Abstract
BackgroundNeurofeedback (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.MethodsAn 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.ResultsFor 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.ConclusionWhile 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.
Highlights
Chronic pain is one of the leading causes of disability (Van Hecke et al, 2013) and negatively impacts wellbeing, sleep, and physical health (Hadi et al, 2019; Murray et al, 2020), as well as costing billions in health care and lost work productivity (American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons, 2009; Langley et al, 2010; Abdulla et al, 2013; Gaskin et al, 2017; Saxen and Rosenquist, 2020)
Alterations in alpha and theta frequency bands in mostly frontal, and some central, regions were observed, suggesting these may be key target areas for NFB for pain management. This is largely consistent with cortical areas found to be active during pain in imaging studies (Apkarian et al, 2005, 2009; Fitzgerald, 2020), and supports the complex nature of pain and the need to better understand the relationship between the brain and pain on a cortical level (EEG) to develop efficacious NFB protocols with EEG
One possible interpretation is that EEG can be more successfully regulated during the early stages of pain, but that this becomes more difficult after sustained exposure to noxious stimulation
Summary
Chronic pain is one of the leading causes of disability (Van Hecke et al, 2013) and negatively impacts wellbeing, sleep, and physical health (Hadi et al, 2019; Murray et al, 2020), as well as costing billions in health care and lost work productivity (American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons, 2009; Langley et al, 2010; Abdulla et al, 2013; Gaskin et al, 2017; Saxen and Rosenquist, 2020). The cortical signature of pain is complex, reliable evidence suggests involvement of a neuromatrix of cortical pathways (Melzack, 1999, 2001, 2005; Fitzgerald, 2020) including the anterior cingulate, prefrontal cortex, insular cortex, and primary and secondary cortices (Casey, 1980; Brooks and Tracey, 2005). If the activity of the brain structures involved in pain processing can be regulated, this could in turn influence our experience of pain (Ros et al, 2010, 2013). This has led to an increased interest in novel interventions for pain management, such as neurofeedback (NFB). The current study is a randomized controlled trial comparing changes in brain activity and pain during NFB with those of a sham-control group
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