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Golshan F, Lysenko R, Nabi Zade M, Alibolandi P, Block H, Masiowski P, O'Connell ME, Sun G, Mickleborough M. Study protocol for a randomized controlled trial of neurofeedback mindfulness in chronic migraines. Contemp Clin Trials Commun 2024; 41:101362. [PMID: 39280788 PMCID: PMC11402407 DOI: 10.1016/j.conctc.2024.101362] [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: 03/17/2024] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 09/18/2024] Open
Abstract
Chronic migraine is a debilitating headache disorder that is associated with excessive analgesic use. As the long-term use of analgesics could cause additional headaches due to medication overuse, there is a need to probe efficient nonprophylactic alternatives and migraineurs' long-term adherence to such possible treatments. This protocol investigates the integration of neurofeedback and mindfulness which are the two common nonpharmacological therapies for migraines. We offer the use of portable EEG headbands for easy home-based data collection and consistent data access from researchers. In order to evaluate the efficacy of this recommended intervention, this is a protocol for a randomized control trial with a waitlisted group and an intervention group consisting of a daily attention task. The protocol presents important criteria which should be checked for consistency in longitudinal data collection from adults with chronic migraine.
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Affiliation(s)
- Faly Golshan
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Rachel Lysenko
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Monika Nabi Zade
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Parham Alibolandi
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Haley Block
- College of Medicine, University of Saskatchewan, Canada
| | | | - Megan E O'Connell
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
| | - Gloria Sun
- College of Medicine, University of Saskatchewan, Canada
| | - Marla Mickleborough
- Department of Psychology & Health Studies, University of Saskatchewan, Canada
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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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Hazewinkel MHJ, Remy K, Black G, Tseng S, Mathew PG, Schoenbrunner A, Janis JE, Austen WG, Jotwani R, Gfrerer L. Treatment delay from onset of occipital neuralgia symptoms to treatment with nerve decompression surgery: a prospective cohort study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:334-343. [PMID: 37995295 DOI: 10.1093/pm/pnad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/16/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The aims of this study were to (1) evaluate the time between onset of occipital neuralgia symptoms and nerve decompression surgery, (2) perform a cost comparison analysis between surgical and nonsurgical treatment of occipital neuralgia, and (3) report postoperative results of nerve decompression for occipital neuralgia. METHODS Subjects (n = 1112) who underwent screening for nerve decompression surgery were evaluated for occipital neuralgia. Of those, 367 patients (33%) met the inclusion criteria. Timing of occipital neuralgia symptom onset and pain characteristics were prospectively collected. Cost associated with the nonsurgical treatment of occipital neuralgia was calculated for the period between onset of symptoms and surgery. RESULTS A total of 226 patients (73%) underwent occipital nerve decompression. The average time between onset of occipital neuralgia and surgery was 19 years (7.1-32). Postoperatively, the median number of pain days per month decreased by 17 (0-26, 57%) (P < .001), the median pain intensity decreased by 4 (2-8, 44%) (P < .001), and median pain duration in hours was reduced by 12 (2-23, 50%) (P < .001). The annual mean cost of nonsurgical occipital neuralgia treatment was $28 728.82 ($16 419.42-$41 198.41) per patient. The mean cost during the 19-year time frame before surgery was $545 847.75($311 968.90-$782 769.82). CONCLUSION This study demonstrates that patients suffer from occipital neuralgia for an average of 19 years before undergoing surgery. Nerve decompression reduces symptom severity significantly and should be considered earlier in the treatment course of occipital neuralgia that is refractory to conservative treatment to prevent patient morbidity and decrease direct and indirect health care costs.
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Affiliation(s)
- Merel H J Hazewinkel
- Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY 10065, United States
| | - Katya Remy
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Grant Black
- Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY 10065, United States
| | - Sierra Tseng
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Paul G Mathew
- Harvard Medical School, Boston, MA 02115, United States
- Department of Neurology, Mass General Brigham Health, Foxborough, MA 02035, United States
- Department of Neurology, Harvard Vanguard Medical Associates, Braintree, MA 02184, United States
| | - Anna Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - William G Austen
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Rohan Jotwani
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Lisa Gfrerer
- Department of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY 10065, United States
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Baglioni V, Bozza F, Beatrice A, Cameli N, Colacino Cinnante EM, Lentini G, Faedda N, Natalucci G, Guidetti V. Non-Pharmacological Treatments in Paediatric Migraine. J Clin Med 2024; 13:1278. [PMID: 38592096 PMCID: PMC10932388 DOI: 10.3390/jcm13051278] [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: 01/31/2024] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
Psychological, social, and biological aspects contribute synergistically to the maintenance and chronicity of pain in primary headaches. An integrated intervention seems to be the most appropriate in the management of these conditions, taking advantage not only of pharmacological strategies, but also of different approaches according to the global assessment and patient necessities. In this perspective, non-pharmacological treatments are becoming increasingly used to overcome these issues also in paediatric migraine treatment. Particularly, nutraceuticals, non-invasive neuromodulation, and behavioural approaches are well tolerated and of potential interest. This paper aims to present the main approaches reported in the literature in the management of migraine in children and adolescents presenting an up-to-date review of the current literature. We therefore performed a narrative presentation for each of these three categories: nutraceuticals (riboflavin; magnesium; melatonin; vitamin D; coenzyme Q10; and polyunsaturated fatty acid); non-invasive neuromodulation (trigeminal nerve stimulator; non-invasive vagal nerve stimulation; transcranial magnetic stimulation; and remote electrical neuromodulation), and behavioural therapies (biofeedback; cognitive behavioural therapy; and mindfulness-based therapy). These approaches are increasingly seen as a valid treatment option in primary headache management also in paediatrics, avoiding medication overuse and drug treatment contraindications.
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Affiliation(s)
- Valentina Baglioni
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Via dei Sabelli 108, 00185 Rome, Italy; (F.B.); (A.B.); (N.C.); (E.M.C.C.); (G.L.); (N.F.); (G.N.); (V.G.)
