Mindfulness meditation trumps placebo in pain reduction | Hacker News Reader

Mindfulness meditation trumps placebo in pain reduction

sciencedaily.com

137 pointsDrScump55 comments

When I read about studies like these I always wonder how the placebo is done.

Here it is actually stated: "sham meditation" and petroleum jelly cream.

One of the problems with this is that the experimentors would know who got the placebo and who did not.

I don't think it is far fetched than a subject would sense whether they were being taught mindfulness mediation which the experimentor perceived as being genuine or "sham meditation" which the experimentor knew to be false.

Whether a subject perceives she is undergoing an effective treatment obviously will effect the placebo effect and probably also show on brain scans.

Hm. Double-blind studies are supposed to measure whether a medical effect is real or all in your head. But meditation is, in a sense, "all in your head" either way. If a patient who genuinely believes that they are doing pain-relieving mindfulness meditation enters a mental state in which pain is relieved, does it matter if that state is "real" mindful meditation or not?

Everything you will ever experience is all in your head.

No snark intended. This is a potent insight in pain science.

It's not all in your head. If I hit you on the head with a sledgehammer, the pain you will feel will in some sense be "all in your head." But the sledgehammer, which is not in your head (unless I hit you really, really hard!), still had something to do with it.

But some people esperience pain without the external cause. No sledge hammers, no cancer, no disease, but pain is present.

Yes, of course, but so what? It is still not true that "Everything you will ever experience is all in your head."

It is correct, from my perspective. Pain is just the interpretation of signals from sensory organs. Our brain could just as easily interpret it as something else or disregard it.

Not really. Try this experiment: hit yourself on the head with a sledgehammer and then try to "interpret" the pain as something else (eating chocolate, say) or just "disregard" it. You'll find it's not so easy.

In fact, you already know that I'm right about this. You are in fact so convinced that I am right that you will not try this experiment. How do I know this? Because millions of years of evolution has hard-wired this understanding of pain into your brain. Anyone who doesn't have this understanding hard-wired into their brains tends not to survive because they end up doing stupid things like hitting themselves on the head with sledgehammers just to see what will happen. In fact, there are a very few people who can't feel pain. It's a very serious problem. They have to be extremely careful because they can easily sustain life-threatening injuries and not realize it.

But you're being a bit dogmatic. We use psychological techniques to reduce pain in, for example, cancer patients.

You're reducing pain to some reaction to the physical world, but we see that some people have pain with no physical stimulus; and we some people who can reduce their pain even though there are physical stimuli present.

When you properly control a study on pain meds you see such a strong placebo response that it's hard to justify using the meds:

https://news.ycombinator.com/item?id=10351230

http://www.nature.com/news/strong-placebo-response-thwarts-p...

All true. That doesn't change the fact that some (in fact, much) subjective experience arises from external stimulus, and so it is not correct to say that everything you experience is all in your head. Some of what you experience is all in your head (dreams, psychosomatic conditions, hallucinations), and the rest is a combination of in your head and not in your head. (Obviously, any phenomenon that is entirely outside of your head is not part of your experience.)

Indeed, prove that your entire life experience is not delusions and hallucinations. The mind is capable of false reality and deep delusions, unless you think you are more capable and aware than your brain...

You think that you have experienced things beyond your own brain, but that is just your brain telling you that. There is probably entire fields of study focused on logically proving that reality is real... We have very little chance of evolving this conversation into something more than ego-fueled arguing. :)

No, you're wrong about that. The ability to do science provides overwhelming evidence that solipsism is false. For an extended treatment, read David Deutsch's "The Fabric of Reality" chapter 3.

You've obviously got more brains in your pinky finger than I have between my ears. :P

It's odd, I know, but entirely factual. All sensation, all your experience of anything ever is a processing output of your brain.

