New brain imaging study shows self-compassion training alters neural responses to chronic pain

A recently published study examined the effects of self-compassion training among people with chronic pain. The study found that self-compassion changes the way the brain processes pain and self-criticism, and suggests that self-compassion skills can improve patients’ mental and physical wellbeing.

Chris Germer, faculty at Harvard Medical School, along with Dr. Susan Pollak, designed and co-taught the intervention. Two articles were published on this research, which can be accessed here.

  • Berry, M. P., Lutz, J., Schuman-Olivier, Z., Germer, C., Pollak, S., Edwards, R. R., … & Napadow, V. (2020). Brief Self-Compassion Training Alters Neural Responses to Evoked Pain for Chronic Low Back Pain: A Pilot Study. Pain Medicine. [link to study]
  • Lutz, J., Berry, M. P., Napadow, V., Germer, C., Pollak, S., Gardiner, P., … & Schuman-Olivier, Z. (2020). Neural activations during self-related processing in patients with chronic pain and effects of a brief self-compassion training–A pilot study. Psychiatry Research: Neuroimaging304, 111155. [link to study]

As many as 1 in 5 adults currently suffer from chronic low back pain, making it one of the most debilitating health problems worldwide. Chronic pain not only interferes with daily activities, it can also affect patients’ mental wellbeing, for example by increasing self-criticism. Long-term opioid treatments for chronic pain are questionable, and there is growing interest in alternative, non-pharmacologic approaches, such as mindfulness. Mindfulness interventions often include teachings of self-compassion, the skill of being kind towards oneself during moments of pain. Self-compassion appears a valuable skill to cope with pain and increase wellbeing for patients with chronic pain, but current research is limited.

“From a theoretical and neurobiological perspective, self-compassion seemed very promising for patients with chronic pain, but there was barely any research on self-compassion trainings and related brain changes in patients with chronic pain,” says Jacqueline Lutz, PhD, former postdoctoral fellow at Cambridge Health Alliance (CHA), who spearheaded the innovative research study through a collaboration between research teams at the MGH Martinos Center for Biomedical Imaging and the Cambridge Health Alliance Center for Mindfulness and Compassion.

The researchers set out to explore the effects of a brief self-compassion training among twenty patients with chronic low back pain. 

“We were surprised to find that only two-weeks of self-compassion training reduced back pain and pain-related disability. Participants also reported more self-compassion and body awareness,” says Michael Berry, co-lead author, former research technician, and PhD student in Clinical Psychology.

Germer, also the co-founder of the Mindful Self-Compassion program, shares some real-life impact of the training:

“Self-compassion seemed to alleviate the stigma of chronic pain and many participants felt better about themselves even when their pain level didn’t change. Others reported that they experienced less pain and self-compassion allowed them to focus on other aspects of their lives.”

But how did self-compassion change brain activations during pain (which was induced using a pressure cuff around participant’s calf), and during self-criticism?

Using functional magnetic imaging (fMRI), the researchers found that when patients used their newly trained self-compassion skills, their brain reacted differently to pressure pain.

The right temporo-parietal junction (TPJ), which processes the salience of pain, was less active and this was associated with less clinical pain. Other brain areas, including the dorsolateral prefrontal cortex (dlPFC), showed increased activation after training, pointing to a specific neural signature of processing pain during self-compassion.

“If self-compassion training can beneficially change the way that pain is processed by the brain, it could significantly impact quality of life for chronic pain patients, who we know from prior brain imaging research have altered neural circuitry for integrating pain into conscious awareness.” says Vitaly Napadow, PhD, an international expert on the neuroscience of pain and the director of the Center for Integrative Pain Neuro Imaging at the MGH Martinos Center for Biomedical Imaging and an associate professor at Harvard Medical School.

Self-compassion training also changed the way participant’s brains processed self-critical situations in the brain scanner.

Areas involved in regulating emotions, including the dlPFC, which after 2 weeks of training, reacted more strongly during periods of self-criticism, suggesting that participants were better able deal with their self-criticism using self-compassion skills. 

Zev Schuman-Olivier, MD, an addiction psychiatrist at Harvard Medical School and director of CHA Center for Mindfulness and Compassion explains, “Self-criticism, stigma, and shame can impact our brain and body and accentuate chronic pain. This study helps us understand that even just two weeks of self-compassion training can impact the way we relate to ourselves and our brain data suggests that this healing process of becoming kinder to ourselves likely starts by activating regions involved in emotion regulation.”

The team warns that this study did not include a control group, and that longer self-compassion training might show even more impact. They hope the study shines a light on self-compassion as a remedy for patients with chronic pain and will spur further research into its potential. 

As challenging as it may be for some people suffering from chronic pain, the skill of “being kind to oneself,” could really be a simple but much needed addition to current chronic pain management.

This study was funded by grants from the Osher Center for Integrative Medicine, Harvard Mind-Brain Interfaculty Initiative the Mind and Life Institute, and the neuroimaging tasks were developed with funding from NCCIH and the NIH Common Fund through the Science of Behavior Change Initiative.

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