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5
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Haghdoost F, Togha M. Migraine management: Non-pharmacological points for patients and health care professionals. Open Med (Wars) 2022; 17:1869-1882. [PMID: 36475060 PMCID: PMC9691984 DOI: 10.1515/med-2022-0598] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 09/16/2022] [Accepted: 10/11/2022] [Indexed: 07/22/2023] Open
Abstract
Migraine is a highly prevalent disorder with an enormous burden on societies. Different types of medications are used for controlling both acute attacks and prevention. This article reviews some non-pharmacological recommendations aiming to manage migraine disorder better and prevent headache attacks. Different triggers of migraine headache attacks, including environmental factors, sleep pattern changes, diet, physical activity, stress and anxiety, some medications, and hormonal changes, are discussed. It is advised that they be identified and managed. Patients should learn the skills to cope with the trigger factors that are difficult to avoid. In addition, weight control, management of migraine comorbidities, lifestyle modification, behavioural treatment and biofeedback, patient education, using headache diaries, and improving patients' knowledge about the disease are recommended to be parts of migraine management. In addition, using neuromodulation techniques, dietary supplements such as riboflavin, coenzyme Q10 and magnesium, and acupuncture can be helpful. Non-pharmacological approaches should be considered in migraine management. Furthermore, the combination of pharmacological and non-pharmacological approaches is more effective than using each separately.
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Affiliation(s)
- Faraidoon Haghdoost
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran, Iran
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran, Iran
- Headache Department, Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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6
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Legarda SB, Michas-Martin PA, McDermott D. Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation. Front Hum Neurosci 2022; 16:894856. [PMID: 35874149 PMCID: PMC9304546 DOI: 10.3389/fnhum.2022.894856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical mechanisms of visual hypersensitivity in women at risk for chronic pelvic pain. Pain 2022; 163:1035-1048. [PMID: 34510138 PMCID: PMC8882209 DOI: 10.1097/j.pain.0000000000002469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Increased sensory sensitivity across non-nociceptive modalities is a common symptom of chronic pain conditions and is associated with chronic pain development. Providing a better understanding of the brain-behavior relationships that underlie multimodal hypersensitivity (MMH) may clarify the role of MMH in the development of chronic pain. We studied sensory hypersensitivity in a cohort of women (n = 147) who had diary confirmation of menstrual status and were enriched with risk factors for chronic pelvic pain, such as dysmenorrhea and increased bladder sensitivity. We administered 2 experimental tasks to evaluate the cross-modal relationship between visual and visceral sensitivity. Visual sensitivity was probed by presenting participants with a periodic pattern-reversal checkerboard stimulus presented across 5 brightness intensities during electroencephalography recording. Self-reported visual unpleasantness ratings for each brightness intensity were simultaneously assessed. Visceral sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visually evoked cortical activity increased with brightness intensity across the entire scalp, especially at occipital electrode sites. Visual stimulation-induced unpleasantness was associated with provoked bladder pain and evoked primary visual cortex activity. However, the relationship between unpleasantness and cortical activity was moderated by provoked bladder pain. These results demonstrate that activity in the primary visual cortex is not greater in individuals with greater visceral sensitivity. We hypothesize that downstream interpretation or integration of this signal is amplified in individuals with visceral hypersensitivity. Future studies aimed at reducing MMH in chronic pain conditions should prioritize targeting of cortical mechanisms responsible for aberrant downstream sensory integration.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L. Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E. Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E. Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Arina GA, Dobrushina OR, Shvetsova ET, Osina ED, Meshkov GA, Aziatskaya GA, Trofimova AK, Efremova IN, Martunov SE, Nikolaeva VV. Infra-Low Frequency Neurofeedback in Tension-Type Headache: A Cross-Over Sham-Controlled Study. Front Hum Neurosci 2022; 16:891323. [PMID: 35669204 PMCID: PMC9164298 DOI: 10.3389/fnhum.2022.891323] [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: 03/07/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Primary headaches are highly prevalent and represent a major cause of disability in young adults. Neurofeedback is increasingly used in the treatment of chronic pain; however, there are few studies investigating its efficacy in patients with headaches. We report the results of a cross-over sham-controlled study on the efficacy of neurofeedback in the prophylactic treatment of tension-type headache (TTH). Participants received ten sessions of infra-low frequency electroencephalographic neurofeedback and ten sessions of sham-neurofeedback, with the order of treatments being randomized. The study also included a basic psychotherapeutic intervention — a psychoeducational session performed before the main study phases and emotional support provided throughout the study period. The headache probability was modeled as a function of the neurofeedback and sham-neurofeedback sessions performed to date. As a result, we revealed a strong beneficial effect of neurofeedback and no influence of the sham sessions. The study supports the prophylactic use of infra-low frequency neurofeedback in patients with TTH. From a methodological point of view, we advocate for the explicit inclusion of psychotherapeutic components in neurofeedback study protocols.
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Affiliation(s)
- Galina A. Arina
- Faculty of Psychology, M. V. Lomonosov Moscow State University, Moscow, Russia
| | - Olga R. Dobrushina
- International Institute of Psychosomatic Health, Moscow, Russia
- Research Center of Neurology, Moscow, Russia
- *Correspondence: Olga R. Dobrushina,
| | | | - Ekaterina D. Osina
- Faculty of Psychology, M. V. Lomonosov Moscow State University, Moscow, Russia
| | | | | | - Alexandra K. Trofimova
- Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
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Schneider H, Riederle J, Seuss S. Therapeutic Effect of Infra-Low-Frequency Neurofeedback Training on Children and Adolescents with ADHD. ARTIF INTELL 2022. [DOI: 10.5772/intechopen.97938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this observational study the outcomes of an EEG-based infra-low-frequency (ILF) neurofeedback intervention on patients with attention deficit (hyperactivity) disorder (ADHD) are presented. The question is addressed whether this computer-aided treatment, which uses a brain-computer-interface to alleviate the clinical symptoms of mental disorders, is an effective non-pharmaceutical therapy for ADHD in childhood and adolescence. In a period of about 15 weeks 196 ADHD patients were treated with about 30 sessions of ILF neurofeedback in an ambulant setting. Besides regular evaluation of the severity of clinical symptoms, a continuous performance test (CPT) for parameters of attention and impulse control was conducted before and after the neurofeedback treatment. During and after the therapy, the patients did not only experience a substantial reduction in the severity of their ADHD-typical clinical symptoms, but also their performance in a continuous test procedure was significantly improved for all examined parameters of attention and impulse control, like response time, variability of reaction time, omission errors and commission errors. In a post neurofeedback intervention assessment 97% of patients reported improvement in symptoms of inattention, hyperactivity or impulsivity. Only 3% of the patients claimed no noticeable alleviation of ADHD-related symptoms. These results suggest that ILF neurofeedback is a clinically effective method that can be considered as a treatment option for ADHD and might help reducing or even avoiding psychotropic medication.
