Nondual Awareness as a Novel Chronic Pain Relieving Mechanism

Mindfulness-based interventions (MBIs) are efficacious nonpharmacologic treatments for chronic pain, yet the psychological mechanisms mediating the pain-relieving effects of MBIs remain incompletely understood. One potential mechanism may involve nondual awareness, a state of consciousness characterized by attenuation of the subject-object duality, reduced self-referential thinking, and an increased sense of connectedness with others and the world-at-large. We conducted a secondary analysis of pooled data from two randomized controlled trials (N=480) investigating the effects of Mindfulness-Oriented Recovery Enhancement (MORE), an 8-week MBI, in patients receiving long-term opioid analgesic therapy for chronic pain. We tested whether nondual awareness, as measured by the Non-Dual Awareness Dimensional Assessment (NADA), mediated the effect of MORE on chronic pain severity and interference. Results demonstrated that MORE was associated with significantly lower chronic pain severity (p=.014) and pain interference (p<.001) compared to a supportive group therapy control condition. Moreover, participants in the MORE condition exhibited significant increases in nondual awareness compared to the control group (p<.001). Multivariate path analyses revealed that increases in nondual awareness significantly mediated reductions in chronic pain severity (p=.002) and pain interference (p=.01). Nondual awareness outperformed the mindfulness facet of nonreactivity as a mediator of mindfulness' pain relieving effects. Study findings demonstrate a link between mindfulness-induced nondual awareness and alleviation of chronic pain. Future research should elucidate the neurobiological mechanisms of this relationship. Moreover, studies could identify other potential interventions that produce nondual awareness (e.g., psychedelics) to address chronic pain, possibly in conjunction with mindfulness-based interventions.