Intracerebral pain processing in a Yoga Master who claims not to feel pain during meditation

Monitoring the neural activity associated with praying in Sahaja Yoga meditation

BACKGROUND

Sahaja Yoga Meditation draws on many religious traditions and uses a variety of techniques including Christian prayer to reach a state known as thoughtless awareness, or mental silence. While there are many studies on the neural correlates of meditation, few studies have focused on the neural correlates of praying. Thus, the aim of our research was to study the neural activity associated with the prayer practices in Sahaja Yoga Mediation, which have not been studied before, to explore effects beyond repetitive speech or "mantra effects". Sixteen experienced Sahaja Yoga Meditation practitioners were scanned using task based functional Magnetic Resonance Imaging while performing formalised and improvised forms of praying and their equivalent secular tasks.

RESULTS

Our results showed the deactivation of bilateral thalamus during both prayers compared to secular conditions and the activation in the medial prefrontal cortex that was reduced by religious and formalised secular speech conditions but increased during improvised secular speech; similarly, frontal regions were deactivated when comparing prayers to their secular equivalents.

DISCUSSION

These results seem to depict two important factors related with praying in Sahaja Yoga Meditation merging inner concentration and social cognition. First, the perception of the surroundings mediated by the thalamus may be decreased during these prayers probably due to the establishment of inner concentration and, second, frontal deactivation effects could be related to reduced social judgement and 'mentalizing', particularly in the medial prefrontal cortex. Our findings suggest that praying by Sahaja Yoga Meditation practitioners is neurophenomenologically different from the social cognitive attempt of praying within Christian praying practices.

Insular dysfunction of interoception in major depressive disorder: from the perspective of neuroimaging

Interoception plays a crucial role in maintaining bodily homeostasis and promoting survival, and is considered the basis of human emotion, cognition, and self-formation. A malfunction of interoception is increasingly suggested to be a fundamental component of different mental health conditions, and depressive disorders have been especially closely associated. Interoceptive signaling and processing depends on a system called the "interoceptive pathway," with the insula, located in the deep part of the lateral fissure, being the most important brain structure in this pathway. Neuroimaging studies have revealed alterations in the structure and function of the insula in a large number of individuals with depression, yet the precise relationship between these alterations and interoceptive dysfunction remains unclear. The goal of this review is to examine the evidence that exists for dysfunction of interoception in people with Major Depressive Disorder (MDD), and to determine the associated specific alterations in the structure and function of the insula revealed by neuroimaging. Overall, three aspects of the potential relationship between interoceptive dysfunction and alterations in insular function in people with depression have been assessed, namely clinical symptoms, quantitative measures of interoceptive function and ability, and interoceptive modulation. To conclude, several specific limitations of the published studies and important lines of enquiry for future research are offered.

EEG signatures of low back and knee joint pain during movement execution: a short report

Chronic musculoskeletal pain has a high prevalence between European citizens, affecting their quality of life and their ability to work. The plastic changes associated with the occurrence of chronic musculoskeletal pain are still not fully understood. The current short report investigated the possible changes in brain activity caused by pain during movement in two of the most common musculoskeletal pain disorders in Denmark, knee pain and low back pain. Electroencephalography (EEG) was recorded from 20 participants (5 participants with knee pain, 5 with low back pain and 10 healthy controls). Participants with pain performed a movement that evoked pain in the area of interest, and the healthy controls performed the same movement. Electromyographic (EMG) signals were also collected to identify movement initiation. No differences were observed in brain activity of participants with pain and healthy controls during rest. During movement execution, though, participants with pain showed significantly higher event related synchronization in the alpha and beta bands compared to healthy controls. These changes could be related to higher cognitive processing, possibly due to the attempt of suppressing the pain. These results highlight the importance of assessing cortical activity during movement to reveal plastic changes due to musculoskeletal pain. This adds to our knowledge regarding plastic changes in cortical activity related to musculoskeletal pain in different locations. Such knowledge could help us identify neurophysiological markers for clinical changes and contribute to the development of new treatment approaches based on neuromodulation such as neurofeedback.

Mining the Mind: Linear Discriminant Analysis of MEG Source Reconstruction Time Series Supports Dynamic Changes in Deep Brain Regions During Meditation Sessions

Meditation practices have been claimed to have a positive effect on the regulation of mood and emotions for quite some time by practitioners, and in recent times there has been a sustained effort to provide a more precise description of the influence of meditation on the human brain. Longitudinal studies have reported morphological changes in cortical thickness and volume in selected brain regions due to meditation practice, which is interpreted as an evidence its effectiveness beyond the subjective self reporting. Using magnetoencephalography (MEG) or electroencephalography to quantify the changes in brain activity during meditation practice represents a challenge, as no clear hypothesis about the spatial or temporal pattern of such changes is available to date. In this article we consider MEG data collected during meditation sessions of experienced Buddhist monks practicing focused attention (Samatha) and open monitoring (Vipassana) meditation, contrasted by resting state with eyes closed. The MEG data are first mapped to time series of brain activity averaged over brain regions corresponding to a standard Destrieux brain atlas. Next, by bootstrapping and spectral analysis, the data are mapped to matrices representing random samples of power spectral densities in [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] frequency bands. We use linear discriminant analysis to demonstrate that the samples corresponding to different meditative or resting states contain enough fingerprints of the brain state to allow a separation between different states, and we identify the brain regions that appear to contribute to the separation. Our findings suggest that the cingulate cortex, insular cortex and some of the internal structures, most notably the accumbens, the caudate and the putamen nuclei, the thalamus and the amygdalae stand out as separating regions, which seems to correlate well with earlier findings based on longitudinal studies.

