Reducing central neuropathic pain with neurofeedback
Individuals frequently experience central neuropathic pain (CNP) following a spinal cord injury and damage to the somato-sensory system. It has a high prevalence also following amputation, MS, Stroke and Parkinson disease. Unfortunately CNP symptoms frequently don't respond to medication and hence a range of alternative approaches have been explored. These include meditation, hypnosis, transcranial Direct Current Stimulation and neurofeedback.
Neurofeedback is a type of biofeeback in which patients are provided with information (feedback) about their brain activity; usually in a visual or auditory form. Although neurofeedback has been used for the treatment of a number of types of pain including complex regional pain syndrome, migraine and fibromyalgia, a protocol for use with CNP has been absent.
Hassan and colleagues conducted a pilot study with a group fo seven patients with paraplegia at a level of T1 or lower and CNP with a report of pain level ≥5 on the Visual Numerical Scale (0 = no pain, 10 = worst pain imaginable). Other measures were recorded to quantify pain levels.
Patients’ EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions.
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 standardised 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.
The authors conclude that Neurofeedback 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 mechanism of neurofeedback training for treatment of central neuropathic pain in
paraplegia: a pilot study"
Muhammad Abul Hassan, Matthew Fraser, Bernard A. Conway, David B. Allan and Aleksandra Vuckovic.
BMC Neurology (2015) 15:200. DOI 10.1186/s12883-015-0445-7