Alpha entrainment drives pain relief using visual stimulation in a sample of chronic pain patients: a proof-of-concept controlled study

Lopez-Diaz, Karen; Henshaw, James; Casson, Alexander J.; Brown, Christopher; Taylor, Jason R.; Trujillo-Barreto, Nelson J.; Arendsen, Laura J.; Jones, Anthony; Sivan, Manoj

doi:10.1097/wnr.0000000000001606

Cited by 10 publications

(12 citation statements)

References 25 publications

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“…If clearer epidemiological and neurobiological links emerge, therapies like biofeedback and entrainment, proven effective for chronic pain (111)(112)(113), may play a role in the management of FS. This is vital considering the current absence of treatments that offer universal or long-term control of not only FS, but also FND as a whole.…”

Section: Discussionmentioning

confidence: 99%

Functional Seizures and Chronic Pain: A Narrative Review of common Pathomechanisms and Clinical Implications

Kannan,

Patel,

Basilio

et al. 2024

Preprint

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Background Functional seizures (FS) manifest as episodic events, bearing superficial similarities to epileptic seizures and represent a major component of Functional Neurological Disorder (FND). FS frequently present with the co-morbidity of chronic pain and the pronounced clinical and epidemiological associations between these conditions suggest potential shared pathomechanisms. Although conventional neuroimaging and neurophysiological assessments do not detect abnormalities in either condition, advanced biophysical signal analyses offer potential biomarkers. Method We undertook comprehensive literature review encompassing studies employing EEG, MEG, functional MRI, PET, and SPECT in FS and chronic pain. Due to the heterogenous nature of the collected data, the results of data extraction and analysis are presented in the form of a narrative synthesis. Results Despite some limitations, altered neural network dynamics are evident in both FS and chronic pain, revealing intriguing common mechanisms. Both conditions exhibit overactivation in sensorimotor networks and alterations in the Default Mode Network (DMN), impacting self-awareness and pain perception. Emotional processing regions, like the anterior cingulate cortex and insula, were affected in both conditions. Furthermore, Thalamocortical dysrhythmia(TCD) offers an intriguing link, influencing pain perception and seizure-like activities. Finally, suppressed alpha oscillations, linked to sensory perception, are prevalent in both conditions. Conclusion We identified shared neural mechanisms and a possible novel explanation (TCD) for co-occurrence of FS and chronic pain. These necessitate further exploration in subsequent studies incorporating patients exhibiting both disorders concurrently. Such research direction holds the potential to introduce novel therapies for not only managing FS or chronic pain, but also managing FND.

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Section: Discussionmentioning

confidence: 99%

Functional Seizures and Chronic Pain: A Narrative Review of common Pathomechanisms and Clinical Implications

Kannan,

Patel,

Basilio

et al. 2024

Preprint

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“…Specifically, whilst neural entrainment of alpha frequencies was effective in reducing pain intensity from experimentally induced acute pain, there was no consistent evidence supporting its use in chronic pain. A recent study 41 published after our search period extended Arendsen et al’s 30 study by testing eight additional volunteers, thereby increasing statistical power. This study provided evidence that visual alpha entrainment may reduce pain intensity ratings for those with chronic pain.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to acute pain, the findings by Arensden et al 30 suggest that 10 Hz visual entrainment may not be effective in reducing pain intensity in patients with chronic musculoskeletal pain. This study may be underpowered (see 41 ). It may also be possible that chronic-pain-induced neural changes can influence the efficacy of alpha entrainment in reducing pain.…”

Section: Discussionmentioning

confidence: 99%

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The efficacy of sensory neural entrainment on acute and chronic pain: A systematic review and meta-analysis