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Effects of hemoencephalographic biofeedback with virtual reality on selected aspects of attention in children with ADHD. Int J Psychophysiol 2021; 170:59-66. [PMID: 34653532 DOI: 10.1016/j.ijpsycho.2021.10.001] [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: 04/08/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022]
Abstract
For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention by biofeedback has been shown in several studies. As evidenced by previous reports, biofeedback (BFB) with virtual reality (VR) allows for controlling distractors, providing an environment that captures participants' attention. The purpose of this study was to evaluate the effects of hemoencephalographic (HEG) BFB with VR in treating deficits in vigilance (assessed using the short form of the Mackworth Clock Task), visual search (the Visual Search Task), and divided attention (Multitasking Test) among children with ADHD. Data subjected to analysis were collected from 87 participants aged 9-15 years. Children were assigned to one of three groups (standard 2D BFB in the lab, VR BFB with a limited visual scene, VR BFB with a complex visual scene) and were subjected to ten HEG BFB sessions. Children in the VR BFB groups exhibited a bigger regional cerebral blood oxygenation slope during BFB and better performance in cognitive tests following the experiment compared to children in the 2D BFB group. The data obtained suggest that HEG BFB with VR may have a more beneficial effect in treating attention deficits compared to standard 2D HEG BFB. We believe that the strong effects of HEG BFB with VR stem from the increased commitment and motivation in individuals, rather than from manipulation with regard to visual scene complexity.
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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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Skalski S, Pochwatko G, Balas R. Effect of
HEG
biofeedback on selected cognitive functions—Randomized study in children with
ADHD
and neurotypical children. INFANT AND CHILD DEVELOPMENT 2021. [DOI: 10.1002/icd.2242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | | | - Robert Balas
- Polish Academy of Sciences Institute of Psychology Warsaw Poland
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Barmherzig R, Rajapakse T. Nutraceuticals and Behavioral Therapy for Headache. Curr Neurol Neurosci Rep 2021; 21:33. [PMID: 33970348 DOI: 10.1007/s11910-021-01120-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Headache affects and disables at least 1 billion people worldwide. Patients and providers seek new therapies to relieve headache without the side effects and financial burden of current treatments. This narrative review highlights recent treatment advances in integrative headache medicine: nutraceuticals and behavioral therapies. RECENT FINDINGS Growing use of complementary and alternative medicine (CAM) therapies for headache (riboflavin, coenzyme Q10, magnesium, vitamin D, melatonin) alongside mainstream treatments is increasing with improving evidence of quality, safety, and tolerability. Increasing interest in medical cannabis is tempered by lack of evidence regarding safety and efficacy. Behavioral therapies including cognitive behavioral therapy (CBT), biofeedback, mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT) improve patient resiliency and self-efficacy outcomes and reduce disability. The body of evidence for nutraceutical and behavioral CAM interventions for headache continues to grow and improve in quality. Providers and patients should educate themselves regarding CAM therapies as part of integrative headache management. Future studies should examine combinatorial trials of CAM therapies against current standards of headache care.
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Affiliation(s)
- Rebecca Barmherzig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thilinie Rajapakse
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. .,Stollery Children's Hospital, Women & Children's Research Institute, Edmonton, AB, Canada.
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Wu YL, Fang SC, Chen SC, Tai CJ, Tsai PS. Effects of Neurofeedback on Fibromyalgia: A Randomized Controlled Trial. Pain Manag Nurs 2021; 22:755-763. [PMID: 33579615 DOI: 10.1016/j.pmn.2021.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/02/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fibromyalgia is a chronic widespread pain condition that is associated with sleep disturbances and cognitive impairments. Neurofeedback has been demonstrated to improve pain, sleep quality, and fatigue. However, few studies have examined the effect of neurofeedback for patients with fibromyalgia. AIM To determine the effects of neurofeedback on pain intensity, symptom severity, sleep quality, and cognitive function in patients with fibromyalgia. DESIGN This study was a randomized controlled trial. METHOD Eighty participants were randomized to a neurofeedback group (N = 60), receiving sensorimotor and alpha rhythm feedback for 8 weeks, or a telephone support group (N = 20). RESULTS Results from the generalized estimating equation modelling revealed significant group-by-time interactions for Brief Pain Inventory pain severity (B = -1.35, SE = 0.46, p = .003) and pain interference (B = -1.75, SE = 0.41, p < .001), Revised Fibromyalgia Impact Questionnaire total scores (B = -16.41, SE = 3.76, p < .001), sleep onset latency (B = -25.33, SE = 9.02, p = .005), and Psychomotor Vigilance Test error (B = -1.38, SE = 0.55, p = .013) after adjustments for age, sex, duration of illness, and group differences at baseline. CONCLUSIONS An 8-week neurofeedback training regimen of sensorimotor rhythm and alpha brain waves significantly improved pain severity and interference, fibromyalgia symptom severity, sleep latency, and sustained attention in patients with fibromyalgia.
