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Mathew J, Adhia DB, Smith ML, De Ridder D, Mani R. Closed-Loop Infraslow Brain-Computer Interface can Modulate Cortical Activity and Connectivity in Individuals With Chronic Painful Knee Osteoarthritis: A Secondary Analysis of a Randomized Placebo-Controlled Clinical Trial. Clin EEG Neurosci 2024:15500594241264892. [PMID: 39056313 DOI: 10.1177/15500594241264892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Introduction. Chronic pain is a percept due to an imbalance in the activity between sensory-discriminative, motivational-affective, and descending pain-inhibitory brain regions. Evidence suggests that electroencephalography (EEG) infraslow fluctuation neurofeedback (ISF-NF) training can improve clinical outcomes. It is unknown whether such training can induce EEG activity and functional connectivity (FC) changes. A secondary data analysis of a feasibility clinical trial was conducted to determine whether EEG ISF-NF training can significantly alter EEG activity and FC between the targeted cortical regions in people with chronic painful knee osteoarthritis (OA). Methods. A parallel, two-arm, double-blind, randomized, sham-controlled clinical trial was conducted. People with chronic knee pain associated with OA were randomized to receive sham NF training or source-localized ratio ISF-NF training protocol to down-train ISF bands at the somatosensory (SSC), dorsal anterior cingulate (dACC), and uptrain pregenual anterior cingulate cortices (pgACC). Resting state EEG was recorded at baseline and immediate post-training. Results. The source localization mapping demonstrated a reduction (P = .04) in the ISF band activity at the left dorsolateral prefrontal cortex (LdlPFC) in the active NF group. Region of interest analysis yielded significant differences for ISF (P = .008), slow (P = .007), beta (P = .043), and gamma (P = .012) band activities at LdlPFC, dACC, and bilateral SSC. The FC between pgACC and left SSC in the delta band was negatively correlated with pain bothersomeness in the ISF-NF group. Conclusion. The EEG ISF-NF training can modulate EEG activity and connectivity in individuals with chronic painful knee osteoarthritis, and the observed EEG changes correlate with clinical pain measures.
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Affiliation(s)
- Jerin Mathew
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
| | - Divya Bharatkumar Adhia
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
- Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Dirk De Ridder
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
- Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
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Raturi AK, Narayanan SS, Jena SPK. EEG Correlates of Suggestion-Induced Stroop Interference Reduction in High-Suggestible Individuals: A Systematic Review and Meta-Analysis. Int J Clin Exp Hypn 2024; 72:289-326. [PMID: 38874567 DOI: 10.1080/00207144.2024.2356856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/11/2023] [Indexed: 06/15/2024]
Abstract
Studies have explored the impact of suggestion on the Stroop effect, aiming to understand how effective suggestion is in modulating this phenomenon. The suggestion effect has been replicated in multiple studies, supporting its robustness, but lacks systematic evaluation. We conducted a systematic review and meta-analysis of relevant English-language studies from PubMed, Web of Science, PsycINFO, Scopus, and ScienceDirect since databases inception until January 2023. Quality of included studies was evaluated using the Joanna Briggs Institute (JBI) appraisal checklist, and potential publication biases were assessed. Subgroup analyses were also performed, and effect sizes were estimated using Hedges' g and analyzed using random effects model. The systematic review was comprised of 19 studies. For the meta-analysis, 14 studies examined the suggestion effect on Stroop interference effect (SIE), while six studies investigated suggestion effects on accuracy. Results have revealed significant overall effects of suggestion on Stroop performance in participants, as evidenced by SIE and accuracy. Subgroup analysis based on types of suggestion demonstrated a significant effect on SIE. Six EEG/ERP studies have also been discussed in the context of the review.
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Affiliation(s)
| | | | - S P K Jena
- Department of Psychology, University of Delhi, India
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3
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Torres CB, Barona EJG, Molina MG, Sánchez MEGB, Manso JMM. A systematic review of EEG neurofeedback in fibromyalgia to treat psychological variables, chronic pain and general health. Eur Arch Psychiatry Clin Neurosci 2024; 274:981-999. [PMID: 37179502 PMCID: PMC11127810 DOI: 10.1007/s00406-023-01612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
This paper is the first up-to-date review of the various EEG-neurofeedback treatments for fibromyalgia patients and their psychological, physiological and general health consequences. Searches were made of the PubMed, PsycNet, Google Scholar and Scopus databases according to PRISMA guidelines for empirical peer-reviewed articles on EEG-neurofeedback treatment of fibromyalgia, yielding a final selection of 17 studies that met the inclusion criteria: (1) published articles and doctoral theses; (2) conducted between 2000 and 2022; (3) reporting empirical and quantitative data. These articles show that there is a wide range of protocols with different designs and procedures to treat fibromyalgia using EEG-neurofeedback techniques. The main symptoms that showed improvement were anxiety, depression, pain, general health and symptom severity, whilst the most commonly used method was traditional EEG neurofeedback based on a sensorimotor rhythm protocol. It may be concluded from the review that the lack of consistency and uniqueness of the protocols makes it very difficult to generalise results, despite the individual improvements identified. This review provides instructions and information that could guide future research and clinical practise, with the data extracted helping to gain a deeper understanding of the state of the art and the needs of the technique for this population group.
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Schuurman BB, Lousberg RL, Schreiber JU, van Amelsvoort TAMJ, Vossen CJ. A Scoping Review of the Effect of EEG Neurofeedback on Pain Complaints in Adults with Chronic Pain. J Clin Med 2024; 13:2813. [PMID: 38792353 PMCID: PMC11122542 DOI: 10.3390/jcm13102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background and Aim: Non-pharmacological treatments such as electroencephalogram (EEG) neurofeedback have become more important in multidisciplinary approaches to treat chronic pain. The aim of this scoping review is to identify the literature on the effects of EEG neurofeedback in reducing pain complaints in adult chronic-pain patients and to elaborate on the neurophysiological rationale for using specific frequency bands as targets for EEG neurofeedback. Methods: A pre-registered scoping review was set up and reported following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews (PRISMA-ScR). The data were collected by searching for studies published between 1985 and January 2023 in PubMed, EMBASE, and PsycINFO. Results: Thirty-two studies on various types of chronic pain were included. The intervention was well-tolerated. Approximately half of the studies used a protocol that reinforced alpha or sensorimotor rhythms and suppressed theta or beta activity. However, the underlying neurophysiological rationale behind these specific frequency bands remains unclear. Conclusions: There are indications that neurofeedback in patients with chronic pain probably has short-term analgesic effects; however, the long-term effects are less clear. In order to draw more stable conclusions on the effectiveness of neurofeedback in chronic pain, additional research on the neurophysiological mechanisms of targeted frequency bands is definitely worthwhile. Several recommendations for setting up and evaluating the effect of neurofeedback protocols are suggested.
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Affiliation(s)
- Britt B. Schuurman
- Department of Psychiatry & Neuro-Psychology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Richel L. Lousberg
- Department of Psychiatry & Neuro-Psychology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Jan U. Schreiber
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Therese A. M. J. van Amelsvoort
- Department of Psychiatry & Neuro-Psychology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Catherine J. Vossen
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
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Diotaiuti P, Corrado S, Tosti B, Spica G, Di Libero T, D’Oliveira A, Zanon A, Rodio A, Andrade A, Mancone S. Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review. Front Psychol 2024; 15:1369487. [PMID: 38770259 PMCID: PMC11104502 DOI: 10.3389/fpsyg.2024.1369487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
The prevalence and impact of chronic pain in individuals worldwide necessitate effective management strategies. This narrative review specifically aims to assess the effectiveness of neurofeedback, an emerging non-pharmacological intervention, on the management of chronic pain. The methodology adopted for this review involves a meticulous search across various scientific databases. The search was designed to capture a broad range of studies related to neurofeedback and chronic pain management. To ensure the quality and relevance of the included studies, strict inclusion and exclusion criteria were applied. These criteria focused on the study design, population, intervention type, and reported outcomes. The review synthesizes the findings from a diverse array of studies, including randomized controlled trials, observational studies, and case reports. Key aspects evaluated include the types of neurofeedback used (such as EEG biofeedback), the various chronic pain conditions addressed (like fibromyalgia, neuropathic pain, and migraines), and the methodologies employed in these studies. The review highlights the underlying mechanisms by which neurofeedback may influence pain perception and management, exploring theories related to neural plasticity, pain modulation, and psychological factors. The results of the review reveal a positive correlation between neurofeedback interventions and improved pain management. Several studies report significant reductions on pain intensity, improved quality of life, and decreased reliance on medication following neurofeedback therapy. The review also notes variations in the effectiveness of different neurofeedback protocols and individual responses to treatment. Despite the promising results, the conclusion of the review emphasizes the need for further research. It calls for larger, well-designed clinical trials to validate the findings, to understand the long-term implications of neurofeedback therapy, and to optimize treatment protocols for individual patients.
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Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Beatrice Tosti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Giuseppe Spica
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Tommaso Di Libero
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Anderson D’Oliveira
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Alessandra Zanon
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Angelo Rodio
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Alexandro Andrade
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
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Mani R, Adhia DB, Awatere S, Gray AR, Mathew J, Wilson LC, Still A, Jackson D, Hudson B, Zeidan F, Fillingim R, De Ridder D. Self-regulation training for people with knee osteoarthritis: a protocol for a feasibility randomised control trial (MiNT trial). FRONTIERS IN PAIN RESEARCH 2024; 4:1271839. [PMID: 38269396 PMCID: PMC10806808 DOI: 10.3389/fpain.2023.1271839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Knee osteoarthritis (OA) is a chronic secondary musculoskeletal pain condition resulting in disability, reduced quality of life, and high societal costs. Pain associated with knee OA is linked to increased sensitivity in sensory, cognitive, and emotional areas of the brain. Self-regulation training targeting brain functioning related to pain experience could reduce pain and its associated disability. Self-regulatory treatments such as mindfulness meditation (MM) and electroencephalography neurofeedback (EEG-NF) training improve clinical outcomes in people with knee OA. A feasibility clinical trial can address factors that could inform the design of the full trial investigating the effectiveness of self-regulation training programmes in people with knee OA. This clinical trial will evaluate the feasibility, safety, acceptability, experience and perceptions of the self-regulatory training programmes. Methods The proposed feasibility trial is based on a double-blind (outcome assessor and investigators), three-arm (MM usual care, EEG-NF + usual care and usual care control group) randomised controlled parallel clinical trial. Participants with knee OA will be recruited from the community and healthcare practices. A research assistant (RA) will administer both interventions (20-min sessions, four sessions each week, and 12 sessions over three successive weeks). Feasibility measures (participant recruitment rate, adherence to interventions, retention rate), safety, and acceptability of interventions will be recorded. An RA blinded to the group allocation will record secondary outcomes at baseline, immediately post-intervention (4th week), and 3 months post-intervention. The quantitative outcome measures will be descriptively summarised. The qualitative interviews will evaluate the participants' experiences and perceptions regarding various aspects of the trial, which includes identifying the barriers and facilitators in participating in the trial, evaluating their opinions on the research procedures, such as their preferences for the study site, and determining the level of acceptability of the interventions as potential clinical treatments for managing knee OA. Māori participant perceptions of how assessment and training practices could be acceptable to a Māori worldview will be explored. The interviews will be audio-recorded and analysed thematically. Discussion This trial will provide evidence on the feasibility, safety, and acceptability of the MM and EEG-NF training in people with knee OA, thus informing the design of a full randomised clinical control trial.
