title: The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study.
abstract: BACKGROUND
  Central neuropathic pain has a prevalence of 40% in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia.
  
  
  METHODS
  Patients' EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. 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 standardized 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.
  
  
  CONCLUSIONS
  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 study is a registered UKCRN clinical trial Nr 9824.
authors.affiliation: Rehabilitation Engineering and Assistive technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK. abulhassan85@yahoo.com.|Department of Biomedical Engineering, NED University of Engineering and Technology, Karachi, Pakistan. abulhassan85@yahoo.com.
authors.forename: Muhammad Abul
authors.initials: MA
authors.lastname: Hassan
authors.affiliation: Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK. Matthew.Fraser@ggc.scot.nhs.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fraser
authors.affiliation: Department of Biomedical Engineering, University of Strathclyde, Strathclyde, UK. b.a.conway@strath.ac.uk.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Conway
authors.affiliation: Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK. davidballan@btinternet.com.
authors.forename: David B
authors.initials: DB
authors.lastname: Allan
authors.affiliation: Rehabilitation Engineering and Assistive technologies, Biomedical Engineering Research Division, University of Glasgow, Glasgow, UK. aleksandra.vuckovic@glasgow.ac.uk.|Biomedical Engineering Research Division, School of Engineering, University of Glasgow, James Watt building (south), G12 8QQ, Glasgow, UK. aleksandra.vuckovic@glasgow.ac.uk.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Vuckovic
mesh_terms: D000328:Adult; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000534:rehabilitation*; D058765:Neurofeedback / Q000379:methods*; D010264:Paraplegia / Q000150:complications / Q000534:rehabilitation*; D010865:Pilot Projects; D016896:Treatment Outcome