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Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation
Open accessAbstract
The subjective experience of one's environment is constructed by interactions among sensory, cognitive, and affective processes. For centuries, meditation has been thought to influence such processes by enabling a nonevaluative representation of sensory events. To better understand how meditation influences the sensory experience, we used arterial spin labeling functional magnetic resonance imaging to assess the neural mechanisms by which mindfulness meditation influences pain in healthy human participants. After 4 d of mindfulness meditation training, meditating in the presence of noxious stimulation significantly reduced pain unpleasantness by 57% and pain intensity ratings by 40% when compared to rest. A two-factor repeated-measures ANOVA was used to identify interactions between meditation and pain-related brain activation. Meditation reduced pain-related activation of the contralateral primary somatosensory cortex. Multiple regression analysis was used to identify brain regions associated with individual differences in the magnitude of meditation-related pain reductions. Meditation-induced reductions in pain intensity ratings were associated with increased activity in the anterior cingulate cortex and anterior insula, areas involved in the cognitive regulation of nociceptive processing. Reductions in pain unpleasantness ratings were associated with orbitofrontal cortex activation, an area implicated in reframing the contextual evaluation of sensory events. Moreover, reductions in pain unpleasantness also were associated with thalamic deactivation, which may reflect a limbic gating mechanism involved in modifying interactions between afferent input and executive-order brain areas. Together, these data indicate that meditation engages multiple brain mechanisms that alter the construction of the subjectively available pain experience from afferent information.
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“The neural mechanisms of mindfulness-based pain relief have demonstrated that reductions of pain intensity are associated with heightened activity of the anterior cingulate cortex, the anterior insula, and the orbitofrontal cortex, while reductions in pain unpleasantness are associated with attenuated activity of the thalamus.32”
From Mechanisms of mindfulness in patients with migraine: Results of a qualitative study. (2023) · cites this paper as [32]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Brain imaging has shown that mindfulnessmeditation-related pain reductions are associated with activation of the perigenual ACC, OFC, and anterior insula (Zeidan et al., 2011;Zeidan et al., 2015).”
From Mindfulness-meditation-based pain relief is not mediated by endogenous opioids (2016) · cites this paper as Zeidan et al., 2011
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Based on our previous studies (Zeidan et al., 2010a;Zeidan et al., 2011;Zeidan et al., 2015) and sample size determination software (G*power, 3.1), 16 subjects per group were considered sufficient to detect a signifi-cant difference (large effect size ϭ p 2 ϭ.14) between groups on a twosided, 0.05 test of proportions [repeated-measures (RM)”
From Mindfulness-meditation-based pain relief is not mediated by endogenous opioids (2016) · cites this paper as Zeidan et al., 2011
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Specifically, mindfulness meditation significantly deactivates the thalamus (Zeidan et al., 2011;Zeidan et al., 2015), potentially reflecting cognitive gating of the transmission of sensory information to the cortex (Zeidan et al., 2011;Zeidan et al., 2012).”
From Mindfulness-meditation-based pain relief is not mediated by endogenous opioids (2016) · cites this paper as Zeidan et al., 2011
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“While mindfulness meditation has been shown to attenuate the subjective pain experience in healthy controls,31, 32”
From Mechanisms of mindfulness in patients with migraine: Results of a qualitative study. (2023) · cites this paper as [32]
The cited source says what the claim attributes to it.
In the citing paper
“Though these mindfulness interventions are too truncated to expect any long-term effects, studies indicate that they can have immediate effects on psychological and neuroendocrine responses to social stress,60 and perceived pain severity in response to noxious heat stimulation.61”
From Mindfulness-Based Interventions for Anxiety and Depression (2017) · cites this paper as [61]
The cited source says what the claim attributes to it.
In the citing paper
“some impact on pain intensity may be reached because mindfulness skills have been found to influence brain mechanisms that may alter the pain experience (Zeidan et al., 2011).”
From Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review (2016) · cites this paper as Zeidan et al., 2011
The cited source says what the claim attributes to it.
In the citing paper
“Importantly, mindfulness-meditation-induced pain relief is also associated with reduced thalamic activity, which may be related to significantly attenuated low-level sensory processing (Zeidan et al., 2011).”