Certainly if you hit my hand with a sledgehammer i will scream about my hand hurting. But what has happened? Nerves depolarise, synapses communicate, a pattern of activity emerges in my brain. And as the conscious entity experiencing that pattern, i experience pain.

If my spinal cord is severed (and i survive otherwise intact) those signals never reach my brain, and i experience no pain. No physical pain as a direct result of your actions, anyway. I may still be annoyed :)

Your experience is 100% dependant on and exclusive to your brain, sledgehammer or no.

Yes, your subjective experience has its locus in your brain, but that is not at all the same thing as "Everything you will ever experience is all in your head." There is an external reality that is separate from your brain. Some of the things you experience (like getting hit on the head with a sledgehammer) involve processes that operate in this external reality, and others (like dreams or psychosomatic pain) don't. This is a salient and useful distinction which "Everything you will ever experience is all in your head" only serves to obscure.

Okay so this may feel like splitting hairs, but...

You're talking about input, I'm talking about output.

Experience is influenced (to varying extent) on sensory input, but they're not the same thing.

Sensory input of course influences experience, I'm not going to deny a sledgehammer to the hand.

While you feel that the distinctions drawn above serve only to obscure things, in fact the reverse may be true. The Cartesian perspective that "output is nothing but a response to input" has been pretty much discarded in modern research into pain, neurology, consciousness, psychiatry, and so on.

So i don't deny the role of sensory input. I'm just pointing out that input is distinct from output; they're not the same thing.

There is no clear line which makes a sensation external or internally based. It's a messy abstraction, but there's some meaning behind it, because things can at least be relatively sorted by how external or internally based they are. For example, you may see a spider which 99.99% of sighted individuals would also see and agree there was a spider there, or you can hallucinate one, where only you would agree about a spider being present. Clearly the first is MORE externally based than the latter.

> I'm just pointing out that input is distinct from output; they're not the same thing.

That's obviously true, but that's a very different statement than the one you originally made, namely, "Everything you will ever experience is all in your head."

In response to your new statement I will say: I understand what "input" means, but I can't imagine what "output" could possibly mean in the context of a discussion on subjective experience.

If you mean that whatever combination of neurons fire to produce a subjective experience in response to external stimuli can also be triggered without those external stimuli in some cases, then yes, that is also obviously true. But that is also a very different claim than "Everything you will ever experience is all in your head."

I feel we may both be pushing on the same open door.

>> I'm just pointing out that input is distinct from output; they're not the same thing.

> That's obviously true, but that's a very different statement than the one you originally made, namely, "Everything you will ever experience is all in your head."

Nope, it's exactly the same. Experience is output, and entirely in your head. Sledgehammers to the body are input. Everything you will ever experience is entirely output. Sledgehammers will influence that output, but input and output are not the same. They are tightly coupled, and one of course strongly influences the other.

I agree with you that these are salient and important distinctions. I simply disagreed with your assertion that "It (experience) is not all in your head." It really is. After all, where else would your experience be?

Okay enough splitting hairs. Personally I feel the distinction is clear and highly relevant. Some references I should have provided earlier:

Melzack, 2001. Pain and the neuromatrix in the brain: http://www.ncbi.nlm.nih.gov/pubmed/11780656

Moseley, 2003. A pain neuromatrix approach to patients with chronic pain. http://www.ncbi.nlm.nih.gov/pubmed/12909433

http://www.bodyinmind.org/resources/journal-articles/full-te...

(Edits: clarity and detail)

The "all in your head" element is always present. Trials seek to discover an effect beyond this, not instead of it.

True - which is why they did the cream as well. At the very least, this study tells us that the mindfulness meditation is a 'more effective' placebo than the cream.

It's very hard do really do in a 'double blind' way - I would not be able to think of something that is to all appearances equal to the real mindfulness mediation, but actually only a fake. There's no substance to it.

Do you have any suggestions to do it better?

This is why trials designs other than RCT can be appropriate. For example, one group could be randomised to receive meditation therapy now, and another group would receive it later. Ethically this is more comfortable too, since neither group is denied a potentially effective treatment.

