Nondual awareness as a novel chronic pain-relieving mechanism.

Mindfulness-based interventions reduce chronic pain, and a secondary analysis of two randomized controlled trials (480 patients on long-term opioid therapy) suggests that nondual awareness—a state of attenuated self-other distinction—partly explains this effect. Participants in an 8-week mindfulness program (MORE) showed significantly lower pain severity and interference than a supportive therapy control group, along with greater increases in nondual awareness. Path analyses indicated that gains in nondual awareness mediated the reductions in pain severity and interference, and nondual awareness was a stronger mediator than the mindfulness facet of nonreactivity. The findings link mindfulness-induced nondual awareness to chronic pain relief, and future work should explore neurobiological mechanisms and other interventions that foster nondual awareness.

Study at a glance

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.