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Affiliation(s)
- Yu-Lin Wu
- St. Mary's Medicine, Nursing and Management College, Yilan, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chen-Jei Tai
- Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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15
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Grazzi L, Toppo C, D’Amico D, Leonardi M, Martelletti P, Raggi A, Guastafierro E. Non-Pharmacological Approaches to Headaches: Non-Invasive Neuromodulation, Nutraceuticals, and Behavioral Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1503. [PMID: 33562487 PMCID: PMC7914516 DOI: 10.3390/ijerph18041503] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
Significant side effects or drug interactions can make pharmacological management of headache disorders very difficult. Non-conventional and non-pharmacological treatments are becoming increasingly used to overcome these issues. In particular, non-invasive neuromodulation, nutraceuticals, and behavioral approaches are well tolerated and indicated for specific patient categories such as adolescents and pregnant women. This paper aims to present the main approaches reported in the literature in the management of headache disorders. We therefore reviewed the available literature published between 2010 and 2020 and performed a narrative presentation for each of the three categories (non-invasive neuromodulation, nutraceuticals, and behavioral therapies). Regarding non-invasive neuromodulation, we selected transcranial magnetic stimulation, supraorbital nerve stimulation, transcranial direct current stimulation, non-invasive vagal nerve stimulation, and caloric vestibular stimulation. For nutraceuticals, we selected Feverfew, Butterbur, Riboflavin, Magnesium, and Coenzyme Q10. Finally, for behavioral approaches, we selected biofeedback, cognitive behavioral therapy, relaxation techniques, mindfulness-based therapy, and acceptance and commitment therapy. These approaches are increasingly seen as a valid treatment option in headache management, especially for patients with medication overuse or contraindications to drug treatment. However, further investigations are needed to consider the effectiveness of these approaches also with respect to the long-term effects.
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Affiliation(s)
- Licia Grazzi
- UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Claudia Toppo
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Domenico D’Amico
- UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Matilde Leonardi
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 00185 Rome, Italy;
| | - Alberto Raggi
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
| | - Erika Guastafierro
- UOC Neurologia, Salute Pubblica e Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (C.T.); (M.L.); (A.R.); (E.G.)
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16
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501463 PMCID: PMC7836135 DOI: 10.1101/2020.12.03.20242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.
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Affiliation(s)
- Matthew J Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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17
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Skalski S. Impact of placebo-related instruction on HEG biofeedback outcomes in children with ADHD. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:383-390. [PMID: 33349043 DOI: 10.1080/21622965.2020.1861546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Studies to date have not revealed any differences between biofeedback (BFB) methods vs. placebo treatment in reducing ADHD symptoms. The purpose of this randomized controlled study was to assess the impact of placebo expectations on gain in hemoencephalographic (HEG) BFB. The final cohort consisted of 33 children with ADHD aged 9-14. Individuals were assigned to one of two groups (with standard active training instruction vs. placebo-related instruction) and were subjected to five HEG BFB sessions. Children with standard instruction exhibited higher growth of regional cerebral blood oxygenation during the HEG BFB session as well as better results in cognitive tests (vigilance and visual search) at the end of the experiment compared to children with placebo-related instruction. The data obtained indicate the difficulty in designing studies assessing BFB efficacy. Placebo expectation may adversely affect HEG BFB outcomes in children with ADHD.
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18
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Buhagiar F, Fitzgerald M, Bell J, Allanson F, Pestell C. Neuromodulation for Mild Traumatic Brain Injury Rehabilitation: A Systematic Review. Front Hum Neurosci 2020; 14:598208. [PMID: 33362494 PMCID: PMC7759622 DOI: 10.3389/fnhum.2020.598208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within the brain. Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population. Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations. Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial. Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279.
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Affiliation(s)
- Francesca Buhagiar
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Sarich Neuroscience Research Institute, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Fiona Allanson
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Carmela Pestell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
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19
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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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20
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21
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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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22
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Kropp P, Meyer B, Dresler T, Fritsche G, Gaul C, Niederberger U, Förderreuther S, Malzacher V, Jürgens TP, Marziniak M, Straube A. [Relaxation techniques and behavioural therapy for the treatment of migraine : Guidelines from the German Migraine and Headache Society]. Schmerz 2019; 31:433-447. [PMID: 28364171 DOI: 10.1007/s00482-017-0214-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Besides pharmacological and interventional possibilities nonpharmacological options, deriving from behavioural approaches may be helpful in the treatment of migraine. Already consulting a patient reduces frequency of attacks. Relaxation (especially progressive muscle relaxation), endurance sports, and biofeedback as well as cognitive behavioural therapy are effective in treatment of migraine. The combination of these treatment options also with pharmacological treatment increase the positive effects.
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Affiliation(s)
- P Kropp
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland.
| | - B Meyer
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland
| | - T Dresler
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland.,Graduiertenschule & Forschungsnetzwerk LEAD, Universität Tübingen, Tübingen, Deutschland
| | - G Fritsche
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland
| | - C Gaul
- Migräne- und Kopfschmerz Klinik Königstein, Königstein im Taunus, Deutschland
| | - U Niederberger
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S Förderreuther
- Neurologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - V Malzacher
- Neurologische Praxis, Reutlingen, Deutschland
| | - T P Jürgens
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - M Marziniak
- Klinik für Neurologie, Zentrum für Neurologische Intensivmedizin, kbo-Isar-Amper-Klinikum München-Ost, München, Deutschland
| | - A Straube
- Neurologie, Ludwig-Maximilians-Universität München, München, Deutschland
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23
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de Tommaso M, Delussi M. Nociceptive blink reflex habituation biofeedback in migraine. FUNCTIONAL NEUROLOGY 2018; 32:123-130. [PMID: 29042000 DOI: 10.11138/fneur/2017.32.3.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reduced habituation of the nociceptive blink reflex (NBR) is considered a trait marker for genetic predisposition to migraine. In this open-label randomized controlled study, we aimed to test the efficacy of a biofeedback training based on learning of habituation of the NBR (NBR biofeedback) compared with pharmacological (topiramate) treatment and NBR biofeedback plus topiramate treatment in a cohort of migraine without aura patients eligible for prophylaxis. Thirty-three migraine patients were randomly assigned to three months of treatment with: 1) NBR biofeedback, 2) NBR biofeedback plus topiramate 50 mg (b.i.d.), or 3) topiramate 50 mg (b.i.d.). Frequency of headache and disability changes were the main study outcomes. Anxiety, depression, sleep, fatigue, quality of life, allodynia and pericranial tenderness were also evaluated. NBR biofeedback reduced the R2 area, without improving R2 habituation. However, it reduced the frequency of headache and disability, similarly to the combined treatment and topiramate alone. Reduced habituation of the NBR is a stable neurophysiological pattern, scarcely modifiable by learning procedures. Training methods able to act on stress-related responses may modulate cortical mechanisms inducing migraine onset and trigeminal activation under stressful trigger factors.
