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Hesam-Shariati N, Alexander L, Chen KY, Craig A, Glare PA, Jensen MP, Lin CT, McAuley JH, Middleton JW, Moseley GL, Newton-John T, Restrepo S, Skinner IW, Zahara P, Gustin SM. A home-based self-directed EEG neurofeedback intervention for people with chronic neuropathic pain following spinal cord injury (the StoPain Trial): description of the intervention. Spinal Cord 2024:10.1038/s41393-024-01031-3. [PMID: 39266672 DOI: 10.1038/s41393-024-01031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/14/2024]
Abstract
STUDY DESIGN Randomised controlled trial. OBJECTIVES The objective is to describe an electroencephalography (EEG) neurofeedback intervention that will be provided in a randomised controlled trial for people with neuropathic pain following spinal cord injury (SCI): the StoPain Trial. In this trial, participants in the treatment group will implement an EEG neurofeedback system as an analgesic intervention at home, while participants in the control group will continue with the treatments available to them in the community. SETTING University-based study in Sydney, Australia. METHODS/RESULTS This manuscript describes the rationale and components of the EEG neurofeedback intervention designed for individuals with SCI neuropathic pain and intended for home-based implementation. Our report is based on the criteria of the Template for Intervention Description and Replication (TIDieR) checklist, and includes why the efficacy of EEG neurofeedback will be investigated, what will be provided, who will administer it, and how, where, when, and how much the EEG neurofeedback intervention will be administered. CONCLUSIONS This manuscript provides a detailed description of a complex intervention used in a randomised controlled trial. This description will facilitate the subsequent interpretation of the trial results and allow for the replication of the intervention in clinical practice and future trials. SPONSORSHIP Australian Government Medical Research Future Fund (2020 Rare Cancers Rare Diseases and Unmet Needs Scheme: 2006020).
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Affiliation(s)
- Negin Hesam-Shariati
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia.
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.
| | - Lara Alexander
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Kevin Yi Chen
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Ashley Craig
- The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Paul A Glare
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Chin-Teng Lin
- CIBCI Lab, Human-centric Artificial Intelligence Centre, Australian AI Institute, FEIT, University of Technology Sydney, Sydney, NSW, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - James W Middleton
- The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kuarna Country, Adelaide, SA, Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sebastian Restrepo
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ian W Skinner
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Allied Health Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, NSW, Australia
| | - Pauline Zahara
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Sylvia M Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
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Navarro-Ledesma S, Hamed-Hamed D, Gonzalez-Muñoz A, Pruimboom L. Impact of physical therapy techniques and common interventions on sleep quality in patients with chronic pain: A systematic review. Sleep Med Rev 2024; 76:101937. [PMID: 38669729 DOI: 10.1016/j.smrv.2024.101937] [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: 11/29/2023] [Revised: 03/20/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024]
Abstract
This systematic review aims to find effectful healthcare strategies, with special focus on drug-free interventions and physical therapy, as part of the treatment for sleep in patients with chronic musculoskeletal pain. Data search was conducted across seven scientific databases. This review is deposited in the Prospero International prospective register of systematic reviews (CRD42023452574). Seventeen RCTs from different healthcare fields complied with our inclusion criteria. Two RCTs investigated manual therapy, five RCTs therapeutic exercise, one RCT Fu's subcutaneous needling, two RCTs physical agents (one on balneotherapy and one on cryo-stimulation), two RCTs cognitive-behavioral therapy, and four RCTs pharmacological therapy and their effect on sleep quality and/or quantity in patients suffering from chronic pain. We included the four RCT's in this systematic review with the purpose to be able to compare natural interventions with allopathic ones. As allopathic interventions are more prone to have secondary negative effects than physical therapy, compare the two types of interventions could be in favor of choosing the most effective treatment with the least secondary negative effects. Additionally, two RCTs on neurofeedback and limbic neuromodulation were also included. The results of the included studies suggest that strategies such as manual therapy, therapeutic exercise, Fu's subcutaneous needling, balneotherapy, cryo-stimulation, neurofeedback, limbic neuromodulation, cognitive-behavioral therapy, and pharmacological therapies have positive effects on patients suffering from chronic pain and sleep disturbances, especially when they suffer musculoskeletal pain. Secondary negative effects were found for the possible overuse of certain medicines such as morphine, a huge problem in the United States. Sleep deficiency is an independent risk factor for many diseases, including chronic pain syndrome and therefore more studies are needed to find non-toxic interventions for people suffering sleep disorders associated with systemic diseases and pain.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Spain; University Chair in Clinical Psychoneuroimmunology (University of Granada and PNI Europe), Spain.
