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

Formal 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 trait mindfulness (TM), or the day-to-day tendency to maintain a non-reactive mental state in the absence of training, associates with reduced pain reactivity, pain sensitivity, 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 TM and pain sensitivity (r = -0.05, p = .80), intensity (r = .01, p = .94) or unpleasantness (r = .07, p = .67), or pain catastrophizing (PC; r = .30, p = .08) in healthy controls, or between TM 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 TM in either sample when probed via seed-based FC analyses. In post-hoc whole brain exploratory analyses, meta-analytically derived DMN nodes (i.e., PCC and vmPFC) showed connectivity with regions unassociated with pain processing as a function of TM, such that healthy adults higher in TM showed greater PCC-cerebellum and vmPFC-parietal FC. Collectively, these findings suggest that the relationship between TM and DMN-FC may be nuanced or lacking in robustness, and cast doubt on TM as a clinically meaningful protective factor in migraine.