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Affiliation(s)
- Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Divya Bharatkumar Adhia
- Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sharon Awatere
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- The Health Boutique, Napier, New Zealand
| | | | - Jerin Mathew
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | | | - Amanda Still
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Jackson
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago, Christchurch, New Zealand
| | - Fadel Zeidan
- Department of Anesthesiology, School of Medicine, University of California, San Diego, CA, United States
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence, Clinical and Translational Science Institute, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Dirk De Ridder
- Department of Surgical Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
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Kenefati G, Rockholt MM, Ok D, McCartin M, Zhang Q, Sun G, Maslinski J, Wang A, Chen B, Voigt EP, Chen ZS, Wang J, Doan LV. Changes in alpha, theta, and gamma oscillations in distinct cortical areas are associated with altered acute pain responses in chronic low back pain patients. Front Neurosci 2023; 17:1278183. [PMID: 37901433 PMCID: PMC10611481 DOI: 10.3389/fnins.2023.1278183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Chronic pain negatively impacts a range of sensory and affective behaviors. Previous studies have shown that the presence of chronic pain not only causes hypersensitivity at the site of injury but may also be associated with pain-aversive experiences at anatomically unrelated sites. While animal studies have indicated that the cingulate and prefrontal cortices are involved in this generalized hyperalgesia, the mechanisms distinguishing increased sensitivity at the site of injury from a generalized site-nonspecific enhancement in the aversive response to nociceptive inputs are not well known. Methods We compared measured pain responses to peripheral mechanical stimuli applied to a site of chronic pain and at a pain-free site in participants suffering from chronic lower back pain (n = 15) versus pain-free control participants (n = 15) by analyzing behavioral and electroencephalographic (EEG) data. Results As expected, participants with chronic pain endorsed enhanced pain with mechanical stimuli in both back and hand. We further analyzed electroencephalographic (EEG) recordings during these evoked pain episodes. Brain oscillations in theta and alpha bands in the medial orbitofrontal cortex (mOFC) were associated with localized hypersensitivity, while increased gamma oscillations in the anterior cingulate cortex (ACC) and increased theta oscillations in the dorsolateral prefrontal cortex (dlPFC) were associated with generalized hyperalgesia. Discussion These findings indicate that chronic pain may disrupt multiple cortical circuits to impact nociceptive processing.
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Affiliation(s)
- George Kenefati
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
| | - Mika M. Rockholt
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
| | - Deborah Ok
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael McCartin
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Qiaosheng Zhang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
| | - Guanghao Sun
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
| | - Julia Maslinski
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
| | - Aaron Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
| | - Baldwin Chen
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
| | - Erich P. Voigt
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, United States
| | - Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
| | - Lisa V. Doan
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Grossman School of Medicine, New York, NY, United States
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Rockholt MM, Kenefati G, Doan LV, Chen ZS, Wang J. In search of a composite biomarker for chronic pain by way of EEG and machine learning: where do we currently stand? Front Neurosci 2023; 17:1186418. [PMID: 37389362 PMCID: PMC10301750 DOI: 10.3389/fnins.2023.1186418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Machine learning is becoming an increasingly common component of routine data analyses in clinical research. The past decade in pain research has witnessed great advances in human neuroimaging and machine learning. With each finding, the pain research community takes one step closer to uncovering fundamental mechanisms underlying chronic pain and at the same time proposing neurophysiological biomarkers. However, it remains challenging to fully understand chronic pain due to its multidimensional representations within the brain. By utilizing cost-effective and non-invasive imaging techniques such as electroencephalography (EEG) and analyzing the resulting data with advanced analytic methods, we have the opportunity to better understand and identify specific neural mechanisms associated with the processing and perception of chronic pain. This narrative literature review summarizes studies from the last decade describing the utility of EEG as a potential biomarker for chronic pain by synergizing clinical and computational perspectives.
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Affiliation(s)
- Mika M. Rockholt
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - George Kenefati
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Lisa V. Doan
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Zebhauser PT, Hohn VD, Ploner M. Resting-state electroencephalography and magnetoencephalography as biomarkers of chronic pain: a systematic review. Pain 2023; 164:1200-1221. [PMID: 36409624 PMCID: PMC10184564 DOI: 10.1097/j.pain.0000000000002825] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
ABSTRACT Reliable and objective biomarkers promise to improve the assessment and treatment of chronic pain. Resting-state electroencephalography (EEG) is broadly available, easy to use, and cost efficient and, therefore, appealing as a potential biomarker of chronic pain. However, results of EEG studies are heterogeneous. Therefore, we conducted a systematic review (PROSPERO CRD42021272622) of quantitative resting-state EEG and magnetoencephalography (MEG) studies in adult patients with different types of chronic pain. We excluded populations with severe psychiatric or neurologic comorbidity. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Semiquantitative data synthesis was conducted using modified albatross plots. We included 76 studies after searching MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and EMBASE. For cross-sectional studies that can serve to develop diagnostic biomarkers, we found higher theta and beta power in patients with chronic pain than in healthy participants. For longitudinal studies, which can yield monitoring and/or predictive biomarkers, we found no clear associations of pain relief with M/EEG measures. Similarly, descriptive studies that can yield diagnostic or monitoring biomarkers showed no clear correlations of pain intensity with M/EEG measures. Risk of bias was high in many studies and domains. Together, this systematic review synthesizes evidence on how resting-state M/EEG might serve as a diagnostic biomarker of chronic pain. Beyond, this review might help to guide future M/EEG studies on the development of pain biomarkers.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Vanessa D. Hohn
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Markus Ploner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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Mussigmann T, Bardel B, Lefaucheur JP. Resting-state electroencephalography (EEG) biomarkers of chronic neuropathic pain. A systematic review. Neuroimage 2022; 258:119351. [PMID: 35659993 DOI: 10.1016/j.neuroimage.2022.119351] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/09/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022] Open
Abstract
Diagnosis and management of chronic neuropathic pain are challenging, leading to current efforts to characterize 'objective' biomarkers of pain using imaging or neurophysiological techniques, such as electroencephalography (EEG). A systematic literature review was conducted in PubMed-Medline and Web-of-Science until October 2021 to identify EEG biomarkers of chronic neuropathic pain in humans. The risk of bias was assessed by the Newcastle-Ottawa-Scale. Experimental, provoked, or chronic non-neuropathic pain studies were excluded. We identified 14 studies, in which resting-state EEG spectral analysis was compared between patients with pain related to a neurological disease and patients with the same disease but without pain or healthy controls. From these heterogeneous exploratory studies, some conclusions can be drawn, even if they must be weighted by the fact that confounding factors, such as medication and association with anxio-depressive disorders, are generally not taken into account. Overall, EEG signal power was increased in the θ band (4-7Hz) and possibly in the high-β band (20-30Hz), but decreased in the high-α-low-β band (10-20Hz) in the presence of ongoing neuropathic pain, while increased γ band oscillations were not evidenced, unlike in experimental pain. Consequently, the dominant peak frequency was decreased in the θ-α band and increased in the whole-β band in neuropathic pain patients. Disappointingly, pain intensity correlated with various EEG changes across studies, with no consistent trend. This review also discusses the location of regional pain-related EEG changes in the pain connectome, as the perspectives offered by advanced techniques of EEG signal analysis (source location, connectivity, or classification methods based on artificial intelligence). The biomarkers provided by resting-state EEG are of particular interest for optimizing the treatment of chronic neuropathic pain by neuromodulation techniques, such as transcranial alternating current stimulation or neurofeedback procedures.
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Affiliation(s)
- Thibaut Mussigmann
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Benjamin Bardel
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France.
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Orakpo N, Yuan C, Olukitibi O, Burdette J, Arrington K. Does Virtual Reality Feedback at Infra-Low Frequency Improve Centralized Pain With Comorbid Insomnia While Mitigating Risks for Sedative Use Disorder?: A Case Report. Front Hum Neurosci 2022; 16:915376. [PMID: 35664347 PMCID: PMC9158522 DOI: 10.3389/fnhum.2022.915376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
This case report concerns a patient with clinically diagnosed moderate-severe insomnia secondary to chronic lower back pain and sciatica, previously treated with hydrocodone, naproxen, cyclobenzaprine and nightly diazepam. He underwent a trial of 20 sessions of virtual reality neurofeedback therapy (VR-NFB) at infra-low frequency, and by the end of 20 sessions achieved sustained analgesia and consequently, a complete resolution of his pain-related insomnia. Follow-up at 1 year confirmed his improvements were sustained, and he maintained his abstinence from sedatives, as observed on the Prescription Monitoring Program for controlled substances. This case highlights the importance of understanding chronic pain and its connection with restorative sleep: incorporating endogenous neuromodulation in behavioral sleep medicine helped to diminish the risk of benzodiazepine use disorder. This may be the first case of complete resolution of chronic pain with comorbid insomnia after treatment with VR-NFB at the infra-low frequency.
