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Cited by 300Mindfulness and Compassion InterventionsPain Management and Placebo EffectPain Mechanisms and Treatments

Mindfulness meditation-based pain relief: a mechanistic account

Open access
Zeidan, Fadel, Vago, David R.·2016·Annals of the New York Academy of Sciences
DOI 10.1111/nyas.13153PMC PMC4941786
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Abstract

Pain is a multidimensional experience that involves interacting sensory, cognitive, and affective factors, rendering the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast‐acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms—an important consideration for the millions of chronic pain patients seeking narcotic‐free, self‐facilitated pain therapy.

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Written from the paper’s full text.

TL;DR

This review argues that mindfulness meditation reduces pain through several distinct psychological and neural routes rather than a single placebo or opioid pathway. It synthesizes experimental and clinical evidence showing that brief training lowers both pain intensity and unpleasantness, while long-term practice mainly alters unpleasantness and pain appraisal.

Key findings

  • Brief mindfulness training (four 20-minute sessions) in 15 healthy volunteers reduced experimentally induced heat pain by an average of 40% for intensity and 57% for unpleasantness; analgesia was linked to sgACC, OFC, and right anterior insula activation and bilateral thalamic deactivation.
  • In a 75-person randomized study, mindfulness meditation, placebo cream, and sham meditation all reduced pain relative to a book-listening control, but mindfulness meditation produced greater pain reduction than either placebo condition; its brain pattern involved OFC, pgACC, and right anterior insula, whereas placebo engaged posterior insula/parietal operculum and thalamus/PAG.
  • In 78 healthy participants, meditation lowered pain intensity and unpleasantness whether given with naloxone or saline, indicating that endogenous opioid blockade did not reverse the effect; this supports non-opioid mechanisms distinct from placebo.
  • Long-term meditators (14 experts with about 10,000 hours; 17 vipassana practitioners averaging 5,979 hours) did not differ from controls in pain intensity but showed reduced pain unpleasantness, with open-monitoring practice linked to lower anticipatory anterior insula activity and greater sensory-region activation alongside decreased appraisal-region activity.

Methods

  • Narrative review of experimental and clinical literature on mindfulness meditation and pain, distinguishing focused attention (samatha) and open monitoring (vipassana).
  • Evidence base includes randomized trials and neuroimaging/pharmacological experiments: for example, 15 healthy pain-free adults, 75 healthy adults, 78 healthy adults, 14 long-term meditators versus 14 controls, 17 vipassana practitioners versus 17 matched controls, plus clinical studies in fibromyalgia, migraine, chronic pelvic pain, IBS, and chronic low back pain.
  • Main synthesis compares self-reported pain intensity and unpleasantness, ASL fMRI activation patterns, and naloxone blockade against placebo, sham meditation, relaxation, CBT, usual care, and other control conditions.

Limitations

  • Stated: the paper notes that clear mechanistic categories and consistent replication are lacking, specific analgesic neural mechanisms for chronic pain remain undetermined, many meditation studies use cross-sectional or case-control designs with limited generalizability, and placebo-controlled meditation trials are scarce; randomized longitudinal designs are encouraged.
  • Stated: meditation is highly susceptible to nonspecific or placebo effects, and long-term meditator findings may not translate directly to brief clinical training.
  • Evident from the text: this is a narrative review without a systematic search or meta-analysis, and several cited primary studies have small samples and varied meditation traditions or training doses, so effect sizes and mechanisms are not directly comparable.

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Integrity signals

Registry

Crossref · 10.1111/nyas.13153

Cites

170 of 170 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 177 cited sources checked · 0 supported · 0 flagged

  • Interpretationcitation

    Mindfulness meditation reduces pain via several distinct psychological and neural pathways.

    “demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms”
    • Also stated in: § Introduction · plain
      “mindfulness meditation attenuates pain through multiple unique psychological and neural processes;15–22”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [15] Zeidan F 2012 Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain Neuroscience letters 520 165 173 22487846 PMC3580050 source

      Not checked in the free run.