Evolution from four mental states to the highest state of consciousness: A neurophysiological basis of meditation as defined in yoga texts

This chapter provides a theoretical introduction to states of consciousness and reviews neuroscientific investigations of meditation. The different states of consciousness consist of four mental states, i.e., cancalata (random thinking), ekagrata (non-meditative focusing), dharna (focused meditation), and dhyana (meditation) as defined in yoga texts. Meditation is a self-regulated mental process associated with deep relaxation and increased internalized attention. Scientific investigations on meditation reported changes in electrophysiological signals and neuroimaging measures. But most outcomes of meditation studies showed inconsistent results, this may be due to heterogeneity in meditation methods and techniques evolved in the last 200 years. Traditionally, the features of meditation include the capacity to sustain a heightened awareness of thoughts, behaviors, emotions, and perceptions. Generally, meditation involves non-reactive effortless monitoring of the content of experience from moment to moment. Focused meditation practice involves awareness on a single object and open monitoring meditation is a non-directive meditation involved attention in breathing, mantra, or sound. Therefore, results of few empirical studies of advanced meditators or beginners remain tentative. This is an attempt to compile the meditation-related changes in electrophysiological and neuroimaging processes among experienced and novice practitioners.

Tonic thermonociceptive stimulation selectively modulates ongoing neural oscillations in the human posterior insula: Evidence from intracerebral EEG

The human insula is an important target for spinothalamic input, but there is still no consensus on its role in pain perception and nociception. In this study, we show that the human insula exhibits activity preferential for sustained thermonociception. Using intracerebral EEG recorded from the insula of 8 patients (2 females) undergoing a presurgical evaluation of focal epilepsy (53 contacts: 27 anterior, 26 posterior), we "frequency-tagged" the insular activity elicited by sustained thermonociceptive and vibrotactile stimuli, by periodically modulating stimulation intensity at a fixed frequency of 0.2 Hz during 75 s. Both types of stimuli elicited an insular response at the frequency of stimulation (0.2 Hz) and its harmonics, whose magnitude was significantly greater in the posterior insula compared to the anterior insula. Compared to vibrotactile stimulation, thermonociceptive stimulation exerted a markedly greater 0.2 Hz modulation of ongoing theta-band (4-8 Hz) and alpha-band (8-12 Hz) oscillations. These modulations were also more prominent in the posterior insula compared to the anterior insula. The identification of oscillatory activities preferential for thermonociception could lead to new insights into the physiological mechanisms of nociception and pain perception in humans.

Pain-related encephalic regions influenced by yoga meditation: An integrative review

INTRODUCTION

The mechanisms underlying the use of yoga in pain relief are still unclear. This study reviewed literature reports on encephalic activity related to analgesia induced by yoga meditation practice.

METHODS

This integrative review examined studies published in the Pubmed, LILACS and MEDLINE databases without restriction of the year of publication. The research involved 16 descriptors related to the words: yoga, pain and neuroimaging methods. Inclusion criteria involved only the publications available online, with free access and written in English.

RESULTS

2 case studies and 1 pilot study met the criteria. Yoga meditation practice induces analgesia primarily through attenuation of the medial pain perception system including the Anterior Cingulate Cortex and Insula regions, as well as the lateral system including the Secondary Sensory Cortex and Thalamus.

CONCLUSION

Yoga induced analgesia is a potentially important adjunct to current pain management. This integrative review revealed that there is a need for further research that analyzes the encephalic regions related to analgesia induced by yoga practice.

An acceptance-based intervention for children and adolescents with cancer experiencing acute pain - a single-subject study

Background

Children and adolescents with cancer report pain as one of their most recurrent and troublesome symptoms throughout the cancer trajectory. Pain evokes psychological distress, which in turn has an amplifying effect on the pain experience. Acceptance-based interventions for experimentally induced acute pain predict increased pain tolerance, decreased pain intensity and decreased discomfort of pain. The aim of this study was to preliminarily evaluate an acceptance-based intervention for children and adolescents with cancer experiencing acute pain, with regard to feasibility and effect on pain intensity and discomfort of pain.

Methods

This is a single-subject study with an AB design with a nonconcurrent multiple baseline. Children and adolescents aged four to 18 years undergoing cancer treatment at the Children’s University Hospital, Uppsala, Sweden, reporting sustained acute pain were offered participation. Pain intensity and discomfort of pain were measured during baseline and at post-intervention. The intervention consisted of a pain exposure exercise lasting approximately 15 minutes.

Results

Five children participated in the study. All participants completed the intervention and reported that it had helped them to cope with the pain in the moment. All participants reported decreased discomfort of pain at post-measurement, three of whom also reported decreased pain intensity.

Conclusion

The results suggest that an acceptance-based intervention may help children and adolescents with cancer to cope with the pain that is often associated with cancer treatment in spite of pharmacological pain management. The results are tentative but promising and warrant further investigation.

