While mindfulness-based interventions (MBIs) appear to have small-to-moderate efficacy in treating chronic pain, the extent to which these effects are mediated by improvements in cognitive functioning remains unclear.
Mohr et al. [Social Science and Humanities Open] conducted two studies to explore this question: (1) a cross-sectional study comparing the cognitive and emotional regulation abilities and interoceptive awareness of patients with chronic pain to those of healthy controls, and (2) an experiment examining the effects of Mindfulness-Based Pain Management (MBPM) compared to treatment-as-usual on the cognitive and emotional regulation abilities and interoceptive awareness of patients with chronic pain.
In the cross-sectional study, researchers compared 24 patients with chronic pain (mean age=43 years; 88% female; 100% White) to 11 healthy controls (mean age = 43 years; 82% female; 82% White) on self-report measures of pain, depression, interoceptive awareness (using the Multidimensional Assessment of Interoceptive Awareness scale, MAIA), and mindfulness (using the Five Facet Mindfulness Questionnaire, FFMQ).
Participants also completed computerized tasks measuring executive functioning (including an emotional Go/No-Go task) and working memory. The emotional Go/No-Go task instructed participants to press a computer key when presented with a specific word and refrain from pressing for other words, which included emotionally neutral, positive, and pain-related words.
Results showed that patients with chronic pain tended to report significantly higher levels of depression and pain, and significantly lower levels of mindfulness and interoceptive awareness, compared to controls. Exploratory analysis suggested that patients with chronic pain and controls differed in terms of how several of their MAIA subscales correlated with various cognitive executive functioning and working memory measures.
In the experiment, the researchers assigned patients with chronic pain who were interested and willing to commit to attending (N=16; mean age=42; 88% female; 100% White) the MBPM program, and those who were uninterested or unwilling to commit (N=14; mean age=38; 86% White) were assigned to treatment-as-usual.
MBPM is an 8-week group program based on Mindfulness-Based Stress Reduction (MBSR) and modified to meet the needs of patients with chronic pain. Due to the COVID pandemic, groups met online for 2-hour weekly group sessions. The pandemic also impacted participation and data collection, with only 47% of the MBPM group attending and completing all evaluations. Participants were assessed pre- and post-intervention using the same measures as in the prior cross-sectional study.
The preliminary results indicated the MBPM group had significantly greater decreases in depression, pain interference, and pain intensity, and significantly greater improvements on several subscales of the FFMQ and MAIA compared to controls.
While there were some pre-to-post improvements on cognitive and memory tasks, the groups did not significantly differ in their degrees of improvement. For example, while the MBPM group significantly improved its false positive rate on the Go/No-Go task when pain-related stimuli were involved and controls did not, the difference in their improvement rates did not reach statistical significance.
The experiment suggests that MBPM might improve depression, pain intensity and interference, mindfulness, and interoceptive awareness in chronic pain patients. Decreased depression and increased interoceptive awareness may, in turn, benefit cognitive executive functioning and working memory.
However, the study’s limitations—including a lack of randomization, high attrition rates, small sample size, and lack of adequate correction for multiple comparisons—should be considered carefully when interpreting the findings.
Reference:
Mohr, E., Matthew, S., Narisetti, L., Duff, C., & Schoenberg, P. (2025). Cognitive mechanisms of mindfulness-based pain management in chronic pain. Social Sciences & Humanities Open.
Link to study