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Affiliation(s)
- Nnamdi Orakpo
- Department of Psychiatry, Garnet Health Medical Center, Middletown, NY, United States
- *Correspondence: Nnamdi Orakpo
| | - Chujun Yuan
- Department of Psychiatry, Garnet Health Medical Center, Middletown, NY, United States
| | - Olanrewaju Olukitibi
- Department of Psychiatry, Garnet Health Medical Center, Middletown, NY, United States
| | - Jeff Burdette
- Department of Psychiatry at Lehigh Valley Health Network, Allentown, PA, United States
| | - Kim Arrington
- Department of Psychiatry, Garnet Health Medical Center, Middletown, NY, United States
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12
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Chen D, Zhang H, Kavitha PT, Loy FL, Ng SH, Wang C, Phua KS, Tjan SY, Yang SY, Guan C. Scalp EEG-based Pain Detection using Convolutional Neural Network. IEEE Trans Neural Syst Rehabil Eng 2022; 30:274-285. [PMID: 35089860 DOI: 10.1109/tnsre.2022.3147673] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pain is an integrative phenomenon coupled with dynamic interactions between sensory and contextual processes in the brain, often associated with detectable neurophysiological changes. Recent advances in brain activity recording tools and machine learning technologies have intrigued research and development of neurocomputing techniques for objective and neurophysiology-based pain detection. This paper proposes a pain detection framework based on Electroencephalogram (EEG) and deep convolutional neural networks (CNN). The feasibility of CNN is investigated for distinguishing induced pain state from resting state in the recruitment of 10 chronic back pain patients. The experimental study recorded EEG signals in two phases: 1. movement stimulation (MS), where induces back pain by executing predefined movement tasks; 2. video stimulation (VS), where induces back pain perception by watching a set of video clips. A multi-layer CNN classifies the EEG segments during the resting state and the pain state. The novel approach offers high and robust performance and hence is significant in building a powerful pain detection algorithm. The area under the receiver operating characteristic curve (AUC) of our approach is 0.83±0.09 and 0.81±0.15, in MS and VS, respectively, higher than the state-of-the-art approaches. The sub-brain-areas are also analyzed, to examine distinct brain topographies relevant for pain detection. The results indicate that MS-induced pain tends to evoke a generalized brain area, while the evoked area is relatively partial under VS-induced pain. This work may provide a new solution for researchers and clinical practitioners on pain detection.
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13
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The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord injury: 2021 update. Spinal Cord 2022; 60:548-566. [PMID: 35124700 PMCID: PMC9209331 DOI: 10.1038/s41393-021-00744-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022]
Abstract
STUDY DESIGN Clinical practice guidelines. OBJECTIVES The objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI). SETTING The guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada. METHODS The guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations. RESULTS The working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made. CONCLUSIONS The CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice.
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14
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Alba G, Terrasa JL, Vila J, Montoya P, Muñoz MA. EEG-heart rate connectivity changes after sensorimotor rhythm neurofeedback training: Ancillary study. Neurophysiol Clin 2021; 52:58-68. [PMID: 34906429 DOI: 10.1016/j.neucli.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Neurofeedback can induce long-term changes in brain functional connectivity, but its influence on the connectivity between different physiological systems is unknown. The present paper is an ancillary study of a previous paper that confirmed the effect of neurofeedback on brain connectivity associated with chronic pain. We analysed the influence of neurofeedback on the connectivity between the electroencephalograph (EEG) and heart rate (HR). METHODS Seventeen patients diagnosed with fibromyalgia were divided into three groups: good sensorimotor rhythm (SMR) training responders (n = 4), bad SMR responders (n = 5) and fake training (SHAM, n = 8). Training consisted of six sessions in which participants learned to synchronize and desynchronize SMR power. Before the first training (pre-resting state) and sixth training (post-resting state) session, open-eye resting-state EEG and electrocardiograph signals were recorded. RESULTS Good responders reduced pain ratings after SMR neurofeedback training. This improvement in fibromyalgia symptoms was associated with a reduction of the connectivity between the central area and HR, between central and frontal areas, within the central area itself, and between central and occipital areas. The sham group and poor responders experienced no changes in their fibromyalgia symptoms. CONCLUSIONS Our results provide new evidence that neurofeedback is a promising tool that can be used to treat of chronic pain syndromes and to obtain a better understanding of the interactions between physiological networks. These findings are preliminary, but they may pave the way for future studies that are more methodologically robust. In addition, new research questions are raised: what is the role of the central-peripheral network in chronic pain and what is the effect of neurofeedback on this network.
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Affiliation(s)
- Guzmán Alba
- Brain, Mind and Behavior Research Center at University of Granada (CIMCYC-UGR), Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, Palma, Spain
| | - Jaime Vila
- Brain, Mind and Behavior Research Center at University of Granada (CIMCYC-UGR), Spain
| | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS), University of Balearic Islands, Palma, Spain
| | - Miguel A Muñoz
- Brain, Mind and Behavior Research Center at University of Granada (CIMCYC-UGR), Spain.
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15
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Hesam-Shariati N, Chang WJ, Wewege MA, McAuley JH, Booth A, Trost Z, Lin CT, Newton-John T, Gustin SM. The analgesic effect of electroencephalographic neurofeedback for people with chronic pain: A systematic review and meta-analysis. Eur J Neurol 2021; 29:921-936. [PMID: 34813662 DOI: 10.1111/ene.15189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/02/2021] [Accepted: 11/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Electroencephalographic (EEG) neurofeedback has been utilized to regulate abnormal brain activity associated with chronic pain. METHODS In this systematic review, we synthesized the evidence from randomized controlled trials (RCTs) to evaluate the effect of EEG neurofeedback on chronic pain using random effects meta-analyses. Additionally, we performed a narrative review to explore the results of non-randomized studies. The quality of included studies was assessed using Cochrane risk of bias tools, and the GRADE system was used to rate the certainty of evidence. RESULTS Ten RCTs and 13 non-randomized studies were included. The primary meta-analysis on nine eligible RCTs indicated that although there is low confidence, EEG neurofeedback may have a clinically meaningful effect on pain intensity in short-term. Removing the studies with high risk of bias from the primary meta-analysis resulted in moderate confidence that there remained a clinically meaningful effect on pain intensity. We could not draw any conclusion from the findings of non-randomized studies, as they were mostly non-comparative trials or explorative case series. However, the extracted data indicated that the neurofeedback protocols in both RCTs and non-randomized studies mainly involved the conventional EEG neurofeedback approach, which targeted reinforcing either alpha or sensorimotor rhythms and suppressing theta and/or beta bands on one brain region at a time. A posthoc analysis of RCTs utilizing the conventional approach resulted in a clinically meaningful effect estimate for pain intensity. CONCLUSION Although there is promising evidence on the analgesic effect of EEG neurofeedback, further studies with larger sample sizes and higher quality of evidence are required.
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Affiliation(s)
- Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Chin-Teng Lin
- Faculty of Engineering and Information Technology, Australian Artificial Intelligence Institute, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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16
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Ide-Walters C, Thompson T. A Sham-Controlled Study of Neurofeedback for Pain Management. Front Neurosci 2021; 15:591006. [PMID: 34381326 PMCID: PMC8350778 DOI: 10.3389/fnins.2021.591006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background Neurofeedback (NFB) attempts to alter the brain’s electrophysiological activity and has shown potential as a pain management technique. Existing studies, however, often lack appropriate control groups or fail to assess whether electrophysiological activity has been successfully regulated. The current study is a randomized controlled trial comparing changes in brain activity and pain during NFB with those of a sham-control group. Methods An experimental pain paradigm in healthy participants was used to provide optimal control of pain sensation. Twenty four healthy participants were blind randomized to receive either 10 × NFB (with real EEG feedback) or 10 × sham (with false EEG feedback) sessions during noxious cold stimulation. Prior to actual NFB training, training protocols were individually determined for each participant based on a comparison of an initial 32-channel qEEG assessment administered at both baseline and during an experimental pain task. Each individual protocol was based on the electrode site and frequency band that showed the greatest change in amplitude during pain, with alpha or theta up-regulation at various electrode sites (especially Pz) the most common protocols chosen. During the NFB sessions themselves, pain was assessed at multiple times during each session on a 0–10 rating scale, and ANOVA was used to examine changes in pain ratings and EEG amplitude both across and during sessions for both NFB and sham groups. Results For pain, ANOVA trend analysis found a significant general linear decrease in pain across the 10 sessions (p = 0.015). However, no significant main or interaction effects of group were observed suggesting decreases in pain occurred independently of NFB. For EEG, there was a significant During Session X Group interaction (p = 0.004), which indicated that EEG amplitude at the training site was significantly closer to the target amplitude for the NFB compared to the sham group during painful stimulation, but this was only the case at the beginning of the cold task. Conclusion While these results must be interpreted within the context of an experimental pain model, they underline the importance of including an appropriate comparison group to avoid attributing naturally occurring changes to therapeutic effects.
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Affiliation(s)
- Charlotte Ide-Walters
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom.,Cancer Research UK, London, United Kingdom
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom
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17
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Hasan MA, Shahid H, Khan HR, Qazi SA, Fraser M. Distinguishing Voluntarily Upregulation of Localized Central Alpha from Widespread Posterior Alpha. Appl Psychophysiol Biofeedback 2021; 46:183-194. [PMID: 33877492 DOI: 10.1007/s10484-021-09511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neurofeedback (NF) training based on alpha upregulation has been widely used on patient and healthy populations. However, active voluntary modulation of central or widespread posterior alpha in response to central alpha feedback is still ambiguous. The objective of this study is to confirm whether patients learn to truly increase alpha power and to determine if patients modulate central or widespread alpha power when alpha feedback is provided from central brain region. This EEG-based NF study was conducted on seven paraplegic patients with same injury type, pain location, and sensitization to ensure homogeneity. In addition to routine NF training sessions, various experiments were performed to compare alpha NF modulation received from C4 with alpha shift during cognitive tasks, occipital or parieto-occipital cortex, and Laplacian montage which is expected to separate localized alpha from widespread alpha, to attain objectives. Moreover, imaginary coherence analysis in alpha band was also performed to check whether C4 training site is coupled with other brain regions and to confirm whether activity at training site leads/lags the activity of other brain regions. The results indicate widespread alpha modulation in patients during regular NF sessions (p < 0.05) with large effect size (> 0.8), sufficiently high statistical power (> 80%), and a narrower confidence interval (CI) in response to NF provided from the central brain region reflecting less uncertainty and higher precision. However, small effect size obtained with Laplacian montage require patients to be trained with Laplacian feedback to achieve a reliable conclusion regarding localized alpha modulation. The outcomes of this study are not only limited to validate true alpha modulation in response to central alpha feedback but also to explore the mechanism of central alpha NF training.