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24
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Raggi A, Grignani E, Leonardi M, Andrasik F, Sansone E, Grazzi L, D'Amico D. Behavioral Approaches for Primary Headaches: Recent Advances. Headache 2018; 58:913-925. [DOI: 10.1111/head.13337] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Eleonora Grignani
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Frank Andrasik
- Department of Psychology; University of Memphis; Memphis TN USA
| | - Emanuela Sansone
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Licia Grazzi
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Domenico D'Amico
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
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25
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Uncensored EEG: The role of DC potentials in neurobiology of the brain. Prog Neurobiol 2018; 165-167:51-65. [PMID: 29428834 DOI: 10.1016/j.pneurobio.2018.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/24/2017] [Accepted: 02/03/2018] [Indexed: 12/11/2022]
Abstract
Brain direct current (DC) potentials denote sustained shifts and slow deflections of cerebral potentials superimposed with conventional electroencephalography (EEG) waves and reflect alterations in the excitation level of the cerebral cortex and subcortical structures. Using galvanometers, such sustained displacement of the EEG baseline was recorded in the early days of EEG recordings. To stabilize the EEG baseline and eliminate artefacts, EEG was performed later by voltage amplifiers with high-pass filters that dismiss slow DC potentials. This left slow DC potential recordings as a neglected diagnostic source in the routine clinical setting over the last few decades. Brain DC waves may arise from physiological processes or pathological phenomena. Recordings of DC potentials are fundamental electro-clinical signatures of some neurological and psychological disorders and may serve as diagnostic, prognostic, and treatment monitoring tools. We here review the utility of both physiological and pathological brain DC potentials in different aspects of neurological and psychological disorders. This may enhance our understanding of the role of brain DC potentials and improve our fundamental clinical and research strategies for brain disorders.
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27
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Surmeli T, Eralp E, Mustafazade I, Kos IH, Özer GE, Surmeli OH. Quantitative EEG Neurometric Analysis-Guided Neurofeedback Treatment in Postconcussion Syndrome (PCS): Forty Cases. How Is Neurometric Analysis Important for the Treatment of PCS and as a Biomarker? Clin EEG Neurosci 2017; 48:217-230. [PMID: 27354361 DOI: 10.1177/1550059416654849] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postconcussion syndrome (PCS) has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on magnetic resonance imaging and computed tomography scans. In this clinical case series, the efficacy of quantitative EEG-guided neurofeedback in 40 subjects diagnosed with PCS was investigated. Overall improvement was seen in all the primary (Symptom Assessment-45 Questionnaire, Clinical Global Impressions Scale, Hamilton Depression Scale) and secondary measures (Minnesota Multiphasic Personality Inventory, Test of Variables for Attention). The Neuroguide Traumatic Brain Index for the group also showed a decrease. Thirty-nine subjects were followed up long term with an average follow-up length of 3.1 years (CI = 2.7-3.3). All but 2 subjects were stable and were off medication. Overall neurofeedback treatment was shown to be effective in this group of subjects studied.
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Affiliation(s)
- Tanju Surmeli
- 1 Living Health Center for Research and Education, Sisli, Istanbul, Turkey
| | - Emin Eralp
- 2 Brain Power Institute, Sisli, Istanbul, Turkey
| | - Ilham Mustafazade
- 1 Living Health Center for Research and Education, Sisli, Istanbul, Turkey
| | - Ismet Hadi Kos
- 1 Living Health Center for Research and Education, Sisli, Istanbul, Turkey
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28
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Albrecht JS, Bubenzer-Busch S, Gallien A, Knospe EL, Gaber TJ, Zepf FD. Effects of a structured 20-session slow-cortical-potential-based neurofeedback program on attentional performance in children and adolescents with attention-deficit hyperactivity disorder: retrospective analysis of an open-label pilot-approach and 6-month follow-up. Neuropsychiatr Dis Treat 2017; 13:667-683. [PMID: 28293109 PMCID: PMC5342612 DOI: 10.2147/ndt.s119694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this approach was to conduct a structured electroencephalography-based neurofeedback training program for children and adolescents with attention-deficit hyperactivity disorder (ADHD) using slow cortical potentials with an intensive first (almost daily sessions) and second phase of training (two sessions per week) and to assess aspects of attentional performance. PATIENTS AND METHODS A total of 24 young patients with ADHD participated in the 20-session training program. During phase I of training (2 weeks, 10 sessions), participants were trained on weekdays. During phase II, neurofeedback training occurred twice per week (5 weeks). The patients' inattention problems were measured at three assessment time points before (pre, T0) and after (post, T1) the training and at a 6-month follow-up (T2); the assessments included neuropsychological tests (Alertness and Divided Attention subtests of the Test for Attentional Performance; Sustained Attention Dots and Shifting Attentional Set subtests of the Amsterdam Neuropsychological Test) and questionnaire data (inattention subscales of the so-called Fremdbeurteilungsbogen für Hyperkinetische Störungen and Child Behavior Checklist/4-18 [CBCL/4-18]). All data were analyzed retrospectively. RESULTS The mean auditive reaction time in a Divided Attention task decreased significantly from T0 to T1 (medium effect), which was persistent over time and also found for a T0-T2 comparison (larger effects). In the Sustained Attention Dots task, the mean reaction time was reduced from T0-T1 and T1-T2 (small effects), whereas in the Shifting Attentional Set task, patients were able to increase the number of trials from T1-T2 and significantly diminished the number of errors (T1-T2 & T0-T2, large effects). CONCLUSION First positive but very small effects and preliminary results regarding different parameters of attentional performance were detected in young individuals with ADHD. The limitations of the obtained preliminary data are the rather small sample size, the lack of a control group/a placebo condition and the open-label approach because of the clinical setting and retrospective analysis. The value of the current approach lies in providing pilot data for future studies involving larger samples.
