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Torres CB, Barona EJG, Molina MG, Sánchez MEGB, Manso JMM. A systematic review of EEG neurofeedback in fibromyalgia to treat psychological variables, chronic pain and general health. Eur Arch Psychiatry Clin Neurosci 2024; 274:981-999. [PMID: 37179502 PMCID: PMC11127810 DOI: 10.1007/s00406-023-01612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
This paper is the first up-to-date review of the various EEG-neurofeedback treatments for fibromyalgia patients and their psychological, physiological and general health consequences. Searches were made of the PubMed, PsycNet, Google Scholar and Scopus databases according to PRISMA guidelines for empirical peer-reviewed articles on EEG-neurofeedback treatment of fibromyalgia, yielding a final selection of 17 studies that met the inclusion criteria: (1) published articles and doctoral theses; (2) conducted between 2000 and 2022; (3) reporting empirical and quantitative data. These articles show that there is a wide range of protocols with different designs and procedures to treat fibromyalgia using EEG-neurofeedback techniques. The main symptoms that showed improvement were anxiety, depression, pain, general health and symptom severity, whilst the most commonly used method was traditional EEG neurofeedback based on a sensorimotor rhythm protocol. It may be concluded from the review that the lack of consistency and uniqueness of the protocols makes it very difficult to generalise results, despite the individual improvements identified. This review provides instructions and information that could guide future research and clinical practise, with the data extracted helping to gain a deeper understanding of the state of the art and the needs of the technique for this population group.
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Schuurman BB, Lousberg RL, Schreiber JU, van Amelsvoort TAMJ, Vossen CJ. A Scoping Review of the Effect of EEG Neurofeedback on Pain Complaints in Adults with Chronic Pain. J Clin Med 2024; 13:2813. [PMID: 38792353 PMCID: PMC11122542 DOI: 10.3390/jcm13102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background and Aim: Non-pharmacological treatments such as electroencephalogram (EEG) neurofeedback have become more important in multidisciplinary approaches to treat chronic pain. The aim of this scoping review is to identify the literature on the effects of EEG neurofeedback in reducing pain complaints in adult chronic-pain patients and to elaborate on the neurophysiological rationale for using specific frequency bands as targets for EEG neurofeedback. Methods: A pre-registered scoping review was set up and reported following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews (PRISMA-ScR). The data were collected by searching for studies published between 1985 and January 2023 in PubMed, EMBASE, and PsycINFO. Results: Thirty-two studies on various types of chronic pain were included. The intervention was well-tolerated. Approximately half of the studies used a protocol that reinforced alpha or sensorimotor rhythms and suppressed theta or beta activity. However, the underlying neurophysiological rationale behind these specific frequency bands remains unclear. Conclusions: There are indications that neurofeedback in patients with chronic pain probably has short-term analgesic effects; however, the long-term effects are less clear. In order to draw more stable conclusions on the effectiveness of neurofeedback in chronic pain, additional research on the neurophysiological mechanisms of targeted frequency bands is definitely worthwhile. Several recommendations for setting up and evaluating the effect of neurofeedback protocols are suggested.
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Affiliation(s)
- Britt B. Schuurman
- Department of Psychiatry & Neuro-Psychology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Richel L. Lousberg
- Department of Psychiatry & Neuro-Psychology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Jan U. Schreiber
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Therese A. M. J. van Amelsvoort
- Department of Psychiatry & Neuro-Psychology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Catherine J. Vossen
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
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Diotaiuti P, Corrado S, Tosti B, Spica G, Di Libero T, D’Oliveira A, Zanon A, Rodio A, Andrade A, Mancone S. Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review. Front Psychol 2024; 15:1369487. [PMID: 38770259 PMCID: PMC11104502 DOI: 10.3389/fpsyg.2024.1369487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
The prevalence and impact of chronic pain in individuals worldwide necessitate effective management strategies. This narrative review specifically aims to assess the effectiveness of neurofeedback, an emerging non-pharmacological intervention, on the management of chronic pain. The methodology adopted for this review involves a meticulous search across various scientific databases. The search was designed to capture a broad range of studies related to neurofeedback and chronic pain management. To ensure the quality and relevance of the included studies, strict inclusion and exclusion criteria were applied. These criteria focused on the study design, population, intervention type, and reported outcomes. The review synthesizes the findings from a diverse array of studies, including randomized controlled trials, observational studies, and case reports. Key aspects evaluated include the types of neurofeedback used (such as EEG biofeedback), the various chronic pain conditions addressed (like fibromyalgia, neuropathic pain, and migraines), and the methodologies employed in these studies. The review highlights the underlying mechanisms by which neurofeedback may influence pain perception and management, exploring theories related to neural plasticity, pain modulation, and psychological factors. The results of the review reveal a positive correlation between neurofeedback interventions and improved pain management. Several studies report significant reductions on pain intensity, improved quality of life, and decreased reliance on medication following neurofeedback therapy. The review also notes variations in the effectiveness of different neurofeedback protocols and individual responses to treatment. Despite the promising results, the conclusion of the review emphasizes the need for further research. It calls for larger, well-designed clinical trials to validate the findings, to understand the long-term implications of neurofeedback therapy, and to optimize treatment protocols for individual patients.
