Nondual awareness as a novel chronic pain-relieving mechanism.
Kush V. Bhatt, Adam W. Hanley, Chantal Martin-Soelch, Chantal Berna, Eric L. Garland
Psychology of Consciousness Theory Research and Practice May 11, 2026 Peer reviewed DOI: 10.1037/cns0000474 via OpenAlex
Summary
Mindfulness-Oriented Recovery Enhancement (MORE), an 8-week mindfulness-based intervention, significantly reduced chronic pain severity and interference in patients on long-term opioid therapy compared to a control group. The study involved 480 participants and found that increases in nondual awareness mediated these reductions in pain. Participants in the MORE group also showed significant increases in nondual awareness. Nondual awareness was a more effective mediator than mindfulness nonreactivity in explaining the pain-relieving effects of mindfulness.
Study at a glance
| Design | randomized controlled trial |
|---|---|
| Sample size | 480 |
| Population | patients receiving long-term opioid analgesic therapy for chronic pain |
| Key finding | Mindfulness-Oriented Recovery Enhancement significantly reduced chronic pain severity and interference while increasing nondual awareness, which mediated these pain reductions. |
Abstract
Mindfulness-based interventions are efficacious nonpharmacologic treatments for chronic pain, yet the psychological mechanisms mediating the pain-relieving effects of mindfulness-based interventions remain incompletely understood. One potential mechanism may involve nondual awareness, a state of consciousness characterized by attenuation of the subject-object duality, reduced self-referential thinking, and an increased sense of connectedness with others and the world at large. We conducted a secondary analysis of pooled data from two randomized controlled trials (N = 480) investigating the effects of Mindfulness-Oriented Recovery Enhancement (MORE), an 8-week mindfulness-based intervention, in patients receiving long-term opioid analgesic therapy for chronic pain. We tested whether nondual awareness, as measured by the Nondual Awareness Dimensional Assessment, mediated the effect of MORE on chronic pain severity and interference. Results demonstrated that MORE was associated with significantly lower chronic pain severity (p = .014) and pain interference (p < .001) compared with a supportive group therapy control condition. Moreover, participants in the MORE condition exhibited significant increases in nondual awareness compared with the control group (p < .001). Multivariate path analyses revealed that increases in nondual awareness significantly mediated reductions in chronic pain severity (p = .002) and pain interference (p = .01). Nondual awareness outperformed the mindfulness facet of nonreactivity as a mediator of mindfulness' pain-relieving effects. Study findings demonstrate a link between mindfulness-induced nondual awareness and alleviation of chronic pain. Future research should elucidate the neurobiological mechanisms of this relationship. Moreover, studies could identify other potential interventions that produce nondual awareness (e.g., psychedelics) to address chronic pain, possibly in conjunction with mindfulness-based interventions.