"Train yourself to let go... of everything you fear to lose.”

– Master Yoda, Revenge of the Sith (Episode III)

As Master Yoda advised the Young Anakin Skywalker to let go of all the worldly feelings and pain he experienced to finally master the stages to become a true Jedi, his advice could not be more relevant today. Pain has become a severely disabling condition and newest numbers indicate that worldwide over 1.5 Billion people suffer from chronic pain. To deal with the high request for pain alleviation, a large body of research has focused on non-pharmacological techniques and ways to facilitate chronic and acute pain. One of them, mindfulness, finds its purpose in paying attention to the experience in the present moment in a nonjudgmental way. Could this practice be a new way of treating chronic pain patients and what are the implications that this research brings with it?

Most research so far has largely focused on the distraction, reappraisal or change of expectations to pain. Mindfulness however, is conceptually different than these strategies, as it directs the attention directly “towards” the pain instead of it focusing “away” from it as one would do in other pain attenuating strategies. A study by Gard et. al (2011) has investigated the modulation of perceived pain and anticipatory anxiety of pain through mindfulness by a group of experienced mindfulness practitioners. To be mindful during pain sensation, one must remember the two components of mindfulness:

1.) Focus of attention to the present moment and
2.) A nonjudgmental and attitude towards the sensation of pain (no appraisal is given at any time)

During the experiment, thirty-four participants were recruited of which seventeen where mindfulness practitioners and the other half acted as control subjects. Electrical stimulation served as the pain stimuli and participants had to rate the stimulus intensity, unpleasantness, and anticipatory anxiety to the pain on self- report questionnaires after the conductance of the electric stimuli. Additionally, structural brain imaging data was acquired during the experiments to explore neural correlates.

Findings of the self reported measurements showed a decrease of 22 percent of pain unpleasantness in the mindfulness practitioners and no changes in the control participants. Furthermore, the results showed decreased anticipatory anxiety of 29 percent in mindfulness practitioners but not in controls. The brain activity patterns underlying pain modulation through mindfulness found in this study were contrary to those described in other brain modulating techniques. Imaging pictures showed a decrease of activation in the frontal part of the brain which is involved in the control of executive behavior. As you might recall, the second component of mindfulness includes the nonjudgmental and accepting attitude. This could also be described as cognitive disengagement (an absence of cognitive control) and be related to the decreased activity in the frontal part of the brain. Mindfulness is aiming at “letting go” rather than controlling the pain and suggests decreased frontal top-down control and increased sensory processing in mindfulness practitioners. Additionally an increased activation in the brain areas related to emotions, inhibition of emotional responses and rational cognitive functions had been reported during the anticipation of pain in mindfulness practitioners. This increased activation might be related to the first component of mindfulness, focused attention, and suggests a stronger processing of distracting events while focusing on the object of attention and maintaining a mindful state.

To summarize, the experiment suggests that the practice of mindfulness during pain can decrease experienced pain unpleasantness and anticipatory anxiety. The neural correlates of this study suggest that pain and anxiety modulation through mindfulness techniques is characterized by an increased sensory processing of the pain sensation itself and a distinct brain state of cognitive disengagement.

But does every mindfulness practitioner experiences such positive pain modulating effects? A more recent study suggests that a high level of catastrophic thinking about pain could influence the effect of mindfulness on pain perception.

Prins et al. (2014) investigated the effects of mindfulness and distraction on pain depends upon individual differences in pain catastrophizing. They found that in high catastrophizers, the subjects who practiced mindfulness had lower pain rating than the control subjects. In low catastrophizers however, the reverse effects were found. This finding is in line with the study by Gard et. al. (2011), suggesting that focusing the attention on the pain, might lead to a higher pain perception. In contrast, mindfulness techniques may be especially helpful in high catastrophizing people by blocking the automatic negative appraisals usually evoked by pain (remember the second component of mindfulness?).

What are the implications of these findings? We now know that mindfulness is a useful technique to moderate the effects of pain and that this moderation effect might depend on your individual level of pain catastrophizing. Furthermore, mindfulness might be a useful technique to reduce the constant struggle to control or suppress pain, which is often seen in high pain catastrophizers, and which has been shown to have counter-productive effects on pain experience. We learned that suppressing pain is “bad” and rather than trying to control it via the “top-down” route we might need to learn to use the “bottom-up” route; focusing our attention on the pain and therefore letting go of it. Anakin Skywalker did not listen to his wise Master Yoda; he tried to suppress the pain and was later consumed by it. Maybe a state of Mindfulness in Anakin would have saved the empire from his rage which did later lead to the “almost” extinction of the Yedi’s.