    • cites [16] Brown CA Jones AK 2010 Meditation experience predicts less negative appraisal of pain: Electrophysiological evidence for the involvement of anticipatory neural responses Pain 150 428 438 20494517 source

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    • cites [17] Gard T Holzel BK Sack AT Hempel H Vaitl D Ott U 2011 Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain Cerebral cortex 191 36 43 PMC3968314 22172578

      Not checked in the free run.

    • cites [18] Grant JA Courtemanche J Rainville P 2011 A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators Pain 152 150 156 21055874 source

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    • cites [19] Lutz A 2013 Altered anterior insula activation during anticipation and experience of painful stimuli in expert meditators NeuroImage 64 538 546 23000783 PMC3787201 source

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    • cites [20] Zeidan F 2016 Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids The Journal of neuroscience: the official journal of the Society for Neuroscience 36 3391 3397 26985045 PMC4792946 source

      Not checked in the free run.

    • cites [21] Zeidan F 2011 Brain mechanisms supporting the modulation of pain by mindfulness meditation The Journal of neuroscience: the official journal of the Society for Neuroscience 31 5540 5548 21471390 PMC3090218 source

      Not checked in the free run.

    • cites [22] Vago D Nakamura Y 2011 Selective Attentional Bias Towards Pain-Related Threat in Fibromyalgia: Preliminary Evidence for Effects of Mindfulness Meditation Training Cognitive Therapy and Research 35 581 594 source

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  • Premisecitation

    Nociceptive input is processed via feedback loops among lower-level sensory areas such as the parabrachial nucleus, PAG, thalamus, SI, and SII.

    “Nociceptive input is subsequently processed through feedback connections between lower-level sensory regions, including the parabrachial nucleus, periaqueductal gray matter (PAG), thalamus, and primary somatosensory (SI) and secondary somatosensory (SII) cortices.72–78”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [72] Basbaum AI Fields HL 1984 Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry Annu Rev Neurosci 7 309 338 6143527 source

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    • cites [73] Coghill RC McHaffie JG Yen YF 2003 Neural correlates of interindividual differences in the subjective experience of pain Proceedings of the National Academy of Sciences of the United States of America 100 8538 8542 12824463 PMC166264 source

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    • cites [74] Coghill RC 1999 Pain intensity processing within the human brain: a bilateral, distributed mechanism Journal of neurophysiology 82 1934 1943 10515983 source

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  • Premisecitation

    CBT and MBSR did not differ significantly on pain-related outcomes.

    “While there were no significant differences between the CBT and MBSR programs in pain-related outcomes”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Cherkin DC 2016 Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial Jama 315 1240 1249 27002445 PMC4914381 source

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  • Interpretationcitation

    Even fairly short mindfulness meditation training can meaningfully reduce chronic low back pain symptoms.

    “Taken together, these findings demonstrate that relatively brief bouts of mindfulness meditation training can significantly attenuate chronic low back pain symptomology.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Research indicates that mindfulness meditation substantially lowers pain in both laboratory and clinical contexts.

    “Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings.”
    • Also stated in: § Introduction · boosted
      “mindfulness-based meditation has repeatedly been found to significantly reduce chronic pain symptomologies;9–14”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [9] Kabat-Zinn J 1982 An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results General hospital psychiatry 4 33 47 7042457 source

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    • cites [10] Kabat-Zinn J Lipworth L Burney R 1985 The clinical use of mindfulness meditation for the self-regulation of chronic pain Journal of behavioral medicine 8 163 190 3897551 source

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    • cites [11] Morone NE Greco CM Weiner DK 2008 Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study Pain 134 310 319 17544212 PMC2254507 source

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    • cites [12] Garland EL 2011 Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations Journal of behavioral medicine PMC3883954 22161025 source

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    • cites [13] Gaylord SA 2011 Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial Am J Gastroenterol 106 1678 1688 21691341 PMC6502251 source

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    • cites [14] Grossman P 2007 Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being Psychotherapy and psychosomatics 76 226 233 17570961 source

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  • May combine two claims. 24

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Nociceptive signals travel to the brain on the opposite side, mainly via the spinothalamic tract.

