Disentangling self from pain: mindfulness meditation-induced pain relief is driven by thalamic-default mode network decoupling.
Disentangling self from pain: mindfulness meditation-induced pain relief is driven by thalamic-default mode network decoupling.
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将自我从痛苦中解脱出来：正念冥想引起的疼痛缓解是由丘脑默认模式网络解耦驱动的。
DOI：
10.1097/j.pain.0000000000002731
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发表时间：
2023
期刊：
影响因子：
7.4
通讯作者：
Zeidan,Fadel
中科院分区：
文献类型：
--
作者：
Riegner,Gabriel;Posey,Grace;Oliva,Valeria;Jung,Youngkyoo;Mobley,William;Zeidan,Fadel
几千年来，正念被认为是通过减少有害感觉的自我评价的影响来减少疼痛的。今天，正念冥想是一种非常流行和有效的疼痛治疗方法，据信它涉及多种与安慰剂无关的机制来减轻疼痛。最近的证据表明，正念冥想引起的疼痛缓解与独特的皮质-丘脑-皮质伤害性过滤机制的参与有关。然而，支持正念冥想镇痛的功能性神经连接仍然未知。这项以机制为重点的临床试验将功能磁共振成像与心理物理疼痛测试（49 C刺激和疼痛视觉模拟量表）相结合，以确定正念冥想对疼痛相关行为和神经反应直接调节的神经连通性。我们假设以正念冥想为基础的疼痛缓解将通过支持评估（前额叶）和伤害性处理（丘脑）的大脑机制之间的更大解耦来反映。在基线疼痛测试后，40名参与者被随机分配到一个经过验证的4期正念冥想或听书方案中。在冥想期间，将功能性磁共振成像和有害热量（49℃；右小腿）结合起来测试研究假设。与对照组相比，正念冥想显著减少了行为和神经疼痛反应。预登记（NCT03414138）全脑分析显示，正念冥想诱导的镇痛分别受到大丘脑-楔前叶解耦和腹内侧前额叶失活的调节，这表明在支持自我参照加工的功能不同的神经机制中存在疼痛调节作用。两项独立的预注册种子到种子的分析发现，以正念冥想为基础的疼痛缓解也与对侧丘脑与前额叶和初级体感皮层的连接较弱有关。因此，我们提出正念冥想与一种新的自我参照伤害性门控机制有关，以减轻疼痛。
For millenniums, mindfulness was believed to diminish pain by reducing the influence of self-appraisals of noxious sensations. Today, mindfulness meditation is a highly popular and effective pain therapy that is believed to engage multiple, nonplacebo-related mechanisms to attenuate pain. Recent evidence suggests that mindfulness meditation–induced pain relief is associated with the engagement of unique cortico-thalamo-cortical nociceptive filtering mechanisms. However, the functional neural connections supporting mindfulness meditation–based analgesia remain unknown. This mechanistically focused clinical trial combined functional magnetic resonance imaging with psychophysical pain testing (49 C stimulation and pain visual analogue scales) to identify the neural connectivity supporting the direct modulation of pain-related behavioral and neural responses by mindfulness meditation. We hypothesized that mindfulness meditation-based pain relief would be reflected by greater decoupling between brain mechanisms supporting appraisal (prefrontal) and nociceptive processing (thalamus). After baseline pain testing, 40 participants were randomized to a well-validated, 4-session mindfulness meditation or book-listening regimen. Functional magnetic resonance imaging and noxious heat (49 C; right calf) were combined during meditation to test study hypotheses. Mindfulness meditation significantly reduced behavioral and neural pain responses when compared to the controls. Preregistered (NCT03414138) whole-brain analyses revealed that mindfulness meditation–induced analgesia was moderated by greater thalamus–precuneus decoupling and ventromedial prefrontal deactivation, respectively, signifying a pain modulatory role across functionally distinct neural mechanisms supporting self-referential processing. Two separate preregistered seed-to-seed analyses found that mindfulness meditation–based pain relief was also associated with weaker contralateral thalamic connectivity with the prefrontal and primary somatosensory cortex, respectively. Thus, we propose that mindfulness meditation is associated with a novel self-referential nociceptive gating mechanism to reduce pain.