Brief relaxation training is not sufficient to alter tolerance to experimental pain in novices

Relaxation techniques, such as deep breathing and muscle relaxation, are aspects common to most forms of mindfulness training. There is now an abundance of research demonstrating that mindfulness training has beneficial effects across a wide range of clinical conditions, making it an important tool for clinical intervention. One area of extensive research is on the beneficial effects of mindfulness on experiences of pain. However, the mechanisms of these effects are still not well understood. One hypothesis is that the relaxation components of mindfulness training, through alterations in breathing and muscle tension, leads to changes in parasympathetic and sympathetic nervous system functioning which influences pain circuits. The current study seeks to examine how two of the relaxation subcomponents of mindfulness training, deep breathing and muscle relaxation, influence experiences of pain in healthy individuals. Participants were randomized to either a 10 minute deep breathing, progressive muscle relaxation, or control condition after which they were exposed to a cold pain task. Throughout the experiment, measures of parasympathetic and sympathetic nervous system activity were collected to assess how deep breathing and progressive muscle relaxation alter physiological responses, and if these changes moderate any effects of these interventions on responses to pain. There were no differences in participants’ pain tolerances or self-reported pain ratings during the cold pain task or in participants’ physiological responses to the task. Additionally, individual differences in physiological functioning were not related to differences in pain tolerance or pain ratings. Overall this study suggests that the mechanisms through which mindfulness exerts its effects on pain are more complex than merely through physiological changes brought about by altering breathing or muscle tension. This indicates a need for more research examining the specific subcomponents of mindfulness, and how these subcomponents might be acting, to better understand their utility as a clinical treatment.

Parents' relationship to pain during children's cancer treatment - a preliminary validation of the Pain Flexibility Scale for Parents

OBJECTIVES

Pain is one of the most frequent and burdensome symptoms for children with cancer. Psychological acceptance has been shown to be beneficial in chronic pain. Acceptance-based interventions for experimentally induced pain have been shown to predict increased pain tolerance and decreased pain intensity. An acceptance-based pilot study for children with cancer experiencing pain has shown promising results. Further, parental acceptance has been shown to predict decreased child distress. To date, no instruments measuring acceptance in the context of acute pain in children are available. The aim of this study was to develop and evaluate an instrument to measure acceptance in parents of children experiencing pain during cancer treatment.

METHODS

A test version of the Pain Flexibility Scale for Parents (PFS-P) was sent to parents of all children undergoing cancer treatment in Sweden at the time of the study. Exploratory factor analysis (n=243) examined numerous solutions. Internal consistency, test-retest reliability and convergent validity were calculated.

RESULTS

A three-factor Promax solution best represented the data. The subscales were pain resistance, valued action and pain fusion. Internal consistency was good (α=0.81-0.93), and the total scale and the subscales demonstrated temporal stability (r=0.76-0.87) and good convergent validity (-0.40 to -0.84).

DISCUSSION

The PFS-P measuring acceptance in parents of children experiencing pain during cancer treatment is now available, enabling evaluation of acceptance in the context of acute pain in children. The scale shows good psychometric properties but needs further validation.

Yoga-based intervention in patients with somatoform disorders: an open label trial

Somatoform disorders are common mental disorders associated with impaired functioning and increased utilization of health resources. Yoga-based interventions have been used successfully for anxiety, depression, and chronic pain conditions. However, literature on the use of yoga in treatment of somatoform disorders is minimal. The current study assessed the effect of a specific yoga-based intervention in patients with somatoform disorders. Consenting patients meeting ICD-10 criteria for somatoform disorders were offered a specific yoga module (1 h per day) as a treatment. Assessments including Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), and others were carried out at baseline and after 2, 6, and 12 weeks. Sixty-four subjects were included in the study and 34 completed 12 weeks follow-up. Significant improvement was noted in pain severity from baseline to 12 weeks after regular yoga sessions. The mean VAS score dropped from 7.24 to 2.88. Worst and average pain score in the last 24 h on BPI dropped from 7.71 to 3.26 and from 6.12 to 2.0,7 respectively. Results of the study suggest that yoga-based intervention can be one of the non-pharmacological treatment options in somatoform disorders. These preliminary findings need replication in larger controlled studies.

Functional neuroanatomy of meditation: A review and meta-analysis of 78 functional neuroimaging investigations

Meditation is a family of mental practices that encompasses a wide array of techniques employing distinctive mental strategies. We systematically reviewed 78 functional neuroimaging (fMRI and PET) studies of meditation, and used activation likelihood estimation to meta-analyze 257 peak foci from 31 experiments involving 527 participants. We found reliably dissociable patterns of brain activation and deactivation for four common styles of meditation (focused attention, mantra recitation, open monitoring, and compassion/loving-kindness), and suggestive differences for three others (visualization, sense-withdrawal, and non-dual awareness practices). Overall, dissociable activation patterns are congruent with the psychological and behavioral aims of each practice. Some brain areas are recruited consistently across multiple techniques-including insula, pre/supplementary motor cortices, dorsal anterior cingulate cortex, and frontopolar cortex-but convergence is the exception rather than the rule. A preliminary effect-size meta-analysis found medium effects for both activations (d=0.59) and deactivations (d=-0.74), suggesting potential practical significance. Our meta-analysis supports the neurophysiological dissociability of meditation practices, but also raises many methodological concerns and suggests avenues for future research.

A case series study of the neurophysiological effects of altered states of mind during intense Islamic prayer

This paper presents a case series with preliminary data regarding the neurophysiological effects of specific prayer practices associated with the Islamic religion. Such practices, like other prayer practices, are likely associated with several coordinated cognitive activities and a complex pattern of brain physiology. However, there may also be changes specific to the goals of Islamic prayer which has, as its most fundamental concept, the surrendering of one's self to God. To evaluate Islamic prayer practices, we measured changes in cerebral blood flow (CBF) using single photon emission computed tomography (SPECT) in three Islamic individuals while practicing two different types of Islamic prayer. In this case series, intense Islamic prayer practices generally showed decreased CBF in the prefrontal cortex and related frontal lobe structures, and the parietal lobes. However, there were also several regions that differed between the two types of prayer practices including increased CBF in the caudate nucleus, insula, thalamus, and globus pallidus. These patterns also appear distinct from concentrative techniques in which an individual focuses on a particular idea or object. It is hypothesized that the changes in brain activity may be associated with feelings of "surrender" and "connectedness with God" described to be experienced during these intense Islamic prayer practices. Overall, these results suggest that several coordinated cognitive processes occur during intense Islamic prayer. Methodological issues and implications of the results are also discussed.

Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus

Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging, and neurophysiological methods, such as magnetoencephalography and electroencephalography, have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural responses to pain stimulation during meditation in the anterior cingulate cortex (ACC) and insula, whereas others showed a decrease in these regions. There have been inconsistent findings to date. Moreover, in general, since the activities of the ACC and insula are correlated with pain perception, the increase in neural activities during meditation would be related to the enhancement of pain perception rather than its reduction. These contradictions might directly contribute to the ‘mystery of meditation.’ In this review, we presented previous findings for brain regions during meditation and the anatomical changes that occurred in the brain with long-term meditation training. We then discussed the findings of previous studies that examined pain-related neural activity during meditation. We also described the brain mechanisms responsible for pain relief during meditation, and possible reasons for paradoxical evidence among previous studies. By thoroughly overviewing previous findings, we hypothesized that meditation reduces pain-related neural activity in the ACC, insula, secondary somatosensory cortex, and thalamus. We suggest that the characteristics of the modulation of this activity may depend on the kind of meditation and/or number of years of experience of meditation, which were associated with paradoxical findings among previous studies that investigated pain-related neural activities during meditation.

Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners

Numerous studies have begun to address how the brain's gray and white matter may be shaped by meditation. This research is yet to be integrated, however, and two fundamental questions remain: Is meditation associated with altered brain structure? If so, what is the magnitude of these differences? To address these questions, we reviewed and meta-analyzed 123 brain morphology differences from 21 neuroimaging studies examining ∼300 meditation practitioners. Anatomical likelihood estimation (ALE) meta-analysis found eight brain regions consistently altered in meditators, including areas key to meta-awareness (frontopolar cortex/BA 10), exteroceptive and interoceptive body awareness (sensory cortices and insula), memory consolidation and reconsolidation (hippocampus), self and emotion regulation (anterior and mid cingulate; orbitofrontal cortex), and intra- and interhemispheric communication (superior longitudinal fasciculus; corpus callosum). Effect size meta-analysis (calculating 132 effect sizes from 16 studies) suggests a global 'medium' effect size (Cohen's d¯=0.46; r¯=.19). Publication bias and methodological limitations are strong concerns, however. Further research using rigorous methods is required to definitively link meditation practice to altered brain morphology.

Meditative analgesia: the current state of the field

Since the first demonstrations that mindfulness-based therapies could have a positive influence on chronic pain patients, numerous studies have been conducted with healthy individuals in an attempt to understand meditative analgesia. This review focuses explicitly on experimental pain studies of meditation and attempts to draw preliminary conclusions based on the work completed in this new field over the past 6 years. Dividing meditative practices into the broad categories of focused attention (FA) and open monitoring (OM) techniques allowed several patterns to emerge. The majority of evidence for FA practices suggests they are not particularly effective in reducing pain. OM, on the other hand, seems to influence both sensory and affective pain ratings depending on the tradition or on whether the practitioners were meditating. The neural pattern underlying pain modulation during OM suggests meditators actively focus on the noxious stimulation while inhibiting other mental processes, consistent with descriptions of mindfulness. A preliminary model is presented for explaining the influence of mindfulness practice on pain. Finally, the potential analgesic effect of the currently unexplored technique of compassion meditation is discussed.

Neuromodulation of cancer pain

Managing cancer-related chronic pain is challenging to health care professionals as well as cancer patients and survivors. The management of cancer-related pain has largely consisted of pharmacological treatments, which has caused researchers to focus on neurotransmitter activity as a mediator of patients' perception of pain rather than the electrical activity during neurobiological processes of cancer-related pain. Consequently, brain-based pain treatment has focused mainly on neurotransmitters and not electrical neuromodulation. Neuroimaging research has revealed that brain activity is associated with patients' perceptions of symptoms across various diagnoses. The brain modulates internally generated neural activity and adjusts perceptions according to sensory input from the peripheral nervous system. Cancer-related pain may result not only from changes in the peripheral nervous system but also from changes in cortical activity over time. Thus, cortical reorganization by way of the brain's natural, plastic ability (neuroplasticity) may be used to manage pain symptoms. Physical and psychological distress could be modulated by giving patients tools to regulate neural activity in symptom-specific regions of interest. Initial research in nononcology populations suggests that encouraging neuroplasticity through a learning paradigm can be a useful technique to help treat chronic pain. Here we review evidence that indicates a measurable link between brain activity and patient-reported psychological and physical distress. We also summarize findings regarding both the neuroelectrical and neuroanatomical experience of symptoms, review research examining the mechanisms of the brain's ability to modify its own activity, and propose a brain-computer interface as a learning paradigm to augment neuroplasticity for pain management.

Is it me or not me? Modulation of perceptual-motor awareness and visuomotor performance by mindfulness meditation

BACKGROUND

Attribution of agency involves the ability to distinguish our own actions and their sensory consequences which are self-generated from those generated by external agents. There are several pathological cases in which motor awareness is dramatically impaired. On the other hand, awareness-enhancement practices like tai-chi and yoga are shown to improve perceptual-motor awareness. Meditation is known to have positive impacts on perception, attention and consciousness itself, but it is still unclear how meditation changes sensorimotor integration processes and awareness of action. The aim of this study was to investigate how visuomotor performance and self-agency is modulated by mindfulness meditation. This was done by studying meditators' performance during a conflicting reaching task, where the congruency between actions and their consequences is gradually altered. This task was presented to novices in meditation before and after an intensive 8 weeks mindfulness meditation training (MBSR). The data of this sample was compared to a group of long-term meditators and a group of healthy non-meditators.