    “From the spinal cord, nociceptive information ascends contralateral to the site of pain to the brain, largely through the spinothalamic pathway.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    An MBSR program improved pain symptoms and life quality in chronic pain patients, and gains persisted at three years.

    “Kabat-Zinn and colleagues revealed that chronic pain patients reported improvements in pain symptomology and quality of life after completing the MBSR program9 and improvements were sustained after a 3-year follow-up.10”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Kabat-Zinn J 1982 An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results General hospital psychiatry 4 33 47 7042457 source

      Not checked in the free run.

    • cites [10] Kabat-Zinn J Lipworth L Burney R 1985 The clinical use of mindfulness meditation for the self-regulation of chronic pain Journal of behavioral medicine 8 163 190 3897551 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meditation-induced analgesia was directly linked to stronger PFC deactivation and greater posterior insula activation.

    “However, meditation-induced analgesia was directly associated with greater deactivation of the PFC and increased activation of the posterior insula”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Gard T Holzel BK Sack AT Hempel H Vaitl D Ott U 2011 Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain Cerebral cortex 191 36 43 PMC3968314 22172578

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The ACC and PFC send projections to the PAG; the PAG projects to the rostral ventral medulla, which in turn projects to the spinal dorsal horn and can suppress nociceptive processing.

    “The ACC and PFC project to the PAG,116 a structure that can be directly activated by opioids. The PAG projects to the rostral ventral medulla,117–119 which, in turn, projects to the spinal dorsal horn and can inhibit nociceptive processing through multiple neurotransmitter systems.120”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [116] Floyd NS 2000 Orbitomedial prefrontal cortical projections to distinct longitudinal columns of the periaqueductal gray in the rat J Comp Neurol 422 556 578 10861526 source

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    • cites [117] Beitz AJ 1982 The organization of afferent projections to the midbrain periaqueductal gray of the rat Neuroscience 7 133 159 7078723 source

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    • cites [118] Mantyh PW 1983 Connections of midbrain periaqueductal gray in the monkey. II. Descending efferent projections J Neurophysiol 49 582 594 6300351 source

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    • cites [119] Mantyh PW 1983 Connections of midbrain periaqueductal gray in the monkey. I. Ascending efferent projections J Neurophysiol 49 567 581 6300350 source

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    • cites [120] Liebeskind JC 1973 Analgesia from electrical stimulation of the periaqueductal gray matter in the cat: behavioral observations and inhibitory effects on spinal cord interneurons Brain Res 50 441 446 4705513 source

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  • May combine two claims.

    Premisecitation

    During noxious heat, long-term Zen practitioners showed increased activity in sensory areas such as thalamus and insula, and decreased activity in evaluation-related mPFC and OFC.

    “long-term Zen practitioners showed significant activation of sensory processing–related brain regions (thalamus, insula) and reduced activation in brain areas that process the evaluation of pain (medial PFC (mPFC), OFC).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Grant JA Courtemanche J Rainville P 2011 A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators Pain 152 150 156 21055874 source

      Not checked in the free run.

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    Premisecitation

    Cognitive pain relief correlates with lower pain-related activation in SI, SII, posterior insula, and parietal operculum, alongside higher activation in ACC, PFC, and insula.

