NEUROFEEDBACK TRAINING IN CHRONIC PAIN SYNDROME

Victoria L. Ibric, MD, PhD (1) and Liviu Dragomirescu, PhD (2)
(1)Therapy & Prevention Center, Pasadena, CA; (2) Institute of Biology, Bucharest

Introduction
Peripheral biofeedback was used for more than 40 years in the treatment of various pain conditions. Neurofeedback has proved beneficial in Epilepsy, Attention Deficit Disorder, and in other disorders. This paper brings new data about the use of neurofeedback in chronic pain.

Method
Since 1996, 147 patients were referred to us for biofeedback training for different chronic pain syndromes such as headaches, back pain, Fibromyalgia, and Complex Regional Pain Syndromes. Patients were previously treated with other modalities without complete resolution of pain. Stress tests and depression/ anxiety scales were taken periodically to monitor progress. Electrodes were set in varied positions according to 10/20 system, and based on the type or location of pain in each individual case. Sessions were 45 minutes long, and VAS pain scale was used pre- and post-training. The neurofeedback was done as “simple neurofeedback” (audio-visual NF), and/or as neurofeedback enhanced by light or electromagnetic closed loop EEG (CL-EEG) neurofeedback. For example, Myofascial Pain Syndrome responded well to “simple neurofeedback” versus Fibromyalgia that required CL-EEG-Neurofeedback. Patients with different pain syndromes required different numbers of neurofeedback sessions.

Results
Out of 147 patients, only 74 completed 20 or more neurofeedback sessions. Out of 74, 68 cases (92%) reported improvement in their pain perception that was sustained for more than five years. We previously reported other longitudinal studies.

Conclusion
Neurofeedback training can permanently modify pain perception and pain affect. The effects obtained through neurofeedback training are based on operant conditioning. Birbaumer, Flor, Lutzenberger and Elbert (1995 and Rainville, Duncan, Price, Carrier and Bushnell (1997) have shown that pain has cortical and sub-cortical representation. Neurofeedback training addresses directly those areas corresponding to pain perception, memory, and affect. Neurofeedback training was enhanced by light or electromagnetic stimulation CL-EEG and the effects obtained were faster, greater, and longer lasting than those obtained through “simple neurofeedback.” We hypothesize that the neuromodulation obtained through enhanced neurofeedback may produce deeper neurophysiological regulations. To confirm this, further investigations are warranted.

References

Birbaumer, N., Flor, H., Lutzenberger, W. & Elbert, T. (1995). The corticalization of pain. In B. Bromm & J. E. Desmendt (Eds.). Pain and the brain: From nociception to cognition. Advances in pain research and therapy: Vol. 22 (pp. 331-343). New York: Raven Press.

Rainville, P., Duncan, G. H., Price, D. D., Carrier, B., & Bushnell, C. M. (1997). Pain affect encoded in human anterior cingulate gyrus but not somato-sensory cortex. Science, 277, 968-971.