Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 11/2019

01-11-2019 | Electromyographic | Original Article

Alpha-phase synchrony EEG training for multi-resistant chronic low back pain patients: an open-label pilot study

Authors: Louis Mayaud, Hélène Wu, Quentin Barthélemy, Patrick Favennec, Yannick Delpierre, Marco Congedo, Arnaud Dupeyron, Michel Ritz

Published in: European Spine Journal | Issue 11/2019

Login to get access

Abstract

Purpose

Chronic low back pain (cLBP) affects a quarter of a population during its lifetime. The most severe cases include patients not responding to interventions such as 5-week-long in-hospital multi-disciplinary protocols. This document reports on a pilot study offering an alpha-phase synchronization (APS) brain rehabilitation intervention to a population of n = 16 multi-resistant cLBP patients.

Methods

The intervention consists of 20 sessions of highly controlled electroencephalography (EEG) APS operant conditioning (neurofeedback) paradigm delivered in the form of visual feedback. Visual analogue scale for pain, Dallas, Hamilton, and HAD were measured before, after, at 6-month and 12-month follow-up. Full-scalp EEG data were analyzed to study significant changes in the brain’s electrical activity.

Results

The intervention showed a great and lasting response of most measured clinical scales. The clinical improvement was lasting beyond the 6-month follow-up endpoints. The EEG data confirm that patients did control (intra-session trends) and learned to better control (intersession trends) their APS neuromarker resulting in (nonsignificant) baseline changes in their resting state activity. Last and most significantly, the alpha-phase concentration (APC) neuromarker, specific to phase rather than amplitude, was found to correlate significantly with the reduction in clinical symptoms in a typical dose–response effect.

