Inner Experience and Neuroscience

Price, Donald D.; Barrell, James J.

doi:10.7551/mitpress/8145.001.0001

Cited by 64 publications

(48 citation statements)

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“…For instance, the experience of chronic pain is dramatically influenced by the context in which it occurs. One example of this comes from studies assessing pain in patients and in women giving birth . The pain of labor was rated as significantly higher on sensory aspects compared to the affective dimension.…”

Section: Resultsmentioning

confidence: 99%

Mindfulness meditation–based pain relief: a mechanistic account

Zeidan

Vago

2016

Annals of the New York Academy of Sciences

223

136

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Pain is a multidimensional experience that involves sensory, cognitive, and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms—an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy.

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Section: Resultsmentioning

confidence: 99%

Mindfulness meditation–based pain relief: a mechanistic account

Zeidan

Vago

2016

Annals of the New York Academy of Sciences

223

136

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“…With respect to the area of hyperalgesia, patients were asked: “Do you expect your area of hyperalgesia to be the same, larger, or smaller than before (ie, compared with baseline).” Patients were also asked to rate the intensity of emotional feelings on a 0 to 10 visual analogue scale and to qualitatively describe these emotions. 50 …”

Section: Magnitude and Mechanisms Of Placebo And Nocebo Effectsmentioning

confidence: 99%

Placebo, nocebo, and neuropathic pain

Vase

Skyt

Hall

2016

Pain

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Over the last decade, the apparent increase in placebo responses in randomized controlled trials (RCTs) of neuropathic pain have complicated and potentially limited development and availability of new effective pain medication. Placebo analgesia and nocebo hyperalgesia effects are well described in nociceptive and idiopathic pain conditions, but less is known about the magnitude and mechanisms of placebo and nocebo effects in neuropathic pain. In neuropathic pain, placebo treatments have primarily been used as control conditions for active agents under investigation in RCTs and these placebo responses are typically not controlled for the natural history of pain and other confounding factors. Recently, mechanistic studies that control for the natural history of pain have investigated placebo and nocebo effects in neuropathic pain in their own right. Large placebo analgesia but no nocebo hyperalgesic effects have been found, and the underlying mechanisms are beginning to be elucidated. Here we review placebo and nocebo effects and the underlying mechanisms in neuropathic pain and compare them with those of nociceptive and idiopathic pain. This allows for a novel discussion on how knowledge of psychological, neurobiological, and genetic factors underlying well-controlled placebo effects may help improve the information that can be obtained from and potentially restore the utility of RCTs.

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“…It has been argued elsewhere that such a demonstration would verify that all the properties of pain are the same as all of the properties of pain-related neural activity [13, 23]. Yet pain is fundamentally an experience whose properties cannot be exactly the same things such as “C-fibers firing” or action potentials within somatosensory and insular cortices (see discussion in 13;23 . Measures of brain activity provided by neuroimaging provide indirect information about neural representations and mechanisms of pain, while self-report measures provide indirect information about the experience of pain.…”

Section: Are Patterns Of Brain Activity or Self-reports Better Accounmentioning

confidence: 99%

Pain Measurement and Brain Activity: Will Neuroimages Replace Pain Ratings?

Robinson

Staud

Price

2013

The Journal of Pain

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Arguments made for the advantages of replacing pain ratings with brain imaging data include assumptions that pain ratings are less reliable and objective and that brain image data would greatly benefit the measurement of treatment efficacy. None of these assumptions are supported by available evidence. Self-report of pain is predictable and does not necessarily reflect unreliability or error. Since pain is defined as an experience, magnitudes of its dimensions can be estimated by well established methods, including those used to validate brain imaging of pain. Brain imaging helps to study pain mechanisms and might be used as proxy measures of pain in persons unable to provide verbal reports. Yet eliminating pain ratings or replacing them with neuroimaging data is misguided because brain images only help explain pain if they are used in conjunction with self-report. There is no ‘objective readout’ mechanism of pain (“pain thermometer”) that is unaffected by psychological factors. Benefits from including neuroimaging data might include increased understanding of underlying neural mechanisms of treatment efficacy, discovery of new treatment vectors, and support of conclusions derived from self-report. However, neither brain imaging nor self-report data are privileged over the other. The assumption that treatment efficacy is hampered by self-report has not been shown; there are a plethora of treatment studies showing that self-report is sensitive to treatment. Dismissal of patients’ self-reports (pain ratings) by brain imaging data is potentially harmful. The aim of replacing self-report with brain imaging data is misguided and has no scientific or philosophical foundation.

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Inner Experience and Neuroscience

Cited by 64 publications

References 0 publications

Mindfulness meditation–based pain relief: a mechanistic account

Mindfulness meditation–based pain relief: a mechanistic account

Placebo, nocebo, and neuropathic pain

Pain Measurement and Brain Activity: Will Neuroimages Replace Pain Ratings?

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