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Affiliation(s)
- Muhammad A Hasan
- Department of Biomedical Engineering, NED University of Engineering and Technology, Karachi, Pakistan. .,Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan.
| | - Hira Shahid
- Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan
| | - Hashim R Khan
- Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan.,Department of Electronics Engineering, NED University of Engineering and Technology, Karachi, Pakistan
| | - Saad A Qazi
- Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan.,Department of Electrical Engineering, NED University of Engineering and Technology, Karachi, Pakistan
| | - Matthew Fraser
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
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18
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Hasan MA, Vuckovic A, Qazi SA, Yousuf Z, Shahab S, Fraser M. Immediate effect of neurofeedback training on the pain matrix and cortical areas involved in processing neuropsychological functions. Neurol Sci 2021; 42:4551-4561. [PMID: 33624179 DOI: 10.1007/s10072-021-05125-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study investigated the impact of neurofeedback training on the deeper cortical structures that comprise the "pain matrix" and are involved in processing neuropsychological functions. METHODS Five paraplegic patients with central neuropathic pain received up to 40 sessions of neurofeedback training. They were asked to simultaneously modulate the relative power of the theta, alpha and beta bands, provided as a feedback from the sensorimotor cortex. The source localization technique was applied on EEG data recorded with 16 electrodes placed over the whole head. RESULTS Neurofeedback training from the sensorimotor cortex induced effects on the pain matrix and in the areas involved in processing neuropsychological functions such as memory, executive functions and emotional regulations. Alpha and beta band activity was most increased in insular, cingulate and frontal cortex regions, and other areas corresponding to executive and emotional function processing. Theta band decreases were noted in the frontal, cingulate and motor cortices. In group analysis, theta and beta band activity was significantly reduced. CONCLUSION The single channel electroencephalogram-based neurofeedback training produced effects on similar areas that are targeted in 19 channels standardized low-resolution brain electromagnetic tomography and expensive time-delayed functional magnetic resonance imaging feedback studies.
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Affiliation(s)
- Muhammad Abul Hasan
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, Pakistan. .,Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan.
| | - Aleksandra Vuckovic
- Centre for Rehabilitation Engineering, Biomedical Engineering Division, School of Engineering, University of Glasgow, Glasgow, UK
| | - Saad A Qazi
- Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan.,Department of Electrical Engineering, NED University of Engineering & Technology, Karachi, Pakistan
| | - Zuha Yousuf
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, Pakistan.,Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan.,Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Sania Shahab
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, Pakistan
| | - Matthew Fraser
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
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19
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Elbogen EB, Alsobrooks A, Battles S, Molloy K, Dennis PA, Beckham JC, McLean SA, Keith JR, Russoniello C. Mobile Neurofeedback for Pain Management in Veterans with TBI and PTSD. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:329-337. [PMID: 31697371 PMCID: PMC7901853 DOI: 10.1093/pm/pnz269] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Chronic pain is common in military veterans with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Neurofeedback, or electroencephalograph (EEG) biofeedback, has been associated with lower pain but requires frequent travel to a clinic. The current study examined feasibility and explored effectiveness of neurofeedback delivered with a portable EEG headset linked to an application on a mobile device. DESIGN Open-label, single-arm clinical trial. SETTING Home, outside of clinic. SUBJECTS N = 41 veterans with chronic pain, TBI, and PTSD. METHOD Veterans were instructed to perform "mobile neurofeedback" on their own for three months. Clinical research staff conducted two home visits and two phone calls to provide technical assistance and troubleshoot difficulties. RESULTS N = 36 veterans returned for follow-up at three months (88% retention). During this time, subjects completed a mean of 33.09 neurofeedback sessions (10 minutes each). Analyses revealed that veterans reported lower pain intensity, pain interference, depression, PTSD symptoms, anger, sleep disturbance, and suicidal ideation after the three-month intervention compared with baseline. Comparing pain ratings before and after individual neurofeedback sessions, veterans reported reduced pain intensity 67% of the time immediately following mobile neurofeedback. There were no serious adverse events reported. CONCLUSIONS This preliminary study found that veterans with chronic pain, TBI, and PTSD were able to use neurofeedback with mobile devices independently after modest training and support. While a double-blind randomized controlled trial is needed for confirmation, the results show promise of a portable, technology-based neuromodulatory approach for pain management with minimal side effects.
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Affiliation(s)
- Eric B Elbogen
- Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amber Alsobrooks
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sara Battles
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kiera Molloy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Paul A Dennis
- Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jean C Beckham
- Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Julian R Keith
- Department of Psychology, University of North Carolina-Wilmington, Wilmington, North Carolina, USA
| | - Carmen Russoniello
- Center for Applied Psychophysiology, East Carolina University, Greenville, North Carolina, USA
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20
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Efficacy evaluation of neurofeedback applied for treatment of central neuropathic pain using machine learning. SN APPLIED SCIENCES 2021. [DOI: 10.1007/s42452-020-04035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractBrain-computer interface (BCI) is believed to be the translator of brain signals into actions based on the model, built on the machine learning (ML) algorithms, incorporated in it. This study reports on the performance of various ML algorithms in evaluating efficacy of neurofeedback applied for treatment of central neuropathic pain (CNP). In the first phase of this study, we applied different ML algorithms for classification of electroencephalography (EEG) patterns, associated with CNP, obtained from three groups of participants, during imagined movement of their limbs, named as able-bodied (AB), paraplegic patients with (PWP) and without (PNP) neuropathic pain. In the second phase, we tested the accuracy of BCI-classifier by applying new EEG data obtained from PWP participants who have completed neurofeedback training provided for the management of pain. Support vector Machine (SVM) algorithm gained higher accuracy, with all groups, than the other classifiers. However, the highest classification accuracy of 99 ± 0.49% was obtained with the right hand motor imagery of (AB vs PWP) group and 61 electrodes. In Conclusion, SVM based BCI-classifier achieved high accuracy in evaluating efficacy of neurofeedback applied for treatment of CNP. Results of this study show that the accuracy of BCI changes with ML algorithm, electrodes combinations, and training data set.
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21
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Peng W, Zhan Y, Jiang Y, Nan W, Kadosh RC, Wan F. Individual variation in alpha neurofeedback training efficacy predicts pain modulation. NEUROIMAGE-CLINICAL 2020; 28:102454. [PMID: 33065472 PMCID: PMC7566954 DOI: 10.1016/j.nicl.2020.102454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/29/2020] [Accepted: 09/27/2020] [Indexed: 11/16/2022]
Abstract
Sensorimotor alpha neurofeedback training effect on pain perception was assessed. Neurofeedback training decreased the sensory-discriminative aspect of pain. Neurofeedback training increased the affective-motivational aspect of pain. Pain modulation by neurofeedback training was dependent upon the training efficacy. Neurofeedback training efficacy predicted sensory-discriminative pain modulation.
Studies have shown an association between sensorimotor α-oscillation and pain perception. It suggests the potential use of neurofeedback (NFB) training for pain modulation through modifying sensorimotor α-oscillation. Here, a single-session NFB training protocol targeted on increasing sensorimotor α-oscillations was applied to forty-five healthy participants. Pain thresholds to nociceptive laser stimulations and pain ratings (intensity and unpleasantness) to identical laser painful stimulations were assessed immediately before and after NFB training. Participants had larger pain thresholds, but rated the identical painful laser stimulation as more unpleasant after NFB training. These pain measurements were further compared between participants with high or low NFB training efficacy that was quantified as the regression slope of α-oscillation throughout the ten training blocks. A significant increase in pain thresholds was observed among participants with high-efficacy; whereas a significant increase in pain ratings was observed among participants with low-efficacy. These results suggested that NFB training decreased the sensory-discriminative aspect of pain, but increased the affective-motivational aspect of pain, whereas both pain modulations were dependent upon the NFB training efficacy. Importantly, correlation analysis across all participants revealed that a greater NFB training efficacy predicted a greater increase in pain thresholds particularly at hand contralateral to NFB target site, but no significant correlation was observed between NFB training efficacy and modulation on pain ratings. It thus provided causal evidence for a link between sensorimotor α-oscillation and the sensory-discriminative aspect of pain, and highlighted the need for personalized neurofeedback for the benefits on pain modulation at the individual level. Future studies can adopt a double-blind sham-controlled protocol to validate NFB training induced pain modulation.
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Affiliation(s)
- Weiwei Peng
- School of Psychology, Shenzhen University, Shenzhen, Guangdong, China; Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen, Guangdong, China
| | - Yilin Zhan
- School of Psychology, Shenzhen University, Shenzhen, Guangdong, China
| | - Yali Jiang
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai, China.