Conclusion

This first experiment highlights the role of the APC neuromarker in relation to the nucleus accumbens activity and its role on nociception and the chronicity of pain. This study suggests APC rehabilitation could be used clinically for the most severe cases of cLBP. Its excellent safety profile and availability as a home-use intervention makes it a potentially disruptive tool in the context of nonsteroidal anti-inflammatory drugs and opioid abuses.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.
Appendix
Available only for authorised users
Literature
1.
Apkarian AV, Hashmi JA, Baliki MN (2011) Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 152(3 Suppl):S49–S64PubMedCrossRef
2.
3.
Baliki MN, Geha PY, Fields HL, Apkarian AV (2010) Predicting value of pain and analgesia: nucleus accumbens response to noxious stimuli changes in the presence of chronic pain. Neuron 66:149–160PubMedPubMedCentralCrossRef
4.
Baptista AF, Fernandes AMBL, Sá KN, Okano AH, Brunoni AR, Lara-Solares A, Iskandar AJ, Guerrero C, Amescua-García C, Kraychete DC et al (2019) Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC2-NIN-CP). Pain Rep 4:e692PubMedPubMedCentralCrossRef
5.
Barry RJ, Clarke AR, McCarthy R, Selikowitz M, Johnstone SJ, Rushby JA (2004) Age and gender effects in EEG coherence: I. Developmental trends in normal children. Clin Neurophysiol 115:2252–2258PubMedCrossRef
6.
7.
Benarroch EE (2016) Involvement of the nucleus accumbens and dopamine system in chronic pain. Neurology 87(16):1720–1726PubMedCrossRef
8.
Bontoux L, Roquelaure Y, Billabert C, Dubus V, Sancho PO, Colin D, Brami L, Moisan S, Fanello S, Penneau-Fontbonne D, Richard I (2004) Étude du devenir à un an de lombalgiques chroniques inclus dans un programme associant reconditionnement à l’effort et action ergonomique. recherche de facteurs prédictifs de retour et de maintien au travail. Annales de réadaptation et de médecine physique 47:563–572PubMedCrossRef
9.
Brena SF, Wolf SL, Chapman SL, Hammonds WD (1980) Chronic back pain: electromyographic, motion and behavioral assessments following sympathetic nerve blocks and placebos. Pain 8:1–10PubMedCrossRef
10.
11.
Bussalb A, Congedo M, Barthélemy Q, Ojeda D, Acquaviva E, Delorme R, Mayaud L (2019) Clinical and experimental factors influencing the efficacy of neurofeedback in ADHD: a meta-analysis. Front Psychiatry 10:35PubMedPubMedCentralCrossRef
12.
Caro XJ, Winter EF (2011) EEG biofeedback treatment improves certain attention and somatic symptoms in fibromyalgia: a pilot study. Appl Psychophysiol Biofeedback 36:193–200PubMedCrossRef
13.
Chang P-C, Pollema-Mays SL, Centeno MV, Procissi D, Contini M, Baria AT, Martina M, Apkarian AV (2014) Role of nucleus accumbens in neuropathic pain: linked multi-scale evidence in the rat transitioning to neuropathic pain. Pain 155:1128–1139PubMedPubMedCentralCrossRef
14.
Cohen MX (2014) Analyzing neural time series data: theory and practice. MIT Press, CambridgeCrossRef
15.
Dolan P, Mannion AF, Adams MA (1995) Fatigue of the erector spinae muscles. A quantitative assessment using “frequency banding” of the surface electromyography signal. Spine 20:149–159PubMedCrossRef
16.
Durup G, Fessard A (1935) I. l’électrencéphalogramme de l’homme. Observations psycho-physiologiques relatives à l’action des stimuli visuels et auditifs. L’année psychologique 36:1–32CrossRef
17.
Fassier J-B (2011) Prévalence, coûts et enjeux sociétaux de la lombalgie. Revue du rhumatisme 78:S38–S41CrossRef
18.
19.
20.
Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H (2009) Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry 50(7):780–789PubMedCrossRef
21.
Ghaziri J, Tucholka A, Larue V, Blanchette-Sylvestre M, Reyburn G, Gilbert G, Lévesque J, Beauregard M (2013) Neurofeedback training induces changes in white and gray matter. Clin EEG Neurosci 44(4):265–272PubMedCrossRef
22.
Gourmelen J, Chastang J-F, Ozguler A, Lanoë J-L, Ravaud J-F, Leclerc A (2007) Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys. Annales de réadaptation et de médecine physique 50:640–644PubMedCrossRef
23.
24.
Hebert R, Lehmann D, Tan G, Travis F, Arenander A (2005) Enhanced EEG alpha time-domain phase synchrony during transcendental meditation: implications for cortical integration theory. Signal Process 85(11):2213–2232CrossRef
25.
Heinrich H, Busch K, Studer P, Erbe K, Moll GH, Kratz O (2014) EEG spectral analysis of attention in ADHD: implications for neurofeedback training? Front Hum Neurosci 8:611PubMedPubMedCentralCrossRef
26.
Horschig JM, Smolders R, Bonnefond M, Schoffelen J-M, Van den Munckhof P, Schuurman PR, Cools R, Denys D, Jensen O (2015) Directed communication between nucleus accumbens and neocortex in humans is differentially supported by synchronization in the theta and alpha band. PLoS ONE 10(9):e0138685PubMedPubMedCentralCrossRef
27.
Jensen MP, Grierson C, Tracy-Smith V, Bacigalupi SC, Othmer S (2007) Neurofeedback treatment for pain associated with complex regional pain syndrome type I. J Neurother 11(1):45–53CrossRef
28.