RESULTS

Mindfulness resulted in a significant improvement in motor control during perceptual-motor conflict in both groups. Novices in mindfulness demonstrated a strongly increased sensitivity to detect external perturbation after the MBSR intervention. Both mindfulness groups demonstrated a speed/accuracy trade-off in comparison to their respective controls. This resulted in slower and more accurate movements.

CONCLUSIONS

Our results suggest that mindfulness meditation practice is associated with slower body movements which in turn may lead to an increase in monitoring of body states and optimized re-adjustment of movement trajectory, and consequently to better motor performance. This extended conscious monitoring of perceptual and motor cues may explain how, while dealing with perceptual-motor conflict, improvement in motor control goes beyond the mere increase of movement time. The reduction of detection threshold in the MBSR group is also likely due to the enhanced monitoring of these processes. Our findings confirmed our assumptions about the positive effect of mindfulness on perceptual-motor integration processes.

Neural mechanisms underlying deafferentation pain: a hypothesis from a neuroimaging perspective

Deafferentation pain following nerve injury annoys patients, and its management is a challenge in clinical practice. Although the mechanisms underlying deafferentation pain remain poorly understood, progress in the development of multidimensional neuroimaging techniques is casting some light on these issues. Deafferentation pain likely results from reorganization of the nervous system after nerve injury via processes that interact with the substrates for pain perception (the pain matrix). Therapeutic effects of motor cortex stimulation on deafferentation pain suggest that the core mechanisms underlying deafferentation pain also interact with the motor system. Therefore, simultaneous neuroimaging and brain stimulation, an emerging neuroimaging technique, was developed to investigate complicated interactions among motor, somatosensory, and pain systems. In healthy participants, parts of the pain matrix (the anterior cingulate cortex, parietal operculum, and thalamus) show activity during both somatosensory stimulation and brain stimulation to the motor cortex. This finding indicates that motor, somatosensory, and pain systems communicate among each other via the neural network. A better understanding of the plastic mechanisms influencing such cross-talk among these systems will help develop therapeutic interventions using brain stimulation and neurofeedback.

Electrocortical activity prior to unpredictable stimuli in meditators and nonmeditators

Advanced meditators occasionally report experiences of timelessness, or states of awareness that seem to transcend the usual boundaries of the subjective present. This type of experience was investigated in eight experienced meditators and eight matched controls by measuring 32 channels of EEG before, during, and after exposure to unpredictable light and sound stimuli. The experiment postulated that if some aspect of consciousness extends beyond the present moment, then prestimulus electrocortical signals should differ depending on stimuli that were about to be selected by a truly random process, and that if such experiences were catalyzed through meditation practice, then prestimulus differences should be more apparent in meditators than in nonmeditators. Each of the 32 EEG channels was baseline adjusted on each trial by the electrical potential averaged between two- and one-second prestimulus, then for each channel the average potential was determined from one-second prestimulus to stimulus onset. The resulting means across subjects in each group were compared by stimulus type using randomized permutation procedures and corrected for multiple comparisons. Within the control group, no EEG channels showed significant prestimulus differences between light versus sound stimulus conditions, but within the meditator group five of 32 channels resulted in significant differences (P < .05, two tailed). Comparisons between control and meditator groups showed significant prestimulus differences prior to audio tone stimuli in 14 of 32 channels (P < .05, two tailed, of which eight channels were P < .005, two tailed). This outcome successfully replicates effects reported in earlier experiments, suggesting that sometimes the subjective sense of awareness extending into the future may be ontologically accurate.

Pain modulation by meditation and electroacupuncture in experimental submaximum effort tourniquet technique (SETT)

CONTEXT

Although acupuncture and meditation are widely utilized in the clinical treatment of pain, trials to evaluate their efficacy and modes of action under experimental conditions have yielded equivocal results.

OBJECTIVE

This feasibility study investigated whether electroacupuncture (EA) and meditation effectively relieve pain within a well-established ischemic pain paradigm (submaximum effort tourniquet technique, SETT).

DESIGN

In this semirandomized trial, experienced meditators were compared with nonmeditators. The nonmeditating subjects were randomly assigned to either an EA group or a nontreatment group.

SETTING

The trial was conducted at the Department of Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany.

PARTICIPANTS

Eight Vipassana meditators (mean experience hours = 2,626.8 ± 1,602.3 hours SD) and 40 control subjects were enrolled.

INTERVENTIONS

SETT (250 mm Hg, time limit = 30 minutes, pain rating limit = 10) was applied twice (baseline vs treatment) on the nondominant arm; EA was applied to the contralateral acupoints LI4 and LI10 (stimulation 20 minutes prior to and throughout the SETT); meditators were asked to meditate throughout the whole experimental procedure.

MAIN OUTCOME MEASURE

Pain ratings were obtained every three minutes on a numerical rating scale (0-10). The ratio of the tolerated time to the ratings served as the pain tolerance index.

RESULTS

At baseline, meditators exhibited significantly greater pain tolerance than the other two groups. During the second or treatment session, pain sensitivity did not change significantly in the nontreatment group, whereas pain tolerance significantly increased and pain ratings decreased to the level of meditation-induced analgesia in the EA group. Electroacupuncture induced no additional pain control benefit for meditators.

