Author: Patrick H Finan1, Carly Hunt2, Michael L Keaser3, Katie Smith4, Sheera Lerman4, Clifton O Bingham5, Frederick Barrett4, Eric L Garland6, Fadel Zeidan7, David A Seminowicz8
Affiliation: <sup>1</sup> Department of Anesthesiology, University of Virginia School of Medicine; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine. Electronic address: finan@virginia.edu.
<sup>2</sup> Department of Anesthesiology, University of Virginia School of Medicine.
<sup>3</sup> Department of Neural and Pain Sciences, University of Maryland School of Dentistry; Center to Advance Chronic Pain Research, University of Maryland Baltimore.
<sup>4</sup> Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine.
<sup>5</sup> Department of Medicine, Division of Rheumatology, Johns Hopkins University.
<sup>6</sup> Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah.
<sup>7</sup> Department of Anesthesiology, University of California-San Diego.
<sup>8</sup> Department of Neural and Pain Sciences, University of Maryland School of Dentistry; Center to Advance Chronic Pain Research, University of Maryland Baltimore; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario.
Conference/Journal: J Pain
Date published: 2024 Jan 18
Other:
Pages: S1526-5900(24)00346-8 , Special Notes: doi: 10.1016/j.jpain.2024.01.343. , Word Count: 304
Positive emotions are a promising target for intervention in chronic pain, but mixed findings across trials to date suggest that existing interventions may not be optimized to efficiently engage the target. The aim of the current pilot mechanistic randomized controlled trial was to test the effects of a positive emotion-enhancing intervention called Savoring Meditation on pain-related neural and behavioral targets in patients with rheumatoid arthritis (RA). Participants included 44 patients with a physician-confirmed diagnosis of RA (n=29 included in fMRI analyses), who were randomized to either Savoring Meditation or a Slow Breathing control. Both meditation interventions were brief (four 20-minute sessions). Self-report measures were collected pre- and post-intervention. An fMRI task was conducted at post-intervention, during which participants practiced the meditation technique on which they had been trained while exposed to non-painful and painful thermal stimuli. Savoring significantly reduced experimental pain intensity ratings relative to rest (p<.001). Savoring also increased cerebral blood flow in the ventromedial prefrontal cortex (vmPFC) and increased connectivity between the vmPFC and caudate during noxious thermal stimulation relative to Slow Breathing (z=2.3 voxelwise, FDR cluster corrected p=0.05). Participants in the Savoring condition also reported significantly increased positive emotions (ps<.05) and reduced anhedonic symptoms (p<.01) from pre- to post-intervention. These findings suggest that Savoring recruits reward-enhancing corticostriatal circuits in the face of pain, and future work should extend these findings to evaluate if these mechanisms of Savoring are associated with improved clinical pain outcomes in diverse patient populations. PERSPECTIVE: Savoring Meditation is a novel positive emotion-enhancing intervention designed for patients with chronic pain. The present findings provide preliminary evidence that Savoring Meditation is acutely analgesic, and engages neural and subjective emotional targets that are relevant to pain self-management. Future work should evaluate the clinical translation of these findings.
Keywords: fMRI; meditation; pain; positive emotion; savoring.
PMID: 38244899 DOI: 10.1016/j.jpain.2024.01.343