Active pain coping is associated with the response in real-time fMRI neurofeedback during pain

Kirsten Emmert,Frank Birklein,Thomas Bauermann,Sven Haller,Cora Rebhorn,Dimitri Van De Ville,Markus Breimhorst

doi:10.1007/s11682-016-9547-0

Abstract

Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback is used as a tool to gain voluntary control of activity in various brain regions. Little emphasis has been put on the influence of cognitive and personality traits on neurofeedback efficacy and baseline activity. Here, we assessed the effect of individual pain coping on rt-fMRI neurofeedback during heat-induced pain. Twenty-eight healthy subjects completed the Coping Strategies Questionnaire (CSQ) prior to scanning. The first part of the fMRI experiment identified target regions using painful heat stimulation. Then, subjects were asked to down-regulate the pain target brain region during four neurofeedback runs with painful heat stimulation. Functional MRI analysis included correlation analysis between fMRI activation and pain ratings as well as CSQ ratings. At the behavioral level, the active pain coping (first principal component of CSQ) was correlated with pain ratings during neurofeedback. Concerning neuroimaging, pain sensitive regions were negatively correlated with pain coping. During neurofeedback, the pain coping was positively correlated with activation in the anterior cingulate cortex, prefrontal cortex, hippocampus and visual cortex. Thermode temperature was negatively correlated with anterior insula and dorsolateral prefrontal cortex activation. In conclusion, self-reported pain coping mechanisms and pain sensitivity are a source of variance during rt-fMRI neurofeedback possibly explaining variations in regulation success. In particular, active coping seems to be associated with successful pain regulation.

Highlights

Real-time functional magnetic resonance imaging neurofeedback recently became a popular method to learn voluntary regulation of brain activity
Two recent meta-analyses on placebo neuroimaging studies showed that expected pain reduction is accompanied by a reduction in dorsal anterior cingulate cortex (ACC) and MCC, insula, thalamus, amygdala, striatum, superior temporal and precentral gyri and lateral prefrontal cortex activation, as well as an increase in activation in the dorsolateral and ventromedial prefrontal cortex, the left inferior parietal lobule and postcentral gyrus, the rostral ACC, the midbrain around the periaqueductal gray (PAG), the left anterior insula, and the striatum (Atlas and Wager 2014; Amanzio et al 2013)
Our results show that active coping styles are associated with the success in neurofeedback; i.e., a smaller pain rating compared with participants with a lower PC 1

Summary

Introduction

Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback recently became a popular method to learn voluntary regulation of brain activity. As it is a rather new technique, publications have focused to date mostly on the technical feasibility and validity of the technique and its possible applications in different clinical fields such as chronic pain (deCharms et al 2005), schizophrenia (Ruiz et al 2013), tinnitus (Haller et al 2010) and depression (Linden et al 2012). It has been shown that pain perception and processing is influenced by a variety of psychological factors This is evident when looking at the placebo/ nocebo effect that influences pain related brain activation (Bingel 2010; Kong et al 2008; Lidstone and Stoessl 2007). Two recent meta-analyses on placebo neuroimaging studies showed that expected pain reduction is accompanied by a reduction in dorsal ACC and MCC, insula, thalamus, amygdala, striatum, superior temporal and precentral gyri and lateral prefrontal cortex activation, as well as an increase in activation in the dorsolateral and ventromedial prefrontal cortex, the left inferior parietal lobule and postcentral gyrus, the rostral ACC, the midbrain around the PAG, the left anterior insula, and the striatum (Atlas and Wager 2014; Amanzio et al 2013)

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Conclusion