Ann. N.Y. Acad. Sci.

ISSN 0077-8923

A N N A L S O F T H E N E W Y O R K A C A D E M Y O F SC I E N C E S
Issue: Advances in Meditation Research: Neuroscience and Clinical Applications

Meditative analgesia: the current state of the field

Joshua A. Grant
Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany

Address for correspondence: Joshua A. Grant, Department of Social Neuroscience, Max Planck Institute for Human Cognitive
and Brain Sciences, Stephanstrasse 1a, Leipzig, Saxony 04103, Germany. grant@cbs.mpg.de

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.

Keywords: meditation; pain; analgesia; mindfulness; emotion; cognition

Introduction A large number of brain regions have been im-

Pain is a subjective experience involving at least
partially dissociable dimensions in relation to both
the experiential features and underlying brain net-
works. The multidimensional nature of pain means
the experience is sensitive to diverse manipulations,
which provide many avenues for pain relief but also
greatly complicate attempts to tease apart contribut-
ing factors. A relatively new player in the pain modu-
lation arena is meditative practice. Both experimen-
tal and clinical studies have demonstrated positive
influences of such practices on pain. This review will
focus on experimental studies and attempt to pro-
vide an account of how different styles of meditation
may modulate the experience of pain.
Pain and pain modulation
Noxious stimulation leads to an experience (pain)
involving a sensory dimension, allowing localization
and discriminability; an affective dimension, reflect-
ing the emotional and motivational relevance of the
stimuli; and a cognitive dimension related to how
aspects of cognition can sculpt one’s experience.1
doi: 10.1111/nyas.12282
Ann. N.Y. Acad. Sci. 1307 (2014) 55–63 
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plicated in processing nociceptive afferent signals
and the experience of pain.2 The primary and sec-
ondary somatosensory cortices (SI, SII), thalamus
(Thal), and posterior insula (pINS) are believed to
underlie the sensory-discriminative dimension of
pain where brain activity commonly corresponds
to participants’ ratings of how intense the stimu-
lus was.3 The affective-motivational dimension of
pain is thought to be processed in the dorsal ante-
rior cingulate cortex (dACC) and the anterior in-
sula (aINS), where ratings of pain unpleasantness
are often found to correspond with brain activity
levels.4 It should be noted that the distinction be-
tween sensory and affective pain ratings and under-
lying anatomy are certainly not absolute and these
brain regions do much more than process pain. Fi-
nally, the prefrontal cortex (PFC) is thought to un-
derlie evaluation, appraisal, or memory related to
the painful stimuli.5
Pain can also be modulated through numer-
ous means, including, but not limited to, atten-
tion/distraction, placebo, hypnosis, anxiety, and
emotion.4,6–8 The descending modulatory system
55
Meditative analgesia
involving opioid neuromodulators, regions of the
PFC, and deeper brain structures, such as the
periaqueductal gray (PAG) and the rostroventral
medulla (RVM), is the most prominent system
studied.9 In brief, incoming pain signals are attenu-
ated following the release of opioids from the PAG
and RVM. The past 6 years has brought forth a se-
ries of studies that suggest that meditative practice
is also an effective modulator of pain, though the
mechanisms underlying this modulatory influence
are still being worked out.
Meditation
Meditation is not a single construct but a host of
mental training exercises that purportedly shape the
brain/mind in highly specific ways, just as more
typical skills are now known to do.10 Tradition-
ally, practitioners are taught a number of lineage-
dependent techniques, which more or less proceed
sequentially across many years. Meditation practices
can be grossly divided into techniques involving re-
stricted focus deployed for sustained periods (fo-
cused attention, FA), which purportedly stabilize or
calm the mind, and more advanced techniques that
can broaden the scope of attention and simulta-
neously deemphasize the elaborative and narrative
nature of the mind (open monitoring, OM).11 Both
practices involve sustained processes. In OM prac-
tice, the monitoring itself becomes the focus, rather
than the varied content arising in one’s mind, in a
kind of distanced monitoring. In FA practice, focus
is deliberately held on a single object. Researchers
focusing on transcendental meditation (TM) have
suggested a third category referred to as automatic
self-transcending, characterized by an absence of
focus and effort.12 The original paper in which
these proposed divisions were made is suggested to
interested readers.11
It should not be assumed that these labels fully
capture the essence of all meditation practices or that
they are mutually exclusive. It is a simple and rather
crude framework that is a largely accepted first step
in coming to terms with the complexity of medita-
tive practices. It is likely that other taxonomies (e.g.,
consciousness oriented) will be needed to fully cap-
ture this diversity. Further complicating matters is
the fact that there are said to be varying degrees
of proficiency within each domain, which would
presumably be reflected in the brain networks un-
derlying the attained skills.
