Effects of non-pharmacological pain treatments on brain states

Mark P Jensen, Leslie H Sherlin, Robert L Askew, Felipe Fregni, Gregory Witkop, Ann Gianas, Jon D Howe, Shahin Hakimian, Mark P Jensen, Leslie H Sherlin, Robert L Askew, Felipe Fregni, Gregory Witkop, Ann Gianas, Jon D Howe, Shahin Hakimian

Abstract

Objective: To (1) evaluate the effects of a single session of four non-pharmacological pain interventions, relative to a sham tDCS procedure, on pain and electroencephalogram- (EEG-) assessed brain oscillations, and (2) determine the extent to which procedure-related changes in pain intensity are associated with changes in brain oscillations.

Methods: 30 individuals with spinal cord injury and chronic pain were given an EEG and administered measures of pain before and after five procedures (hypnosis, meditation, transcranial direct current stimulation [tDCS], neurofeedback, and a control sham tDCS procedure).

Results: Each procedure was associated with a different pattern of changes in brain activity, and all active procedures were significantly different from the control procedure in at least three bandwidths. Very weak and mostly non-significant associations were found between changes in EEG-assessed brain activity and pain.

Conclusions: Different non-pharmacological pain treatments have distinctive effects on brain oscillation patterns. However, changes in EEG-assessed brain oscillations are not significantly associated with changes in pain, and therefore such changes do not appear useful for explaining the benefits of these treatments.

Significance: The results provide new findings regarding the unique effects of four non-pharmacological treatments on pain and brain activity.

Keywords: Brain states; Chronic pain; Electroencephalography; Non-pharmacological treatments; Spinal cord injury.

Conflict of interest statement

Conflict of Interest Statement

Leslie Sherlin is a principle owner of Nova Tech EEG, Inc., which provides QEEG analysis services and distributes QEEG equipment and analysis software tools. He is also the chief science officer for Neurotopia, Inc. where he develops hardware and software platforms for cognitive and neurofeedback training in athlete populations. Finally he is a provider of QEEG analysis and neurofeedback services and is a principle owner at Arizona Brain Performance Center. The other authors declare no conflicts of interest.

Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Pre- to post-session changes in absolute bandwidth at different electrode sites.

