Skip to main content
Log in

Changes in Interoception in Mind-body Therapies for Chronic Pain: A Systematic Review and Meta-Analysis

  • Special Issue: Meta-Analyses and Reviews
  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Emerging literature has demonstrated deficits in interoception (i.e., the perception of physical sensations from inside the body) in individuals with chronic pain conditions. Mind-body therapies (MBTs) are purported to improve chronic pain in part through improving or restoring interoceptive abilities. The present systematic review and meta-analysis aimed to examine changes in interoception in MBTs for chronic pain conditions.

Methods

A systematic search of PubMed, PsycINFO, Scopus, CINAHL, and ProQuest Dissertation and Theses was conducted from database inception to February 2023. English language intervention studies evaluating the effect of MBTs on interoception in adults with chronic pain conditions were examined. Changes in pain (severity and interference) following treatment were examined as secondary outcomes.

Results

A total of 11 studies (10 unique samples) were identified. Meta-analytic results reveal significant improvements in total interoceptive awareness (Becker’s d = 1.168, p < .01) as well as improvements in seven of eight subdomains of interoceptive awareness (ds = 0.28 to 0.81). MBTs were also associated with reductions in both pain intensity (d = -1.46, p = .01) and pain interference (d = -1.07, p < .001).

Conclusions

Preliminary research suggests that MBTs demonstrate improvements in interoceptive awareness and reduce pain in adults with chronic pain. Literature on changes in other domains of interoception, such as interoceptive accuracy, following MBTs is severely lacking. Although more rigorous studies are needed to corroborate results, the present findings lay an important foundation for future research to examine interoception as a possible underlying mechanism of MBTs to improve pain outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults — United States, 2016. MMWR. 2018;67:1001–6.

    PubMed  PubMed Central  Google Scholar 

  2. Mehling WE. If it all comes down to bodily awareness, how do we know? Assessing bodily awareness Kinesiol Rev. 2020;9:254–60.

    Article  Google Scholar 

  3. Rivest-Gadbois E, Boudrias M-H. What are the known effects of yoga on the brain in relation to motor performances, body awareness and pain? A narrative review Complement Ther Med. 2019;44:129–42.

    Article  PubMed  Google Scholar 

  4. Kazdin AE. Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol. 2007;3:1–27.

    Article  PubMed  Google Scholar 

  5. Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain. Prog Neurobiol. 2009;87:81–97.

    Article  PubMed  Google Scholar 

  6. Yong RJ, Mullins PM, Bhattacharyya N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163:e328–32.

    Article  PubMed  Google Scholar 

  7. Dueñas M, Ojeda B, Salazar A, et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–67.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13:715–24.

    Article  PubMed  Google Scholar 

  9. Greenberg EN. The consequences of chronic pain. J Pain Palliat Care Pharmacother. 2012;26:64–7.

    Article  PubMed  Google Scholar 

  10. Niv D, Kreitler S. Pain and quality of life. Pain Pract. 2001;1:150–61.

    Article  PubMed  CAS  Google Scholar 

  11. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162:276–86.

    Article  PubMed  Google Scholar 

  12. Ehde DM, Dillworth TM, Turner JA. Cognitive-Behavioral Therapy for individuals with chronic pain. Am Psychol. 2014;69:153–66.

    Article  PubMed  Google Scholar 

  13. McCracken LM, Vowles KE. Acceptance and Commitment Therapy and mindfulness for chronic pain. Am Psychol. 2014;69:178–87.

    Article  PubMed  Google Scholar 

  14. Shipton EA. Physical therapy approaches in the treatment of low back pain. Pain Ther. 2018;7:127–37.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Craig AD. Interoception: The sense of the physiological condition of the body. Curr Opin Neurobiol. 2003;13:500–5.

    Article  PubMed  CAS  Google Scholar 

  16. Craig AD. How do you feel - now? The anterior insula and human awareness. Nat Rev Neurosci. 2009;10:59–70.

    Article  PubMed  CAS  Google Scholar 

  17. Garfinkel SN, Seth AK, Barrett AB, et al. Knowing your own heart: Distinguishing interoceptive accuracy from interoceptive awareness. Biol Psychol. 2015;104:65–74.

