Abstract
Entraining alpha activity with rhythmic visual, auditory, and electrical stimulation can reduce experimentally induced pain. However, evidence for alpha entrainment and pain reduction in patients with chronic pain is limited. This feasibility study investigated whether visual alpha stimulation can increase alpha power in patients with chronic musculoskeletal pain and, secondarily, if chronic pain was reduced following stimulation. In a within-subject design, 20 patients underwent 4-min periods of stimulation at 10 Hz (alpha), 7 Hz (high-theta, control), and 1 Hz (control) in a pseudo-randomized order. Patients underwent stimulation both sitting and standing and verbally rated their pain before and after each stimulation block on a 0–10 numerical rating scale. Global alpha power was significantly higher during 10 Hz compared to 1 Hz stimulation when patients were standing (t = −6.08, p < 0.001). On a more regional level, a significant increase of alpha power was found for 10 Hz stimulation in the right-middle and left-posterior region when patients were sitting. With respect to our secondary aim, no significant reduction of pain intensity and unpleasantness was found. However, only the alpha stimulation resulted in a minimal clinically important difference in at least 50% of participants for pain intensity (50%) and unpleasantness ratings (65%) in the sitting condition. This study provides initial evidence for the potential of visual stimulation as a means to enhance alpha activity in patients with chronic musculoskeletal pain. The brief period of stimulation was insufficient to reduce chronic pain significantly. This study is the first to provide evidence that a brief period of visual stimulation at alpha frequency can significantly increase alpha power in patients with chronic musculoskeletal pain. A further larger study is warranted to investigate optimal dose and individual stimulation parameters to achieve pain relief in these patients.
Highlights
Chronic pain is a prevalent and debilitating condition that has a wide-reaching impact on physical and mental well-being (Breivik et al, 2006; Van Hecke et al, 2013)
Post hoc repeated-measures t-tests showed that alpha power was significantly higher during 10 Hz stimulation compared to the 1 Hz control stimulation during the standing condition (t = −6.08, p < 0.001)
There was no significant increase of global alpha power during the sitting condition (t = −1.30, p = 0.21)
Summary
Chronic pain is a prevalent and debilitating condition that has a wide-reaching impact on physical and mental well-being (Breivik et al, 2006; Van Hecke et al, 2013). Regardless of the specific diagnostic classification, is influenced by multifactorial mechanisms including central sensitization, and is associated with changes in brain structure and function (Kulkarni et al, 2007; Gwilym et al, 2010; Baliki et al, 2014; Brown et al, 2014). These observations justify greater focus on the development of brain-based treatments that have generalizable efficacy across musculoskeletal conditions. The brain’s response to pain provides a promising target for the development of novel pain therapies (Jensen et al, 2008)
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