| | - Roi Cohen Kadosh
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China; Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macau, China
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22
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Hesam-Shariati N, Chang WJ, McAuley JH, Booth A, Trost Z, Lin CT, Newton-John T, Gustin SM. The Analgesic Effect of Electroencephalographic Neurofeedback for People With Chronic Pain: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2020; 9:e22821. [PMID: 33030439 PMCID: PMC7582146 DOI: 10.2196/22821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 01/13/2023] Open
Abstract
Background Chronic pain is a global health problem, affecting around 1 in 5 individuals in the general population. The understanding of the key role of functional brain alterations in the generation of chronic pain has led researchers to focus on pain treatments that target brain activity. Electroencephalographic neurofeedback attempts to modulate the power of maladaptive electroencephalography frequency powers to decrease chronic pain. Although several studies have provided promising evidence, the effect of electroencephalographic neurofeedback on chronic pain is uncertain. Objective This systematic review aims to synthesize the evidence from randomized controlled trials to evaluate the analgesic effect of electroencephalographic neurofeedback. In addition, we will synthesize the findings of nonrandomized studies in a narrative review. Methods We will apply the search strategy in 5 electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycInfo, and CINAHL) for published studies and in clinical trial registries for completed unpublished studies. We will include studies that used electroencephalographic neurofeedback as an intervention for people with chronic pain. Risk-of-bias tools will be used to assess methodological quality of the included studies. We will include randomized controlled trials if they have compared electroencephalographic neurofeedback with any other intervention or placebo control. The data from randomized controlled trials will be aggregated to perform a meta-analysis for quantitative synthesis. The primary outcome measure is pain intensity assessed by self-report scales. Secondary outcome measures include depressive symptoms, anxiety symptoms, and sleep quality measured by self-reported questionnaires. We will investigate the studies for additional outcomes addressing adverse effects and resting-state electroencephalography analysis. Additionally, all types of nonrandomized studies will be included for a narrative synthesis. The intended and unintended effects of nonrandomized studies will be extracted and summarized in a descriptive table. Results Ethics approval is not required for a systematic review, as there will be no patient involvement. The search for this systematic review commenced in July 2020, and we expect to publish the findings in early 2021. Conclusions This systematic review will provide recommendations for researchers and health professionals, as well as people with chronic pain, about the evidence for the analgesic effect of electroencephalographic neurofeedback. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42020177608; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=177608 International Registered Report Identifier (IRRID) PRR1-10.2196/22821
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Affiliation(s)
- Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Chin-Teng Lin
- Australian Artificial Intelligence Institute, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
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Hesam-Shariati N, Newton-John T, Singh AK, Tirado Cortes CA, Do TTN, Craig A, Middleton JW, Jensen MP, Trost Z, Lin CT, Gustin SM. Evaluation of the Effectiveness of a Novel Brain-Computer Interface Neuromodulative Intervention to Relieve Neuropathic Pain Following Spinal Cord Injury: Protocol for a Single-Case Experimental Design With Multiple Baselines. JMIR Res Protoc 2020; 9:e20979. [PMID: 32990249 PMCID: PMC7556378 DOI: 10.2196/20979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neuropathic pain is a debilitating secondary condition for many individuals with spinal cord injury. Spinal cord injury neuropathic pain often is poorly responsive to existing pharmacological and nonpharmacological treatments. A growing body of evidence supports the potential for brain-computer interface systems to reduce spinal cord injury neuropathic pain via electroencephalographic neurofeedback. However, further studies are needed to provide more definitive evidence regarding the effectiveness of this intervention. OBJECTIVE The primary objective of this study is to evaluate the effectiveness of a multiday course of a brain-computer interface neuromodulative intervention in a gaming environment to provide pain relief for individuals with neuropathic pain following spinal cord injury. METHODS We have developed a novel brain-computer interface-based neuromodulative intervention for spinal cord injury neuropathic pain. Our brain-computer interface neuromodulative treatment includes an interactive gaming interface, and a neuromodulation protocol targeted to suppress theta (4-8 Hz) and high beta (20-30 Hz) frequency powers, and enhance alpha (9-12 Hz) power. We will use a single-case experimental design with multiple baselines to examine the effectiveness of our self-developed brain-computer interface neuromodulative intervention for the treatment of spinal cord injury neuropathic pain. We will recruit 3 participants with spinal cord injury neuropathic pain. Each participant will be randomly allocated to a different baseline phase (ie, 7, 10, or 14 days), which will then be followed by 20 sessions of a 30-minute brain-computer interface neuromodulative intervention over a 4-week period. The visual analog scale assessing average pain intensity will serve as the primary outcome measure. We will also assess pain interference as a secondary outcome domain. Generalization measures will assess quality of life, sleep quality, and anxiety and depressive symptoms, as well as resting-state electroencephalography and thalamic γ-aminobutyric acid concentration. RESULTS This study was approved by the Human Research Committees of the University of New South Wales in July 2019 and the University of Technology Sydney in January 2020. We plan to begin the trial in October 2020 and expect to publish the results by the end of 2021. CONCLUSIONS This clinical trial using single-case experimental design methodology has been designed to evaluate the effectiveness of a novel brain-computer interface neuromodulative treatment for people with neuropathic pain after spinal cord injury. Single-case experimental designs are considered a viable alternative approach to randomized clinical trials to identify evidence-based practices in the field of technology-based health interventions when recruitment of large samples is not feasible. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000556943; https://bit.ly/2RY1jRx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/20979.
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Affiliation(s)
- Negin Hesam-Shariati
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Avinash K Singh
- School of Computer Science, University of Technology Sydney, Sydney, Australia
| | | | | | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Northern Clinical School, University of Sydney, Kolling Institute, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Northern Clinical School, University of Sydney, Kolling Institute, Sydney, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Chin-Teng Lin
- School of Computer Science, University of Technology Sydney, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
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Ponsel S, Zhang J, Pilz M, Yanovsky Y, Brankačk J, Draguhn A. Alterations of distributed neuronal network oscillations during acute pain in freely-moving mice. IBRO Rep 2020; 9:195-206. [PMID: 32944670 PMCID: PMC7481812 DOI: 10.1016/j.ibror.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/07/2020] [Indexed: 01/01/2023] Open
Abstract
Injection of capsaicine in mice causes prolonged acute pain and characteristic changes in neuronal network oscillations. Changes are most prominent in higher-order phenomena like interregional oscillation coherence. Power in standard frequency bands is largely unaltered. Behavioral states related to acute pain can be predicted from network activity by a logistic regression classifier.
The experience of pain involves the activation of multiple brain areas. Pain-specific activity patterns within and between these local networks remain, however, largely unknown. We measured neuronal network oscillations in different relevant regions of the mouse brain during acute pain, induced by subcutaneous injection of capsaicin into the left hind paw. Field potentials were recorded from primary somatosensory cortex, anterior cingulate cortex (ACC), posterior insula, ventral posterolateral thalamic nucleus, parietal cortex, central nucleus of the amygdala and olfactory bulb. Analysis included power spectra of local signals as well as interregional coherences and cross-frequency coupling (CFC). Capsaicin injection caused hypersensitivity to mechanical stimuli for at least one hour. At the same time, CFC between low (1−12 Hz) and fast frequencies (80−120 Hz) was increased in the ACC, as well as interregional coherence of low frequency oscillations (< 30 Hz) between several networks. However, these changes were not significant anymore after multiple comparison corrections. Using a variable selection method (elastic net) and a logistic regression classifier, however, the pain state was reliably predicted by combining parameters of power and coherence from various regions. Distinction between capsaicin and saline injection was also possible when data were restricted to frequencies <30 Hz, as used in clinical electroencephalography (EEG). Our findings indicate that changes of distributed brain oscillations may provide a functional signature of acute pain or pain-related alterations in activity.
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Affiliation(s)
- Simon Ponsel
- Institute for Physiology and Pathophysiology, Heidelberg University, Germany
| | - Jiaojiao Zhang
- Institute for Physiology and Pathophysiology, Heidelberg University, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, Heidelberg University, Germany
| | - Yevgenij Yanovsky
- Institute for Physiology and Pathophysiology, Heidelberg University, Germany
| | - Jurij Brankačk
- Institute for Physiology and Pathophysiology, Heidelberg University, Germany
| | - Andreas Draguhn
- Institute for Physiology and Pathophysiology, Heidelberg University, Germany
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25
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Roy R, de la Vega R, Jensen MP, Miró J. Neurofeedback for Pain Management: A Systematic Review. Front Neurosci 2020; 14:671. [PMID: 32765208 PMCID: PMC7378966 DOI: 10.3389/fnins.2020.00671] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic pain is a significant global health issue. For most individuals with chronic pain, biomedical treatments do not provide adequate relief. Given the evidence that neurophysiological abnormalities are associated with pain, it is reasonable to consider treatments that target these factors, such as neurofeedback (NF). The primary objectives of this review were to summarize the current state of knowledge regarding: (1) the different types of NF and NF protocols that have been evaluated for pain management; (2) the evidence supporting each NF type and protocol; (3) if targeted brain activity changes occur with NF training; and (4) if such brain activity change is associated with improvements on treatment outcomes. Methods: Inclusion criteria were intentionally broad to encompass every empirical study using NF in relation to pain. We considered all kinds of NF, including both electroencephalogram- (EEG-) and functional magnetic resonance imagining- (fMRI-) based. We searched the following databases from inception through September 2019: Pubmed, Ovid, Embase, Web of Science, PsycINFO. The search strategy consisted of a combination of key terms referring to all NF types and pain conditions (e.g., neurofeedback, rt-fMRI-NF, BOLD, pain, migraine). Results: A total of 6,552 citations were retrieved; 24 of these that were included in the review. Most of the studies were of moderate quality, included a control condition and but did not include a follow-up. They focused on studying pain intensity (83%), pain frequency, and other variables (fatigue, sleep, depression) in samples of adults (n = 7-71) with headaches, fibromyalgia and other pain conditions. Most studies (79%) used EEG-based NF. A wide variety of NF types and protocols have been used for pain management aiming to either increase, decrease or regulate brain activity in certain areas theoretically associated with pain. Conclusions: Given the generally positive results in the studies reviewed, the findings indicate that NF procedures have the potential for reducing pain and improving other related outcomes in individuals with chronic pain. However, the current evidence does not provide definitive conclusions or allow for reliable recommendations on which protocols or methods of administration may be the most effective. These findings support the need for continued - but higher quality - research in this area.
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Affiliation(s)
- Rubén Roy
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain–ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Tarragona, Spain
| | - Rocío de la Vega
- Center for Child Health, Behavior and Development, Children's Research Institute, Seattle, WA, United States
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain–ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Tarragona, Spain
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26
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Patel K, Sutherland H, Henshaw J, Taylor JR, Brown CA, Casson AJ, Trujillo‐Barreton NJ, Jones AKP, Sivan M. Effects of neurofeedback in the management of chronic pain: A systematic review and meta‐analysis of clinical trials. Eur J Pain 2020; 24:1440-1457. [DOI: 10.1002/ejp.1612] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/08/2020] [Accepted: 05/31/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Kajal Patel
- School of Medicine University of Manchester Manchester UK
| | - Heather Sutherland
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | - James Henshaw
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | - Jason R. Taylor
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | | | - Alexander J. Casson
- School of Electrical and Electronic Engineering University of Manchester Manchester UK
| | | | - Anthony K. P. Jones
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
| | - Manoj Sivan
- Division of Neuroscience and Experimental Psychology University of Manchester Manchester UK
- Academic Department of Rehabilitation Medicine University of Leeds Leeds UK
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27
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Bismuth J, Vialatte F, Lefaucheur JP. Relieving peripheral neuropathic pain by increasing the power-ratio of low-β over high-β activities in the central cortical region with EEG-based neurofeedback: Study protocol for a controlled pilot trial (SMRPain study). Neurophysiol Clin 2020; 50:5-20. [DOI: 10.1016/j.neucli.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/27/2022] Open
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Ahmed H, Jones A, Sivan M. The brain alpha rhythm in the perception and modulation of pain. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2020. [DOI: 10.47795/gbpd9851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
A spinal cord injury (SCI) may result in impairments of motor, sensory, and autonomous functions below the injury level. Worldwide, the prevalence of SCI is 1:1000 and the incidence is between 4 and 9 new cases per 100,000 people per year. Most common causes for traumatic SCI are traffic accidents, falls, and violence. Nowadays, the proportion of patients with tetraplegia and paraplegia is equal. In industrialized countries, the percentage of nontraumatic injuries increases together with age. Most patients with initially preserved motor functions below the injury level show a substantial functional recovery, while three quarters of patients with initially complete SCI remain that way. In SCI, brain-computer interfaces (BCIs) may be used in the subacute phase as part of a restorative therapy program and, later, for control of assistive devices most needed by individuals with high cervical lesions. Research on structural and functional reorganization of the deefferented and deafferented brain after SCI is inconclusive mainly because of varying methods of analysis and the heterogeneity of the investigated populations. A better characterization of study participants with SCI together with documentation of confounding factors such as antispasticity medication or neuropathic pain is indicated.