    Article  PubMed  Google Scholar 

  18. Calì G, Ambrosini E, Picconi L, et al. Investigating the relationship between interoceptive accuracy, interoceptive awareness, and emotional susceptibility. Front Psychol. 2015;6:1202.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Farb N, Daubenmier J, Price CJ, et al. Interoception, contemplative practice, and health. Front Psychol. 2015;6:763.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mehling W. Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philos Trans R Soc Lond B Biol Sci. 2016;371:20160013.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mehling WE, Price C, Daubenmier JJ, et al. The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS ONE. 2012;7:e48230.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Mehling WE, Acree M, Stewart A, Silas J, Jones A. The Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). PLoS ONE. 2018;13:e0208034.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Katkin ES, Morell MA, Goldband S, et al. Individual differences in heartbeat discrimination Psychophysiol. 1982;19:160–6.

    CAS  Google Scholar 

  24. Schandry R. Heart beat perception & emotional experience. Psychophysiol. 1981;18:483–8.

    Article  CAS  Google Scholar 

  25. Whitehead WE, Drescher VM, Heiman P, et al. Relation of heart rate control to heartbeat perception. Biofeedback Self-Regul. 1977;2:371–92.

    Article  Google Scholar 

  26. Zamariola G, Maurage P, Luminet O, et al. Interoceptive accuracy scores from the heartbeat counting task are problematic. Biol Psychol. 2018;137:12–7.

    Article  PubMed  Google Scholar 

  27. Mehling WE, Wrubel J, Daubenmier JJ, et al. Body awareness: A phenomenological inquiry into the common ground of mind-body therapies. Philos Ethics Humanit Med. 2011;6:6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Di Lernia D, Serino S, Riva G. Pain in the body. Altered interoception in chronic pain conditions: A systematic review. Neurosci Biobehav Rev. 2016;71:328–41.

  29. Schmitz N, Napieralski J, Schroeder D, et al. Interoceptive sensibility, alexithymia, and emotion regulation in individuals suffering from fibromyalgia. Psychopathol. 2021;54:144–9.

    Article  Google Scholar 

  30. Valenzuela-Moguillansky C, Reyes-Reyes A, Gaete MI. Exteroceptive and interoceptive body-self awareness in fibromyalgia patients. Front Hum Neurosci. 2017;11:117.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Di Lernia D, Lacerenza M, Ainley V, et al. Altered interoceptive perception and the effects of interoceptive analgesia in musculoskeletal, primary, and neuropathic chronic pain conditions. J Pers Med. 2020;10:201.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ceunen E, Vlaeyen JWS, Diest IV. On the origin of interoception. Front Psychol. 2016;7:743.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gedney JJ, Logan H. Perceived control and negative affect predict expected and experienced acute clinical pain: A structural modeling analysis. Clin J Pain. 2007;23:35.

    Article  PubMed  Google Scholar 

  34. Tang J, Gibson SJ. A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. J Pain. 2005;6:612–9.

    Article  PubMed  Google Scholar 

  35. Wiech K, Ploner M, Tracey I. Neurocognitive aspects of pain perception. Trends Cogn Sci. 2008;12:306–13.

    Article  PubMed  Google Scholar 

  36. Mehling W, Daubenmier J, Price, et al. Self-reported interoceptive awareness in primary care patients with past or current low back pain. J Pain Res. 2013:403.

  37. Cioffi D, Holloway J. Delayed costs of suppressed pain. J Pers Soc Psychol. 1993;64:274–82.

    Article  PubMed  CAS  Google Scholar 

  38. Johnson MH. How does distraction work in the management of pain? Curr Pain Headache Rep. 2005;9:90–5.

    Article  PubMed  Google Scholar 

  39. Prins B, Decuypere A, Damme SV. Effects of mindfulness and distraction on pain depend upon individual differences in pain catastrophizing. Eur J Pain. 2014;18:1307–15.

    Article  PubMed  CAS  Google Scholar 

  40. De Peuter S, Diest IV, Vansteenwegen D, et al. Understanding fear of pain in chronic pain: Interoceptive fear conditioning as a novel approach. Eur J Pain. 2011;15:889–94.

