Volitional limbic neuromodulation exerts a beneficial clinical effect on Fibromyalgia

Abstract

Volitional neural modulation using neurofeedback has been indicated as a potential treatment for chronic conditions that involve peripheral and central neural dysregulation. Here we utilized neurofeedback in patients suffering from Fibromyalgia-a chronic pain syndrome that involves sleep disturbance and emotion dysregulation. These ancillary symptoms, which have an amplification effect on pain, are known to be mediated by heightened limbic activity. In order to reliably probe limbic activity in a scalable manner fit for EEG-neurofeedback training, we utilized an Electrical Finger Print (EFP) model of amygdala-BOLD signal (termed Amyg-EFP), that has been successfully validated in our lab in the context of volitional neuromodulation. We anticipated that Amyg-EFP-neurofeedback training aimed at limbic down modulation should improve chronic pain in patients suffering from Fibromyalgia, by balancing disturbed indices for sleep and affect. We further expected that improved clinical status would correspond to successful training as indicated by improved down modulation of the Amygdala-EFP signal. Thirty-Four Fibromyalgia patients (31F; age 35.6±11.82) participated in a randomized placebo-controlled trial with biweekly Amyg-EFP-neurofeedback sessions and placebo of sham neurofeedback (n=9) for a total duration of five consecutive weeks. Following training, participants in the Real-neurofeedback group were divided into good (n=13) or poor (n=12) modulators according to their success in the neurofeedback training. Before and after treatment, self-reports on pain, depression, anxiety, fatigue and sleep quality were obtained, as well as objective sleep Indices. Long-term clinical follow-up was made available, within up to three years of the neurofeedback training completion. REM latency and objective sleep quality index were robustly improved following the treatment course only in the Real-neurofeedback group (both time*group p<0.05) and to a greater extent among good modulators (both time*sub-group p<0.05). In contrast, self-report measures did not reveal a treatment-specific response at the end of the treatment. However, the follow-up assessment revealed a delayed improvement

The potential of functional near-infrared spectroscopy-based neurofeedback – a systematic review and recommendations for best practice

“…It should be noted that, with a few exceptions in fMRI-neurofeedback (e.g., Goldway et al, 2019), variability measures have been neglected in most neurofeedback success definitions. According to learning theories, the probability of a certain behavior (brain activity) should increase after learning (Skinner, 1963), but variability (noise) should also be reduced.…”

Neurofeedback for Chronic Pain

“…Evidence regarding efficacy of fMRI neurofeedback in pain is limited understandably due to the increased difficulties and expenses associated with this form. The common region of interest which has been targeted in fMRI studies has been rostral anterior cingulate gyrus (rACC), whereby increased activity of rACC, measured through detecting an increase in blood oxygen level dependent signal from the region, has been associated with pain reduction [36,37]. However, these studies have been severely limited in terms of number of sessions [37,38], therefore the full benefit of the neurofeedback which occurs over the course of several sessions has not been explored yet in fMRI neurofeedback for chronic pain.…”

“…Another form of stimulation which can be explored in the context of neurofeedback is tactile stimulation. Some studies have even combined two forms of stimuli such as visual and auditory whereby patient is shown an angry and shouting patient [36]. In order to calm the patient, the individual has to achieve the desired changes in the brain rhythms.…”

“…Key randomized controlled trials in the field have been summarized in Table 2. Reduction in pain has been reported across several pain conditions such as Fibromyalgia [27,29,36,41] Table 1. Neurofeedback targets [17].…”

Neurofeedback training in major depressive disorder: a systematic review of clinical efficacy, study quality and reporting practices

“…These studies provide preliminary data that suggest that neurofeedback training may be effective in changing brain function and treating some neuropsychiatric symptoms, including those related to disturbances in the reward system. Noteworthy, clinical effects have been reported to last also during longitudinal follow-ups [56][57][58][59][60].…”