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Affiliation(s)
- Rüdiger Rupp
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
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30
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Al-Taleb MKH, Purcell M, Fraser M, Petric-Gray N, Vuckovic A. Home used, patient self-managed, brain-computer interface for the management of central neuropathic pain post spinal cord injury: usability study. J Neuroeng Rehabil 2019; 16:128. [PMID: 31666096 PMCID: PMC6822418 DOI: 10.1186/s12984-019-0588-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 09/06/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Central Neuropathic Pain (CNP) is a frequent chronic condition in people with spinal cord injury (SCI). Previously, we showed that using laboratory brain-computer interface (BCI) technology for neurofeedback (NFB) training, it was possible to reduce CNP in people with SCI. In this study, we show results of patient self-managed treatment in their homes with a BCI-NFB using a consumer EEG device. METHODS Users: People with chronic SCI (17 M, 3 F, 50.6 ± 14.1 years old), and CNP ≥4 on a Visual Numerical Scale. LOCATION Laboratory training (up to 4 sessions) followed by home self-managed NFB. User Activity: Upregulating the EEG alpha band power by 10% above a threshold and at the same time downregulating the theta and upper beta (20-30 Hz) band power by 10% at electrode location C4. Technology: A consumer grade multichannel EEG headset (Epoch, Emotiv, USA), a tablet computer and custom made NFB software. EVALUATION EEG analysis, before and after NFB assessment, interviews and questionnaires. RESULTS Effectiveness: Out of 20 initially assessed participants, 15 took part in the study. Participants used the system for 6.9 ± 5.5 (median 4) weeks. Twelve participants regulated their brainwaves in a frequency specific manner and were most successful upregulating the alpha band power. However they typically upregulated power around their individual alpha peak (7.6 ± 0.8 Hz) that was lower than in people without CNP. The reduction in pain experienced was statistically significant in 12 and clinically significant (greater than 30%) in 8 participants. Efficiency: The donning was between 5 and 15 min, and approximately 10-20% of EEG data recorded in the home environment was noise. Participants were mildly stressed when self-administering NFB at home (2.4 on a scale 1-10). User satisfaction: Nine participants who completed the final assessment reported a high level of satisfaction (QUESQ, 4.5 ± 0.8), naming effectiveness, ease of use and comfort as main priorities. The main factors influencing frequency of NFB training were: health related issues, free time and pain intensity. CONCLUSION Portable NFB is a feasible solution for home-based self-managed treatment of CNP. Compared to pharmacological treatments, NFB has less side effects and provides users with active control over pain. TRIAL REGISTRATION GN15NE124 , Registered 9th June 2016.
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Affiliation(s)
- M K H Al-Taleb
- Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK.,Wasit University, Wasit, Iraq
| | - M Purcell
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Fraser
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - N Petric-Gray
- Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK
| | - A Vuckovic
- Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK.
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31
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Vučković A, Altaleb MKH, Fraser M, McGeady C, Purcell M. EEG Correlates of Self-Managed Neurofeedback Treatment of Central Neuropathic Pain in Chronic Spinal Cord Injury. Front Neurosci 2019; 13:762. [PMID: 31404253 PMCID: PMC6670070 DOI: 10.3389/fnins.2019.00762] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Neurofeedback (NFB) is a neuromodulatory technique that enables voluntary modulation of brain activity in order to treat neurological condition, such as central neuropathic pain (CNP). A distinctive feature of this technique is that it actively involves participants in the therapy. In this feasibility study, we present results of participant self-managed NFB treatment of CNP. METHODS Fifteen chronic spinal cord injured (SCI) participants (13M, 2F), with chronic CNP equal or greater than 4 on the Visual Numeric Scale, took part in the study. After initial training in hospital (up to 4 sessions), they practiced NF at home, on average 2-3 times a week, over a period of several weeks (min 4, max 20). The NFB protocol consisted of upregulating the alpha (9-12 Hz) and downregulating the theta (4-8 Hz) and the higher beta band (20-30 Hz) power from electrode location C4, for 30 min. The output measures were pain before and after NFB, EEG before and during NFB and pain questionnaires. We analyzed EEG results and show NFB strategies based on the Power Spectrum Density of each single participant. RESULTS Twelve participants achieved statistically significant reduction in pain and in eight participants this reduction was clinically significant (larger than 30%). The most successfully regulated frequency band during NFB was alpha. However, most participants upregulated their individual alpha band, that had an average dominant frequency at αp = 7.6 ± 0.8 Hz (median 8 Hz) that is lower than the average of the general population, which is around 10 Hz. Ten out of fifteen participants significantly upregulated their individual alpha power (αp ± 2 Hz) as compared to 4 participants who upregulated the power in the fixed alpha band (8-12 Hz). Eight out of the twelve participants who achieved a significant reduction of pain, significantly upregulated their individual alpha band power. There was a significantly larger increase in alpha power (p < 0.0001) and decrease of theta power (p < 0.04) in participant specific rather than in fixed frequency bands. CONCLUSION Neurofeedback is a neuromodulatory technique that gives participants control over their pain and can be self-administered at home. Regulation of individual frequency band was related to a significant reduction in pain.
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Affiliation(s)
- Aleksandra Vučković
- Rehabilitation and Assistive Devices, Biomedical Engineering Division, School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Manaf Kadum Hussein Altaleb
- Rehabilitation and Assistive Devices, Biomedical Engineering Division, School of Engineering, University of Glasgow, Glasgow, United Kingdom
- Faculty of Electrical Engineering, Wasit University, Wasit, Iraq
| | - Matthew Fraser
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Ciarán McGeady
- Rehabilitation and Assistive Devices, Biomedical Engineering Division, School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Mariel Purcell
- Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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32
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Henderson LA. Trigeminal neuropathic pain: Evidence of central changes from human brain imaging investigations. AUST ENDOD J 2018. [DOI: 10.1111/aej.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luke A. Henderson
- Department of Anatomy and Histology; University of Sydney; Sydney New South Wales Australia
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33
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Rey B, Rodríguez A, Lloréns-Bufort E, Tembl J, Muñoz MÁ, Montoya P, Herrero-Bosch V, Monzo JM. Design and Validation of an FPGA-Based Configurable Transcranial Doppler Neurofeedback System for Chronic Pain Patients. SENSORS 2018; 18:s18072278. [PMID: 30011900 PMCID: PMC6069097 DOI: 10.3390/s18072278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022]
Abstract
Neurofeedback is a self-regulation technique that can be applied to learn to voluntarily control cerebral activity in specific brain regions. In this work, a Transcranial Doppler-based configurable neurofeedback system is proposed and described. The hardware configuration is based on the Red Pitaya board, which gives great flexibility and processing power to the system. The parameter to be trained can be selected between several temporal, spectral, or complexity features from the cerebral blood flow velocity signal in different vessels. As previous studies have found alterations in these parameters in chronic pain patients, the system could be applied to help them to voluntarily control these parameters. Two protocols based on different temporal lengths of the training periods have been proposed and tested with six healthy subjects that were randomly assigned to one of the protocols at the beginning of the procedure. For the purposes of the testing, the trained parameter was the mean cerebral blood flow velocity in the aggregated data from the two anterior cerebral arteries. Results show that, using the proposed neurofeedback system, the two groups of healthy volunteers can learn to self-regulate a parameter from their brain activity in a reduced number of training sessions.
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Affiliation(s)
- Beatriz Rey
- Departamento de Ingeniería Gráfica, Universitat Politècnica de València, Camino Vera s/n, 46022 Valencia, Spain.
| | - Alejandro Rodríguez
- Departamento de Ingeniería Gráfica, Universitat Politècnica de València, Camino Vera s/n, 46022 Valencia, Spain.
| | - Enrique Lloréns-Bufort
- Instituto de Instrumentación para Imagen Molecular (I3M), Centro Mixto CSIC-Universitat Politècnica de València-CIEMAT, Camino de Vera s/n, 46022 Valencia, Spain.
| | - José Tembl
- Departamento de Neurología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain.
| | - Miguel Ángel Muñoz
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Granada, 18071 Granada, Spain.
| | - Pedro Montoya
- Instituto Universitario de Investigación en Ciencias de la Salud, Universitat Illes Balears, 07122 Palma, Spain.
| | - Vicente Herrero-Bosch
- Instituto de Instrumentación para Imagen Molecular (I3M), Centro Mixto CSIC-Universitat Politècnica de València-CIEMAT, Camino de Vera s/n, 46022 Valencia, Spain.
| | - Jose M Monzo
- Instituto de Instrumentación para Imagen Molecular (I3M), Centro Mixto CSIC-Universitat Politècnica de València-CIEMAT, Camino de Vera s/n, 46022 Valencia, Spain.
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Jensen MP, Battalio SL, Chan JF, Edwards KA, Day MA, Sherlin LH, Ehde DM. USE OF NEUROFEEDBACK AND MINDFULNESS TO ENHANCE RESPONSE TO HYPNOSIS TREATMENT IN INDIVIDUALS WITH MULTIPLE SCLEROSIS: Results From a Pilot Randomized Clinical Trial. Int J Clin Exp Hypn 2018; 66:231-264. [PMID: 29856281 DOI: 10.1080/00207144.2018.1460546] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This pilot study evaluated the possibility that 2 interventions hypothesized to increase slower brain oscillations (e.g., theta) may enhance the efficacy of hypnosis treatment, given evidence that hypnotic responding is associated with slower brain oscillations. Thirty-two individuals with multiple sclerosis and chronic pain, fatigue, or both, were randomly assigned to 1 of 2 interventions thought to increase slow wave activity (mindfulness meditation or neurofeedback training) or no enhancing intervention, and then given 5 sessions of self-hypnosis training targeting their presenting symptoms. The findings supported the potential for both neurofeedback and mindfulness to enhance response to hypnosis treatment. Research using larger sample sizes to determine the generalizability of these findings is warranted.