From Mindfulness-meditation-based pain relief is not mediated by endogenous opioids (2016) · cites this paper as Zeidan et al., 2011
The cited source says what the claim attributes to it.
In the citing paper
“Brief mindfulness interventions have been reported to reduce experimentally-induced pain in the laboratory, 15, 16”
From Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. (2017) · cites this paper as [15]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“So, decreased functional connectivity in these regions may contribute to enhanced quality of life that is reported post-ACT [21,40].”
From Graph theory analysis of induced neural plasticity post-Acceptance and Commitment Therapy for chronic pain (2020) · cites this paper as [40]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Activation of these regions has been linked to thoughts of helplessness, pessimism, and rumination in the instance of CMP [40].”
From Graph theory analysis of induced neural plasticity post-Acceptance and Commitment Therapy for chronic pain (2020) · cites this paper as [40]
Experimental — accuracy not yet measuredIn the citing paper
“A number of studies have found that meditation-related activation or volume increases are lateralized to the right hemisphere and correspond to tonic alertness–related brain areas (lateral PFC, inferior parietal, and anterior insula).65–70”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [70]
In the citing paper
“Buddhist meditation practices have been found to be associated with increases in activation in the dACC both during meditation45,65,76,78,86 and during tasks.70,80,81,87–89”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [70]
In the citing paper
“Converging evidence suggests that meditation training may be associated with decreased DMN activity,67, 70, 87, 94, 97–99”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [70]
In the citing paper
“Buddhist meditation practices have been found to be associated with increased activity in the DLPFC, both during meditation45,65,76–79 and during tasks,67,70,80,81 as well as larger frontal gray matter volumes.66,82,83”
From Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness (2014) · cites this paper as [70]
In the citing paper
“Vipassana meditation has been described as a state of nonappraisal and/or a nonelaborative mental stance.45,137”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [137]
In the citing paper
“Regression analyses revealed that greater pain relief was directly associated with greater activation of the pgACC, right anterior insula, and bilateral OFC.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“Focusing on the breath before the intervention reduced pain unpleasantness ratings but not pain intensity ratings when compared with rest.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“To this extent, it is now well established that mindfulness meditation significantly reduces pain after brief mental training (4 days > 4 weeks).62,134–136,141”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“In the presence of noxious heat, mindfulness significantly reduced SI activation corresponding to the stimulation site (right leg), suggesting that mindfulness reduces ascending nociceptive inputs to somatosensory cortical regions.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“In the presence of noxious heat, mindfulness significantly reduced SI activation corresponding to the stimulation site (right leg), suggesting that mindfulness reduces ascending nociceptive inputs to somatosensory cortical regions.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“After training, mindful attention to the breath significantly reduced pain intensity (↓40%) and pain unpleasantness (↓57%) ratings when compared with rest.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“Mindfulness meditation produced widespread activation of the (1) ACC extending from the dACC to the perigenual ACC (pgACC), (2) bilateral orbitofrontal cortex (OFC), (3) the primary somatosensory cortices (SI) corresponding to the face region, (4) bilateral ventral striatum, and (5) deactivation of the default mode network.141”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“Greater mindfulness-based pain relief was also associated with significant extensive, bilateral deactivation of the thalamus, a critical node of ascending nociceptive information from the spinal cord (Fig. 1).49”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“There was also significant deactivation of the PAG and thalamus, replicating and extending on the findings described in the previous ASL study.141”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“Furthermore, when compared with BOLD, ASL fMRI can reliably assess rostral neural regions, such as the OFC,126 a brain area repeatedly implicated in mindfulness meditation,135,141 but suffering from substantial susceptibility artifacts.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [141]
In the citing paper
“For instance, we found that mindfulness significantly increases on average by 13% after only three to four, 20 minutes sessions of mindfulness–based mental training [83; 84; 86–88].”
