Mechanisms of Mindfulness Meditation and Self-Hypnosis for Pain in Older Adults With Chronic Pain

Inclusion criteria

• be ≥60 years of age;
• have self-reported chronic pain (≥3-months, with pain experienced on ≥ 50% of days);
• endorse an average intensity of pain ≥3 on a 0-10 numerical rating scale (NRS) for most days of the previous 3-months;
• be able to read, speak, and understand English;
• be naïve to meditation and hypnosis:
• never received formal training in or attended a mindfulness meditation or therapeutic hypnosis course;
• have not practiced meditation (e.g., mindfulness meditation, Zen, Buddhism, or meditation applications such as certain types of CALM meditation; or therapeutic hypnosis (e.g., hypnosis applications) in the past 6-months;
• \<20-min. practice/week of meditation or therapeutic hypnosis (not described above) over the past 6-months;
• if currently taking analgesic or psychotropic medication, medication must have been stabilized for ≥4-weeks prior to this study and does not anticipate changes in the medication during the study;
• access to a private place with adequate internet reception to support participation in intervention training sessions;
• not currently participating in another clinical trial or interventional study for chronic pain and willing to refrain from participation in any other clinical trial or interventional study for chronic pain during active participation in this study;
• willing, able, and committed to participate in an in-person EEG, and two MRI/fMRI scans; and
• able to use an electronic device (e.g., smart phone, tablet, computer) independently to access email and webpages or have someone available in their home who can help them with initial session set-up and then leave for the treatment sessions.

Exclusion criteria

• have a history of a medical condition that could produce an abnormal EEG (e.g., epilepsy, history of traumatic brain injury);
• have an EEG confounder (e.g., congenital or acquired skull defects, missing sections or holes in the skull, or plates, screws, or other implants within the skull or brain) that would interfere with reliable EEG data collection;
• have metals in the body (e.g., pacemakers and/or cochlear implant) that are not allowed by IBIC MRI technicians;
• self-report claustrophobia or other contraindications to MRI scanning;
• have uncontrolled hypertension;
• have a primary chronic pain condition of headache;
• have chronic pain due to malignancy (e.g., cancer) or a chronic pain condition for which surgery is recommended and/or planned;
• alcohol abuse (operationalized as scoring ≥5 (male) or ≥4 (female) and responds that they have three or more standard drinks on a typical day or they have six or more drinks on one occasion less than monthly or greater on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C), or any substance (drug) abuse, all of which may impact EEG measures.
• severe cognitive impairment defined as ≥2 errors on the 6-Item Cognitive Impairment test or show signs of cognitive impairment on the Montreal Cognitive Assessment (MoCA, using demographically-adjusted normative cut-offs that take into account race, ethnicity, age, and educational attainment);
• currently receiving other psychosocial treatments for any pain condition (as this may influence these treatment results);
• self-report previous participation in an experimental pain study;
• report \<2 on a 0-10 NRS for pain intensity in response to experimental "heat" pain stimuli (in order to avoid floor effects and to ensure participants are not too insensitive to thermal pain to reliably produce detectable pain-related brain activation);
• unstable medical or psychiatric condition (e.g., mania, psychotic symptoms) that would interfere with study participation; or
• active suicidal ideation/intent indicating significant risk.