| | - Dina Hamed-Hamed
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Ana Gonzalez-Muñoz
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Granada, Spain; Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018, Malaga, Spain
| | - Leo Pruimboom
- University Chair in Clinical Psychoneuroimmunology (University of Granada and PNI Europe), Spain
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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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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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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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Ribeiro TF, Carriello MA, de Paula EP, Garcia AC, da Rocha GL, Teive HAG. Clinical applications of neurofeedback based on sensorimotor rhythm: a systematic review and meta-analysis. Front Neurosci 2023; 17:1195066. [PMID: 38053609 PMCID: PMC10694284 DOI: 10.3389/fnins.2023.1195066] [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: 03/28/2023] [Accepted: 07/07/2023] [Indexed: 12/07/2023] Open
Abstract
Background Among the brain-machine interfaces, neurofeedback is a non-invasive technique that uses sensorimotor rhythm (SMR) as a clinical intervention protocol. This study aimed to investigate the clinical applications of SMR neurofeedback to understand its clinical effectiveness in different pathologies or symptoms. Methods A systematic review study with meta-analysis of the clinical applications of EEG-based SMR neurofeedback performed using pre-selected publication databases. A qualitative analysis of these studies was performed using the Consensus tool on the Reporting and Experimental Design of Neurofeedback studies (CRED-nf). The Meta-analysis of clinical efficacy was carried out using Review Manager software, version 5.4.1 (RevMan 5; Cochrane Collaboration, Oxford, UK). Results The qualitative analysis includes 44 studies, of which only 27 studies had some kind of control condition, five studies were double-blinded, and only three reported a blind follow-up throughout the intervention. The meta-analysis included a total sample of 203 individuals between stroke and fibromyalgia. Studies on multiple sclerosis, insomnia, quadriplegia, paraplegia, and mild cognitive impairment were excluded due to the absence of a control group or results based only on post-intervention scales. Statistical analysis indicated that stroke patients did not benefit from neurofeedback interventions when compared to other therapies (Std. mean. dif. 0.31, 95% CI 0.03-0.60, p = 0.03), and there was no significant heterogeneity among stroke studies, classified as moderate I2 = 46% p-value = 0.06. Patients diagnosed with fibromyalgia showed, by means of quantitative analysis, a better benefit for the group that used neurofeedback (Std. mean. dif. -0.73, 95% CI -1.22 to -0.24, p = 0.001). Thus, on performing the pooled analysis between conditions, no significant differences were observed between the neurofeedback intervention and standard therapy (0.05, CI 95%, -0.20 to -0.30, p = 0.69), with the presence of substantial heterogeneity I2 = 92.2%, p-value < 0.001. Conclusion We conclude that although neurofeedback based on electrophysiological patterns of SMR contemplates the interest of numerous researchers and the existence of research that presents promising results, it is currently not possible to point out the clinical benefits of the technique as a form of clinical intervention. Therefore, it is necessary to develop more robust studies with a greater sample of a more rigorous methodology to understand the benefits that the technique can provide to the population.