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Affiliation(s)
- Johanna S Albrecht
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich; Center for Pediatrics and Adolescent Medicine Elisabeth Hospital Rheydt, Mönchengladbach
| | - Sarah Bubenzer-Busch
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich
| | - Anne Gallien
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; Clinic for Neurology, Medical Center City Region Aachen, Würselen
| | - Eva Lotte Knospe
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich
| | - Tilman J Gaber
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich; NeuroCare Group, Munich, Germany
| | - Florian D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich; Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Paediatrics and Child Health & School of Psychiatry and Clinical Neurosciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia; Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services, Perth, WA, Australia
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Miró J, Castarlenas E, de la Vega R, Roy R, Solé E, Tomé-Pires C, Jensen MP. Psychological Neuromodulatory Treatments for Young People with Chronic Pain. CHILDREN (BASEL, SWITZERLAND) 2016; 3:E41. [PMID: 27929419 PMCID: PMC5184816 DOI: 10.3390/children3040041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/15/2016] [Accepted: 11/30/2016] [Indexed: 01/02/2023]
Abstract
The treatment of young people with chronic pain is a complex endeavor. Many of these youth do not obtain adequate relief from available interventions. Psychological neuromodulatory treatments have been shown to have potential benefit for adults with chronic pain. Here, we review and summarize the available information about the efficacy of three promising psychological neuromodulatory treatments-neurofeedback, meditation and hypnosis-when provided to young people with chronic pain. A total of 16 articles were identified and reviewed. The findings from these studies show that hypnotic treatments are effective in reducing pain intensity for a variety of pediatric chronic pain problems, although research suggests variability in outcomes as a function of the specific pain problem treated. There are too few studies evaluating the efficacy of neurofeedback or meditation training in young people with chronic pain to draw firm conclusions regarding their efficacy. However, preliminary data indicate that these treatments could potentially have positive effects on a variety of outcomes (e.g., pain intensity, frequency of pain episodes, physical and psychological function), at least in the short term. Clinical trials are needed to evaluate the effects of neurofeedback and meditation training, and research is needed to identify the moderators of treatment benefits as well as better understand the mechanisms underlying the efficacy of all three of these treatments. The findings from such research could enhance overall treatment efficacy by: (1) providing an empirical basis for better patient-treatment matching; and (2) identifying specific mechanisms that could be targeted with treatment.
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Affiliation(s)
- Jordi Miró
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Elena Castarlenas
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Rocío de la Vega
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105, USA.
| | - Rubén Roy
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Ester Solé
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Catarina Tomé-Pires
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105, USA.
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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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Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice. Neurophysiol Clin 2015; 45:423-33. [PMID: 26553293 DOI: 10.1016/j.neucli.2015.10.077] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 01/17/2023] Open
Abstract
The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject's EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioural modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on "the disease") and integrative biopsychosocial model of health (centred on "the illness"). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by institutional structures for the clinical practice of EEG NF.
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Millings A, Morris J, Rowe A, Easton S, Martin JK, Majoe D, Mohr C. Can the effectiveness of an online stress management program be augmented by wearable sensor technology? Internet Interv 2015. [DOI: 10.1016/j.invent.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Penzien DB, Irby MB, Smitherman TA, Rains JC, Houle TT. Well-Established and Empirically Supported Behavioral Treatments for Migraine. Curr Pain Headache Rep 2015; 19:34. [DOI: 10.1007/s11916-015-0500-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ritter P, Born J, Brecht M, Dinse HR, Heinemann U, Pleger B, Schmitz D, Schreiber S, Villringer A, Kempter R. State-dependencies of learning across brain scales. Front Comput Neurosci 2015; 9:1. [PMID: 25767445 PMCID: PMC4341560 DOI: 10.3389/fncom.2015.00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/06/2015] [Indexed: 01/09/2023] Open
Abstract
Learning is a complex brain function operating on different time scales, from milliseconds to years, which induces enduring changes in brain dynamics. The brain also undergoes continuous “spontaneous” shifts in states, which, amongst others, are characterized by rhythmic activity of various frequencies. Besides the most obvious distinct modes of waking and sleep, wake-associated brain states comprise modulations of vigilance and attention. Recent findings show that certain brain states, particularly during sleep, are essential for learning and memory consolidation. Oscillatory activity plays a crucial role on several spatial scales, for example in plasticity at a synaptic level or in communication across brain areas. However, the underlying mechanisms and computational rules linking brain states and rhythms to learning, though relevant for our understanding of brain function and therapeutic approaches in brain disease, have not yet been elucidated. Here we review known mechanisms of how brain states mediate and modulate learning by their characteristic rhythmic signatures. To understand the critical interplay between brain states, brain rhythms, and learning processes, a wide range of experimental and theoretical work in animal models and human subjects from the single synapse to the large-scale cortical level needs to be integrated. By discussing results from experiments and theoretical approaches, we illuminate new avenues for utilizing neuronal learning mechanisms in developing tools and therapies, e.g., for stroke patients and to devise memory enhancement strategies for the elderly.
