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Rustamov N, Haroutounian S, Leuthardt EC. Non-invasive non-pharmacological therapies for chronic pain: A commentary on Ikarashi et al. Eur J Pain 2024; 28:861-862. [PMID: 38400746 DOI: 10.1002/ejp.2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Nabi Rustamov
- Department of Neurosurgery, Washington University, St. Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University, St. Louis, Missouri, USA
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University, St. Louis, Missouri, USA
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2
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Ikarashi H, Otsuru N, Gomez-Tames J, Hirata A, Nagasaka K, Miyaguchi S, Sakurai N, Ohno K, Kodama N, Onishi H. Modulation of pain perception through transcranial alternating current stimulation and its nonlinear relationship with the simulated electric field magnitude. Eur J Pain 2024; 28:1018-1028. [PMID: 38318653 DOI: 10.1002/ejp.2249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Oscillatory activities observed in multiple regions are closely associated with the experience of pain. Specifically, oscillatory activities within the theta- and beta-frequency bands, observed in the left dorsolateral prefrontal cortex (DLPFC), have been implicated in pain perception among healthy individuals and those with chronic pain. However, their physiological significance remains unclear. METHODS We explored the modulation of pain perception in healthy individuals by theta- and beta-band transcranial alternating current stimulation (tACS) over the left DLPFC and examined the relationship between the modulation effect and magnitude of the electric field elicited by tACS in the left DLPFC using computational simulation. RESULTS Our findings revealed that both theta- and beta-tACS increased the heat pain threshold during and after stimulation. Notably, the simulated electric field magnitude in the left DLPFC exhibited an inverted U-shaped relationship with the pain modulation effect for theta-tACS. CONCLUSIONS Our study findings suggested that there would be an optimal electric field strength to produce a high analgesic effect for theta-tACS. SIGNIFICANCE The application of theta- and beta-tACS interventions targeting the left DLPFC might facilitate the treatment of chronic pain. Furthermore, the attainment of effective pain modulation via theta-tACS over the DLPFC warrants the use of optimal stimulus intensity.
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Affiliation(s)
- H Ikarashi
- Graduate School, Niigata University of Health and Welfare, Niigata, Japan
| | - N Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - J Gomez-Tames
- Department of Electromechanical Engineering, Nagoya Institute of Technology, Nagoya, Aichi, Japan
- Center of Biomedical Physics and Information Technology, Nagoya Institute of Technology, Nagoya, Aichi, Japan
| | - A Hirata
- Department of Electromechanical Engineering, Nagoya Institute of Technology, Nagoya, Aichi, Japan
- Center of Biomedical Physics and Information Technology, Nagoya Institute of Technology, Nagoya, Aichi, Japan
| | - K Nagasaka
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - S Miyaguchi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - N Sakurai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - K Ohno
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - N Kodama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - H Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Castejón J, Chen F, Yasoda-Mohan A, Ó Sé C, Vanneste S. Chronic pain - A maladaptive compensation to unbalanced hierarchical predictive processing. Neuroimage 2024; 297:120711. [PMID: 38942099 DOI: 10.1016/j.neuroimage.2024.120711] [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: 03/04/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024] Open
Abstract
The ability to perceive pain presents an interesting evolutionary advantage to adapt to an ever-changing environment. However, in the case of chronic pain (CP), pain perception hinders the capacity of the system to adapt to changing sensory environments. Similar to other chronic perceptual disorders, CP is also proposed to be a maladaptive compensation to aberrant sensory predictive processing. The local-global oddball paradigm relies on learning hierarchical rules and processing environmental irregularities at a local and global level. Prediction errors (PE) between actual and predicted input typically trigger an update of the forward model to limit the probability of encountering future PEs. It has been hypothesised that CP hinders forward model updating, reflected in increased local deviance and decreased global deviance. In the present study, we used the local-global paradigm to examine how CP influences hierarchical learning relative to healthy controls. As hypothesised, we observed that deviance in the stimulus characteristics evoked heightened local deviance and decreased global deviance of the stimulus-driven PE. This is also accompanied by respective changes in theta phase locking that is correlated with the subjective pain perception. Changes in the global deviant in the stimulus-driven-PE could also be explained by dampened attention-related responses. Changing the context of the auditory stimulus did not however show a difference in the context-driven PE. These findings suggest that CP is accompanied by maladaptive forward model updating where the constant presence of pain perception disrupts local deviance in non-nociceptive domains. Furthermore, we hypothesise that the auditory-processing based biomarker identified here could be a marker of domain-general dysfunction that could be confirmed by future research.
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Affiliation(s)
- Jorge Castejón
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Ireland; Senior MSK Physiotherapist CompassPhysio LTD, Ireland
| | - Feifan Chen
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Ireland
| | - Anusha Yasoda-Mohan
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Colum Ó Sé
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Ireland
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland.
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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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Demarest P, Rustamov N, Swift J, Xie T, Adamek M, Cho H, Wilson E, Han Z, Belsten A, Luczak N, Brunner P, Haroutounian S, Leuthardt EC. A novel theta-controlled vibrotactile brain-computer interface to treat chronic pain: a pilot study. Sci Rep 2024; 14:3433. [PMID: 38341457 PMCID: PMC10858946 DOI: 10.1038/s41598-024-53261-3] [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: 05/23/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Limitations in chronic pain therapies necessitate novel interventions that are effective, accessible, and safe. Brain-computer interfaces (BCIs) provide a promising modality for targeting neuropathology underlying chronic pain by converting recorded neural activity into perceivable outputs. Recent evidence suggests that increased frontal theta power (4-7 Hz) reflects pain relief from chronic and acute pain. Further studies have suggested that vibrotactile stimulation decreases pain intensity in experimental and clinical models. This longitudinal, non-randomized, open-label pilot study's objective was to reinforce frontal theta activity in six patients with chronic upper extremity pain using a novel vibrotactile neurofeedback BCI system. Patients increased their BCI performance, reflecting thought-driven control of neurofeedback, and showed a significant decrease in pain severity (1.29 ± 0.25 MAD, p = 0.03, q = 0.05) and pain interference (1.79 ± 1.10 MAD p = 0.03, q = 0.05) scores without any adverse events. Pain relief significantly correlated with frontal theta modulation. These findings highlight the potential of BCI-mediated cortico-sensory coupling of frontal theta with vibrotactile stimulation for alleviating chronic pain.
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Affiliation(s)
- Phillip Demarest
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St Louis, MO, 63130, USA
| | - Nabi Rustamov
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - James Swift
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Tao Xie
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Markus Adamek
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Hohyun Cho
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Elizabeth Wilson
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Washington University Pain Center, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Zhuangyu Han
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St Louis, MO, 63130, USA
| | - Alexander Belsten
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Nicholas Luczak
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Peter Brunner
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St Louis, MO, 63130, USA
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Simon Haroutounian
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
- Washington University Pain Center, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA
| | - Eric C Leuthardt
- Division of Neurotechnology, Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA.
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St Louis, MO, 63130, USA.
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St Louis, MO, 63110, USA.
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