    “Pain relief produced by these cognitive techniques are associated with significant reductions in pain-related brain activation (i.e., SI, SII, posterior insula, parietal operculum) and activation in higher-order brain regions, such as the ACC, PFC, and insula.86, 89, 98–110”
    Quote in the paperSubstantial claim0 of 10 sources checked
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    • cites [89] Eippert F 2009 Activation of the opioidergic descending pain control system underlies placebo analgesia Neuron 63 533 543 19709634 source

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    • cites [98] Tracey I 2002 Imaging attentional modulation of pain in the periaqueductal gray in humans The Journal of neuroscience: the official journal of the Society for Neuroscience 22 2748 2752 11923440 PMC6758341 source

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    • cites [99] Valet M 2004 Distraction modulates connectivity of the cingulo-frontal cortex and the midbrain during pain--an fMRI analysis Pain 109 399 408 15157701 source

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    • cites [100] Koyama T 2005 The subjective experience of pain: where expectations become reality Proceedings of the National Academy of Sciences of the United States of America 102 12950 12955 16150703 PMC1200254 source

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    • cites [103] Wager TD 2011 Predicting individual differences in placebo analgesia: contributions of brain activity during anticipation and pain experience The Journal of neuroscience: the official journal of the Society for Neuroscience 31 439 452 21228154 PMC3735131 source

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    • cites [104] Wager TD 2004 Placebo-induced changes in FMRI in the anticipation and experience of pain Science 303 1162 1167 14976306 source

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    • cites [105] Wager TD Scott DJ Zubieta JK 2007 Placebo effects on human mu-opioid activity during pain Proceedings of the National Academy of Sciences of the United States of America 104 11056 11061 17578917 PMC1894566 source

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    Premisecitation

    The PFC, insula, and ACC are rich in opioid receptors and contribute to analgesia via descending inhibitory pathways.

    “Importantly, the PFC, insula, and ACC contain high concentrations of opioid receptors and are associated with producing analgesia through descending inhibitory systems.105, 111–115”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [105] Wager TD Scott DJ Zubieta JK 2007 Placebo effects on human mu-opioid activity during pain Proceedings of the National Academy of Sciences of the United States of America 104 11056 11061 17578917 PMC1894566 source

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    • cites [111] Casey KL 2000 Selective opiate modulation of nociceptive processing in the human brain Journal of neurophysiology 84 525 533 10899224 source

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    • cites [112] Willoch F 2004 Central poststroke pain and reduced opioid receptor binding within pain processing circuitries: a [11C]diprenorphine PET study Pain 108 213 220 15030940 source

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    • cites [113] Adler LJ 1997 Regional brain activity changes associated with fentanyl analgesia elucidated by positron emission tomography Anesthesia and analgesia 84 120 126 8989012 source

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    • cites [115] Jones AK 1991 In vivo distribution of opioid receptors in man in relation to the cortical projections of the medial and lateral pain systems measured with positron emission tomography Neuroscience letters 126 25 28 1650933 source

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    Premisecitation

    Factors such as conditioning, psychosocial context, facilitator attention, setting, posture, and demand characteristics might mediate health gains attributed to mindfulness meditation.

    “Nonspecific and potentially confounding variables, such as conditioning effects, psychosocial contexts, facilitator attention, intervention setting, body posture, and/or demand characteristics associated with the belief that one is practicing meditation,15, 27, 135 could mediate mindfulness meditation–related health improvements.136, 137”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [15] Zeidan F 2012 Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain Neuroscience letters 520 165 173 22487846 PMC3580050 source

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    • cites [27] Tang YY Holzel BK Posner MI 2015 The neuroscience of mindfulness meditation Nature reviews Neuroscience 16 213 225 25783612 source

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    • cites [135] Salomons TV Kucyi A 2011 Does Meditation Reduce Pain through a Unique Neural Mechanism? The Journal of neuroscience: the official journal of the Society for Neuroscience 31 12705 12707 21900549 PMC6623400 source

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    • cites [136] Colloca L 2010 How the number of learning trials affects placebo and nocebo responses Pain 151 430 439 20817355 PMC2955814 source

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    • cites [137] Lui F 2010 Neural bases of conditioned placebo analgesia Pain 151 816 824 20943318 source

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  • May combine two claims.

