If you’re in a lot of pain, asking yourself to take a deep breath and embrace the sensations in your body may not seem so comforting. But new research analyzing pain signals on MRIs suggests that mindfulness meditation as a pain reliever goes beyond the placebo effect of waiting for a response, actually leading to a very real reduction in pain.

Mindfulness meditation is the practice of paying attention to passing sensory events without judging or resisting them. This practice, which has its origins in Hindu and Buddhist traditions, has increasingly attracted the attention of Western academic disciplines since it entered Western popular culture in the 1970s.

“The mind is incredibly powerful, and we are still trying to understand how it can be used to manage pain,” says Fadel Zeidan, an anesthesiologist at the University of California, San Diego (UCSD).

“By separating pain from the self and relinquishing value judgments, mindfulness meditation can directly change the way we experience pain without the use of any medication, costs nothing, and can be applied anywhere.”

Neuroscientist Gabriel Rigner, Zeidan, and their colleagues at UCSD sought to understand how the brain responds to pain and determine whether the pain-relieving effect of mindfulness meditation was more than a placebo or just a placebo, as they suspected.

They recruited 115 healthy participants who were divided into two separate clinical trials. In both cases, researchers touched the back of each participant’s right calf with a heated probe that created painful but harmless heat waves. The participants’ brains were MRI scanned before and after the experiments, and they themselves rated the intensity and bothersomeness of the pain on a scale from 0 to 10.

Before the studies began, some of the participants completed four separate 20-minute mindfulness meditation sessions led by experienced instructors who taught them to focus on changing their breathing patterns and to accept thoughts, feelings, and emotions that may arise without reacting or judging.

Another group received an equivalent meditation that involved only deep breathing, while others received a petroleum jelly-based placebo cream that was said to reduce pain. Another group, used as a control, listened to an audiobook instead of meditation instructions. This was Selborne’s Natural History and Antiquities by the 18th-century naturalist minister Gilbert White.

MRI scanning allowed researchers to obtain data on a variety of pain signatures, including: the nociceptive specific pain signature (NPS), which is related to pain intensity; negative emotional pain signature (NAPS), which is associated with the emotional experience of pain; and the stimulus-independent pain signature (SIIPS-1), which is associated with psychosocial factors such as our expectations of pain and thus defines placebo-based measures.

Mindfulness meditation resulted in greater reductions in self-reported pain as well as NPS and NAPS compared to placebo and control, but placebo cream was the only treatment that showed a significantly lower response on the SIIPS-1 placebo-focused measure. This suggests that the positive effects of mindfulness meditation are based on different mechanisms than placebo: if these overlap, meditation should have a significant effect on SIIPS-1.

“It has long been thought that the placebo effect overrides brain mechanisms triggered by active treatments, but these results suggest that may not be the case when it comes to pain,” says Zeidan. “Instead, the two brain responses are completely different and support the use of mindfulness meditation as a direct intervention to treat chronic pain, rather than as a way to create a placebo effect.”

The team hopes these findings will help guide treatment and improve the quality of life for the millions of people living with chronic pain every day.

“We look forward to continuing to explore the neurobiology of mindfulness and how we can use this ancient practice in the clinic,” says Zeidan. This study was published in the journal Biological Psychiatry.