Journal club talk on Zeidan et al. 2011

1. Brain Mechanisms Supporting the
Modulation of Pain by Mindfulness
Meditation
Zeidan et al. (2011), J Neuro

2. What is Mindfulness?
• Defined
– Present-moment awareness and attention to
internal and external experiences
– Focused attention: cognitive practice of sustained
attention on breath
• Psychological and physiological benefits
– Increased well-being, decreased psychopathology
– Better outcomes in stressed patient populations
– Decreased subjective experience of pain

3. Brain Mechanisms Underlying
Mindfulness
• Limbic regions
– Amygdala: functional and structural changes
• Cortical regions
– Top-down modulation of limbic regions 
attenuated affective response to stress
• PASL MRI  measures CBF

4. Hypotheses
1. Meditation will reduce pain ratings
2. Meditation will modulate activity in brain
regions associated with pain processing
1. PFC, ACC, anterior insula
3. Is meditation-related activation associated
with pain modulation?

5. Methods

6. Stimuli & Measures
• 32 5-sec heat stimuli (35-49 C)
• Experimental stimuli: 5 min 55 sec
– Heat condition: 12 sec 45C/12 sec 35C
– Neutral condition: 35 C
• Delivered to R calf by thermal stimulator
• Other measures: HR, RR, FMI, global CBF
• Visual Analog Scale
– “No pain sensation” – “Most intense imaginable”

7. Pain Ratings Across Sessions

8. • Activations and
deactivations pre-
training (vs rest)
• ATB
– Less DMN activation
 cognitively
engaged
• Pain-related activity
– Consistent with
previous studies
– Validates
methodology

9. Post-Training Outcome Measures
• After 4 days of meditation training,
mindfulness skills increased (FMI)
• Respiration Rate
– Decreased during meditation in presence of
noxious stimuli
– Decreased in post-training
• Heart Rate
– Greater during noxious stimulation

10. Meditation
• SI  nose and
throat
• Interoceptive
attention
• ACC, Insula
• Pain Modulation
• OFC, ventral
striatum, vlPFC
• PCC, mPFC

11. Pain
• Insula
• ACC
• SII
• Similar to pre-
training and
previous studies
•ACC and AI
overlap  pain
modulation

12. SI and SMA: interaction between
meditation and noxious stimuli
• SI activation during meditation compared to rest in
the presence of noxious heat stimulation

13. • Right AI and bilateral
ACC
– Greater meditation-
induced activation 
greater reductions in pain
intensity ratings
• OFC, thalamus
– Greatest meditation-
induced
activation/deactivation 
greater reductions in pain
unpleasantness

14. • Meditation activates self-regulation areas
– Cognitive control: ACC
– Emotion regulation: OFC
– Interoceptive awareness: AI

15. Pain-related brain activity post-training
• Reduced: SI, insula, SII
• Increased: frontal pole, thalamus, mPFC, ACC

16. Proposed Mechanisms for Meditation-
Induced Pain Reduction
1) Executive regions  SII, insular cortex, PPC
 SI
2) ACC and right AI as pain modulatory regions
affected by mindfulness
3) Increased affective regulation and reward
processing by OFC
4) Limbic-thalamic gating mechanism activated
by meditation

17. Take-Home Message
• Mindfulness is among the cognitive
manipulations that can decrease pain perception
– Shares common modulatory pathway with attentional
control, placebo, reducing expectations of pain
• This may occur via changes in signaling between
executive regions and subcortical structures

18. Critique
• Small sample size
• Didn’t account for other individual trait
differences that may influence pain
modulation
• Long-term effects? Is sustained practice
required?
• Relation to structural changes?