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

Abstract

AbstractFormal training in mindfulness-based practices promotes reduced experimental and clinical pain, which may be driven by reduced emotional pain reactivity and undergirded by alterations in the default mode network (DMN), implicated in mind-wandering and self-referential processing. Recent results published in this journal suggest that mindfulness, defined here as the day-to-day tendency to maintain a non-reactive mental state in the absence of training, associates with lower pain reactivity, greater heat-pain thresholds, and resting-state DMN functional connectivity (FC) in healthy adults in a similar manner to trained mindfulness. The extent to which these findings extend to chronic pain samples and replicate in healthy samples is unknown. Using data from healthy adults (n = 36) and episodic migraine patients (n = 98) and replicating previously published methods, we observed no significant association between mindfulness and heat-pain threshold (r = -0.05, p = .80), pain intensity (r = -.02, p = .89) or unpleasantness (r = .02, p = .89), or pain catastrophizing (PC; r = .30, p = .08) in healthy controls, or between mindfulness and headache frequency (r = -.11, p = .26), severity (r = .03, p = .77), impact (r = -.17, p = .10) or PC (r = -0.09, p = .36) in patients. There was no association between DMN connectivity and mindfulness in either sample when probed via seed-based FC analyses. In post-hoc whole brain exploratory analyses, a meta-analytically derived DMN node (i.e., posterior cingulate cortex; PCC) showed connectivity with regions unassociated with pain processing as a function of mindfulness, such that healthy adults higher in mindfulness showed greater PCC-cerebellum FC. Collectively, these findings suggest that the relationship between mindfulness and DMN-FC may be nuanced or lacking in robustness, and cast doubt on mindfulness as a clinically meaningful protective factor in migraine.PerspectiveThis study tested relationships between mindfulness and pain, pain reactivity and default mode connectivity in healthy adults and migraine patients. Findings cast doubt on mindfulness as an individual difference marker of the ability to cope with pain in healthy adults, and as a protective factor in episodic migraine.