Abstract
BACKGROUND: Rather than a passive reflection of nociception, pain is shaped by the interplay between one's experiences, current cognitive-affective states, and expectations. The placebo response, a paradoxical yet reliable phenomenon, is postulated to reduce pain by engaging mechanisms shared with active therapies. It has been assumed that mindfulness meditation, practiced by sustaining nonjudgmental awareness of arising sensory events, merely reflects mechanisms evoked by placebo. Recently, brain-based multivariate pattern analysis has been validated to successfully disentangle nociceptive-specific, negative affective, and placebo-based dimensions of the subjective pain experience. METHODS: To determine whether mindfulness meditation engages distinct brain mechanisms from placebo and sham mindfulness to reduce pain, multivariate pattern analysis pain signatures were applied across 2 randomized clinical trials that employed overlapping psychophysical pain testing procedures (49 °C noxious heat; visual analog pain scales) and distinct functional magnetic resonance imaging techniques (blood oxygen level-dependent; perfusion based). After baseline pain testing, 115 healthy participants were randomized into a 4-session mindfulness meditation (n = 37), placebo-cream conditioning (n = 19), sham mindfulness meditation (n = 20), or book-listening control (n = 39) intervention. After each intervention, noxious heat was administered during functional magnetic resonance imaging and each manipulation. RESULTS: A double dissociation in the multivariate pattern analysis signatures supporting pain regulation was revealed by mindfulness meditation compared with placebo cream. Mindfulness meditation produced significantly greater reductions in pain intensity and pain unpleasantness ratings and nociceptive-specific and negative affective pain signatures than placebo cream, sham mindfulness meditation, and control interventions. The placebo-cream group significantly lowered the placebo-based signature. CONCLUSIONS: Mindfulness meditation and placebo engaged distinct and granular neural pain signatures to reduce pain.