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Affiliation(s)
| | | | - Joy F Chan
- a University of Washington , Seattle , USA
| | | | - Melissa A Day
- b The University of Queensland , Brisbane , Australia
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35
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Swingle PG, Hartney E. Enhancing health leadership performance using neurotherapy. Healthc Manage Forum 2018; 31:92-96. [PMID: 29717646 DOI: 10.1177/0840470417751158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The discovery of neuroplasticity means the brain can change, functionally, in response to the environment and to learning. While individuals can develop harmful patterns of brain activity in response to stressors, they can also learn to modify or control neurological conditions associated with specific behaviors. Neurotherapy is one way of changing brain functioning to modify troubling conditions which can impair leadership performance, through responding to feedback on their own brain activity, and enhancing optimal leadership functioning through learning to maximize such cognitive strengths as mental efficiency, focus, creativity, perseverance, and executive functioning. The present article outlines the application of the concept of optimal performance training to organizational leadership in a healthcare context, by describing approaches to neurotherapy and illustrating their application through a case study of a health leader learning to overcome the neurological and emotional sequelae of workplace stress and trauma.
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Affiliation(s)
| | - Elizabeth Hartney
- 2 Centre for Health Leadership and Research, Royal Roads University, Victoria, British Columbia, Canada
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Ecsy K, Brown CA, Jones AKP. Cortical nociceptive processes are reduced by visual alpha-band entrainment in the human brain. Eur J Pain 2017; 22:538-550. [PMID: 29139226 DOI: 10.1002/ejp.1136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute noxious stimuli induce a suppression of cortical alpha activity, yet little is known about whether increasing alpha activity affects the processing of noxious stimuli. We have previously shown that visual alpha stimulation reduces experimental pain. Here, we demonstrate that increasing alpha power causes a reciprocal suppression of acute nociceptive processing. METHODS We attempted to increase cortical alpha activity through visual entrainment at 8 Hz, 10 Hz and 12 Hz to investigate the influence on the electrophysiological pain response. Moderately painful laser-heat stimuli were delivered following 10 minutes of visual entrainment across the alpha range. RESULTS Alpha power increased significantly relative to the 1 Hz control condition following 8 Hz and 10 Hz visual stimulation. Significant reductions in the P2 peak amplitude of the laser-evoked potential were found following visual entrainment at 10 Hz; the frequency stimulation resulting in the largest reduction in pain perception. Source analysis revealed that, following the 10 Hz stimulation, sources of increased alpha power and decreased nociceptive processing overlapped in precuneus and posterior cingulate cortex, with further reductions in nociceptive processing in insula cortex. CONCLUSIONS As far as we are aware, this is the first study to provide direct evidence that experimental induction of increased alpha power suppresses the cortical processing of acute pain. SIGNIFICANCE While it is known that visual stimulation can increase the brain's oscillatory alpha rhythms, here, we show that this increase in alpha power occurs alongside reduced cortical processing of nociception, as measured with EEG. This establishes an objective marker of alpha entrainment-based analgesia that may be useful in the development of neuromodulatory treatments for clinical pain.
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Affiliation(s)
- K Ecsy
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, United Kingdom
| | - C A Brown
- Department of Psychological Sciences, University of Liverpool, United Kingdom
| | - A K P Jones
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, United Kingdom
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Bäumler M, Feller M, Krafft S, Schiffer M, Sommer J, Straube A, Weinges F, Ruscheweyh R. Learned control over spinal nociception: Transfer and stability of training success in a long-term study. Clin Neurophysiol 2017; 128:2462-2469. [PMID: 29096221 DOI: 10.1016/j.clinph.2017.09.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/16/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Healthy subjects can learn to use cognitive-emotional strategies to suppress their spinal nociception, quantified by the nociceptive flexor reflex (RIII reflex), when given visual RIII feedback. This likely reflects learned activation of descending pain inhibition. Here, we investigated if training success persists 4 and 8 months after the end of RIII feedback training, and if transfer (RIII suppression without feedback) is possible. METHODS 18 and 8 subjects who had successfully completed feedback training were investigated 4 and 8 months later. RESULTS At 4 months, RIII suppression during feedback and transfer was similar to that achieved at the final RIII feedback training session (to 50 ± 22%, 53 ± 21% and 52 ± 21% of baseline, all differences n.s.). At 8 months, RIII suppression was somewhat (not significantly) smaller in the feedback run (to 64 ± 17%) compared to the final training session (56 ± 19%). Feedback and transfer runs were similar (to 64 ± 17% vs. 68 ± 24%, n.s.). Concomitant reductions in pain intensity ratings were stable at 4 and 8 months. CONCLUSIONS RIII feedback training success was completely maintained after 4 months, and somewhat attenuated 8 months after training. Transfer was successful. SIGNIFICANCE These results are an important pre-requisite for application of RIII feedback training in the context of clinical pain.
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Affiliation(s)
- Maximilian Bäumler
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany; Department of Anesthesiology, Ludwig-Maximilians-University Munich, Germany
| | - Moritz Feller
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany
| | - Stefanie Krafft
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany; Research Training Group 2175, Ludwig-Maximilians-University Munich, Germany
| | | | - Jens Sommer
- Department of Psychiatry, University of Marburg, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany; Research Training Group 2175, Ludwig-Maximilians-University Munich, Germany
| | | | - Ruth Ruscheweyh
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany; Department of Neurology, University of Münster, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Germany; Research Training Group 2175, Ludwig-Maximilians-University Munich, Germany.
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Wang RW, Kuo HC, Chuang SW. Humor drawings evoked temporal and spectral EEG processes. Soc Cogn Affect Neurosci 2017; 12:1359-1376. [PMID: 28402573 PMCID: PMC5597898 DOI: 10.1093/scan/nsx054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 11/24/2022] Open
Abstract
The study aimed to explore the humor processing elicited through the manipulation of artistic drawings. Using the Comprehension-Elaboration Theory of humor as the main research background, the experiment manipulated the head portraits of celebrities based on the independent variables of facial deformation (large/small) and addition of affective features (positive/negative). A 64-channel electroencephalography was recorded in 30 participants while viewing the incongruous drawings of celebrities. The electroencephalography temporal and spectral responses were measured during the three stages of humor which included incongruity detection, incongruity comprehension and elaboration of humor. Analysis of event-related potentials indicated that for humorous vs non-humorous drawings, facial deformation and the addition of affective features significantly affected the degree of humor elicited, specifically: large > small deformation; negative > positive affective features. The N170, N270, N400, N600-800 and N900-1200 components showed significant differences, particularly in the right prefrontal and frontal regions. Analysis of event-related spectral perturbation showed significant differences in the theta band evoked in the anterior cingulate cortex, parietal region and posterior cingulate cortex; and in the alpha and beta bands in the motor areas. These regions are involved in emotional processing, memory retrieval, and laughter and feelings of amusement induced by elaboration of the situation.
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Affiliation(s)
- Regina W.Y. Wang
- Design Perceptual Awareness Lab (D:PAL)
- The Department of Industrial and Communication Design
| | - Hsien-Chu Kuo
- Design Perceptual Awareness Lab (D:PAL)
- The Department of Industrial and Communication Design
| | - Shang-Wen Chuang
- Design Perceptual Awareness Lab (D:PAL)
- Taiwan Building Technology Center, National Taiwan University of Science and Technology (Taiwan Tech), Taipei, Taiwan
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Camfferman D, Moseley GL, Gertz K, Pettet MW, Jensen MP. Waking EEG Cortical Markers of Chronic Pain and Sleepiness. PAIN MEDICINE 2017; 18:1921-1931. [PMID: 28087845 DOI: 10.1093/pm/pnw294] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective Spectral power analyses of EEG recordings are reported to distinguish the cortical activity of individuals with chronic pain from those of controls. Further study of these spectral patterns may provide a greater understanding of the processes associated with chronic pain, in addition to providing potential biometric markers of chronic pain for use in both clinical and research settings. However, sleep deprived groups have demonstrated similar characteristics in their spectral power characteristics, particularly in alpha bandwidth power activity. Methods 103 individuals with chronic pain provided resting awake EEG data in addition to ratings of pain and sleep quality. Two Principal Axis Factor analyses using Promax rotation produced one pain and one sleep factor from relevant questionnaire data provided by participants. These factors were then used to test hypothesized relationships with alpha and theta bandwidth power at the frontal and parietal areas of the cortex. Results Our findings suggest that reductions in alpha bandwidth power are independently associated with both chronic pain intensity ratings and measures of sleep deficits. Conversely, theta bandwidth power was not found to be associated with either chronic pain or sleep quality measures. Conclusions This study's findings support that chronic pain intensity and sleep deficits are related to the Alpha spectral bandwidth activity in individuals with chronic pain.
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Affiliation(s)
- Danny Camfferman
- Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - G Lorimer Moseley
- Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Mark W Pettet
- Integrated Brain Imaging Center, University of Washington, Seattle, Washington, USA
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Alpha-range visual and auditory stimulation reduces the perception of pain. Eur J Pain 2016; 21:562-572. [DOI: 10.1002/ejp.960] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 12/14/2022]
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Relief of neuropathic pain after spinal cord injury by brain-computer interface training. Spinal Cord Ser Cases 2016; 2:16021. [PMID: 28053764 DOI: 10.1038/scsandc.2016.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 05/27/2016] [Accepted: 07/01/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to report the effects of brain-computer interface (BCI) training, a neurofeedback rehabilitation technique, on persistent neuropathic pain (NP) after cervical spinal cord injury (SCI). SUBJECTS AND METHODS We present the case of a 71-year-old woman with NP in her left upper extremity after SCI (C8). She underwent BCI training as outpatient rehabilitation for 4 months to enhance event-related desynchronization (ERD), which is triggered by the patient's motor intuition. Scalp electroencephalography was recorded to observe the ERD during every BCI training session. The patient's pain was evaluated with the McGill Pain Questionnaire (MPQ) and a visual analog scale (VAS). The MPQ was performed after every BCI training session, and the patient assessed the VAS score on her own, once every few days during the BCI training period. RESULTS After the BCI training started, the patient's ERD during the BCI training period increased significantly, from 15.6-30.3%. Moreover, her VAS score decreased gradually, from 8 to 5, after the BCI training started, although the MPQ did not change significantly. CONCLUSION BCI training has the potential to provide relief for patients with persistent NP via brain plasticity, and to improve their activities of daily living and quality of life.