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Affiliation(s)
- Tatiana Ferri Ribeiro
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Marcelo Alves Carriello
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Eugenio Pereira de Paula
- Physical Education (UFPR)—Invited Colaborador, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Amanda Carvalho Garcia
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Guilherme Luiz da Rocha
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
| | - Helio Afonso Ghizoni Teive
- Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
- Department of Clinical Medicine, UFPR, and Coordinator of the Movement Disorders Sector, Neurology Service, Clinic Hospital, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil
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Gikaro JM, Bigambo FM, Minde VM, Swai EA. Efficacy of electrophysical agents in fibromyalgia: A systematic review and network meta-analysis. Clin Rehabil 2023; 37:1295-1310. [PMID: 37082791 DOI: 10.1177/02692155231170450] [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] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To examine the effectiveness of electrophysical agents in fibromyalgia. DATA SOURCES CINAHL, Cochrane Library, Embase, Medline, PEDro, and Web of Science were searched from their inceptions to March 27, 2023. METHODS This study was registered in PROSPERO (CRD42022354326). Methodological quality of included trials was assessed using PEDro scale, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. The primary outcomes were pain, functional status, and mood. RESULTS Fifty-four studies involving 3045 patients with fibromyalgia were eligible for qualitative synthesis and 47 (pain), 31 (functional status), and 26 (mood) for network meta-analysis. The network consistency model revealed that, when compared with true control, transcutaneous electrical nerve stimulation and microcurrent improved pain symptoms (P = 0.006 and P = 0.037, respectively); repetitive transcranial magnetic stimulation improved patient functional status (P = 0.018); and microcurrent (P = 0.001), repetitive transcranial magnetic stimulation (P = 0.022), and no treatment (P = 0.038) significantly improved mood after intervention. Surface under the cumulative ranking indicated that microcurrent was most likely to be the best for managing pain and mood (surface under the cumulative ranking: 70% and 100%, respectively); low-level laser therapy for pain and mood (80% and 70%, respectively); and repetitive transcranial magnetic stimulation for improving functional status and mood (80% and 70%, respectively). CONCLUSION This review found low to moderate quality evidence that microcurrent, laser therapy, and repetitive transcranial magnetic stimulation are the most effective electrophysical agents for improving at least one outcome in fibromyalgia.
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Affiliation(s)
- John Marwa Gikaro
- Department of Physiotherapy, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Francis Manyori Bigambo
- Department of Orthopedics and Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania
| | - Victor Mark Minde
- Department of Physiotherapy, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elia Asanterabi Swai
- Department of Physiotherapy, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Mosch B, Hagena V, Herpertz S, Ruttorf M, Diers M. Neural correlates of control over pain in fibromyalgia patients. Neuroimage Clin 2023; 37:103355. [PMID: 36848728 PMCID: PMC9982683 DOI: 10.1016/j.nicl.2023.103355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
The perceived lack of control over the experience of pain is arguably-one major cause of agony and impaired life quality in patients with chronic pain disorders as fibromyalgia (FM). The way perceived control affects subjective pain as well as the underlying neural mechanisms have so far not been investigated in chronic pain. We used functional magnetic resonance imaging (fMRI) to examine the neural correlates of self-controlled compared to computer-controlled heat pain in healthy controls (HC, n = 21) and FM patients (n = 23). Contrary to HC, FM failed to activate brain areas usually involved in pain modulation as well as reappraisal processes (right ventrolateral (VLPFC), dorsolateral prefrontal cortex (DLPFC) and dorsal anterior cingulate cortex (dACC)). Computer-controlled (compared to self-controlled) heat revealed significant activations of the orbitofrontal cortex (OFC) in HC, whereas FM activated structures that are typically involved in neural emotion processing (amygdala, parahippocampal gyrus). Additionally, FM displayed disrupted functional connectivity (FC) of the VLPFC, DLPFC and dACC with somatosensory and pain (inhibition)-related areas during self-controlled heat stimulation as well as significantly decreased gray matter (GM) volumes compared to HC in DLPFC and dACC. The described functional and structural changes provide evidence for far-reaching impairments concerning pain-modulatory processes in FM. Our investigation represents a first demonstration of dysfunctional neural pain modulation through experienced control in FM according to the extensive functional and structural changes in relevant sensory, limbic and associative brain areas. These areas may be targeted in clinical pain therapeutic methods involving TMS, neurofeedback or cognitive behavioral trainings.
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Affiliation(s)
- Benjamin Mosch
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Verena Hagena
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany
| | - Michaela Ruttorf
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany; Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim 68167, Germany
| | - Martin Diers
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum 44791, Germany.