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Affiliation(s)
- Petra Ritter
- Minerva Research Group BrainModes, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany ; Department of Neurology, Charité University Medicine Berlin Berlin, Germany ; Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin Berlin, Germany ; Berlin School of Mind and Brain & Mind and Brain Institute, Humboldt-Universität zu Berlin Berlin, Germany
| | - Jan Born
- Department of Medical Psychology and Behavioral Neurobiology & Center for Integrative Neuroscience (CIN), University of Tübingen Tübingen, Germany
| | - Michael Brecht
- Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin Berlin, Germany
| | - Hubert R Dinse
- Neural Plasticity Lab, Institute for Neuroinformatics, Ruhr-University Bochum Bochum, Germany ; Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum Bochum, Germany
| | - Uwe Heinemann
- Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin Berlin, Germany ; NeuroCure Cluster of Excellence Berlin, Germany
| | - Burkhard Pleger
- Clinic for Cognitive Neurology, University Hospital Leipzig Leipzig, Germany ; Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Dietmar Schmitz
- Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin Berlin, Germany ; NeuroCure Cluster of Excellence Berlin, Germany ; Neuroscience Research Center NWFZ, Charité University Medicine Berlin Berlin, Germany ; Max-Delbrück Center for Molecular Medicine, MDC Berlin, Germany ; Center for Neurodegenerative Diseases (DZNE) Berlin, Germany
| | - Susanne Schreiber
- Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin Berlin, Germany ; Department of Biology, Institute for Theoretical Biology (ITB), Humboldt-Universität zu Berlin Berlin, Germany
| | - Arno Villringer
- Berlin School of Mind and Brain & Mind and Brain Institute, Humboldt-Universität zu Berlin Berlin, Germany ; Clinic for Cognitive Neurology, University Hospital Leipzig Leipzig, Germany ; Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Richard Kempter
- Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin Berlin, Germany ; Department of Biology, Institute for Theoretical Biology (ITB), Humboldt-Universität zu Berlin Berlin, Germany
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Moshkani Farahani D, Tavallaie SA, Ahmadi K, Fathi Ashtiani A. Comparison of neurofeedback and transcutaneous electrical nerve stimulation efficacy on treatment of primary headaches: a randomized controlled clinical trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e17799. [PMID: 25389484 PMCID: PMC4222010 DOI: 10.5812/ircmj.17799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/07/2014] [Accepted: 06/25/2014] [Indexed: 11/21/2022]
Abstract
Background: Headache is one of the most prevalent investigated complaints in the neurology clinics and is the most common pain-related complaint worldwide. Stress is a significant factor that causes and triggers headaches. Since healthcare practitioners experience a lot of stress in their careers, they are more prone to headaches. Objectives: This study was designed to evaluate and compares the efficacy of neurofeedback behavioural therapy (NFB) and transcutaneous electrical nerve stimulation (TENS) in the treatment of primary headaches in healthcare providers. Patients and Methods: The current study was a clinical trial, performed in Teheran, IR Iran, with two experimental groups and a control group. Convenient sampling method was used to recruit patients. Independent variables were NFB and TENS and dependent variables were frequency, severity, and duration of headache. Blanchard headache diary was used for assessment. Hence, 45 healthcare providers with primary headache were selected and randomly allocated to one of the NFB, TENS, and control groups by block random assignment method. All three groups completed the headache diary during one week before and after the treatment period as pretest and posttests, respectively. The NFB group was treated in the period between pretest and posttest with fifteen 30-minute treatment sessions three times a week and the TENS group was treated with fifteen 20-minute daily sessions. The control group received none of these treatments. Results: The results from the analysis of covariance showed that treatment with NFB and TENS had caused significant decrease in the frequency, severity, and duration of headache in experimental groups. The results of the LSD post-hoc test indicated that there were significant differences in the frequency, severity, and duration of pain among experimental groups and the control group. Moreover, there were significant differences between pain frequencies in experimental groups. Conclusions: According to the results and given the significant reductions in the frequency, severity, and duration of headaches, it seems that NFB and TENS might have an effective role in reducing primary headaches of healthcare providers. In addition, comparing the two methods, treatment with NFB was more effective in reducing headache frequency and severity.
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Affiliation(s)
- Davood Moshkani Farahani
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Teheran, IR Iran
- Corresponding Author: Davood Moshkani Farahani, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Teheran, IR Iran. Tel: +98-2144813175, Fax: +98-2144813175, E-mail:
| | - Seyed Abbas Tavallaie
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Teheran, IR Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Teheran, IR Iran
| | - Ali Fathi Ashtiani
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Teheran, IR Iran
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Shafiei SA, Firoozabadi SM. Local ELF-magnetic field: a possible novel therapeutic approach to psychology symptoms. Neurol Sci 2014; 35:1651-6. [DOI: 10.1007/s10072-014-1905-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/22/2014] [Indexed: 10/25/2022]
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Jensen MP, Gertz KJ, Kupper AE, Braden AL, Howe JD, Hakimian S, Sherlin LH. Steps toward developing an EEG biofeedback treatment for chronic pain. Appl Psychophysiol Biofeedback 2013; 38:101-8. [PMID: 23532434 DOI: 10.1007/s10484-013-9214-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic pain, usually refractory to analgesics, is a significant problem for many individuals with spinal cord injury (SCI). Preliminary studies suggest that electroencephalography (EEG) biofeedback (also known as neurofeedback, NF) has the potential to help patients with otherwise refractory chronic pain. However, there remain many unanswered questions about the effects and mechanisms of this treatment. We studied 13 individuals with SCI and chronic pain with NF. Ten of the 13 individuals completed 4 sessions each of three different neurofeedback protocols assigned in random order for a total of 12 NF sessions. All three protocols had similar immediate effects on pain intensity. In addition, the participants reported modest pre- to post-treatment decreases in worst pain and pain unpleasantness following completion of the 12 NF sessions. These improvements were maintained at 3-month follow-up. The majority of the participants felt they benefited from and were satisfied with the treatment. No significant effects on measures of other outcome domains (sleep quality, pain interference and fatigue) were observed, although there was a non-significant trend for an increase in fatigue. Finally, pre- to post-treatment changes in EEG bandwidth activity, consistent with the training protocols, were observed in θ and α but not β frequencies. The findings provide preliminary support for the potential efficacy of NF for the treatment of SCI-related pain, and suggest that further clinical studies are warranted.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Box 359612, 325 Ninth Avenue, Seattle, WA 98104, USA.