[Pain and itch perception in the human limbic system]

Both electrophysiological studies such as magnetoencephalography (MEG) and hemodynamic studies such as functional magnetic resonance imaging (fMRI) are intensively being used to elucidate underlying mechanisms of human pain and itch perception. MEG following A-delta (first pain) and C fiber stimulation (second pain) were similar except for a longer latency for the latter. At first, primary somatosensory cortex (SI) contralateral to the stimulation is activated and then secondary somatosensory cortex (SII), insula, amygdala and anterior cingulate cortex (ACC) in the bilateral hemispheres are activated sequentially. As for findings using fMRI, the stimulation of both C and A-delta fibers activated the bilateral thalamus, bilateral SII, right (ipsilateral) middle insula, and bilateral Brodmann's area (BA) 24/32, with the majority of activity found in the posterior portion of the ACC. However, magnitude of activity in the BA32/8/6, including ACC and pre-supplementary motor area (pre-SMA), and the bilateral anterior insula was significantly stronger following the stimulation of C nociceptors than A-delta nociceptors. Findings following itch stimulation were similar to those following pain stimulation, but the precuneus may be itch selective brain region. This unique finding was confirmed by both MEG and fMRI studies.

Research on integrative healthcare: context and priorities

It is important that integrative healthcare research be conducted to optimize the effectiveness, safety, costs, and social and economic impact of prospective, personalized, patient-centered, comprehensive, and holistic healthcare that focuses on well-being as well as disease management, and that the research itself be well understood. The scope of this research extends beyond evaluation of specific therapies, to include evaluations of multimodality whole system intervention, practitioner-patient relationships, patient goals and priorities, promoting self-care and resilience, personalized diagnostic and therapeutic measures, practitioner well-being, the comparative effectiveness of different educational and outreach strategies in improving health and healthcare, and the environmental/social causes and consequence of health and healthcare. In this paper, we describe the state of the science of research on integrative healthcare, research needs, and opportunities offered by cutting-edge research tools. We propose a framework for setting priorities in integrative health research, list areas for discussion, and pose a few questions on a future research agenda.

Isolated and combined effects of electroacupuncture and meditation in reducing experimentally induced ischemic pain: a pilot study

Acupuncture and meditation are promising treatment options for clinical pain. However, studies investigating the effects of these methods on experimental pain conditions are equivocal. Here, the effects of electroacupuncture (EA) and meditation on the submaximum effort tourniquet technique (SETT), a well-established, opiate-sensitive pain paradigm in experimental placebo research were studied. Ten experienced meditators (6 male subjects) and 13 nonmeditators (6 male subjects) were subjected to SETT (250 mmHG) on one baseline (SETT only) and two treatment days (additional EA contralaterally to the SETT, either at the leg on ST36 and LV3 or at the arm on LI4 and LI10 in randomized order). Numeric Rating Scale (NRS) ratings (scale 0-10) were recorded every 3 min. During baseline, meditation induced significantly greater pain tolerance in meditators when compared with the control group. Both the EA conditions significantly increased pain tolerance and reduced pain ratings in controls. Furthermore, EA diminished the group difference in pain sensitivity, indicating that meditators had no additional benefit from acupuncture. The data suggest that EA as a presumable bottom-up process may be as effective as meditation in controlling experimental SETT pain. However, no combined effect of both the techniques could be observed.

Meditation experience predicts less negative appraisal of pain: electrophysiological evidence for the involvement of anticipatory neural responses

The aim of mindfulness meditation is to develop present-focused, non-judgmental, attention. Therefore, experience in meditation should be associated with less anticipation and negative appraisal of pain. In this study we compared a group of individuals with meditation experience to a control group to test whether any differences in the affective appraisal of pain could be explained by lower anticipatory neural processing. Anticipatory and pain-evoked ERPs and reported pain unpleasantness were recorded in response to laser stimuli of matched subjective intensity between the two groups. ERP data were analysed after source estimation with LORETA. No group effects were found on the laser energies used to induce pain. More experienced meditators perceived the pain as less unpleasant relative to controls, with meditation experience correlating inversely with unpleasantness ratings. ERP source data for anticipation showed that in meditators, lower activity in midcingulate cortex relative to controls was related to the lower unpleasantness ratings, and was predicted by lifetime meditation experience. Meditators also reversed the normal positive correlation between medial prefrontal cortical activity and pain unpleasantness during anticipation. Meditation was also associated with lower activity in S2 and insula during the pain-evoked response, although the experiment could not disambiguate this activity from the preceding anticipation response. Our data is consistent with the hypothesis that meditation reduces the anticipation and negative appraisal of pain, but effects on pain-evoked activity are less clear and may originate from preceding anticipatory activity. Further work is required to directly test the causal relationship between meditation, pain anticipation, and pain experience.

The role of anterior insular cortex in social emotions

Functional neuroimaging investigations in the fields of social neuroscience and neuroeconomics indicate that the anterior insular cortex (AI) is consistently involved in empathy, compassion, and interpersonal phenomena such as fairness and cooperation. These findings suggest that AI plays an important role in social emotions, hereby defined as affective states that arise when we interact with other people and that depend on the social context. After we link the role of AI in social emotions to interoceptive awareness and the representation of current global emotional states, we will present a model suggesting that AI is not only involved in representing current states, but also in predicting emotional states relevant to the self and others. This model also proposes that AI enables us to learn about emotional states as well as about the uncertainty attached to events, and implies that AI plays a dominant role in decision making in complex and uncertain environments. Our review further highlights that dorsal and ventro-central, as well as anterior and posterior subdivisions of AI potentially subserve different functions and guide different aspects of behavioral regulation. We conclude with a section summarizing different routes to understanding other people's actions, feelings and thoughts, emphasizing the notion that the predominant role of AI involves understanding others' feeling and bodily states rather than their action intentions or abstract beliefs.