    Interpretationreasoning

    The neural underpinnings of mindfulness-based pain relief align with the proposed mindful state: more sensory processing and less pain appraisal.

    “Taken together, these findings are important because they demonstrate that the neural mechanisms involved in mindfulness-based pain relief are consistent with the postulated psychological expression/experience of mindfulness (i.e., greater sensory processing and parallel reductions in pain appraisal).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Mindfulness meditation pain relief involved more executive-level pain modulation, while sham mindfulness analgesia arose from bottom-up processes resembling placebo and relaxation.

    “That is, mindfulness meditation–related pain relief was associated with greater executive-level modulation of pain and, in contrast, sham mindfulness meditation–induced analgesia was driven by bottom-up processes consistent with placebo and relaxation.144”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [144] Benson H Greenwood MM Klemchuk H 1975 The relaxation response: psychophysiologic aspects and clinical applications International journal of psychiatry in medicine 6 87 98 773864 source

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    Premisecitation

    MBSR outperformed HEP in lowering inflammatory responses after social stress and in reducing experimentally induced pain ratings.

    “However, the MBSR program was more effective at reducing inflammatory responses following social stress141 and experimentally-induced pain ratings.139”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [141] Rosenkranz MA 2013 A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation Brain, behavior, and immunity 27 174 184 PMC3518553 23092711 source

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    • cites [139] MacCoon DG 2012 The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR) Behaviour research and therapy 50 3 12 22137364 PMC3257026 source

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  • May combine two claims.

    Interpretationreasoning

    Brief mental training in meditation influences both sensory and affective pain responses.

    “Thus, meditation after brief mental training affects sensory and affective pain-related responses.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A proposed meta-awareness shift allows skilled meditators to experience an intrusive sensation without evaluating it.

    “For instance, a shift in meta-awareness has been proposed,45 in which adept meditators can engage an invasive sensation (e.g., pain) without appraising/evaluating the event.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Vago DR Silbersweig DA 2012 Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness Frontiers in human neuroscience 6 296 23112770 PMC3480633 source

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  • May combine two claims.

    Premiseown data

    Placebo cream analgesia involved less pain-related activity in posterior insula/parietal operculum and SII, and more activity in thalamus and PAG, than mindfulness meditation.

    “Placebo-cream analgesia was associated with significant reductions in pain-related brain activation (posterior insula/parietal operculum; secondary somatosensory cortices) and produced greater activation in the thalamus and PAG compared to mindfulness meditation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Zeidan F 2015 Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia The Journal of neuroscience: the official journal of the Society for Neuroscience 35 15307 15325 26586819 PMC4649004 source

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  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Changes in executive attention are hypothesized to enable broad modulation of both pain intensity and unpleasantness.

    “The comprehensive modulation of both the intensity- and unpleasantness-related dimensions of pain is hypothetically facilitated through changes in executive attention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Both HEP and MBSR reduced self-reported anxiety, distress, hostility, and attentional stability, with no significant group differences.

    “Although the HEP and MBSR program were effective at reducing self-reports of anxiety, distress, hostility,139 and attentional stability,140 there were no significant differences between groups.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [139] MacCoon DG 2012 The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR) Behaviour research and therapy 50 3 12 22137364 PMC3257026 source

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    • cites [140] MacCoon DG 2014 No sustained attention differences in a longitudinal randomized trial comparing mindfulness based stress reduction versus active control PloS one 9 e97551 24955584 PMC4067292 source

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    Premisecitation

    Cognitive pain modulation from placebo, conditioned pain modulation, and attentional control partly depends on descending pain control and can be blocked by naloxone.