I wonder if there is a well tested, robust placebo for meditation. Time to trawl the literature for protocols and designs.

Use an activity-based sham therapy as the control, and have it administered by someone who believes it works. Waving magnets over the subject's body, for example.

Some meditation teachers concentrate on Buddhist teachings that's not part of mindfullness. They believe those teachings to be more important than mindfullness. If the experimentors ask one of those teachers to teach the patients to meditate, the meditation will be "fake".

Can that really substitute as a placebo, though? I'd imagine you'd have to first verify that those teachings are no more effective than a placebo, which runs into the same problem as the original purpose of finding a proper placebo comparison.

Edit: Sorry, I misunderstood your comment. However, if they're testing the effectiveness of the meditation technique, then the teacher's belief in the method shouldn't affect the outcome of the result, assuming the technique is the same in both cases.

Those behind the study appear to be of the view that it can't be done:

"This study could not be designed in a double-blind fashion due to the nature of meditation training and placebo conditioning. Specifically, placebo cream could not be applied to all groups because this manipulation could potentially elicit analgesia even though the subjects were informed that the cream was inert (Kaptchuk et al., 2010). Furthermore, whereas subjects in the placebo-induced analgesia and book-listening control groups were clearly aware of their group assignment, subjects in the mindfulness and sham-mindfulness groups were blinded to their intervention assignment. For the mindfulness and sham-mindfulness groups, responses related to psychosocial influences (i.e., demand characteristics) presumably were minimal given that no significant differences in “perceived meditative effectiveness” were observed (p = 0.88; Table 2)."

> At the very least, this study tells us that the mindfulness meditation is a 'more effective' placebo than the cream.

Which leads one to consider - what is a placebo anyway? It's a mental state one puts oneself in that improves physically measurable symptoms. That seems indistinguishable to me from meditation. If you think about it, it's kind of funny that skeptics like to dismiss impressive sounding treatments as being placebos. A placebo is a pretty impressive phenomenon!

If one can reliably create a reliable, powerful treatment that actually works (fixes what you're targeting rather rather than symptoms, unless symptoms are what you're targeting as in this case) by putting ones self into a mental state, that sounds like a win, even if it does meet the definition of a placebo.

I always did wonder about that. Current research implies that placebos work as long as you believe they will work, even if you know they are a placebo. But then why would you need the placebo in the first place?

There seems to be no need to do anything really, if you can just stop thinking you're feeling bad then you'll actually feel better.

In principle there's no need for any specific instructions on meditation either, but it does seem to be related to meditation where you also aim to stop thinking about certain things, so those instructions are likely to be useful, even if they only turn out to be yet another placebo. After you gain more confidence that you can do it, you should have less need for those instructions though.

> Current research implies that placebos work as long as you believe they will work, even if you know they are a placebo.

It depends on the research. There's some that don't find a strong placebo response.

>it's kind of funny that skeptics like to dismiss impressive sounding treatments as being placebos. A placebo is a pretty impressive phenomenon!

It's not about whether a treatment works at all - it's about whether it works better than any old random thing. If it doesn't, you can hardly call it a treatment. Sure you could go "hallelujah, a new medicine!" when you find that a sugar pill provides a slight improvement, just like sand pills and empty pills and homeopathy. But you haven't actually discovered anything new.

> But you haven't actually discovered anything new.

The fact that sugar pills work may not be new, but it's still pretty remarkable.

It may be remarkable. But it is not a property of the sugar pills.

If you take an African witch doctor with hours of trance dancing and plenty of chicken blood, it is probably all placebo.

Both for someone of the same tribe, who has been brought up in the same belief system, having been taught to look at the doctors in awe, a dramatic treatment by a witch doctor probably is tremendously powerful.

My guess is that it will be much more powerful than mindfulness meditation. (And this is regardless of what is attempted treated - (self-reported) pain from a hot prick or the common cold.)