Maddison

Nazar

Obara

et al. 2022

British Journal of Pain

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Background Changes to the power of neural oscillations in cortical and sub-cortical structures can change pain perception. Rhythmic sensory stimulation is a non-invasive method that can increase power in specific frequencies of neural oscillations. If the stimulation frequency targets those frequencies related to pain perception, such as alpha or theta frequencies, there can be a reduction in perceived pain intensity. Thus, sensory neural entrainment may provide an alternative to pharmacological intervention for acute and chronic pain. This review aimed to identify and critically appraise the evidence on the effectiveness of sensory entrainment methods for pain perception. Methods We undertook a systematic search across Medline, Embase, PsycInfo, Web of Science and Scopus in November 2020 to identify studies investigating the efficacy of sensory entrainment on adults. We assessed studies for their quality using the PRISMA checklist. A random-effects model was used in a meta-analysis to measure the effect of entrainment on pain perception. Results Our systematic review yielded nine studies fitting the search criteria. Studies investigated the effect of visual and auditory entrainment on pain intensity rating, electrophysiological markers of pain and amount of analgesia needed during surgery. The meta-analysis suggests that alpha (8–13 Hz) sensory entrainment is effective for acute pain perception, whereas theta (4–7 Hz) entrainment is effective for chronic pain. Conclusions Although there is heterogeneity in the current evidence, our review highlights the potential use of sensory entrainment to affect acute and chronic pain. Further research is required regarding the timing, duration and frequency of the stimulation to determine the best application for maximum efficacy.

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“…Sensorimotor PAF has been reported as a reliable biomarker of subjective pain intensity and pain sensitivity, with slower PAF possibly reflecting pre-disease pain sensitivity (Babiloni et al, 2006 ; Furman et al, 2018 , 2019 , 2020 ) or marking a ‘chronification’ process of pain (de Vries et al, 2013 ). Targeted modulation of alpha activity through visual stimulation, as well as transcranial alternating or direct current stimulation, also has been associated with chronic pain relief (Ahn, Prim, Alexander, McCulloch, & Fröhlich, 2019 ; Arendsen, Hugh-Jones, & Lloyd, 2018 ; Lopez-Diaz et al, 2021 ). Recent evidence indicates that alpha synchrony between relevant networks enables feedforward/feedback processing and flexible routing of information in the integration of sensory and contextual processes (Kim & Davis, 2020 ; Kisler et al, 2020 ; Ploner et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation treatment of major depressive disorder and comorbid chronic pain: response rates and neurophysiologic biomarkers

Corlier¹,

Tadayonnejad

Wilson³

et al. 2021

Psychol. Med.

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Background Major depressive disorder (MDD) and chronic pain are highly comorbid, and pain symptoms are associated with a poorer response to antidepressant medication treatment. It is unclear whether comorbid pain also is associated with a poorer response to treatment with repetitive transcranial magnetic stimulation (rTMS). Methods 162 MDD subjects received 30 sessions of 10 Hz rTMS treatment administered to the left dorsolateral prefrontal cortex (DLPFC) with depression and pain symptoms measured before and after treatment. For a subset of 96 patients, a resting-state electroencephalogram (EEG) was recorded at baseline. Clinical outcome was compared between subjects with and without comorbid pain, and the relationships among outcome, pain severity, individual peak alpha frequency (PAF), and PAF phase-coherence in the EEG were examined. Results 64.8% of all subjects reported pain, and both depressive and pain symptoms were significantly reduced after rTMS treatment, irrespective of age or gender. Patients with severe pain were 27% less likely to respond to MDD treatment than pain-free individuals. PAF was positively associated with pain severity. PAF phase-coherence in the somatosensory and default mode networks was significantly lower for MDD subjects with pain who failed to respond to MDD treatment. Conclusions Pain symptoms improved after rTMS to left DLPFC in MDD irrespective of age or gender, although the presence of chronic pain symptoms reduced the likelihood of treatment response. Individual PAF and baseline phase-coherence in the sensorimotor and midline regions may represent predictors of rTMS treatment outcome in comorbid pain and MDD.

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Alpha entrainment drives pain relief using visual stimulation in a sample of chronic pain patients: a proof-of-concept controlled study

Cited by 10 publications

References 25 publications

Functional Seizures and Chronic Pain: A Narrative Review of common Pathomechanisms and Clinical Implications

Functional Seizures and Chronic Pain: A Narrative Review of common Pathomechanisms and Clinical Implications

The efficacy of sensory neural entrainment on acute and chronic pain: A systematic review and meta-analysis

Repetitive transcranial magnetic stimulation treatment of major depressive disorder and comorbid chronic pain: response rates and neurophysiologic biomarkers

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