    “it is well established that the cognitive modulation of pain, including manipulations such as placebo89, 91–93, 105, 145, conditioned pain modulation,94 and attentional control,97 is partially dependent on descending pain control systems98, 146 and can be reversed by the opioid antagonist naloxone.90, 91, 97, 147”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [89] Eippert F 2009 Activation of the opioidergic descending pain control system underlies placebo analgesia Neuron 63 533 543 19709634 source

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    • cites [91] Levine JD Gordon NC Fields HL 1978 The mechanism of placebo analgesia Lancet 2 654 657 80579 source

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    • cites [92] Zubieta JK 2005 Placebo effects mediated by endogenous opioid activity on mu-opioid receptors The Journal of neuroscience: the official journal of the Society for Neuroscience 25 7754 7762 16120776 PMC6725254 source

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    • cites [93] Amanzio M Benedetti F 1999 Neuropharmacological dissection of placebo analgesia: expectation-activated opioid systems versus conditioning-activated specific subsystems The Journal of neuroscience: the official journal of the Society for Neuroscience 19 484 494 9870976 PMC6782391 source

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    • cites [105] Wager TD Scott DJ Zubieta JK 2007 Placebo effects on human mu-opioid activity during pain Proceedings of the National Academy of Sciences of the United States of America 104 11056 11061 17578917 PMC1894566 source

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    • cites [145] Petrovic P 2002 Placebo and opioid analgesia-- imaging a shared neuronal network Science 295 1737 1740 11834781 source

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    • cites [94] King CD 2013 Reduction of conditioned pain modulation in humans by naltrexone: an exploratory study of the effects of pain catastrophizing J Behav Med 36 315 327 22534819 PMC3774309 source

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    • cites [98] Tracey I 2002 Imaging attentional modulation of pain in the periaqueductal gray in humans The Journal of neuroscience: the official journal of the Society for Neuroscience 22 2748 2752 11923440 PMC6758341 source

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    • cites [146] Bantick SJ 2002 Imaging how attention modulates pain in humans using functional MRI Brain: a journal of neurology 125 310 319 11844731 source

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  • May combine two claims.

    Interpretationreasoning

    Novices use more effortful reappraisal to reduce pain, whereas experts use no-appraisal mechanisms.

    “In contrast, novice meditators engage more effortful reappraisal processes to reduce pain, and adept meditators employ no-appraisal mechanisms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    After brief training of under a week, meditation significantly lowers both pain intensity and unpleasantness ratings.

    “While meditation after brief training (less than 1 week) produces significant reductions in pain intensity and unpleasantness ratings,20, 21, 23, 122, 142”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [20] Zeidan F 2016 Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids The Journal of neuroscience: the official journal of the Society for Neuroscience 36 3391 3397 26985045 PMC4792946 source

      Not checked in the free run.

    • cites [21] Zeidan F 2011 Brain mechanisms supporting the modulation of pain by mindfulness meditation The Journal of neuroscience: the official journal of the Society for Neuroscience 31 5540 5548 21471390 PMC3090218 source

      Not checked in the free run.

    • cites [23] Zeidan F 2015 Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia The Journal of neuroscience: the official journal of the Society for Neuroscience 35 15307 15325 26586819 PMC4649004 source

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    • cites [122] Perlman DM 2010 Differential effects on pain intensity and unpleasantness of two meditation practices Emotion 10 65 71 20141303 PMC2859822 source

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    • cites [142] Zeidan F 2010 The effects of brief mindfulness meditation training on experimentally induced pain The journal of pain: official journal of the American Pain Society 11 199 209 19853530 source

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  • May combine two claims.

    Premiseown data

    Compared with mindfulness meditation, sham mindfulness meditation produced more thalamic activation and more rostral ACC deactivation.

    “In contrast to mindfulness meditation, sham mindfulness meditation produced greater activation in the thalamus and deactivation of the rostral ACC.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Zeidan F 2015 Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia The Journal of neuroscience: the official journal of the Society for Neuroscience 35 15307 15325 26586819 PMC4649004 source

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  • May combine two claims.

    Interpretationcitation

    Long-term meditation does not alter pain intensity but does affect the unpleasantness component of self-reported pain.