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Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Beatrice Tosti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Giuseppe Spica
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Tommaso Di Libero
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Anderson D’Oliveira
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Alessandra Zanon
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Angelo Rodio
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
| | - Alexandro Andrade
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Lazio, Italy
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Rockholt MM, Kenefati G, Doan LV, Chen ZS, Wang J. In search of a composite biomarker for chronic pain by way of EEG and machine learning: where do we currently stand? Front Neurosci 2023; 17:1186418. [PMID: 37389362 PMCID: PMC10301750 DOI: 10.3389/fnins.2023.1186418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Machine learning is becoming an increasingly common component of routine data analyses in clinical research. The past decade in pain research has witnessed great advances in human neuroimaging and machine learning. With each finding, the pain research community takes one step closer to uncovering fundamental mechanisms underlying chronic pain and at the same time proposing neurophysiological biomarkers. However, it remains challenging to fully understand chronic pain due to its multidimensional representations within the brain. By utilizing cost-effective and non-invasive imaging techniques such as electroencephalography (EEG) and analyzing the resulting data with advanced analytic methods, we have the opportunity to better understand and identify specific neural mechanisms associated with the processing and perception of chronic pain. This narrative literature review summarizes studies from the last decade describing the utility of EEG as a potential biomarker for chronic pain by synergizing clinical and computational perspectives.
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Affiliation(s)
- Mika M. Rockholt
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - George Kenefati
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Lisa V. Doan
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
| | - Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Management, New York University Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience & Physiology, Neuroscience Institute, New York University Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Zebhauser PT, Hohn VD, Ploner M. Resting-state electroencephalography and magnetoencephalography as biomarkers of chronic pain: a systematic review. Pain 2023; 164:1200-1221. [PMID: 36409624 PMCID: PMC10184564 DOI: 10.1097/j.pain.0000000000002825] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
ABSTRACT Reliable and objective biomarkers promise to improve the assessment and treatment of chronic pain. Resting-state electroencephalography (EEG) is broadly available, easy to use, and cost efficient and, therefore, appealing as a potential biomarker of chronic pain. However, results of EEG studies are heterogeneous. Therefore, we conducted a systematic review (PROSPERO CRD42021272622) of quantitative resting-state EEG and magnetoencephalography (MEG) studies in adult patients with different types of chronic pain. We excluded populations with severe psychiatric or neurologic comorbidity. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Semiquantitative data synthesis was conducted using modified albatross plots. We included 76 studies after searching MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and EMBASE. For cross-sectional studies that can serve to develop diagnostic biomarkers, we found higher theta and beta power in patients with chronic pain than in healthy participants. For longitudinal studies, which can yield monitoring and/or predictive biomarkers, we found no clear associations of pain relief with M/EEG measures. Similarly, descriptive studies that can yield diagnostic or monitoring biomarkers showed no clear correlations of pain intensity with M/EEG measures. Risk of bias was high in many studies and domains. Together, this systematic review synthesizes evidence on how resting-state M/EEG might serve as a diagnostic biomarker of chronic pain. Beyond, this review might help to guide future M/EEG studies on the development of pain biomarkers.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Vanessa D. Hohn
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Markus Ploner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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