Mathew Jerin, Adhia Divya Bharatkumar, Smith Mark Llewellyn, De Ridder Dirk, Mani Ramakrishnan
Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.
Clin EEG Neurosci. 2025 Mar;56(2):165-180. doi: 10.1177/15500594241264892. Epub 2024 Jul 26.
Chronic pain is a percept due to an imbalance in the activity between sensory-discriminative, motivational-affective, and descending pain-inhibitory brain regions. Evidence suggests that electroencephalography (EEG) infraslow fluctuation neurofeedback (ISF-NF) training can improve clinical outcomes. It is unknown whether such training can induce EEG activity and functional connectivity (FC) changes. A secondary data analysis of a feasibility clinical trial was conducted to determine whether EEG ISF-NF training can significantly alter EEG activity and FC between the targeted cortical regions in people with chronic painful knee osteoarthritis (OA). A parallel, two-arm, double-blind, randomized, sham-controlled clinical trial was conducted. People with chronic knee pain associated with OA were randomized to receive sham NF training or source-localized ratio ISF-NF training protocol to down-train ISF bands at the somatosensory (SSC), dorsal anterior cingulate (dACC), and uptrain pregenual anterior cingulate cortices (pgACC). Resting state EEG was recorded at baseline and immediate post-training. The source localization mapping demonstrated a reduction ( = .04) in the ISF band activity at the left dorsolateral prefrontal cortex (LdlPFC) in the active NF group. Region of interest analysis yielded significant differences for ISF ( = .008), slow ( = .007), beta ( = .043), and gamma ( = .012) band activities at LdlPFC, dACC, and bilateral SSC. The FC between pgACC and left SSC in the delta band was negatively correlated with pain bothersomeness in the ISF-NF group. The EEG ISF-NF training can modulate EEG activity and connectivity in individuals with chronic painful knee osteoarthritis, and the observed EEG changes correlate with clinical pain measures.
慢性疼痛是一种感知，源于感觉辨别、动机情感和下行疼痛抑制脑区之间活动的失衡。有证据表明，脑电图（EEG）超低频波动神经反馈（ISF-NF）训练可改善临床结果。目前尚不清楚这种训练是否能诱发EEG活动和功能连接（FC）的变化。我们进行了一项可行性临床试验的二次数据分析，以确定EEG ISF-NF训练是否能显著改变慢性疼痛性膝骨关节炎（OA）患者目标皮质区域之间的EEG活动和FC。我们进行了一项平行、双臂、双盲、随机、假对照临床试验。患有与OA相关的慢性膝关节疼痛的患者被随机分配接受假NF训练或源定位比率ISF-NF训练方案，以降低体感（SSC）、背侧前扣带回（dACC）的ISF频段，并上调膝前扣带回皮质（pgACC）的ISF频段。在基线和训练后即刻记录静息状态EEG。源定位映射显示，主动NF组左侧背外侧前额叶皮质（LdlPFC）的ISF频段活动降低（ = 0.04）。感兴趣区域分析显示，LdlPFC、dACC和双侧SSC的ISF（ = 0.008）、慢波（ = 0.007）、β波（ = 0.043）和γ波（ = 0.012）频段活动存在显著差异。ISF-NF组中，δ频段pgACC与左侧SSC之间的FC与疼痛困扰呈负相关。EEG ISF-NF训练可调节慢性疼痛性膝骨关节炎患者的EEG活动和连接性，且观察到的EEG变化与临床疼痛指标相关。