    “long-term meditation does not produce changes/differences in pain intensity but rather influences the unpleasantness dimension of self-reported pain.17, 121, 122”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] Gard T Holzel BK Sack AT Hempel H Vaitl D Ott U 2011 Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain Cerebral cortex 191 36 43 PMC3968314 22172578

      Not checked in the free run.

    • cites [121] Grant JA Rainville P 2009 Pain sensitivity and analgesic effects of mindful states in Zen meditators: a cross-sectional study Psychosomatic medicine 71 106 114 19073756 source

      Not checked in the free run.

    • cites [122] Perlman DM 2010 Differential effects on pain intensity and unpleasantness of two meditation practices Emotion 10 65 71 20141303 PMC2859822 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mindfulness meditation lowers PAG activity, and the PAG helps enable opioid-mediated descending pain inhibition.

    “On the other hand, mindfulness meditation also reduces activation in the PAG, a brain region involved in facilitating opioid-mediated descending pain inhibition.72, 149”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [72] Basbaum AI Fields HL 1984 Endogenous pain control systems: brainstem spinal pathways and endorphin circuitry Annu Rev Neurosci 7 309 338 6143527 source

      Not checked in the free run.

    • cites [149] Watkins LR Mayer DJ 1982 Organization of endogenous opiate and nonopiate pain control systems Science 216 1185 1192 6281891 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    OFC activity may strengthen inhibitory links from thalamic reticular nuclei, limiting cortical elaboration of nociceptive signals, as suggested by lower thalamic, PAG, and SI activity.

    “Activation of the OFC may facilitate inhibitory connections of the thalamic reticular nuclei (TRN) to further reduce the elaboration of nociceptive information throughout the cortex (evidenced by reductions in thalamic, PAG, and SI activation).21, 23”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Zeidan F 2011 Brain mechanisms supporting the modulation of pain by mindfulness meditation The Journal of neuroscience: the official journal of the Society for Neuroscience 31 5540 5548 21471390 PMC3090218 source

      Not checked in the free run.

    • cites [23] Zeidan F 2015 Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia The Journal of neuroscience: the official journal of the Society for Neuroscience 35 15307 15325 26586819 PMC4649004 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Recent studies of fibromyalgia and chronic low back pain patients receiving mindfulness training show a decoupling of sensory and affective pain, where pain intensity or frequency may not decrease but coping improves.

    “Some recent studies of fibromyalgia22 and chronic low back pain54 patients who received mindfulness training also see a similar decoupling of sensory and affective pain, such that pain intensity or frequency does not necessarily decrease, but coping with the pain does improve.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22] Vago D Nakamura Y 2011 Selective Attentional Bias Towards Pain-Related Threat in Fibromyalgia: Preliminary Evidence for Effects of Mindfulness Meditation Training Cognitive Therapy and Research 35 581 594 source

      Not checked in the free run.

    • cites [54] Morone NE 2008 “I felt like a new person.” the effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries The journal of pain: official journal of the American Pain Society 9 841 848 18550444 PMC2569828 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Long-term meditation practice is linked to more somatosensory activation and less activity in appraisal-related vmPFC.

    “In contrast, the neural mechanisms involved in long-term meditation practice are associated with significantly greater activation in somatosensory regions and deactivation of appraisal-related brain regions (vmPFC).17, 18”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Gard T Holzel BK Sack AT Hempel H Vaitl D Ott U 2011 Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain Cerebral cortex 191 36 43 PMC3968314 22172578

      Not checked in the free run.

    • cites [18] Grant JA Courtemanche J Rainville P 2011 A non-elaborative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators Pain 152 150 156 21055874 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    In long-term meditators, separation of sensory pain from its meaning suggests that meditation's analgesic effects can grow with more practice.