Higher cortical modulation of pain perception in the human brain: Psychological determinant

Pain perception and its genesis in the human brain have been reviewed recently. In the current article, the reports on pain modulation in the human brain were reviewed from higher cortical regulation, i.e. top-down effect, particularly studied in psychological determinants. Pain modulation can be examined by gene therapy, physical modulation, pharmacological modulation, psychological modulation, and pathophysiological modulation. In psychological modulation, this article examined (a) willed determination, (b) distraction, (c) placebo, (d) hypnosis, (e) meditation, (f) qi-gong, (g) belief, and (h) emotions, respectively, in the brain function for pain modulation. In each, the operational definition, cortical processing, neuroimaging, and pain modulation were systematically deliberated. However, not all studies had featured the brain modulation processing but rather demonstrated potential effects on human pain. In our own studies on the emotional modulation on human pain, we observed that emotions could be induced from music melodies or pictures perception for reduction of tonic human pain, mainly in potentiation of the posterior alpha EEG fields, likely resulted from underneath activities of precuneous in regulation of consciousness, including pain perception. To sum, higher brain functions become the leading edge research in all sciences. How to solve the information bit of thinking and feeling in the brain can be the greatest challenge of human intelligence. Application of higher cortical modulation of human pain and suffering can lead to the progress of social humanity and civilization.

Neuroanthropology: evolution and emotional embodiment

The Decade of the Mind is a proposal for a research initiative focused on four areas of neuroscience, including mental health, high-level cognitive function, education, and computational applications. Organizing efforts to date have primarily included cognitive scientists, computer scientists, and engineers, as well as physicians. At the same time anthropologists have started to explore the implications of neuroscience for understanding culture. Here we suggest that evolutionary neuroscience can be used to bridge knowledge obtained by social scientists with that obtained in the neurosciences for a more complete appreciation of the mind. We consider such a perspective as neuroanthropology. We use embodiment, an anthropological concept that has been substantiated by recent findings in neuroscience, to illustrate an integrative biocultural approach within neuroanthropology and suggest future possible directions for research.

Tai Chi and Meditation

The aim of this article is to review the literature on Tai Chi and meditation. A coherent construct is developed that includes a comparative analysis and conceptual synthesis of existing theories. The authors discuss a set of assumptions that justify this synthesis; they also argue that this construct would facilitate greater understanding of Tai Chi from the perspective of meditation. Such synthesis may bring “additional” benefits to Tai Chi practitioners as they could recognize that this mind—body technique holds the essence of meditation. Within the scope of this article, the evidence shows a majority of common features when concerning Tai Chi and meditation. These mutual similarities should be taken into account when performing this type of mind—body medicine by patients and/or therapists. Finally, the authors suggest that this inspiring compilation of movements and mindfulness can be used for practical purposes.

Religiousness and spirituality in fibromyalgia and chronic pain patients

The influence of psychosocial factors on pain experience and patient response has received increasing interest and recognition. Patients with chronic pain from several sources (eg, musculoskeletal, cancer, or sickle cell) usually report that religiousness and spirituality are important in their lives. Prayer is the most used complementary therapy; religious coping is among the most common strategies used to deal with pain. Religious variables are not usually associated with pain measures, except in some studies indicating that petitionary prayer is related to higher pain levels, possibly suggesting a turning to religion due to increasing pain. The best available evidence supports a positive association between religiousness and spirituality, with higher well-being and positive affect, and a negative association with depressive and anxiety symptoms. We discuss the importance of addressing spiritual issues in clinical practice, and increasing and improving research on religiousness/spirituality in chronic pain patients.

Psychobiology of mindfulness

There is controversy about whether mindfulness-based approaches to psychotherapy represent a new wave of cognitive-behavioral therapy or a core process in all psychotherapies. One way of conceptualizing mindfulness is in terms of emotion regulation; mindfulness is a strategy aimed at opposing suppression and avoidance. Dispositional mindfulness has been associated with greater activation in prefrontal cortex and greater deactivation of amygdala during affect labeling. A number of rigorous studies of mindfulness-based cognitive therapy for depression have been positive. However, much remains to be discovered about the underlying mechanisms of and clinical indications for mindfulness-based approaches.

fMRI study of pain reaction in the brain under state of "Qigong"

In this study, 4 male Qigong masters (aged 60 +/- 12) who had Qigong practicing experience for more than 30 years were tested. By using the technique of fMRI, the change of brain function under the state of Qigong was observed through the peripheral pain stimulation generated by potassium penetrating method. The fMRI examination was running on a GE signa VH/3.0 T MRI machine and block design was used. The test was repeated several times, which was carried out before and 15 min after Qigong practicing. The heart and respiration rate of these 4 Qigong masters were monitored during the whole test. SPM2 was used for the data analysis, and the result showed that before Qigong practicing, besides SI and SII-insula regions, many other Brodmann areas, the cigulate cortex, the thalamus, and the cerebellum were all activated, while 15 min after that, the activated areas were decreased obviously, which were mainly at the SII-insula region and some other Brodmann areas. Since the SII-insula region was activated in both of these two states, further analysis of the response curve was focused on it. Its response amplitude under the state of Qigong (3.5%) was greater than that before Qigong (1.2%). Our result indicated that the main manifestation of brain functional change under Qigong was functional suppressing, but in some particular regions such as SII-insula region in our study, the response amplitude was increased. Further study of the exact physiological mechanism of Qigong is needed.

