Mindfulness meditation is related to sensory‐affective uncoupling of pain in trained novice and expert practitioners

Summary

Mindfulness meditation reduces the unpleasantness of pain without lowering its perceived intensity, and this effect is stronger in expert meditators than in novices. In a cross-sectional study, participants practiced Open Monitoring meditation or attentional distraction while receiving thermal pain stimuli of varying duration. Meditation lowered unpleasantness ratings compared to distraction in both groups. Expert meditators reported less pain catastrophizing, showed a greater separation between sensory and affective pain processing during long stimuli, and this uncoupling carried over into the control condition. Higher pain catastrophizing scores predicted weaker sensory-affective uncoupling during long stimuli and higher pain intensity ratings during short stimuli. The findings indicate that mindfulness specifically targets the emotional dimension of pain and that pain catastrophizing interferes with this process.

Study at a glance

Abstract

BACKGROUND: Mindfulness meditation can alleviate acute and chronic pain. It has been proposed that mindfulness meditation reduces pain by uncoupling sensory and affective pain dimensions. However, studies to date have reported mixed results, possibly due to a diversity of styles of and expertise in mindfulness meditation. Furthermore, the interrelations between mindfulness meditation and pain catastrophizing during acute pain remain little known. METHODS: This cross-sectional study investigated the effect of a style of mindfulness meditation called Open Monitoring (OM) on sensory and affective pain experience by comparing novice (2-day formal training; average ~20 hr practice) to expert practitioners (>10.000 hr practice). We implemented a paradigm that was designed to amplify the cognitive-affective aspects of pain experience by the manipulation of pain anticipation and uncertainty of stimulus length (8 or 16 s thermal pain stimuli). We collected pain intensity and unpleasantness ratings and assessed trait pain catastrophizing with the Pain Catastrophizing Scale (PCS). RESULTS: Across groups, mindfulness meditation reduced unpleasantness, but not intensity ratings compared to attentional distraction. Experts reported a lower score on PCS, reduced amplification of unpleasantness by long painful stimuli, and larger sensory-affective uncoupling than novices particularly during long painful stimuli. In experts, meditation-induced uncoupling spilled over the control condition. Across groups and task conditions, a higher score on PCS predicted lower sensory-affective uncoupling during long painful stimuli and higher ratings of pain intensity during short painful stimuli. CONCLUSION: These findings suggest that mindfulness meditation specifically down-regulates pain affect as opposed to pain intensity, and that pain catastrophizing undermines sensory-affective uncoupling of pain. SIGNIFICANCE: In this study, we found that a style of mindfulness meditation referred to as OM reduced unpleasantness but not intensity ratings compared to attentional distraction in trained novice (state effect) and expert meditators (state and trait effects). We also observed that trait pain catastrophizing scores predicted this sensory-affective uncoupling. These findings advance our understanding of the cognitive mechanisms underlying mindfulness meditation and can inform treatment strategies for chronic pain.