Abstract
BackgroundCentral neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia.MethodsPatients’ EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20–30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three frequency bands accompanied with changes in the coherence most notable in the beta band. The standardized low resolution electromagnetic tomography analysis of EEG before and after neurofeedback therapy showed the statistically significant reduction of power in beta frequency band in all tested patients. Areas with reduced power included the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex and the Insular Cortex.ConclusionsNeurofeedback training produces both immediate and longer term reduction of central neuropathic pain that is accompanied with a measurable short and long term modulation of cortical activity. Controlled trials are required to confirm the efficacy of this neurofeedback protocol on treatment of pain. The study is a registered UKCRN clinical trial Nr 9824.
Highlights
Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury
We propose neurofeedback training for treatment of Central neuropathic pain (CNP) in chronic paraplegic patients setting three objectives: (I) Testing the immediate and longer term effect of neurofeedback training on CNP, (II) Understanding the putative mechanism through which neurofeedback induces wide-spread changes of EEG activity during neurofeedback training, (III)Assessing the long term effect of training on all cortical structures involved in processing of pain
This paper presents the effect of neurofeedback training on reduction of CNP and on related neurological measures
Summary
Central neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. CNP symptoms do not respond well to medications and the drugs used to treat this type of pain are often associated with significant adverse effects [6]. Neuroimagining studies have confirmed that neuromodulation techniques such as hypnosis and meditation, can globally influence pain matrix [7, 10]. Neurostimulation techniques such as rTMS and tDCS typically target primary motor cortex, thereby sending inhibitory signals directly to thalamus and reducing the perceived sensation of pain [11]. It is believed that neurofeedback facilitates global brain connectivity and leads to neuroplasticity [12]
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