title: Self-regulation of brain activity in patients with postherpetic neuralgia: a double-blind randomized study using real-time FMRI neurofeedback.
abstract: BACKGROUND
  A pilot study has shown that real-time fMRI (rtfMRI) neurofeedback could be an alternative approach for chronic pain treatment. Considering the relative small sample of patients recruited and not strictly controlled condition, it is desirable to perform a replication as well as a double-blinded randomized study with a different control condition in chronic pain patients. Here we conducted a rtfMRI neurofeedback study in a subgroup of pain patients - patients with postherpetic neuralgia (PHN) and used a different sham neurofeedback control. We explored the feasibility of self-regulation of the rostral anterior cingulate cortex (rACC) activation in patients with PHN through rtfMRI neurofeedback and regulation of pain perception.
  
  
  METHODS
  Sixteen patients (46-71 years) with PHN were randomly allocated to a experimental group (n = 8) or a control group (n = 8). 2 patients in the control group were excluded for large head motion. The experimental group was given true feedback information from their rACC whereas the control group was given sham feedback information from their posterior cingulate cortex (PCC). All subjects were instructed to perform an imagery task to increase and decrease activation within the target region using rtfMRI neurofeedback.
  
  
  RESULTS
  Online analysis showed 6/8 patients in the experimental group were able to increase and decrease the blood oxygen level dependent (BOLD) fMRI signal magnitude during intermittent feedback training. However, this modulation effect was not observed in the control group. Offline analysis showed that the percentage of BOLD signal change of the target region between the last and first training in the experimental group was significantly different from the control group's and was also significantly different than 0. The changes of pain perception reflected by numerical rating scale (NRS) in the experimental group were significantly different from the control group. However, there existed no significant correlations between BOLD signal change and NRS change.
  
  
  CONCLUSIONS
  Patients with PHN could learn to voluntarily control over activation in rACC through rtfMRI neurofeedback and alter their pain perception level. The present study may provide new evidence that rtfMRI neurofeedback training may be a supplemental approach for chronic clinical pain management.
authors.affiliation: Department of Radiology, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Min
authors.initials: M
authors.lastname: Guan
authors.affiliation: Department of Radiology, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Lijia
authors.initials: L
authors.lastname: Ma
authors.affiliation: Department of Dermatology, Second People's Hospital of Zhengzhou, Zhengzhou, Henan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: China National Digital Switching System Engineering and Technological Research Center, Zhengzhou, Henan, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yan
authors.affiliation: McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Québec, Canada.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhao
authors.affiliation: China National Digital Switching System Engineering and Technological Research Center, Zhengzhou, Henan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Tong
authors.affiliation: Department of Radiology, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Shewei
authors.initials: S
authors.lastname: Dou
authors.affiliation: Department of Pain Management, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Linjie
authors.initials: L
authors.lastname: Xia
authors.affiliation: Department of Radiology, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Meiyun
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Radiology, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Dapeng
authors.initials: D
authors.lastname: Shi
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D051474:Neuralgia, Postherpetic / Q000503:physiopathology* / Q000628:therapy; D058765:Neurofeedback; D058748:Pain Perception; D010296:Parietal Lobe / Q000503:physiopathology; D013702:Temporal Lobe / Q000503:physiopathology; D016896:Treatment Outcome
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