    Article  PubMed  Google Scholar 

  41. Garfinkel M, Schumacher HR. Yoga Rheum Dis Clin N Am. 2000;26:125–32.

    Article  CAS  Google Scholar 

  42. American Psychological Association (APA). Mind-body intervention. n.d.

  43. Rice BI. Mind-body interventions. Diabetes Spectr. 2001;14:213–2017.

    Article  Google Scholar 

  44. Grant JA, Courtemanche J, Duerden EG, et al. Cortical thickness and pain sensitivity in zen meditators: Mindfulness training and emotion regulation. Emot. 2010;10:43–53.

    Article  Google Scholar 

  45. Villemure C, Ceko M, Cotton VA, et al. Insular cortex mediates increased pain tolerance in yoga practitioners. Cereb Cortex. 2014;24:2732–40.

    Article  PubMed  Google Scholar 

  46. Williams JMG. Mindfulness and psychological process Emot. 2010;10:1–7.

    Google Scholar 

  47. Cramer H, Lauche R, Haller H, et al. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013;29:450–60.

    Article  PubMed  Google Scholar 

  48. Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan—A web and mobile app for systematic reviews. Syst Rev. 2016;5:210.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Haller H, Lauche R, Cramer H, et al. Craniosacral therapy for the treatment of chronic neck pain: A randomized sham-controlled trial. Clin J Pain. 2016;32:441–9.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Price CJ, Thompson EA. Measuring dimensions of body connection: body awareness and bodily dissociation. J Altern Complement Med. 2007;13:945–53.

    Article  PubMed  Google Scholar 

  52. Tran US, Birnbaum L, Burzler MA, et al. Self-reported mindfulness accounts for the effects of mindfulness interventions and nonmindfulness controls on self-reported mental health: A preregistered systematic review and three-level meta-analysis of 146 randomized controlled trials. Psychol Bull. 2022;148:86–106.

    Article  Google Scholar 

  53. Sterne JAC, Savović J, Page MJ, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ Online. 2019;366: l4898.

    Article  PubMed  Google Scholar 

  54. Evans S, Fernandez S, Olive L, et al. Psychological and mind-body interventions for endometriosis: A systematic review. J Psychosom Res. 2019;124:109756.

    Article  PubMed  Google Scholar 

  55. Lipsey MW, Wilson DB. Practical meta-analysis. Reprinted. CA: Sage; 2006.

    Google Scholar 

  56. Becker BJ. Synthesizing standardized mean-change measures. Br J Math Stat Psychol. 1988;41:257–78.

    Article  Google Scholar 

  57. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  58. JASP Team. JASP (Version 0.17) [Computer software] 2023.

  59. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48.

    Article  Google Scholar 

  60. Lauche R, Stumpe C, Fehr J, et al. The effects of Tai Chi and neck exercises in the treatment of chronic nonspecific neck pain: A randomized controlled trial. J Pain. 2016;17:1013–27.

    Article  PubMed  Google Scholar 

  61. Lauche R, Wayne P, Fehr J, et al. Does postural awareness contribute to exercise-induced improvements in neck pain intensity? A secondary analysis of a randomized controlled trial evaluating Tai Chi and neck exercises. Spine. 2017;42:1195–200.

    Article  PubMed  Google Scholar 

  62. Osypiuk K, Ligibel J, Giobbie-Hurder A, et al. Qigong mind-body exercise as a biopsychosocial therapy for persistent post-surgical pain in breast cancer: A pilot study. Integr Cancer Ther. 2020;19:1534735419893766.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Ahmadi H, Adib H, Selk-Ghaffari M, et al. Comparison of the effects of the Feldenkrais method versus core stability exercise in the management of chronic low back pain: A randomised control trial. Clin Rehabil. 2020;34:1449–57.

    Article  PubMed  Google Scholar 

  64. Shim M, Johnson RB, Gasson S, et al. A model of dance/movement therapy for resilience-building in people living with chronic pain. Eur J Integr Med. 2017;9:27–40.

    Article  Google Scholar 

  65. Roberts RL, Ledermann K, Garland EL. Mindfulness-oriented recovery enhancement improves negative emotion regulation among opioid-treated chronic pain patients by increasing interoceptive awareness. J Psychosom Res. 2022;152:110677.