56 Ann. N.Y. Acad. Sci. 1307 (2014) 55–63 
Grant
FA and pain
Theoretically there are several means by which FA
techniques may influence pain, though at present
most remain empirical questions. Physiological
changes that accompany FA, including reductions
in respiration or heart rate, have been shown to
affect pain.13,14 Purportedly, FA quiets the mind,
suggesting less rumination and/or anxiety, which
are known to exacerbate pain; less rumination
and/or anxiety has been reported following med-
itation training.15,16 It would be interesting to know
whether these reductions are the experiential coun-
terpart to the proposed physiological changes. Fi-
nally, FA techniques may provide practitioners with
enough control over their attention to allow effective
pain control through distraction. The remainder of
this section will review research relevant to these
potential mechanisms.
Attention research with typical healthy popula-
tions has shown that attending to an object or loca-
tion increases the corresponding neural activity.17
Conversely, activity reflecting other objects or lo-
cations is diminished. The same seems to be true
of pain. Distraction reduces reports of pain (both
sensory and affective) and is associated with activ-
ity reductions in the INS, ACC, Thal, and SI, with
increases in the PFC and the PAG.18–21 Given the ac-
cumulating evidence that meditation improves per-
formance on attention tasks, practitioners may also
be better at distracting themselves.22
A case study by Kakigi et al. suggests FA training
does increase the capacity to distract oneself from
pain.23 A yogi, claiming to feel no pain during med-
itation, received painful and innocuous laser stim-
ulation in a normal waking and meditative state.
Brain images revealed activation of the typical pain-
related regions including the SI/SII, dACC, INS,
and Thal during the nonmeditative state. Remark-
ably, activation of most of these regions was com-
pletely absent during the meditative state, matching
his report of an absence of pain. Further, greater
activation was seen in frontal and parietal attention-
related regions, suggesting he was actively engaged.
Since the degree of activity of the SI/SII, dACC,
INS, and Thal typically corresponds to the level of
reported pain, it seems the yogi was indeed mod-
ulating his experience.2 Yogic meditation tends to
focus on FA and allegedly leads to absorption (of
mind with object) at advanced stages. Meditators
do appear to experience higher levels of mental
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Grant
absorption and have thicker gray matter in regions
supporting attention.24 Thus, the yogi was poten-
tially deploying his attention so fully as to become
absorbed in his meditation and effectively dimin-
ished all other sensation. How this sensory gating
might work is not clear but presumably must occur
early (i.e., thalamus or lower) if all pain-related re-
gions were attenuated. Unfortunately, such extreme
forms of attention have not been studied and, while
intriguing, too much weight cannot be placed on a
case report. Although similar but less extreme re-
sults were reported in a study of TM meditators
(who restrict focus to a mantra), replication with a
larger sample could be particularly illuminating and
important for our understanding of pain.25
The Zen Buddhist tradition, spanning both
FA and OM, also appears to influence pain
perception.26 In this study, participants were asked
to simply attend to painful heat rather than for-
mally meditate. Meditators and controls did not
differ with reference to pain ratings in a baseline
condition, though the Zen practitioners required
significantly hotter stimuli to reach moderate pain.
When instructed to sustain attention on the stim-
uli, rather than away from it as the yogi presumably
had, control subjects reported the expected pain in-
creases of approximately 15%, whereas meditators
showed no change from baseline and had lower res-
piration rates. This suggests that a meditative state
is not necessary to observe effects in practition-
ers and, further, that they do not display typical
attention-related increases in pain. A study pub-
lished the following year examining Tibetan med-
itators practicing FA, but with a focus away from
the stimulus, found no difference between medita-
tors and controls but unfortunately a nonmeditative
control condition was not employed.27
Taken together, it appears FA meditation may be
associated with baseline changes in pain sensitiv-
ity and reduced hypersensitivity when focusing on
pain; however, this may not apply to all traditions.
