Mindfulness and Pain Reactivity, Connectivity in Patients With Episodic Migraine

No meaningful associations were identified between mindfulness and pain, pain catastrophizing, or default mode connectivity in patients with episodic migraine.

Few significant associations exist between dispositional mindfulness and pain, which includes pain reactivity and default mode connectivity in patients with migraine and in healthy adults. There may be a nuanced or non-robust relationship between mindfulness and default mode network (DMN) connectivity. These are the findings of a study published in The Journal of Pain.

Previous studies suggest that mindfulness, in a similar manner to trained mindfulness, associates with greater heat-pain thresholds, lower pain reactivity, and resting-state DMN functional connectivity in healthy adults. It is unknown how this relates to chronic pain or if these results can be duplicated in healthy individuals.

Researchers sought to investigate if the inverse associations between mindfulness and DMN connectivity, pain catastrophizing, and heat-pain threshold in healthy individuals extend to individuals with chronic pain from episodic migraine. They also aimed to replicate previous findings in healthy individuals.

The researchers hypothesized that greater mindfulness would associate with: 1) lower clinical pain (ie, reduced headache frequency and headache pain and reduced self-reported headache impact), lower pain catastrophizing, and reduced DMN connectivity in patients, and 2) reduced heat-pain threshold, experimental pain severity, lower pain catastrophizing and reduced DMN connectivity in healthy control individuals.

The relationship between mindfulness and default mode network connectivity may be nuanced or non-robust.

They conducted a secondary cross-sectional analysis of baseline data collected during a parent trial (R01AT007171) from 2014 to 2017 comparing enhanced mindfulness-based stress reduction with active control individuals.

In the current study, researchers incorporated data from 98 patients with episodic migraine and 36 healthy adults replicating previously published methods.

No significant association was observed between mindfulness and headache frequency, severity, impactor pain catastrophizing in patients with migraine or between mindfulness and heat-pain threshold, pain intensity, or pain catastrophizing in healthy control individuals. They found no association between mindfulness and default mode network connectivity in either group.


The researchers noted that post-hoc exploratory analysis revealed connectivity with brain regions unassociated with pain processing as a function of mindfulness (greater functional connectivity between the posterior cingulate cortex-and cerebellum was observed in healthy adults higher in mindfulness). According to the researchers, this suggests the possibility of nuanced or non-robust associations between mindfulness and DMN functional connectivity.

Study limitations include patient expectation bias, underpowered control sample, lack of explicit understanding of mindfulness in untrained individuals limiting clinical benefits, and the replication of previously published methods lacking precision.

Researchers concluded that they found “few significant associations between dispositional mindfulness and pain, pain reactivity and default mode connectivity in healthy adults and migraine patients.” They added that “The relationship between mindfulness and default mode network connectivity may be nuanced or non-robust.”

Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Hunt C, Letzen JE, Krimmel SR, et al. Is mindfulness associated with lower pain reactivity and connectivity of the default mode network? A replication and extension study in healthy and episodic migraine participants. J Pain. Published online August 4, 2022. doi:10.1016/j.jpain.2022.07.011