Jensen MP, Hakimian S, Sherlin LH, Fregni F (2008) New insights into neuromodulatory approaches for the treatment of pain. J Pain 9(3):193–199PubMedCrossRef
29.
Koes BW, van Tulder M, Lin CWC, Macedo LG, McAuley J, Maher C (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19:2075–2094PubMedPubMedCentralCrossRef
30.
Lawlis GF, Cuencas R, Selby D, McCoy CE (1989) The development of the Dallas pain questionnaire. An assessment of the impact of spinal pain on behavior. Spine 14(5):511–516PubMedCrossRef
31.
Machado LAC, Kamper SJ, Herbert RD, Maher CG, McAuley JH (2008) Imperfect placebos are common in low back pain trials: a systematic review of the literature. Eur Spine J 17(7):889PubMedPubMedCentralCrossRef
32.
Maris E, Oostenveld R (2007) Nonparametric statistical testing of EEG-and MEG-data. J Neurosci Methods 164:177–190PubMedCrossRef
33.
Mayer K, Wyckoff SN, Schulz U, Strehl U (2012) Neurofeedback for adult attention-deficit/hyperactivity disorder: investigation of slow cortical potential neurofeedback—preliminary results. J Neurother 16:37–45CrossRef
34.
Mayer TG, Gatchel RJ, Mayer H, Kishino ND, Keeley J, Mooney V (1987) A prospective two-year study of functional restoration in industrial low back injury: an objective assessment procedure. JAMA 258:1763–1767PubMedCrossRef
35.
McKnight JT, Fehmi LG (2001) Attention and neurofeedback synchrony training: clinical results and their significance. J Neurother 5:45–61CrossRef
36.
Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin C-WC, Chenot J-F, van Tulder M, Koes BW (2018) Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 27:2791–2803PubMedCrossRef
37.
Pearl J (2009) Causal inference in statistics: an overview. Stat Surv 3:96–146CrossRef
38.
Peniston EG, Kulkosky PJ (1991) Alpha-theta brainwave neurofeedback for Vietnam veterans with combat-related post-traumatic stress disorder. Med Psychother 4:47–60
39.
Rainville P, Duncan GH, Price DD, Carrier B, Bushnell MC (1997) Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science 277:968–971PubMedCrossRef
40.
Ren W, Centeno MV, Berger S, Wu Y, Na X, Liu X, Kondapalli J, Apkarian AV, Martina M, Surmeier DJ (2016) The indirect pathway of the nucleus accumbens shell amplifies neuropathic pain. Nat Neurosci 19(2):220–222PubMedCrossRef
41.
Reynolds GS (1975) A primer of operant conditioning, rev. APA PsycNET
42.
Rossignol M, Rozenberg S, Leclerc A (2009) Epidemiology of low back pain: what’s new? Joint Bone Spine 76:608–613PubMedCrossRef
43.
Ruoff GE, Rosenthal N, Jordan D, Karim R, Kamin M (2003) Tramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study. Clin Ther 25:1123–1141PubMedCrossRef
44.
Schwartz N, Temkin P, Jurado S, Lim BK, Heifets BD, Polepalli JS, Malenka RC (2014) Decreased motivation during chronic pain requires long-term depression in the nucleus accumbens. Science 345:535–542PubMedPubMedCentralCrossRef
45.
Spengler DM, Bigos SJ, Martin NA, Zeh J, Fisher L, Nachemson A (1986) Back injuries in industry: a retrospective study. I. Overview and cost analysis. Spine 11:241–245PubMedCrossRef
46.
van Laarhoven AIM, Vogelaar ML, Wilder-Smith OH, van Riel PLCM, van de Kerkhof PCM, Kraaimaat FW, Evers AWM (2011) Induction of nocebo and placebo effects on itch and pain by verbal suggestions. Pain 152(7):1486–1494PubMedCrossRef
47.
van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 20:19–39PubMedCrossRef
48.
Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abebo TA, Abera SF et al (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. The Lancet 390:1211–1259CrossRef
49.
Wang J-R, Hsieh S (2013) Neurofeedback training improves attention and working memory performance. Clin Neurophysiol 124:2406–2420PubMedCrossRef
50.
Wangler S, Gevensleben H, Albrecht B, Studer P, Rothenberger A, Moll GH, Heinrich H (2011) Neurofeedback in children with ADHD: specific event-related potential findings of a randomized controlled trial. Clin Neurophysiol 122:942–950PubMedCrossRef
51.
Westfall PH, Young SS (1993) Resampling-based multiple testing: examples and methods for p-value adjustment. Wiley, Hoboken
52.
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370PubMedCrossRef
Metadata
Title
Alpha-phase synchrony EEG training for multi-resistant chronic low back pain patients: an open-label pilot study
Authors
Louis Mayaud
Hélène Wu
Quentin Barthélemy
Patrick Favennec
Yannick Delpierre
Marco Congedo
Arnaud Dupeyron
Michel Ritz
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 11/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-019-06051-9

Other articles of this Issue 11/2019

European Spine Journal 11/2019 Go to the issue

Abstracts

EUROSPINE 2019: ePosters

Correction

Correction to: Sagittal balance of the spine

Original Article

An evaluation of contrast dispersal pattern on preganglionic epidural injection through trans-lateral recess approach in patients with lumbosacral radiculopathy

Announcements

Announcements

Original Article

New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data

Abstracts

EUROSPINE 2019: Quick Fires