Treating Chronic Pain by Modulating Phenomenological and Psychophysiological Indices of Self-Transcendence: Single-Blind Randomized Controlled Clinical Trial Protocol

Abstract BackgroundChronic 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. ObjectiveThis study aims to evaluate whether adding direct pointing instruction to traditional mindful breathing enhances self-transcendence and pain relief. We will assess the effects of 2 mindfulness training protocols, mindful breathing (MB) and MB plus direct pointing (DP) instruction, on subjective and neurophysiological markers of self-transcendence and on pain-related outcomes. MethodsIn this study, we will conduct a 3-arm randomized controlled trial with 173 adults with CMP, assigned to one of the following groups: (1) 4, 30-minute sessions of traditional mindful breathing instruction, (2) 4, 30-minute sessions of MB+DP instruction, or (3) a waitlist control group. 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. Additional outcomes include acute pain intensity and pain-related functional interference, measured at baseline through 3-month follow-up. ResultsData collection began in October 2024 and will conclude by May 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. ConclusionsThis will be the first randomized controlled trial to examine whether direct pointing instruction enhances analgesia by eliciting self-transcendence. Findings may advance understanding of the mechanisms underlying mindfulness-based pain relief and inform the development of more targeted MBIs for chronic pain. Results will be disseminated through peer-reviewed publications, conference presentations, and stakeholder engagement, with potential implications for clinical practices.