Pain regulation during mindfulness meditation: phenomenological fingerprints in novice and expert practitioners

Summary

People respond to pain based on psychological mechanisms, beliefs, and expectations. Mindfulness meditation helps regulate pain through positive reappraisal and emotional regulation, but how people subjectively experience pain in connection with meditation is not well understood. In a mixed-methods study combining qualitative interviews with an experimental thermal pain task, 32 novices who received short meditation training and 30 experts with over 10,000 lifetime hours of practice described their pain experiences. Five phenomenological clusters emerged: pain as an unpleasant sensation prompting avoidance-suppression, volitional agency-distanciation, or positive cognitive reappraisal and flexibility; and, mainly among experts, pain as an opportunity for metacognitive insights about mental processes and for deconstructing suffering, with the fifth cluster integrating shared human suffering and compassion. Each cluster correlated with distinct self-reports during the pain task.

Study at a glance

Abstract

Background: The way people respond to pain is based on psychological mechanisms, beliefs and expectations. Mindfulness meditation (MM) has been shown to regulate pain and mental suffering through different mechanisms such as positive reappraisal, attentional and emotional regulation. Yet, subjective experience and meaning of pain in connection with MM are still largely unexplored.Methods: The present mixed-methods study combined an interpretative-phenomenological qualitative approach with an experimental thermal pain paradigm to explore and compare the meaning of experiencing pain in 32 novices who received short meditation training and 30 experts in meditation practice (more than 10, 000 hours in life). We collected the qualitative data during in-depth semi-structured interviews where we probed participants’ response strategies. During the pain task, we collected self-reports of intensity and unpleasantness, while after the task we collected self-reports of avoidance, openness, vividness and blissfulness. Results: Five phenomenological clusters (PhC) emerged from the interviews, including three which described pain as an unpleasant sensation calling for: 1) experiential avoidance-suppression, 2) volitional agency-distanciation, or 3) a positive cognitive reappraisal and flexibility. Two additional clusters (4-5), containing mostly expert meditators, thematized pain sensation as an opportunity to gain metacognitive insights about mental processes, and to deconstruct one’s suffering through these insights. PhC5 further integrates these insights with the recognition that suffering is part of the shared human experience and with the aspiration to relieve others from suffering. Each PhC was correlated to a unique profile of self-reports during the pain paradigm. Conclusion: These findings need to be replicated in patients with severe and chronic pain and practicing MM. They also warrant the integration of this mixed-method approach with brain imaging data to refine the experiential neuroscience of pain.Significance: We compared the meaning of experiencing and regulating pain in novices and expert meditators using qualitative interviews. We identified five phenomenological clusters describing relevant features implicated in pain response strategies and meditation. These clusters were organized along a pseudo-gradient, which captured meditation expertise and predicted self-reports related to a pain paradigm and psychometric scales associated with pain and its regulation. These findings advance our understanding of the metacognitive mechanisms and beliefs underlying mindfulness meditation and can inform pain treatment strategies