Further, the Zen practitioners in whom these base-
line effects were observed also practice OM medita-
tion, making it difficult to attribute these effects to
FA per se. Somewhat paradoxically, the suggestion
that meditative training enhances one’s attentional
capacity might have led to the hypothesis that med-
itators, being trained to better wield their attention,
would show larger increases in pain than controls;
this was not the case.26 In fact, meditators were more
Ann. N.Y. Acad. Sci. 1307 (2014) 55–63 
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Meditative analgesia
tolerant and showed no increase at all, suggesting
that either their physiological state (lower respira-
tion) overrides such effects or they deploy their at-
tention in a different way. A third condition in that
study, discussed later, suggests both may be true.
OM and pain
Although FA meditation is purportedly calming and
stabilizes the mind, one of the proposed contribu-
tions of the Buddha was the realization that this is
not sufficient to overcome suffering. He suggested
one also needs to develop insight into the idiosyn-
crasies of the mind, behavior, and perception of the
world.13 These are some of the aims of OM tech-
niques such as, or involving, mindfulness.
The concept of mindfulness is, for the most part,
considered to lie in the domain of OM. The term
likely subsumes many mental processes including
monitoring of one’s internal and/or external envi-
ronment, with an emphasis on sustaining the mon-
itoring itself rather than the content. Also included
are reductions in mental elaboration and judgment
of the currently perceived content, suggesting the
abatement of memory-related networks, as well as
reductions in reactivity.
Given the multifaceted descriptions of mind-
fulness in the literature, there are likely multi-
ple mechanisms at play when it comes to pain
modulation.28,29 The first study to examine mind-
fulness and pain reported that learning to be
mindful resulted in increased cold-pain tolerance
but found no evidence linking the change to
mindfulness.30 The psychophysical study by Grant
and Rainville discussed earlier also included a con-
dition where participants were asked to attend to
pain mindfully.26 Control subjects reported no dif-
ference in pain compared to their baseline, while Zen
practitioners reported significantly reduced sensory
(18%) and affective (23%) pain ratings, with the
most experienced meditators having the largest re-
ductions. Meditators also scored higher on several
dimensions of a mindfulness questionnaire and had
lower respiration rates in the mindful (and concen-
tration) condition. Further, the mindfulness-related
pain reductions were no longer significant after con-
trolling for respiration, which itself was positively
correlated with the nonreactivity scale of mindful-
ness questionnaire. Given that mindful attention
involves monitoring of the experience itself, it is
unlikely that the observed pain reductions were due
57
Meditative analgesia
to distraction. This suggests that the pain-reducing
properties of an OM-like state revolve around the in-
duction of a calm parasympathetic-dominant state.
Similar results, in terms of pain experience, were
reported after comparing OM to FA in advanced
Tibetan meditators and controls.27 However, unlike
the Zen practitioners, Tibetans showed only attenu-
ation of the affective dimension of pain during OM.
These behavioral studies suggest that
mindfulness-related practices do indeed influ-
ence pain. In terms of mechanisms, the pain
reduction in Zen practitioners engaging in OM-like
attention was largely explained by changes in
respiration, which also correlated with nonreac-
tivity scores, suggesting a shift to a calmer, more
parasympathetic-dominant state. Although the
Tibetans also showed pain reduction, no com-
plementary measures were reported, limiting the
possible conclusions. Next, several brain imaging
studies shedding more light on these effects are
reviewed.
Brain imaging techniques, such as functional
magnetic resonance imaging (fMRI), often allow
one to distinguish between competing hypotheses.
In reference to meditation and pain, if pain reduc-
tion was being accomplished through distraction,
one should observe stimulus-related brain activity
reductions in pain-related regions. If this was oc-
curring via the descending inhibitory pathways, one
should also see increases in activity in the subgen-
ual ACC and PAG. On the other hand, OM prac-
tices could be predicted to increase stimulus-related
brain activity, as these practices involve monitor-
ing of one’s present experience (i.e., the pain itself).
Interestingly, no other known pain modulator re-
duces pain and at the same time results in increased
activity of pain-related brain regions. There is now
substantial evidence that this is indeed the case for
meditation.
Grant et al. conducted a second study with Zen
practitioners employing fMRI to measure brain
activity during pain.31 In a normal waking (i.e.,
nonmeditative) state, stronger brain activation in
several pain-related areas (dACC, aINS, Thal) was
observed for meditators compared to controls, de-
spite having matched the groups with respect to
painful experience. These regions remained stronger
in meditators after statistically controlling for their
higher input levels. Interestingly, numerous brain
regions, including the amygdala, hippocampus, and
58 Ann. N.Y. Acad. Sci. 1307 (2014) 55–63 
Grant
orbitofrontal, medial prefrontal, and dorsolateral
prefrontal cortices, had reduced activity for the
meditators, but not for the controls, during pain.
