Neuromodulatory Approaches for Chronic Pain Management: Research Findings and Clinical Implications

Abstract

Two lines of evidence provide preliminary support for the role that brain state, measured via electroencephalogram (EEG), may play in chronic pain. First, research has identified a link between brain EEG activity and the experience of pain. Second, there are a number of published studies documenting the beneficial effects of interventions that impact the cortical activity associated with chronic pain. These interventions include neurobehavioral treatments such as neurofeedback and hypnosis as well as invasive and non-invasive brain stimulation. Preliminary data showing the efficacy of neuromodulatory strategies for treating pain provides compelling reason to examine how cortical activity (as measured by EEG) may underlie the experience of pain. Existing data already suggest specific approaches that neurofeedback clinicians might consider when treating patients with chronic pain. Reciprocally, observations by neurofeedback practitioners could provide important case data that could foster the design of more definitive randomized clinical trials using such strategies for the treatment of chronic pain. Mark P. Jensen is affiliated with the

EEG Neurofeedback in the Treatment of Chronic Pain: A Case Series

“…Consistent with this research linking brain oscillation patterns to the severity of pain, a number of studies have demonstrated improvements in pain sensation/perception in various pain conditions following neurofeedback training (Jensen et al, 2009;Prinsloo, Gabel, Lyle, & Cohen, 2012). However, there are important gaps in our knowledge regarding the potential of neurofeedback for treating pain.…”

“…All treatment protocols were determined by the clinician and at the time of patient presentation or during the course of treatment. Given the authors' interest in determining the efficacy of electrode sites and bandwidths cited in the literature (e.g., Jensen et al, 2009), treatment protocols were based on this literature rather than on quantitative EEG (qEEG) findings.…”

“…With the previous level of symptom improvement reestablished, sessions 30-33 employed a twochannel set up at the following sites: F1-A1 and F2-A2, as suggested in Jensen et al (2009), based on research indicating a role for the dorsal anterior cingulate in the affective experience of pain (Rainville et al, 1997). This was conducted with a reward band of 8-13 Hz and inhibits at 4-7 Hz and 15-32 Hz, setting a broader fast frequency inhibit in order to address possible overarousal problems that might be contributing to the patient's pain symptoms.…”

“…Thus, it is reasonable to hypothesize that the stronger the magnitude of event-related desynchronization of alpha in anticipation of pain, the greater the subjectively rated experience of pain. In addition, research has shown that individuals with chronic pain exhibit increased beta and decreased alpha CNS activity, with additional increased theta activity in individuals with spinal cord injury and chronic pain (Jensen et al, 2009).…”

Neuromodulatory treatments for chronic pain: efficacy and mechanisms

“…13,107 The first assumption is that brain oscillations in certain bandwidths reflect neurophysiological processes that underlie the experience of pain. The second assumption is that neurofeedback training effectively alters the amplitude of those pain-related oscillations, shifting them from patterns associated with the experience of pain to patterns associated with the experience of comfort.…”