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Six-Means A. Migraines and CAM. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2013. [DOI: 10.1080/15398285.2013.833454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koberda JL, Koberda P, Bienkiewicz AA, Moses A, Koberda L. Pain Management Using 19-ElectrodeZ-Score LORETA Neurofeedback. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/10874208.2013.813204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW Millions of youth sustain concussion each year; although most fully recover following an isolated concussion, a significant minority develop prolonged symptoms and disability following concussion. This article reviews recent data regarding the epidemiology of postconcussion syndrome (PCS) and recommendations for the evaluation and management of postconcussive symptoms in pediatrics. RECENT FINDINGS PCS is a constellation of symptoms related to head injury including somatic symptoms, sleep dysregulation, cognitive deficits and emotional disturbance. Postconcussive symptoms affect 1.5-11% of concussed youth for more than 1 month after injury, depending on the population studied. Girls have a higher risk of postconcussive headache but it is not clear if cognitive recovery differs between the sexes. Advanced neuroimaging techniques demonstrate a correlation between postconcussive symptoms and functional neurological changes. However, pre-existing and psychosocial factors also affect risk for prolonged PCS. Current treatment strategies are based mainly on expert opinion and studies of related syndromes. SUMMARY Although a minority of concussed youth develop prolonged PCS, those who are affected can develop significant disability. Prolonged postconcussive symptoms are likely due to interactions between the biological injury, pre-existing risk factors and psychosocial issues. Further research is essential to improve outcomes for this vulnerable population.
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Wietzikoski EC, Boschen SL, Miyoshi E, Bortolanza M, Dos Santos LM, Frank M, Brandão ML, Winn P, Da Cunha C. Roles of D1-like dopamine receptors in the nucleus accumbens and dorsolateral striatum in conditioned avoidance responses. Psychopharmacology (Berl) 2012; 219:159-69. [PMID: 21720753 DOI: 10.1007/s00213-011-2384-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 06/13/2011] [Indexed: 01/25/2023]
Abstract
RATIONALE Aversively motivated learning is more poorly understood than appetitively motivated learning in many aspects, including the role of dopamine receptors in different regions of the striatum. OBJECTIVES The present study investigated the roles of the D1-like DA receptors in the nucleus accumbens (NAc) and dorsolateral striatum (DLS) on learning and performance of conditioned avoidance responses (CARs). METHODS Adult male Wistar rats received intraperitoneal (i.p.), intra-NAc, or intra-DLS injections of the D1 dopamine receptor agonist SKF 81297 or the D1 receptor antagonist SCH 23390 20 min before or immediately after a training session in the CAR task two-way active avoidance, carried out 24 h before a test session. RESULTS Pre-training administration of SCH 23390, but not SKF 81297, caused a significant decrease in the number of CARs in the test, but not in the training session, when injected into the DLS, or in either session when injected into the NAc. It also caused a significant increase in the number of escape failures in the training session when injected into the NAc. Systemic administration caused a combination of these effects. Post-training administrations of these drugs caused no significant effect. CONCLUSIONS The results suggest that the D1-like receptors in the NAc and DLS play important, though different, roles in learning and performance of CAR.
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Affiliation(s)
- Evellyn Claudia Wietzikoski
- Departamento de Farmacologia, Laboratório de Fisiologia e Farmacologia do Sistema Nervoso Centra, C.P. 19.031, 81.531-980 UFPR, Curitiba, PR, Brazil
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Abstract
PURPOSE OF REVIEW This review provides a comprehensive selection of the latest clinical trial results in antimigraine treatment. RECENT FINDINGS The oral calcitonine gene-related peptide antagonist telcagepant is efficacious in acute treatment. Compared to triptans, its efficacy is almost comparable but its tolerance is superior. The same is true for the 5HT-1F agonist lasmiditan, another agent devoid of vascular effects. Triptans, as other drugs, are more efficient if taken early but nonsteroidal anti-inflammatory drugs and analgesics remain useful for acute treatment, according to several meta-analyses. Single-pulse transcranial magnetic stimulation during the aura rendered more patients pain-free (39%) than sham stimulation (22%) in one study. Topiramate could be effective for migrainous vertigo, but it did not prevent transformation to chronic migraine in patients with high attack frequency. Onabotulinumtoxin A was effective for chronic migraine and well tolerated, but the therapeutic gain over placebo was modest; the clinical profile of responders remains to be determined before widespread use. Occipital nerve stimulation was effective in intractable chronic migraine with 39% of responders compared to 6% after sham stimulation. This and other neuromodulation techniques, such as sphenopalatine ganglion stimulation, are promising treatments for medically refractory patients but large controlled trials are necessary. One study suggests that outcome of patent foramen ovale closure in migraine might depend on anatomic and functional characteristics. SUMMARY Drugs with a better efficacy or side-effect profile than triptans may soon become available for acute treatment. The future may also look brighter for some of the very disabled chronic migraineurs thanks to novel drug and neuromodulation therapies.
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Drechsler R. Ist Neurofeedbacktraining eine wirksame Therapiemethode zur Behandlung von ADHS? Ein Überblick über aktuelle Befunde. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2011. [DOI: 10.1024/1016-264x/a000035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Neurofeedbacktraining hat sich zunehmend als eine klinische Behandlungsmethode für Kinder mit ADHS etabliert, obwohl methodisch befriedigende Wirksamkeitsstudien lange fehlten. Der Überblicksartikel führt zunächst in die Grundlagen von Neurofeedback bei ADHS ein und stellt die wichtigsten Methoden und Protokolle vor. Anschliessend werden aktuelle Studien mit verschiedenen Kontrollbedingungen, Bildgebungsbefunde und Ansätze, die den Zusammenhang zwischen kortikaler Regulation und klinischen Verbesserungen untersuchen, zusammengefasst. Neben vielen offenen methodischen Fragen gibt es auch einige wenige Ergebnisse, die eine spezifische Wirkung von Neurofeedbacktraining stützen. In welchem Ausmass aber die gelernte kortikale Regulation tatsächlich kausal zu den klinischen Verbesserungen beiträgt, müssen zukünftige Untersuchungen noch zeigen.
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