In others words; the self-healing/self-suggesting effects that we call placebo has something to do with belief; and probably belief in a broad sense, whether the subject believes, whether the doctor believes and whether the surroundings in general believes.

In a way things like mindfulness meditation is part of the "folk-religion" of the modern man. Read any women's magazine / self-help book and it will tell you that mindfulness, positive thinking, biodynamic food and exercise has strong effects on your physical, psychological, sociological, even financial well-being.

Most of this is not science. But some science supports of the claims.

I think that a good question for science to ask is "has these things always been true?" Are they deep physiological facts or are they changing over time, over culture?

The study summary mentions that the effect of the cream was 10%. The cream I suppose was made to look like traditional western medicine applied by some kind of nurse or doctor.

Suppose this experiment had been done in the 50es where skeptism towards Western medicine was much lower and a doctor's authority was much stronger. Would the effect be same? My guess is it would be stronger.

Likewise maybe saying a prayer worked better for the believing Christian Western man of 200 years ago than the modern "scientific" techniques of positive thinking, mindfulness etc. would have.

How would you crack this in a scientific experiment?

It is probably very hard because the experimenter's beliefs also comes into play. Double-blind is one way to go about this but for what is examined here it is probably not possible to do effectively. And secondly the subjects would be affected by what they believe works and already know about.

Maybe a simple place to start would be to ask the subject (and the experimentor) if they believe the treatment would work? And maybe survey general attitudes towards traditional medicine, alternative medicine, meditation, health etc.

How far down the rabbit hole does it go though? Even if you show a physical mechanism, you can always claim it was your belief system and mental state which allowed the physical mechanism to take place. You're liable to end up in a cholera-esque place where people subconsciously or consciously create their own realities.

The rabbit hole is probably very deep.

But some of these things are well-understood. So if you test a pill and it is green, tiny, makes your tommy hurt for 10 minutes - then make sure that your placebo has the same properties in the your double blind experiment.

Secondly you can break things down and find out why they work. Why does mindfulness meditation stop the pain of being burnt?

Psychology as a science has many problems; in a way I think they believe too much - have too many strong ideas. I guess that is why the treatments have changed so much thru the years - and the diagnosises too - people have completely different (psychological) diseases today than a few decades ago.

Also their experiments are often underpowered or have methodological errors.

Maybe they should devote themselves to studying placebo rather than perceived actual treatments.

It would be useful to know if the pill should be red or green, the nurse brunette or blonde.

:-p

Pain reduction is just one benefit.

Another one is stress reduction, leading to a stronger immune system, less asthma, improved digestion, etc.

The main point is probably that you rewire your brain: http://news.harvard.edu/gazette/story/2011/01/eight-weeks-to... which means doing it on a regular basis improves your hardware, not just your software.

You will end up managing your emotions more efficiently, which is extremely useful for people who need to stay away from d e p r e s s i o n and a n x i e t y.

Why did you space out those two words? To make it unsearchable? But why?

75 subjects divided into 4 groups, so about 19 people per group.

Suppose the study was studying the effect of coin tosses per group. The standard deviation is sqrt(19)/19 or about 23%. And that is only one sigma.

So we might also conclude that those who flip heads are <insert effect here> than those who flip tails. Is anyone really surprised that the reproducibility study [1] found reproducibility comparable that of a coin toss (to about one sigma)?

[1] http://www.nature.com/news/over-half-of-psychology-studies-f...

The std. dev. of a binomial is sqrt(n p (1-p)). So for 19 coin flips that's ~2.2, or 11%, not 23%.

Plus your setup is not relevant to the setup that they performed (check figure 3).

I am not so surprised that many studies are not replicated, but I also am not surprised when critical internet comments are weaker than the analysis they criticize.

> The std. dev. of a binomial is sqrt(n p (1-p)). So for 19 coin flips that's ~2.2, or 11%, not 23%.