From Neural mechanisms supporting the relationship between dispositional mindfulness and pain (2018) · cites this paper as [88]
In the citing paper
“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 [21]
In the citing paper
“We postulated that mindfulness meditation attenuates pain through engagement of top-down (OFC to thalamus) inhibition of ascending nociceptive information.15, 20, 21, 23”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“Meditation, after the four-session intervention, during noxious heat produced a mean 40% reduction in pain intensity and 57% reduction in pain unpleasantness ratings.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“Greater activation of the subgenual ACC (sgACC), OFC, and right anterior insula (Fig. 1) was associated with mindfulness meditation–based analgesia.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“We also found that mindfulness meditation–based pain relief was associated with greater bilateral thalamic deactivation (Fig. 1) 21.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“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”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“While meditation after brief training (less than 1 week) produces significant reductions in pain intensity and unpleasantness ratings,20, 21, 23, 122, 142”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“Novice meditators recruit higher-order brain regions (OFC, sgACC, anterior insula) to downregulate ascending nociceptive input at the level of the thalamus through shifts in executive attention.21,23”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“Mindfulness meditation–based pain relief was associated with similar brain activation as in our previous neuroimaging study,21 including greater activation of the OFC, pregenual ACC (pgACC), and right anterior insula.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [21]
In the citing paper
“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 [21]
In the citing paper
“Mindfulness training decreases the suffering that accompanies painful stimuli,48,50 an effect that seems in part to be orthogonal to opioid-dependent pain processing.47”
From Randomized, wait-list–controlled pilot study of app-delivered mindfulness for patients reporting chronic pain (2021) · cites this paper as [50]
In the citing paper
“These promising results at the end of the proposed mindfulness program may indicate reduced subjective pain and changes in the brain [25-27].”
From A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation (2017) · cites this paper as [27]
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Oshiro, Y., Quevedo, A. S., McHaffie, J. G., Kraft, R. A., & Coghill, R. C. (2009) · The Journal of Neuroscience · doi:10.1523/jneurosci.5538-08.2009 · Cited by 133
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Self-citationDoes meditation training lead to enduring changes in the anticipation and experience of pain?
Buhle, J. T., & Wager, T. D. (2010) · Pain · doi:10.1016/j.pain.2010.05.004 · Cited by 21
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A thalamo-cortical model of the executive attention system
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Flagged first, then by citations
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Cited by
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The Neuroscience of Mindfulness Meditation
Tang, Y.-Y., Hölzel, B. K., & Posner, M. I. (2015) · Nature reviews. Neuroscience · doi:10.1038/nrn3916 · Cited by 2,889
Cognitive and emotional control of pain and its disruption in chronic pain
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Metadata
- Authors
- Zeidan, F., Martucci, K. T., Kraft, R. A., Gordon, N. S., McHaffie, J. G., & Coghill, R. C.
- Affiliations
- Marquette University (US)
- Wake Forest University Health Sciences (US)
- Corresponding author
- Zeidan, Fadel
- Venue
- The Journal of Neuroscience
- Publisher
- Society for Neuroscience
- Published
- 2011-04-06
- Volume
- 31
- Issue
- 14
- Pages
- 5540-5548
- ISSN
- 0270-6474 (ISSN-L)
- 1529-2401
- PMC
- PMC3090218
- OpenAlex
- W2151568754
- Cited by
- 640
- References
- 64
- Citations by year
- 2026: 31 · 2025: 27 · 2024: 42 · 2023: 40 · 2022: 42 · 2021: 49 · 2020: 42 · 2019: 46 · 2018: 47 · 2017: 44 · 2016: 41 · 2015: 50 · 2014: 55 · 2013: 35 · 2012: 37
- FWCI
- 47.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Neuroscience (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- e-Publications@Marquette (Marquette University) (submittedVersion)
- Funders
- Wake Forest University
- Mind and Life Institute
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke (NS-39426, R01NS039426)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Keywords
- mindfulness meditation, pain modulation, pain unpleasantness, pain intensity, primary somatosensory cortex, anterior cingulate cortex, anterior insula, orbitofrontal cortex, thalamus, arterial spin labeling, individual differences, meditation training
- MeSH terms
- Adult, Analysis of Variance, Attention, Brain, Brain Mapping, Female, Humans, Image Processing, Computer-Assisted, Individuality, Functional Laterality, Magnetic Resonance Imaging, Male, Oxygen, Pain, Pain Measurement, Physical Stimulation, Psychophysics, Regression Analysis, Pain Threshold, Meditation, Young Adult, Pain Management
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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.
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