References

    1. Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain. Prog Neurobiol. 2009;87:81–97.
    1. Ardolino G, Bossi B, Barbieri S, Priori A. Non-synaptic mechanisms underlie the after-effects of cathodal transcutaneous direct current stimulation of the human brain. J Physiol. 2005;568:653–63.
    1. Bromm B, Lorenz J. Neurophysiological evaluation of pain. Electroencephalogr Clin Neurophysiol. 1998;107:227–53.
    1. Brunoni AR, Nitsche MA, Bolognini N, Bikson M, Wagner T, Merabet L, et al. Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions. Brain Stimul. 2012;5:175–95.
    1. Brunoni AR, Valiengo L, Baccaro A, Zando TA, de Oliveira JF, Goulaart A, et al. The Sertraline vs electrical current therapy for treating depression clinical study: Results from a factoraial, randomized, controlled trial. JAMA Psychiatry. doi: 10.1001/2013.jamapsychiatry.32. in press.
    1. Buhle J, Wager TD. Does meditation training lead to enduring changes in the anticipation and experience of pain? Pain. 2010;150:382–3.
    1. Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychol Bull. 2006;132:180–211.
    1. Cardenas DD, Turner JA, Warms CA, Marshall HM. Classification of chronic pain associated with spinal cord injuries. Arch Phys Med Rehab. 2002;83:1708–14.
    1. Carmody J. Evolving conceptions of mindfulness in clinical settings. J Cogn Psychother. 2009;23:270–80.
    1. Caro XJ, Winter EF. EEG biofeedback treatment improves certain attention and somatic symptoms in fibromyalgia: a pilot study. Appl Psychophysiol Biofeedback. 2011;36:193–200.
    1. Chen AC. Human brain measures of clinical pain: a review. II. Tomographic imagings. Pain. 1993;54:133–44.
    1. Chen AC. New perspectives in EEG/MEG brain mapping and PET/fMRI neuroimaging of human pain. Int J Psychophysiol. 2001;42:147–59.
    1. Chen AC, Dworkin SF, Drangsholt MT. Cortical power spectral analysis of acute pathophysiological pain. Int J Neurosci. 1983;18:269–78.
    1. Congedo M, Sherlin L. EEG source analysis: methods and clinical implications. In: Coben R, Evans J, editors. Neurofeedback and neuromodulation techniques and applications. New York: Academic Press/Elsevier; pp. 25–46.
    1. Crawford HJ. Cognitive and psychophysiological correlates of hypnotic responsiveness and hypnosis. In: Brown DP, Fass ML, editors. Creative master in hypnosis and hypnoanalysis: A festschrift for Erika Fromm. Hillsdate, NJ: Erlbaum; 1990. pp. 155–68.
    1. Crawford HJ, Gruzelier JH. A midstream view of the neuropsychophysiology of hypnosis: Recent recearch and future directions. In: Fromm E, Nash MR, editors. Contemporary Hypnosis Research. Vol. 1992. New York: Guilford Press; 1992. pp. 227–66.
    1. Derbyshire SW, Whalley MG, Stenger VA, Oakley DA. Cerebral activation during hypnotically induced and imagined pain. Neuroimage. 2004;23:392–401.
    1. Dunn BR, Hartigan JA, Mikulas WL. Concentration and mindfulness meditations: unique forms of consciousness? Appl Psychophysiol Biofeedback. 1999;24:147–65.
    1. Egner T, Gruzelier JH. EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials. Clin Neurophysiol. 2004;115:131–9.
    1. Egner T, Strawson E, Gruzelier JH. EEG signature and phenomenology of alpha/theta neurofeedback training versus mock feedback. Appl Psychophysiol Biofeedback. 2002;27:261–70.
    1. Egner T, Zech TF, Gruzelier JH. The effects of neurofeedback training on the spectral topography of the electroencephalogram. Clin Neurophysiol. 2004;115:2452–60.
    1. Fell J, Axmacher N, Haupt S. From alpha to gamma: electrophysiological correlates of meditation-related states of consciousness. Med Hypotheses. 2010;75:218–24.
    1. Fenton BW, Palmieri PA, Boggio P, Fanning J, Fregni F. A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain Stimul. 2009;2:103–7.
    1. Fregni F, Boggio PS, Lima MC, Ferreira MJ, Wagner T, Rigonatti SP, et al. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury. Pain. 2006;122:197–209.
    1. Gannon L, Sternback RA. Alpha enhancement as a treatment for pain: A case study. J Behav Ther Exp Psychiatry. 1971;2:209–13.
    1. Gelman A, Hill J. Data analysis using regression and multilevel/hierarchical models. New York: Cambridge University Press; 2007.
    1. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, et al. Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. Int J Psychophysiol. 2009;74:149–57.
    1. Goldstein H. Multilevel Cross-Classified Models. Soc Meth Res. 1994;22:364–75.
    1. Graffin NF, Ray WJ, Lundy R. EEG concomitants of hypnosis and hypnotic susceptibility. J Abnorm Psychol. 1995;104:123–31.
    1. Green JP, Barabasz AF, Barrett D, Montgomery GH. Forging ahead: the 2003 APA Division 30 definition of hypnosis. Int J Clin Exp Hypn. 2005;53:259–64.
    1. Gustin SM, Peck CC, Cheney LB, Macey PM, Murray GM, Henderson LA. Pain and plasticity: is chronic pain always associated with somatosensory cortex activity and reorganization? J Neurosci. 2012;32:14874–84.
    1. Institute of Medicine Committee on Advancing Pain Research Care and Education. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, D.C: National Academies Press; 2011.
