Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced XXXX .

@entity1 @entity1337 @entity158
Mindfulness meditation reduces @entity158 in experimental and clinical settings. However, it remains unknown whether mindfulness meditation engages @entity158 -relieving mechanisms other than those associated with the placebo effect (e.g., conditioning, psychosocial context, beliefs). To determine whether the analgesic mechanisms of mindfulness meditation are different from placebo, we randomly assigned 75 healthy, @entity1 volunteers to 4 d of the following: (1) mindfulness meditation, (2) placebo conditioning, (3) sham mindfulness meditation, or (4) book-listening control intervention. We assessed intervention efficacy using psychophysical evaluation of experimental @entity158 and functional neuroimaging. Importantly, all cognitive manipulations (i.e., mindfulness meditation, placebo conditioning, sham mindfulness meditation) significantly @entity158 intensity and unpleasantness ratings when compared to rest and the control condition (p < 0.05). Mindfulness meditation reduced @entity158 intensity (p = 0.032) and @entity158 unpleasantness (p < 0.001) ratings more than placebo @entity1337 . Mindfulness meditation also reduced @entity158 intensity (p = 0.030) and @entity158 unpleasantness (p = 0.043) ratings more than sham mindfulness meditation. Mindfulness-meditation-related @entity158 relief was associated with greater activation in brain regions associated with the cognitive modulation of @entity158 , including the orbitofrontal, subgenual anterior cingulate, and anterior insular cortex. In contrast, placebo @entity1337 was associated with activation of the dorsolateral prefrontal cortex and deactivation of sensory processing regions (secondary somatosensory cortex). Sham mindfulness meditation-induced @entity1337 was not correlated with significant neural activity, but rather by greater reductions in respiration rate. This study is the first to demonstrate that mindfulness-related @entity158 relief is mechanistically distinct from placebo @entity1337 . The elucidation of this distinction confirms the existence of multiple, cognitively driven, supraspinal mechanisms for @entity158 modulation. SIGNIFICANCE STATEMENT: Recent findings have demonstrated that mindfulness meditation significantly reduces @entity158 . Given that the "gold standard" for evaluating the efficacy of behavioral interventions is based on appropriate placebo comparisons, it is imperative that we establish whether there is an effect supporting meditation-related @entity158 relief above and beyond the effects of placebo. Here, we provide novel evidence demonstrating that mindfulness meditation produces greater @entity158 relief and employs distinct neural mechanisms than placebo cream and sham mindfulness meditation. Specifically, mindfulness meditation-induced @entity158 relief activated higher-order brain regions, including the orbitofrontal and cingulate cortices. In contrast, placebo @entity1337 was associated with @entity158 -related brain activation. These findings demonstrate that mindfulness meditation reduces @entity158 through unique mechanisms and may foster greater acceptance of meditation as an adjunct @entity158 therapy.
