Functional connectivity changes in low back pain patients after α-wave neurofeedback training
Poster No:
82
Submission Type:
Abstract Submission
Authors:
Camille Grande1, Manal Ikram2, Joel Greffier3, Jean Paul Beregi3, Alexis Hom3, Arnaud Dupeyron3, Fabricio Pereira4
Institutions:
1Aix-Marseille University, Marseille, Provence-Alpes-Côte d’Azur, 2University of Montpellier, Montpellier, Occitanie, 3University Hospital Center of Nimes, Nimes, Occitanie, 4University of Nimes, Nimes, Occitanie
First Author:
Co-Author(s):
Introduction:
Low-back pain (LBP) is a prevalent condition, impacting around 23% of the population and ranking as a primary musculoskeletal disorder with an 84% prevalence rate. It is characterized by discomfort spanning from the T12 to S1 vertebrae, lacking a specific identifiable pathological cause. LBP manifests in three distinct phases: the acute phase, a brief flare-up lasting less than 6 weeks; the sub-acute phase extending from 6 to 12 weeks; and the chronic stage. The chronic low back pain (cLBP) is defined by persistent pain persisting for more than three months, significantly affecting daily life and work commitments [1]. Despite constituting only 20% of LBP cases, cLBP incurs a substantial 80% of France's total annual expenditure on LBP, amounting to 2.7 billion euros.
Pain perception extends beyond a simple stimulus-response pattern, involving activation in motor, sensory, and emotional regions, displaying substantial variability among individuals and within the same person. The literature frequently illustrates a "pain matrix," depicting consistent activation of cortical and subcortical networks during the acute pain experience in healthy individuals [2]. This includes primary (S1) and secondary sensory cortices (S2) and the posterior insula, processing sensory details (pain location, duration). Furthermore, it encompasses regions like the anterior cingulate cortex (ACC), anterior insula, prefrontal cortical areas (PFC), and subcortical areas (basal ganglia and thalamus), contributing to the motivational and emotional facets of pain and its modulation.
In this longitudinal study, fMRI was utilized to evaluate alterations in fronto-striatal functional connectivity in patients with cLBP who underwent a 20-day neurofeedback program centered on alpha-synchrony. While these brain oscillations are believed to significantly influence individual pain perception, the specific mechanisms remain to be fully elucidated
Pain perception extends beyond a simple stimulus-response pattern, involving activation in motor, sensory, and emotional regions, displaying substantial variability among individuals and within the same person. The literature frequently illustrates a "pain matrix," depicting consistent activation of cortical and subcortical networks during the acute pain experience in healthy individuals [2]. This includes primary (S1) and secondary sensory cortices (S2) and the posterior insula, processing sensory details (pain location, duration). Furthermore, it encompasses regions like the anterior cingulate cortex (ACC), anterior insula, prefrontal cortical areas (PFC), and subcortical areas (basal ganglia and thalamus), contributing to the motivational and emotional facets of pain and its modulation.
In this longitudinal study, fMRI was utilized to evaluate alterations in fronto-striatal functional connectivity in patients with cLBP who underwent a 20-day neurofeedback program centered on alpha-synchrony. While these brain oscillations are believed to significantly influence individual pain perception, the specific mechanisms remain to be fully elucidated
Methods:
We conducted a pilot study on a neurofeedback alpha-synchronization training in cLBP patients. Participants underwent a first meeting with an fMRI, a questionnaire set and a neurofeedback session. Then, they practiced neurofeedback in alpha-synchronization training for 20 days and came back to the hospital for the same monitoring under a rsfMRI acquisition. The first objective of this study was to describe the observed functional connectivity alterations between the medial prefrontal cortex and the nucleus accumbens on fMRI acquisitions in "resting state" and "alpha-synchronization", before and after a neurofeedback protocol. The second objective was to search for correlations between the functional connectivity alterations, and the changes in clinical scores (pain, disability, and quality of life) following the neurofeedback protocol
Results:
Wilcoxon test showed no significant medial prefrontal cortex - nucleus accumbens functional connectivity. We then we correlated the connectivity maps with pain scales and found 6 significantly functionally connected regions to the medial prefrontal cortex: the right middle occipital gyrus, primary visual cortex, precuneus and caudate nucleus at two distinct locations, and the left putamen. Spearman's correlation displayed significant results (p<.05) between the resting state "before" and the "worst mental pain in the past 7 days" as assessed with the psychological and physical pain visual analogue scale (PPP-VAS) [3]
·Cortical and subcortical regions showing enhanced rsfcMRI following the protocol. Right Middle Occipital Gyrus [a], Right Primary Visual Cortex [b], Right Caudate Nucleus [c-e], Left Putamen [f]
Conclusions:
This study brings clinical evidence of functional connectivity alterations between the medial prefrontal cortex and cortical and subcortical regions in chronic low back pain patients. We also showed that clinical scores could perhaps be correlated with changes in functional connectivity. Clinical studies with a higher number of participants are needed in order to highlight clear chronic pain cortical processes.
Brain Stimulation:
Non-Invasive Stimulation Methods Other 1
Perception, Attention and Motor Behavior:
Perception: Pain and Visceral 2
Keywords:
Electroencephaolography (EEG)
FUNCTIONAL MRI
Pain
Other - Neurofeedback
1|2Indicates the priority used for review
Provide references using author date format
[2] Apkarian, A. V. (2011), ‘Pain and the brain: Specificity and plasticity of the brain in clinical chronic pain’, Pain, 152(3), S49–S64
[3] Jollant, F. (2020), ‘A Visual Analog Scale to measure Psychological and Physical Pain: A preliminary validation of the PPP-VAS in two independent samples of depressed patients’, Prog Neuropsychopharmacol Biol Psychiatry, vol 90,55-61