    Article  Google Scholar 

  66. Berry MP, Lutz J, Schuman-Olivier Z, et al. Brief self-compassion training alters neural responses to evoked pain for chronic low back pain: A pilot study. Pain Med. 2020;21:2172–85.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Paolucci T, Zangrando F, Iosa M, et al. Improved interoceptive awareness in chronic low back pain: A comparison of Back school versus Feldenkrais method. Disabil Rehabil. 2017;39:994–1001.

    Article  PubMed  Google Scholar 

  68. Zangrando F, Piccinini G, Tagliolini C, et al. The efficacy of a preparatory phase of a touch-based approach in treating chronic low back pain: A randomized controlled trial. J Pain Res. 2017;10:941–9.

    Article  PubMed  PubMed Central  Google Scholar 

  69. de Jong M, Lazar SW, Hug K, et al. Effects of Mindfulness-Based Cognitive Therapy on body awareness in patients with chronic pain and comorbid depression. Front Psychol. 2016;7:967.

    PubMed  PubMed Central  Google Scholar 

  70. von Hippel PT. The heterogeneity statistic I(2) can be biased in small meta-analyses. BMC Med Res Methodol. 2015;15:35.

    Article  Google Scholar 

  71. Hilton L, Hempel S, Ewing BA, et al. Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Ann Behav Med. 2017;51:199–213.

    Article  PubMed  Google Scholar 

  72. Garland EL, Brintz CE, Hanley AW, et al. Mind-body therapies for opioid-treated pain: A systematic review and meta-analysis. Arch Intern Med. 2020;180:91–105.

    Google Scholar 

  73. Oh SS, Galanter J, Thakur N, et al. Diversity in clinical and biomedical research: A promise yet to be fulfilled. PLoS Med. 2015;12:e1001918.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Passmore SR, Kisicki A, Gilmore-Bykovskyi A, et al. “There’s not much we can do…” Researcher-level barriers to the inclusion of underrepresented participants in translational research. J Clin Transl Sci. 2022;6:e4.

    Article  PubMed  Google Scholar 

  75. Park CL, Braun T, Siegel T. Who practices yoga? A systematic review of demographic, health-related, and psychosocial factors associated with yoga practice. J Behav Med. 2015;38:460–71.

    Article  PubMed  Google Scholar 

  76. Johnson BT, Hennessy EA. Systematic reviews and meta-analyses in the health sciences: Best practice methods for research syntheses. Soc Sci Med. 1982;2019(233):237–51.

    Google Scholar 

  77. Ferentzi E, Olaru G, Geiger M, et al. Examining the factor structure and validity of the Multidimensional Assessment of Interoceptive Awareness. J Pers Assess. 2021;103:675–84.

    Article  PubMed  Google Scholar 

  78. Shoji M, Mehling WE, Hautzinger M, et al. Investigating Multidimensional Interoceptive Awareness in a Japanese population: Validation of the Japanese MAIA-J. Front Psychol. 2018;9:1855.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Herbert BM, Pollatos O, Klusmann V. Interoception and health. Eur J Health Psychol. 2020;27:127–31.

    Article  Google Scholar 

  80. Quadt L, Critchley HD, Garfinkel SN. Interoception and emotion: Shared mechanisms and clinical implications. In Tsakiris, De Preester, editors. The interoceptive mind: From homeostasis to awareness. Oxford University Press; 2018, p. 123–43.

Download references

Funding

This work was supported by the National Institutes of Health F31AT012315 to KEG.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Katherine E. Gnall.

Ethics declarations

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

For this type of study formal consent is not required.

Research Involving Human Participants and/or Animals

This article does not contain any studies conducted with human participants by any of the authors.

Competing Interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 574 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gnall, K.E., Sinnott, S.M., Laumann, L.E. et al. Changes in Interoception in Mind-body Therapies for Chronic Pain: A Systematic Review and Meta-Analysis. Int.J. Behav. Med. (2024). https://doi.org/10.1007/s12529-023-10249-z

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12529-023-10249-z

Keywords

Navigation