This particular pattern of brain activation had
never been reported before this study, but has since
been largely replicated by two groups. Studying
Vipassana meditation, Gard et al. found reductions
in the affective dimension of pain during OM med-
itation for practitioners compared to controls.32
These reductions were associated with increased
activation of pain-related areas (pINS) and de-
creased lateral frontal activity. Studying highly ex-
perienced Tibetan practitioners performing an OM
practice, Lutz et al. reported greater aINS and
dACC activity during pain for meditators com-
pared to controls.33 Further, meditators reported
lower affective pain ratings. These studies of ex-
perienced meditators show an impressive corre-
spondence, particularly given clear differences in
methodologies, designs, and meditation traditions
being studied. The results suggest that OM tech-
niques lead to pain reduction, through enhance-
ment of activity in pain-related brain regions and
reduced activation of other brain regions. A brief
review of the roles played by these regions will help
with the subsequent interpretation of the underlying
mechanisms.
The orbitofrontal cortex (OFC) receives input
from all sensory modalities and is believed to in-
corporate the relative value or importance of the
stimulus for the individual.34 The amygdala is clas-
sically associated with emotional salience and, in
conjunction with the hippocampus and medial PFC,
associative learning and conditioning.35 The hip-
pocampus is a memory-related structure that may
work with the dorsolateral PFC (DLPFC) in re-
trieval processes.36,37 Finally the medial PFC has
also been implicated in self-referential processing.38
Reduced activity in these regions during pain
could certainly mean many things but happens
to map onto descriptions of mindfulness quite
closely. More specifically, the increases in acti-
vation in the dACC and aINS could very well
correspond to increased stimulus saliency due to
intentional monitoring of the experience.39 Re-
ductions in DLPFC and hippocampal activation
may reflect fewer memory-related retrieval pro-
cesses as one engages less in elaborative mental nar-
ratives. Reductions in OFC activation may reflect
the nonjudgmental aspects of mindfulness, and the
C 2013 New York Academy of Sciences.
Grant
reductions in amygdala activation may reflect the
attenuated reactivity or fear associated with the
stimulus. Although this elaborate and speculative
proposal is certainly biased by the framework
in which these studies were conducted (mindful-
ness), there are several additional findings offering
support.
The imaging study of Zen practitioners also re-
ported that during pain, meditators (but not con-
trols) reduced the functional connectivity between
the DLPFC and the dACC.31 The degree to which
these regions were decoupled predicted the baseline
pain sensitivity of the individual. Meditators with
the highest pain tolerance showed the greatest de-
coupling, suggesting that this may be the means by
which they are able to withstand such high temper-
atures. Importantly, practitioners were not medi-
tating, suggesting that they can modulate pain “on
the fly.” Recall also that the dACC was highly active
during pain for meditators and the DLPFC was de-
activated. The second important finding was present
in two of the three imaging studies discussed. Grant
et al. and Lutz et al. both showed that brain activity
was not correlated with pain ratings in meditators,
whereas it was for control subjects, as is typical.31,33
For Zen practitioners, pain ratings were rather cor-
related with the DLPFC, where greater reductions
in activity were associated with lower pain reports.
This provides evidence that the decay of activity
in this region does indeed influence perception.31
Together, these results suggest that meditators may
have learned to decouple the monitoring of aversive
stimulation from the processes that lead to it being
labeled or experienced as pain. The results also sug-
gest that this OM-based analgesia is not mediated
via the descending inhibitory control network, as
there is no evidence of the involvement of key re-
gions such as the subgenual ACC or PAG. Further-
more, distraction is not consistent with increases in
pain-related cortices.
Although this field is still young, to stimulate
discussion and debate I would like to propose a
basic model by which OM techniques, particularly
mindfulness, may influence nociception and pain.
The proposition is that mindfulness is a cascade of
events, resulting passively from the sustained ob-
servation or monitoring of the currently attended
experience. Consistent with the attention literature,
observing the noxious stimulus should accentuate
the percept and associated neural activity in rele-
Ann. N.Y. Acad. Sci. 1307 (2014) 55–63 
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Meditative analgesia
vant cortices (dACC, INS, SI/SII, Thal).17 Whether
it is possible or not, I would argue that a state of ab-
solute sensory focus, in the present moment, must
by definition not include memory-dependent pro-
cesses. Thus, sustaining a present-centered sensory
focus should preclude the formation of elaborate
mental narratives, extensive self-related processing,
and higher level appraisal, as these processes de-
pend on active retrieval and thought generation.
