The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study

Central neuropathic pain (CNP) is caused by an injury to the somato-sensory system and is highly prevalent in spinal cord injury, among other conditions. CNP symptoms often do not respond well to medications, so nonpharmacological treatments are of interest. Neurofeedback is a type of biofeedback in which patients are provided information about their brain activity in a visual or auditory form. During neurofeedback training, EEG power is calculated in θ (4–8 Hz), α (9–12 Hz), lower β (12–15 Hz) and higher β (20–30) Hz bands. Contingencies are set such that increases in the α or SMR and decreases in the Ɵ and β were reinforced. Patients were instructed to relax and to ‘apply whichever mental strategy they prefer to make the bars green’. Areas with reduced power included the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex and the Insular Cortex. 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.

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  Six out of seven patients reported immediate reduction of pain during neurofeedback training.
• 2
  Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy.
• 3
  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.