuals with extensive experience with yoga have been shown to tolerate induced pain about twice as long as controls without a yoga practice [22].”
Background
- Authors
- Villemure, C., eko, M., Cotton, V. A., & Bushnell, M. C.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Villemure, C.
- ORCID
- Bushnell, M. C.
- Venue
- Cerebral Cortex
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-05-21
- Volume
- 24
- Issue
- 10
- Pages
- 2732-2740
- ISSN
- 1047-3211 (ISSN-L)
- 1460-2199
- PMC
- PMC4153807
- OpenAlex
- W2136857862
- Semantic Scholar
- 00b87cdf1383b9dd344dc2d9d1f0ba9398b7133d
- Cited by
- 163
- References
- 63
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 15 · 2023: 16 · 2022: 5 · 2021: 16 · 2020: 18 · 2019: 10 · 2018: 14 · 2017: 12 · 2016: 12 · 2015: 12 · 2014: 7
- FWCI
- 5.65
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- Cerebral Cortex (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Center for Complementary and Alternative Medicine
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- yoga, pain tolerance, insula, gray matter volume, white matter integrity, interoceptive awareness, parasympathetic activation, nociception
- MeSH terms
- Adult, Cerebral Cortex, Female, Humans, Magnetic Resonance Imaging, Male, Yoga, Pain Threshold, Diffusion Tensor Imaging, Pain Perception, White Matter, Gray Matter
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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