However, all thoughts, whether future or past ori-
ented, or even low-level stimulus identification and
classification, presumably must involve some de-
gree of retrieval from memory stores. Thus, it would
be absurd to suggest that advanced meditators re-
frain from identifying stimuli altogether, particu-
larly in a nonmeditative state. Rather, the suggestion
is that the degree to which one can maintain (or
chooses to invoke) this sensory focus and present-
centeredness proportionally reduces the higher or-
der thinking that features many facets known to
influence pain.40 There is no need to posit an active
inhibitor of these processes (with reference to brain
regions), as is typically the case for emotion regula-
tion strategies, as the sustained monitoring would
essentially lead to passive decay, potentially through
reduced functional connectivity between brain re-
gions, of these memory-dependent processes and
presumably the accompanying brain activation.41
Whether these regions would decouple in paral-
lel or in a particular sequence would be an open
question.
In addition to providing an explanation of the
imaging results of OM and pain discussed earlier,
the dependence of the model on an initial ability
to sustain one’s monitoring (rather than lapse into
mental elaboration) reflects the traditional order of
teaching wherein practitioners first must learn to
stabilize and sustain their attention. In line with the
recently proposed sensory-attentional cognitive the-
ory of mindfulness, as practitioners become more
proficient at sustaining sensory focus, the skills re-
lated to the concept of mindfulness should also in-
crease (concomitant with greater decay/decoupling)
and the effort required to achieve them should
diminish.42 This is important as the increased ac-
tivation in the dACC and INS in the studies of
Grant et al. and Gard et al. discussed earlier were in
fact strongest in the most junior of the experienced
meditators and were not associated with the great-
est pain reduction.31,32 It is also noteworthy that
59
Meditative analgesia
studies involving mindful modulation of negative
affect have not shown similar activation increases
of the dACC and INS, suggesting it is not the prac-
tice itself that drives these salience-related regions
but possibly the presence of a somatic stimulus that
promotes sensory focus.43
A rather important prediction can be derived
from the model proposed earlier. Namely, if mind-
fully observing a noxious stimulus results in some
degree of passive decay of memory-dependent pro-
cesses, then there should be weaker encoding and
associations formed with information presented
concomitantly with the stimulus. At first blush,
this might raise some eyebrows; however, essentially
what is being described is a conditioning paradigm.
It has long been held that the Buddhist practice
of mindfulness can be viewed as a process to shed
light on and eventually reduce unhealthy condi-
tioned responses.44 Many of the deactivated brain
regions observed in the previous work with OM
and pain are integral players in associative learn-
ing, with the amygdala, hippocampus, and medial
PFC being intimately involved in the acquisition
and storage of conditioned fear responses.35 Thus,
the model would predict, consistent with tradi-
tional claims, that individuals performing mindful-
ness would show less of a conditioned response fol-
lowing the pairing of an originally neutral stimulus
with an unconditioned aversive stimulus (pain). To
understand how mindfulness actually operates,
studies will need to begin to propose such mod-
els and attempt to decompose the construct,
ideally measuring change of the individual com-
ponents, longitudinally. Work along this line has
already started.
Longitudinal studies
The first experimental study of pain and mindful-
ness employed a longitudinal design30 and found
that training in mindfulness led to increased cold-
pain tolerance. Consistent with this, an important
study from 2011 trained meditation-naive partici-
pants over 4 days in mindful breathing.45 In addi-
tion to decreased pain sensitivity following training,
heat-induced pain was dramatically reduced, on par
with a strong analgesic. Overall brain activation was
reduced in the SI, with pain reductions correlat-
ing with increases in the INS, ACC, and OFC. Al-
though the increases in pain-related regions match
those of advanced practitioners, activity remained
60 Ann. N.Y. Acad. Sci. 1307 (2014) 55–63 
Grant
correlated with the painful experience (albeit in-
versely), that is, activation and experience were not
decoupled. Interestingly, the OFC was activated in
beginners, while it was deactivated in experienced
practitioners.31 As suggested in an earlier review, it
may be the case that beginners cannot inhibit auto-
matic appraisal of their experience and actively reap-
praise it within the framework of mindfulness,46
whereas more experienced practitioners may actu-
ally achieve something closer to no appraisal. How-
ever, these claims will certainly require more work
to validate or invalidate.
The anticipation of pain
The anticipation of pain is known to influence the
experience itself and often arises owing to condi-
tioned fear of previously experienced stimuli and
situations. Several studies have examined antici-
pation of pain, in relation to OM meditation. In
Tibetans, anticipating pain led to lower activation
of the ACC, INS, and amygdala, whereas increases
were observed in the ACC and INS during the ac-
tual pain.33 Similarly, using electroencephalography
(EEG), Brown et al. showed that mindfulness med-
itators experience painful laser stimulation as less
unpleasant, which was correlated with their expe-
rience level, and showed reduced dACC responses
while anticipating pain.47 Finally, in Vipassana med-
itators, increased activation of an anterior portion
of the ACC was observed, an area that has previ-
ously been linked to opioid analgesia.32,48 Although
this could be taken as evidence for activity in the
descending inhibitory control networks, one would
also expect PAG activation, and, further, during the
pain itself, activation was not decreased in this study,
rather it increased. Although these results do not
correspond quite as well as those for the receipt of
pain, they do suggest OM practice is associated with
reductions in anticipation, which influence the sub-
sequent painful experience. More research, and an
integration of the existing experimental and clinical
work on meditation and pain, is needed to better
characterize how changes in anticipatory processes
influence pain.
An unexplored technique
I would like to end by briefly introducing a medita-
tive practice called metta or Loving Kindness, which
theoretically may also influence pain. The Buddhist
practice involves intentionally generating feelings
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Grant
of love and warmth toward other beings. When
applied to suffering it is often called compassion
meditation. It has been proposed that feelings that
characterize close interpersonal bonds are instan-
tiated through the release of endogenous opioids
in the brain, which reinforce those bonds.49–51 It is
known that we have more empathy for those with
whom we share a bond, which activates pain-related
networks, and, further, that adopting a compassion-
ate attitude toward another person activates regions
involved in opioid neuromodulation.52–56 Given
that opioids are the most potent painkillers known
and that the feelings that underlie compassion may
be associated with the natural release of opioids,
it would not be a stretch to predict that compas-
sion would also be associated with opioid-mediated
analgesia. Preliminary data in an advanced Tibetan
monk suggest this may be true.57 The monk was
asked to perform compassion meditation, which
had already been shown (in this individual) to ac-
tivate opioid-related brain regions.56 His reports of
pain unpleasantness were greatly attenuated, sug-
gesting that opioids may indeed underlie a compas-
sionate state.57 If these results were to be replicable
in larger samples it would have extremely important
societal implications. A more compassionate society
has clear benefits for everyone, but demonstrating
that the individual may suffer less by being com-
passionate may provide the impetus to make it a
reality.
Conclusions
It is clear that meditative training can influence
pain and, further, that there are multiple means by
which this may be accomplished. There is not much
support for FA techniques influencing pain. In Ti-
betans, it simply did not differ from controls, and
in Zen practitioners, it was not possible to dissoci-
ate the contributions of prior training in both FA
and OM practice. However, a case report suggests
extreme yogic forms of FA may dramatically reduce
pain through an active distraction-like process. OM
techniques are the most studied and appear to be the
most proficient, possibly working through increases
in sensory focus, leading to, according to the model
proposed, a cascade of functional effects that map on
well to the construct of mindfulness. Physiological
change, toward a more parasympathetic-dominant
state, also appears relevant, as do changes in fear,
anxiety, and anticipation. Indeed, clinical work sug-
Ann. N.Y. Acad. Sci. 1307 (2014) 55–63 
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Meditative analgesia
gests that meditative practice may positively influ-
ence these processes in those suffering from chronic
pain.58 Importantly, effects do not seem limited to
the meditative state and, while not discussed, can
also influence brain structure.24,59 It will be crucial
in the coming years to validate whether individ-
ual differences on measures such as genetics or diet
could explain many of the observed results. There
are definite weaknesses in the reviewed studies, in-
cluding lack of control of the factors just mentioned,
small sample sizes, cross-sectional designs, and the
ever-present issue of an appropriate control group
for special populations such as meditators. How-
ever, the increasing number of longitudinal studies
being reported is encouraging and suggests that the
field is well on its way to unraveling the mechanisms
underlying meditative analgesia.
Conflicts of interest
The author declares no conflicts of interest.
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