    “The decoupling between the sensory experience and the meaning and/or contextualization of what the pain means to the self, in long-term meditation practitioners, provides evidence that the analgesic effects of meditation can be developed and enhanced through greater practice”
    Quote in the paperSubstantial claim
26 of 26

  • The paper relies on this without support.

    A lack of mechanistic classification and reproducibility has lowered clinical acceptance of meditation for treating pain.

    “However, lack of mechanistic classification and reproducibility has reduced the clinical acceptance of meditation to treat pain.”

  • The paper relies on this without support.

    Placebo-controlled meditation studies have been scarce.

    “Yet, placebo-controlled meditation studies have been limited”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Hypnosis and mindfulness meditation are promising for multiple chronic pain conditions and are considered priorities for additional research and dissemination.

    “Two self-management approaches, hypnosis (HYP)[12–14] and mindfulness meditation(MM)[15–17], show promise across a range of chronic pain conditions and have been identified as priorities for further study and dissemination.[18]”

    From The chronic pain skills study: Protocol for a randomized controlled trial comparing hypnosis, mindfulness meditation and pain education in Veterans (2020) · cites this paper as [17]

    The section “Mindfulness meditation improves chronic pain symptomology” reports benefits across several pain conditions and calls for further research on mindfulness for chronic low back pain. The paper mentions hypnosis only as a mechanism of pain relief; it does not identify both hypnosis and mindfulness as priorities for further study and dissemination. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Randomized trials indicate that mindfulness alleviates pain by reducing thalamic amplification of nociceptive signals via prefrontal cognitive control mechanisms.

    “and reducing thalamic amplification of nociceptive signals via prefrontal cognitive control mechanisms. 14”

    From Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. (2017) · cites this paper as [14]

    The section on placebo analgesia describes a randomized study in which mindfulness reduced pain and was associated with greater OFC activation and less thalamic activation than placebo conditions. But the section on brief training calls OFC-to-thalamus inhibition a postulated mechanism, and the Conclusion describes that mechanism as hypothetical. The claim overstates the evidence by presenting this proposed causal pathway as established by randomized trials. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Mindfulness training can relieve pain through effects on cognitive, emotional, sensory, and self-processing neural networks.

    “mindfulness training can relieve pain via effects on cognitive, emotional, sensory, and self-processing neural networks [60]”

    From Mindfulness and physical disease: a concise review (2019) · cites this paper as [60]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Interventions are said to produce chronic pain

    Minor

    The passage says mindfulness interventions produce chronic pain, whereas the same section says they attenuate chronic low-back-pain symptoms.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Zeidan F., 2015, Handbook of Mindfulness Science: Theory, Research and Practice, 171

Cited by

Sorted by citations

Related

Authors
Zeidan, F., & Vago, D. R.
Affiliations
  • Wake Forest University Health Sciences (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Zeidan, Fadel
ORCID
Venue
Annals of the New York Academy of Sciences
Publisher
Wiley
Published
2016-06
Volume
1373
Issue
1
Pages
114-127
ISSN
  • 0077-8923 (ISSN-L)
  • 1749-6632
DOI
10.1111/nyas.13153
PMC
PMC4941786
OpenAlex
W2481681901
Semantic Scholar
88b3f873df74b7d29e92231c12b70cf9158b3802
Cited by
300
References
170
Citations by year
2026: 23 · 2025: 44 · 2024: 32 · 2023: 31 · 2022: 45 · 2021: 44 · 2020: 27 · 2019: 25 · 2018: 19 · 2017: 10
FWCI
2.66
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 40 d)
Locations
  • Annals of the New York Academy of Sciences (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR001420)
  • National Center for Advancing Translational Sciences
  • National Center for Complementary and Integrative Health (L30 AT006838, F32AT006949, K99AT008238)
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
mindfulness meditation, analgesia, chronic pain, opioid epidemic, non-pharmacological pain management, pain mechanisms, opioid use disorder
MeSH terms
Humans, Treatment Outcome, Meditation, Chronic Pain, Pain Management, Mindfulness

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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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

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