You are correct. The usual way in which std dev is applied is ± sigma accounts for about 68% of the trials, which is 2 std deviations, and is what I had in mind. So for 19 people flipping a coin, you'll have a range of about 23% variation.

That factor of 2 does not change the message.

"Mindfulness meditation reduced pain by activating brain regions (orbitofrontal and anterior cingulate cortex) associated with the self-control of pain while the placebo cream lowered pain by reducing brain activity in pain-processing areas (secondary somatosensory cortex).

Another brain region, the thalamus, was deactivated during mindfulness meditation, but was activated during all other conditions. This brain region serves as a gateway that determines if sensory information is allowed to reach higher brain centers. By deactivating this area, mindfulness meditation may have caused signals about pain to simply fade away, Zeidan said."

You can read the full paper here:

http://jn.sfn.org/press/November-18-2015-Issue/zns0461501530...

Fascinating results.

Placebo is just a derrogatory term for the fact that your mind influences your body and your perception of what is real.

It is a perversion of capitalist societies to only accept a physical and obvious influence as being able to change something.

The trick is - our mind is physical - at least physically manifested - and so it should be evident for even mildly educated people that your mind can affect your body.

So instead of disregarding placebo as some bullshit that is used to test whether something actually works - why not invest some time and money into perfecting the application of placebo effects?

Well, and here we are back to the mechanisms of capitalism - you couldn't sell that very well ... that's the problem.

And if you think about it - perfecting the reliability and effect of placebo "medication" would inevitably lead in a straight path to ... meditation.

Ok so how do I try this out?

You could try this, which is similar, but more serious and demanding (the 10 day course): https://www.dhamma.org/

If you have the time, it can be one of the most unique and life changing experiences, in a good way, one can have.

Silence, food etc are easy. But ten hours of meditation everyday for 10 days sounds scary. Could you talk more about your experience?

I attended one of these ten day retreats in September. It was a worthwhile experience, but it hasn't produced any great change in my day-to-day experience.

That said, many people I met at the retreat reported feelings of great personal significance. I'm completely open to the possibility that the fault lies with me, but I wonder whether these reports were influenced by group pressure, since there is something of a sense of community and to admit that you "didn't feel anything" is to exclude yourself. After ten days of silence and seclusion from the world (there's no technology, communication, reading, etc.), you will want all the social interaction and acceptance you can get.

Also bear in mind that this is basically a self-selected group of people who are searching for "something." Whatever "it" is, it doesn't come as a surprise to me that people find it after ten days alone with their thoughts (which still come to mind, however much you try to focus on bodily sensations).

As an aside, I was also turned off by some of the quasi-religious content of the retreat. The website claims that this is a strictly evidence-based practice, but you'll quickly realize this isn't the case when you hear Goenka chanting in Pali or explaining the benefits of meditation as an effect of releasing "sankhara."

After the retreat, I thought a fellow named Harmanjit Singh did an excellent job evaluating Goenka's teachings here: http://harmanjit.blogspot.com/2007/07/critique-of-vipassana-...

If I ever have another continuous twelve days to spare, I'd still be willing to try another retreat with a more secular focus.

There's a great book called Mindfulness in Plain English, which I've been recommending for some time. It's direct, to the point, and addresses many topics such as distractions, pain during practice, exactly how to prepare, and of course what to do with your mind.

I think this is complete: http://www.urbandharma.org/udharma4/mpe.html

But it's always nice to have something in paperback or Kindle: http://www.amazon.co.uk/Mindfulness-Plain-English-Anniversar...

The printed edition also has a nice afterword.

Try Headspace. I've been using it for a while and I find it helpful.

I've really enjoyed "Search Inside Yourself," a book by the person who runs the courses at Google. It takes an engineering eye to the benefits of mindfulness.