    1. Jacobs GD, Benson H, Friedman R. Topographic EEG mapping of the relaxation response. Biofeedback Self Regul. 1996;21:121–9.
    1. Jacobson L, Ezra A, Berger U, Lavidor M. Modulating oscillatory brain activity correlates of behavioral inhibition using transcranial direct current stimulation. Clin Neurophysiol. 2012;123:979–84.
    1. Jasper HH. The ten-twenty electrode system of the International Federation. Electroencephalogr Clin Neurophysiol. 1958;10:371–5.
    1. Jensen M, Grierson C, Tracy-Smith V, Bacigalupi SC, Othermer S. Neurofeedback treatment for pain associated with Complex Regional Pain Syndrome Type I: A case series. J Neurother. 2007a;11:45–53.
    1. Jensen M, Hakimian S, Sherlin LH, Fregni F. New insights into non-pharmacological and noninvasive neuromodulatory approaches for the treatment of pain. J Pain. 2008;9:193–9.
    1. Jensen M, Patterson DR. Hypnotic treatment of chronic pain. J Behav Med. 2006;29:95–124.
    1. Jensen M, Turner JA, Romano JM, Fisher L. Comparative reliability and validity of chronic pain intensity measures. Pain. 1999;83:157–62.
    1. Jensen MP. A neuropsychological model of pain: research and clinical implications. J Pain. 2010;11:2–12.
    1. Jensen MP, Barber J, Romano JM, Hanley MA, Raichle KA, Molton IR, et al. Effects of self-hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal-cord injury. Int J Clin Exp Hypn. 2009;57:239–68.
    1. Jensen MP, Ehde DM, Gertz KJ, Stoelb BL, Dillworth TM, Hirsh AT, et al. Effects of self-hypnosis training and cognitive restructuring on daily pain intensity and catastrophizing in individuals with multiple sclerosis and chronic pain. Int J Clin Exp Hypn. 2011;59:45–63.
    1. Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R, editors. Handbook of pain assessment. Vol. 2001. New York: Guilford; 2001. pp. 15–34.
    1. Jensen O, Kaiser J, Lachaux JP. Human gamma-frequency oscillations associated with attention and memory. Trends Neurosci. 2007b;30:317–24.
    1. Kayiran S, Dursun E, Dursun N, Ermutlu N, Karamursel S. Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial. Appl Psychophysiol Biofeedback. 2010;35:293–302.
    1. Keeser D, Padberg F, Reisinger E, Pogarell O, Kirsch V, Palm U, et al. Prefrontal direct current stimulation modulates resting EEG and event-related potentials in healthy subjects: a standardized low resolution tomography (sLORETA) study. Neuroimage. 2011;55:644–57.
    1. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (Revised 2011) J Spinal Cord Med. 2011;34:535– 46.
    1. Lefaucheur JP, Drouot X, Menard-Lefaucheur I, Keravel Y, Nguyen JP. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology. 2006;67:1568–74.
    1. Maeoka H, Matsuo A, Hiyamizu M, Morioka S, Ando H. Influence of transcranial direct current stimulation of the dorsolateral prefrontal cortex on pain related emotions: a study using electroencephalographic power spectrum analysis. Neurosci Lett. 2012;512:12–6.
    1. Marchand WR. Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and zen meditation for depression, anxiety, pain, and psychological distress. J Psychiatr Pract. 2012;18:233–52.
    1. Marino RJ, Barros T, Biering-Sorensen F, Burns SP, Donovan WH, Graves DE, et al. International standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2003;26:S50– S6.
    1. Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabil Neural Repair. 2012;26:646–52.
    1. Nakamura M, Nishiwaki Y, Ushida T, Toyama Y. Prevalence and characteristics of chronic musculoskeletal pain in Japan. J Orthop Sci. 2011;16:424–32.
    1. Patterson DR, Jensen M. Hypnosis and clinical pain. Psychol Bull. 2003;29:495–521.
    1. Portilla AS, Bravo GL, Miraval FK, Villamar MF, Schneider JC, Ryan CM, et al. A feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury. J Burn Care Res. 2013;34:48–52.
    1. Prichep LS, John ER. QEEG profiles of psychiatric disorders. Brain Topogr. 1992;4:249–57.
    1. Reid KJ, Harker J, Bala MM, Truyers C, Kellen E, Bala MM, et al. Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact. Curr Med Res Opin. 2011;27:449–62.
    1. Salinas E, Sejnowski TJ. Correlated neuronal activity and the flow of neural information. Nat Rev Neurosci. 2001;2:539–50.
    1. Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag. 2011;16:445–50.
    1. Sime A. Case study of trigeminal neuralgia using neurofeedback and peripheral biofeedback. J Neurother. 2004;8:59–71.
    1. Wagner T, Fregni F, Fecteau S, Grodzinsky A, Zahn M, Pascual-Leone A. Transcranial direct current stimulation: a computer-based human model study. Neuroimage. 2007;35:1113–24.
    1. Williams JD, Gruzelier JH. Differentiation of hypnosis and relaxation by analysis of narrow band theta and alpha frequencies. Int J Clin Exp Hypn. 2001;49:185–206.
    1. Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011;31:5540–8.
    1. Zhang ZG, Hu L, Hung YS, Mouraux A, Iannetti GD. Gamma-band oscillations in the primary somatosensory cortex--a direct and obligatory correlate of subjective pain intensity. J Neurosci. 2012;32:7429–38.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere