Is Mindfulness Effective for Chronic Pain?
Studies show that mindfulness on its own has almost no effect on chronic pain. But when it's preceded by a shift in how you perceive the pain — it can become far more effective.
The answer is probably yes — but only a little. A comprehensive 2017 systematic review found only a small effect on pain levels, depression, and quality of life (Hilton et al, 2017).
But — that may not be the whole story…
A group of researchers at Harvard developed a "mind-body" treatment for chronic pain (based on the theory of Dr. John Sarno), aimed at changing how the brain interprets chronic pain — coming to perceive it as a non-dangerous sensation — alongside encouraging healthy emotional expression.
They ran a controlled clinical trial in people with chronic back pain, comparing a group that received the treatment they had developed followed by mindfulness, against a group that received mindfulness alone.
The results showed 64% full recovery from pain (!) in the group that got the "mind-body" treatment followed by mindfulness, compared with far lower numbers in the mindfulness-only group (Donnino et al, 2021).
How Did This Happen?
Mindfulness is a mental technique that applies non-judgmental attention to a particular sensation or experience (pain, for instance), and through that is meant to reduce the emotional reaction to that experience (which in turn should reduce pain). That said, when the brain reads pain as a threat to the body, sitting non-judgmentally with the "threatening" sensation may not change much — because the danger still feels real, and the brain's "danger mechanism" is still running.
If, on the other hand, the interpretation of the pain has first shifted from a dangerous sensation to a safe one, then mindfulness can be highly effective — strengthening exactly those neural connections that turn down the "danger mechanism," and with it the pain response.
In a follow-up paper, the researchers found that pain-related anxiety was the variable that explained the patients' improvement. In other words, the more the participants reduced their fear, anxiety, and sense of threat about the symptom itself, the more their pain and disability dropped as well (Pester et al, 2023).
That same treatment (again followed by mindfulness) was also tested in a group of patients with Long Covid — a syndrome of fatigue, pain, and brain fog thought to stem from a neuroplastic origin. In that study, this time without a control group, there was a large effect: a drop in symptoms that held up at a one-month follow-up (Donnino et al, 2023). Here too, lowering the sense of danger around the symptoms helped patients benefit from the mindfulness that followed.
In short, persistent physical pain can arise from neural networks shaped by the anticipation of danger and a sense of threat — not from "stress" alone. That's why changing how we interpret the pain — no longer reading it as a danger signal — and lowering the anxiety around it are critical pieces of being able to reduce chronic pain.
Mindfulness needs a context and a frame of reference — otherwise it may work, but far less well…