I'd recommend something in the spectrum of Jon Kabat Zinn's work in whatever format you prefer. For casual interest, you can find him guiding mediations on youtube or buy any of his older books for pretty much nothing on used book sites.

People with chronic pain or health issues may want something with more support like the stress clinic at UMASS lowell medical. But you really only need about 15 minutes of instruction and guided meditation and then to find whatever motivators work for you.

https://en.wikipedia.org/wiki/Jon_Kabat-Zinn

From the footer of the press release kindly submitted here:

"Story Source:

The above post is reprinted from materials provided by Wake Forest Baptist Medical Center. Note: Materials may be edited for content and length."

It helps the quality of discussion here on Hacker News, especially the quality of discussion of medical topics, to prefer sources other than press releases and press release recycling services like ScienceDaily for news on medical topics. Most new medical study findings are never replicated and are presumptively false.[1] Most study findings about placebo effects do not take into account the complications of defining what a placebo is, really, in a clinical trial context or what mechanisms might produce a placebo effect.[2] The small-n study reported here relies on subject patient measures of a subjective symptom, pain, and doesn't suggest any actual clinical effect on patients that can be objectively measured (such as reduction of tissue damage).

Press releases are a known part of the science hype cycle used to draw in more funding for research labs.[3] Let's go behind the hype and see what experienced science journalists and other scientists say about each lab's press release before opening discussion here.

Anyway, Hacker News participants have been saying for years that it's a good idea to look for better sources than Science Daily.[4] If Science Daily is the only place of publication for a finding, I find it more useful to look for another source before presuming the hyped finding represents a fact about the world.

[1] "Why Most Published Research Findings Are False", John P. A. Ioannidis, August 30, 2005

http://journals.plos.org/plosmedicine/article?id=10.1371/jou...

[2] "Are Placebos Getting Stronger?" Steven Novella, October 21, 2015

https://www.sciencebasedmedicine.org/are-placebos-getting-st...

"Placebo by Conditioning", Steven Novella, July 29, 2015

https://www.sciencebasedmedicine.org/placebo-by-conditioning...

"Placebo, Are You There?" Harriet Hall February 24, 2015

https://www.sciencebasedmedicine.org/placebo-are-you-there/

[3] "The Science News Cycle"

http://www.phdcomics.com/comics/archive.php?comicid=1174

"Related by coincidence only? University and medical journal press releases versus journal articles"

http://www.sciencebasedmedicine.org/index.php/related-by-coi...

"Anatomy of a Press Release"

http://www.skepticblog.org/2012/06/21/anatomy-of-a-press-rel...

[4] Comments about ScienceDaily:

http://news.ycombinator.com/item?id=3992206

"Blogspam.

"Original article (to which ScienceDaily has added precisely nothing):

http://www.washington.edu/news/articles/abundance-of-rare-dn...

"Underlying paper in Science (paywalled):

http://www.sciencemag.org/content/early/2012/05/16/science.1...

"Brief writeup from Nature discussing this paper and a couple of others on similar topics:

http://www.nature.com/news/humans-riddled-with-rare-genetic-...

http://news.ycombinator.com/item?id=4108603

"Everything I've ever seen on HN -- I don't know about Reddit -- from ScienceDaily has been a cut-and-paste copy of something else available from nearer the original source. In some cases ScienceDaily's copy is distinctly worse than the original because it lacks relevant links, enlightening pictures, etc.

" . . . . if you find something there and feel like sharing it, it's pretty much always best to take ten seconds to find the original source and submit that instead of ScienceDaily."

Ironical headline, to my knowledge, mediation is mindlessness state.

Mediation doesn't appear in the title.

Mindfulness meditation does, and it's an almost exact opposite of a mindlessness state.

Both "mindless" meditation and mindful meditation have their purpose. They are not the same thing, and people who do not practice meditation do not understand they are different.

I find both extremely important in maintaining my mental state during times of stress. A half hour of meditation a day keeps the mental hospital away.

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