Accepted for/Published in: JMIR Research Protocols
Date Submitted: Aug 13, 2025
Date Accepted: Jan 23, 2026
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Treating chronic pain by modulating phenomenological and psychophysiological indices of self-transcendence: A double-blind randomized controlled clinical trial protocol
ABSTRACT
Background:
Chronic musculoskeletal pain (CMP) imposes a significant psychological, physical, and emotional burden on millions of adults in the United States. A challenge in treating CMP is its tendency to become enmeshed with a person's sense of self. Mindfulness-based interventions (MBIs) offer a promising approach to help patients disentangle pain from their sense of self. However, rigorous research is needed to determine which styles of mindfulness practice most effectively promote self-transcendence, a candidate mechanism for durable pain relief.
Objective:
This study aims to evaluate whether adding direct pointing instruction to traditional mindfulness breathing enhances self-transcendence and pain relief. We will assess the effects of two mindfulness training protocols, mindful breathing and mindful breathing + direct pointing instruction, on subjective and neurophysiological markers of self-transcendence, and on pain-related outcomes.
Methods:
In this study, we will conduct a three-arm randomized controlled trial with 173 adults with CMP, assigned to one of the following conditions: 1) four, 30-minute sessions of traditional mindful breathing instruction, 2) four, 30-minute sessions of mindful breathing + direct pointing instruction, or 3) a waitlist control condition. Self-transcendence will be assessed during the first and final intervention sessions using validated self-report measures and psychophysiological indices, including electroencephalography (EEG; theta activity) and functional near-infrared spectroscopy (fNIRS; default mode network [DMN] activity). Primary outcomes include changes in self-transcendence, theta activity, and DMN activity. Secondary outcomes include acute pain intensity and pain-related functional interference, measured at baseline and 3-month follow-up.
Results:
Data collection began in October of 2024 and conclude by May of 2027. As this is a protocol paper, no results are yet available. We will report recruitment rates, baseline characteristics, and initial outcome trends in the full trial results paper.
Conclusions:
This will be the first randomized controlled trial to examine whether direct pointing instruction produces analgesia by eliciting self-transcendence. Findings may advance understanding of the mechanisms underlying mindfulness-based pain relief and inform the development of more targeted, identity-focused MBIs for chronic pain. Results will be disseminated through peer-reviewed publications, conference presentations, and stakeholder engagement, with potential implications for clinical practice. Clinical Trial: This trial was prospectively registered on April 25, 2025 with the Open Science Framework (OSF): DOI 10.17605/OSF.IO/3UY2C
Citation
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Copyright
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