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Patil AU, Madathil D, Fan YT, Tzeng OJL, Huang CM, Huang HW. Neurofeedback for the Education of Children with ADHD and Specific Learning Disorders: A Review. Brain Sci 2022; 12:brainsci12091238. [PMID: 36138974 PMCID: PMC9497239 DOI: 10.3390/brainsci12091238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Neurofeedback (NF) is a type of biofeedback in which an individual’s brain activity is measured and presented to them to support self-regulation of ongoing brain oscillations and achieve specific behavioral and neurophysiological outcomes. NF training induces changes in neurophysiological circuits that are associated with behavioral changes. Recent evidence suggests that the NF technique can be used to train electrical brain activity and facilitate learning among children with learning disorders. Toward this aim, this review first presents a generalized model for NF systems, and then studies involving NF training for children with disorders such as dyslexia, attention-deficit/hyperactivity disorder (ADHD), and other specific learning disorders such as dyscalculia and dysgraphia are reviewed. The discussion elaborates on the potential for translational applications of NF in educational and learning settings with details. This review also addresses some issues concerning the role of NF in education, and it concludes with some solutions and future directions. In order to provide the best learning environment for children with ADHD and other learning disorders, it is critical to better understand the role of NF in educational settings. The review provides the potential challenges of the current systems to aid in highlighting the issues undermining the efficacy of current systems and identifying solutions to address them. The review focuses on the use of NF technology in education for the development of adaptive teaching methods and the best learning environment for children with learning disabilities.
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Affiliation(s)
- Abhishek Uday Patil
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Deepa Madathil
- Jindal Institute of Behavioural Sciences, O.P. Jindal Global University, Haryana 131001, India
| | - Yang-Tang Fan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Ovid J. L. Tzeng
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- College of Humanities and Social Sciences, Taipei Medical University, Taipei 106339, Taiwan
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei 106308, Taiwan
- Hong Kong Institute for Advanced Studies, City University of Hong Kong, Hong Kong
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Hsu-Wen Huang
- Department of Linguistics and Translation, City University of Hong Kong, Hong Kong
- Correspondence: ; Tel.: +852-3442-2579
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11
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Hamed R, Mizrachi L, Granovsky Y, Issachar G, Yuval-Greenberg S, Bar-Shalita T. Neurofeedback Therapy for Sensory Over-Responsiveness-A Feasibility Study. SENSORS 2022; 22:s22051845. [PMID: 35270991 PMCID: PMC8914621 DOI: 10.3390/s22051845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/22/2022]
Abstract
Background: Difficulty in modulating multisensory input, specifically the sensory over-responsive (SOR) type, is linked to pain hypersensitivity and anxiety, impacting daily function and quality of life in children and adults. Reduced cortical activity recorded under resting state has been reported, suggestive of neuromodulation as a potential therapeutic modality. This feasibility study aimed to explore neurofeedback intervention in SOR. Methods: Healthy women with SOR (n = 10) underwent an experimental feasibility study comprising four measurement time points (T1—baseline; T2—preintervention; T3—postintervention; T4—follow-up). Outcome measures included resting-state EEG recording, in addition to behavioral assessments of life satisfaction, attaining functional goals, pain sensitivity, and anxiety. Intervention targeted the upregulation of alpha oscillatory power over ten sessions. Results: No changes were detected in all measures between T1 and T2. Exploring the changes in brain activity between T2 and T4 revealed power enhancement in delta, theta, beta, and gamma oscillatory bands, detected in the frontal region (p = 0.03−<0.001; Cohen’s d = 0.637−1.126) but not in alpha oscillations. Furthermore, a large effect was found in enhancing life satisfaction and goal attainment (Cohen’s d = 1.18; 1.04, respectively), and reduced pain sensitivity and anxiety trait (Cohen’s d = 0.70). Conclusion: This is the first study demonstrating the feasibility of neurofeedback intervention in SOR.
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Affiliation(s)
- Ruba Hamed
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Limor Mizrachi
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
| | - Yelena Granovsky
- Laboratory of Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Rambam Health Care Campus, Technion, Haifa 3109601, Israel;
| | - Gil Issachar
- Biomedical Engineering Department, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Shlomit Yuval-Greenberg
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 6997801, Israel;
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, Faculty of Medicine, School of Health Professions, Tel Aviv University, Tel Aviv 6997801, Israel; (R.H.); (L.M.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-525437631
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12
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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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