New insights into neuromodulatory approaches for the treatment of pain

Two lines of evidence about the association between the experience of pain and brain state (measured via electroencephalogram or EEG) have recently come to light. First, research from a number of sources suggests a link between brain EEG activity and the experience of pain. Specifically, this research suggests that the subjective experience of pain is associated with relatively lower amplitudes of slower wave (delta, theta, and alpha) activity and relatively higher amplitudes of faster wave (beta) activity. Second, there has been a recent increase in interest in interventions that impact the cortical neuromodulation of pain, including behavioral treatments (such as self-hypnosis training and neurofeedback) and both invasive and noninvasive brain stimulation. Although a direct causal link between experience of pain and brain activity as measured by EEG has not been established, the targeting of pain treatment at a cortical level by trying to affect EEG rhythms directly is an intriguing possibility.

PERSPECTIVE

Preliminary evidence suggests the possibility, which has not yet adequately tested or proven, that the experience of chronic pain is linked to cortical activity as assessed via an electroencephalogram. Support for this hypothesis would have important implications for understanding the mechanisms that underlie a number of pain treatments, and for developing new innovative treatments for chronic pain management.

Size abnormalities of the superior parietal cortices are related to dissociation in borderline personality disorder

Recent evidence suggests that borderline personality disorder (BPD) is related to reduced size of the parietal lobe. Dissociative symptoms occur in the majority of individuals with BPD. Structural magnetic resonance imaging (3D-MRI) was used to assess volumes of the superior (precuneus, postcentral gyrus) and inferior parietal cortices in 30 young women with BPD who had been exposed to severe childhood sexual and physical abuse and 25 healthy control subjects. Compared with control subjects, BPD subjects had significantly smaller right-sided precuneus (-9%) volumes. The left postcentral gyrus of BPD subjects with the comorbid diagnosis of dissociative amnesia (DA) or dissociative identity disorder (DID) was significantly increased compared with controls (+13%) and compared with BPD subjects without these disorders (+11%). In BPD subjects, stronger depersonalization was significantly related to larger right precuneus size. Possibly, larger precuneus size in BPD is related to symptoms of depersonalization. Increased postcentral gyrus size in BPD may be related to the development of DA or DID in the presence of severe childhood abuse.

Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial

BACKGROUND

Numerous studies have explored the effectiveness of complementary and alternative medicine in the treatment of migraine but there is no documented investigation of the effectiveness of yoga therapy for migraine management.

OBJECTIVES

To investigate the effectiveness of holistic approach of yoga therapy for migraine treatment compared to self-care.

DESIGN

A randomized controlled trial.

METHODS

Seventy-two patients with migraine without aura were randomly assigned to yoga therapy or self-care group for 3 months. Primary outcomes were headache frequency (headache diary), severity of migraine (0-10 numerical scale) and pain component (McGill pain questionnaire). Secondary outcomes were anxiety and depression (Hospital anxiety depression scale), medication score.

RESULTS

After adjustment for baseline values, the subjects' complaints related to headache intensity (P < .001), frequency (P < .001), pain rating index (P < .001), affective pain rating index (P < .001), total pain rating index (P < .001), anxiety and depression scores (P < .001), symptomatic medication use (P < .001) were significantly lower in the yoga group compared to the self-care group.

CONCLUSION

The study demonstrated a significant reduction in migraine headache frequency and associated clinical features, in patients treated with yoga over a period of 3 months. Further study of this therapeutic intervention appears to be warranted.

Intranasal trigeminal function in subjects with and without an intact sense of smell

The intranasal trigeminal system is involved in the perception of odors. To investigate the cerebral processing of sensory information from the trigeminal nerve in detail we studied subjects with and without olfactory function using functional magnetic resonance imaging. A normosmic group (n=12) was compared with a group of anosmic subjects (n=11). For trigeminal stimulation gaseous CO(2) was used. Following right-sided stimulation with CO(2) controls exhibited a stronger right-sided cerebral activation than anosmic subjects. Stronger activation was found in controls compared to anosmic subjects for the right prefrontal cortex, the right somatosensory cortex (SI), and the left parietal insula. In contrast, relatively higher activation was found in anosmic subjects for the left supplementary motor area in the frontal lobe, the right superior and middle temporal lobe, the left parahippocampal gyrus in the limbic lobe, and the sub-lobar region of the left putamen and right insula which was mostly due to a decreased BOLD signal of controls in these areas. Additional conjunction analysis revealed that activated areas common to the two groups were the cerebellum and the right premotor frontal cortex. These data suggest that the processing of the trigeminally mediated information is different in the presence or absence of an intact sense of smell, pointing towards the intimate connection between the two chemosensory systems.

Tongue Piercing by a Yogi: QEEG Observations

: This study reports on the QEEG observations recorded from a yogi during tongue piercing in which he demonstrated voluntary pain control. The QEEG was recorded with a Lexicor 1620 from 19 sites with appropriate controls for impedence and artifacts. A neurologist read the data for abnormalities and the QEEG was analyzed by mapping, single and multiple hertz bins, coherence, and statistical comparisons with a normative database. The session included a meditation baseline and tongue piercing. During the meditative baseline period the yogi's QEEG maps suggesting that he was able to lower his brain activity to a resting state. This state showed a predominance of slow wave potentials (delta) during piercing and suggested that the yogi induced a state that may be similar to those found when individuals are under analgesia. Further research should be conducted with a group of individuals who demonstrate exceptional self-regulation to determine the underlying mechanisms, and whether the skills can be used to teach others how to manage pain.