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Hasan MA, Fraser M, Conway BA, Allan DB, Vučković A. Reversed cortical over-activity during movement imagination following neurofeedback treatment for central neuropathic pain. Clin Neurophysiol 2016; 127:3118-3127. [PMID: 27472548 PMCID: PMC4988467 DOI: 10.1016/j.clinph.2016.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/17/2016] [Accepted: 06/13/2016] [Indexed: 12/02/2022]
Abstract
OBJECTIVE One of the brain signatures of the central neuropathic pain (CNP) is the theta band over-activity of wider cortical structures, during imagination of movement. The objective of the study was to investigate whether this over-activity is reversible following the neurofeedback treatment of CNP. METHODS Five paraplegic patients with pain in their legs underwent from twenty to forty neurofeedback sessions that significantly reduced their pain. In order to assess their dynamic cortical activity they were asked to imagine movements of all limbs a week before the first and a week after the last neurofeedback session. Using time-frequency analysis we compared EEG activity during imagination of movement before and after the therapy and further compared it with EEG signals of ten paraplegic patients with no pain and a control group of ten able-bodied people. RESULTS Neurofeedback treatment resulted in reduced CNP and a wide spread reduction of cortical activity during imagination of movement. The reduction was significant in the alpha and beta band but was largest in the theta band. As a result cortical activity became similar to the activity of other two groups with no pain. CONCLUSIONS Reduction of CNP is accompanied by reduced cortical over-activity during movement imagination. SIGNIFICANCE Understanding causes and consequences mechanism through which CNP affects cortical activity.
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Affiliation(s)
- Muhammad Abul Hasan
- Rehabilitation Engineering and Assistive Technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK; Department of Biomedical Engineering, NED University of Engineering and Technology, Karachi, Pakistan(1)
| | - Matthew Fraser
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
| | - Bernard A Conway
- Department of Biomedical Engineering, University of Strathclyde, UK
| | - David B Allan
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
| | - Aleksandra Vučković
- Rehabilitation Engineering and Assistive Technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK.
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Khanna P, Swann NC, de Hemptinne C, Miocinovic S, Miller A, Starr PA, Carmena JM. Neurofeedback Control in Parkinsonian Patients Using Electrocorticography Signals Accessed Wirelessly With a Chronic, Fully Implanted Device. IEEE Trans Neural Syst Rehabil Eng 2016; 25:1715-1724. [PMID: 28113590 DOI: 10.1109/tnsre.2016.2597243] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Parkinson's disease (PD) is characterized by motor symptoms such as rigidity and bradykinesia that prevent normal movement. Beta band oscillations (13-30 Hz) in neural local field potentials (LFPs) have been associated with these motor symptoms. Here, three PD patients implanted with a therapeutic deep brain neural stimulator that can also record and wirelessly stream neural data played a neurofeedback game where they modulated their beta band power from sensorimotor cortical areas. Patients' beta band power was streamed in real-time to update the position of a cursor that they tried to drive into a cued target. After playing the game for 1-2 hours each, all three patients exhibited above chance-level performance regardless of subcortical stimulation levels. This study, for the first time, demonstrates using an invasive neural recording system for at-home neurofeedback training. Future work will investigate chronic neurofeedback training as a potentially therapeutic tool for patients with neurological disorders.
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Huang R, Wang J, Wu D, Long H, Yang X, Liu H, Gao X, Zhao R, Lai W. The effects of customised brainwave music on orofacial pain induced by orthodontic tooth movement. Oral Dis 2016; 22:766-774. [PMID: 27417074 DOI: 10.1111/odi.12542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 02/05/2023]
Affiliation(s)
- R Huang
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - J Wang
- Department of Stomatology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
| | - D Wu
- School of Computer and Information; Beijing Jiaotong University; Beijing China
| | - H Long
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - X Yang
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
- Department of Stomatology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
| | - H Liu
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - X Gao
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - R Zhao
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - W Lai
- State Key Laboratory of Oral Diseases; Department of Orthodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
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Henderson LA, Di Pietro F. How do neuroanatomical changes in individuals with chronic pain result in the constant perception of pain? Pain Manag 2016; 6:147-59. [PMID: 26997246 DOI: 10.2217/pmt.15.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Since the advent of anatomical brain imaging analysis techniques, numerous reports have shown altered regional brain anatomy in individuals with various chronic pain conditions. While early reports of increased regional brain volumes in taxi drivers and pianists were simply interpreted as responses to excessive use, the mechanisms responsible for anatomical changes associated with chronic pain are not so straightforward. The main aim of this paper is to explore the potential underlying cellular changes responsible for change in gross brain anatomy in individuals with chronic pain, in particular pain following nervous system damage. Determining the basis of these changes may provide a platform for development of targeted, personalized and ultimately more effective treatment regimens.
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Affiliation(s)
- Luke A Henderson
- Department of Anatomy & Histology, F13, University of Sydney, Sydney, Australia
| | - Flavia Di Pietro
- Department of Anatomy & Histology, F13, University of Sydney, Sydney, Australia
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Jensen MP, Gianas A, George HR, Sherlin LH, Kraft GH, Ehde DM. Use of Neurofeedback to Enhance Response to Hypnotic Analgesia in Individuals With Multiple Sclerosis. Int J Clin Exp Hypn 2016; 64:1-23. [PMID: 26599991 DOI: 10.1080/00207144.2015.1099400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This proof of principle study examined the potential benefits of EEG neurofeedback for increasing responsiveness to self-hypnosis training for chronic pain management. The study comprised 20 individuals with multiple sclerosis (MS) who received 5 sessions of self-hypnosis training--1 face-to-face session and 4 prerecorded sessions. Participants were randomly assigned to have the prerecorded sessions preceded by either (a) EEG biofeedback (neurofeedback) training to increase left anterior theta power (NF-HYP) or (b) a relaxation control condition (RLX-HYP). Eighteen participants completed all treatment sessions and assessments. NF-HYP participants reported greater reductions in pain than RLX-HYP participants. The findings provide support for the potential treatment-enhancing effects of neurofeedback on hypnotic analgesia and also suggest that effective hypnosis treatment can be provided very efficiently.
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Affiliation(s)
| | - Ann Gianas
- a University of Washington , Seattle , USA
| | | | - Leslie H Sherlin
- b Southwest College of Naturopathic Medicine , Tempe , Arizona , USA
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Hassan MA, Fraser M, Conway BA, Allan DB, Vuckovic A. The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study. BMC Neurol 2015; 15:200. [PMID: 26462651 PMCID: PMC4604632 DOI: 10.1186/s12883-015-0445-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/29/2015] [Indexed: 01/30/2023] Open
Abstract
Background Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia. Methods Patients’ EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20–30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three frequency bands accompanied with changes in the coherence most notable in the beta band. The standardized low resolution electromagnetic tomography analysis of EEG before and after neurofeedback therapy showed the statistically significant reduction of power in beta frequency band in all tested patients. Areas with reduced power included the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex and the Insular Cortex. Conclusions Neurofeedback training produces both immediate and longer term reduction of central neuropathic pain that is accompanied with a measurable short and long term modulation of cortical activity. Controlled trials are required to confirm the efficacy of this neurofeedback protocol on treatment of pain. The study is a registered UKCRN clinical trial Nr 9824.
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Affiliation(s)
- Muhammad Abul Hassan
- Rehabilitation Engineering and Assistive technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK. .,Department of Biomedical Engineering, NED University of Engineering and Technology, Karachi, Pakistan.
| | - Matthew Fraser
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.
| | - Bernard A Conway
- Department of Biomedical Engineering, University of Strathclyde, Strathclyde, UK.
| | - David B Allan
- Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.
| | - Aleksandra Vuckovic
- Rehabilitation Engineering and Assistive technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK. .,Biomedical Engineering Research Division, School of Engineering, University of Glasgow, James Watt building (south), G12 8QQ, Glasgow, UK.
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Petri RP, Walter JA, Wright J. Integrative Health and Healing Practices Specifically for Service Members: Self-Care Techniques. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard P. Petri
- United States Army, Chairman, NATO HFM-195 Task Force, Integrative Medicine Interventions for Military Personnel, El Paso, TX
| | | | - Jon Wright
- Summer Intern, Volunteer, Samueli Institute, Alexandria, VA
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Martins WR, Diniz LR, Blasczyk JC, Lagoa KF, Thomaz S, Rodrigues ME, de Oliveira RJ, Bonini-Rocha AC. Immediate changes in electroencephalography activity in individuals with nonspecific chronic low back pain after cranial osteopathic manipulative treatment: study protocol of a randomized, controlled crossover trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:223. [PMID: 26165865 PMCID: PMC4499448 DOI: 10.1186/s12906-015-0732-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022]
Abstract
Background Osteopathic medicine is based on a diagnostic and therapeutic system to treat tissue mobility/ motility dysfunctions in general, using different approaches (depending on the target tissue) known as osteopathic manipulative treatment. Among the available techniques those ones addressed to the cranial field are the most questioned because of the lack of scientific evidence; but the compression of the 4th ventricle technique has been largely studied in clinical trials. Studies have shown that the technique may affect both central and autonomous nervous system, modulating some reflexes (Traube-Hering baro signal), and modifying brain cortex electrical activity through central sensitization in subjects with chronic low back pain. Thus, investigators hypothesize that the compression of the 4th ventricle may modulate peak alpha frequency (eletroencephalographic assessment) and promote physical relaxation in subjects in vigil. Methods/Design A randomized, controlled crossover trial with blinded assessor was designed to test the hypothesis. A total of 81 participants will be assigned to three treatment conditions, with seven days of washout: (I) compression of the 4th ventricle; (II) sham compression of the fourth ventricle; (III) control (no intervention). The (I) power amplitude and the (II) frequencies of the dominant peak in the alpha band will be the primary outcome measures of the study. All participants will be recruited at the Outpatient Rehabilitation Service of the University Hospital of Brasília – University of Brasília. All the electroencephalographic exams will be conducted by a blinded assessor. Discussion The investigators hypothesize that patients with chronic low back pain submitted to the technique would have the peak alpha frequency modulated and, thus, would experience physical relaxation. Trial registration NCT02111382
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Jensen MP, Adachi T, Hakimian S. Brain Oscillations, Hypnosis, and Hypnotizability. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 57:230-253. [PMID: 25792761 DOI: 10.1080/00029157.2014.976786] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this article, we summarize the state-of-science knowledge regarding the associations between hypnosis and brain oscillations. Brain oscillations represent the combined electrical activity of neuronal assemblies, and are usually measured as specific frequencies representing slower (delta, theta, alpha) and faster (beta, gamma) oscillations. Hypnosis has been most closely linked to power in the theta band and changes in gamma activity. These oscillations are thought to play a critical role in both the recording and recall of declarative memory and emotional limbic circuits. Here we propose that it is this role that may be the mechanistic link between theta (and perhaps gamma) oscillations and hypnosis; specifically that theta oscillations may facilitate, and that changes in gamma activity observed with hypnosis may underlie, some hypnotic responses. If these hypotheses are supported, they have important implications for both understanding the effects of hypnosis, and for enhancing response to hypnotic treatments.
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