Neurofeedback for chronic pain management
Published 26th May, 2021 by REDO
A brand-new practice has the potential to revolutionize the treatment of chronic pain. The method is known as neurofeedback, which can potentially relieve thousands of people of daily pain and save society great expenses.
Estimated reading time 8 minutes
Pain is individual
Thousands of Danes need pain-relieving treatment for chronic muscle- and joint-pain. People are different; our bodies react individually towards pain impulses and the medication, meant to ease the pain, also affects each individual differently. People, who suffer from chronic pain, may experience lack of sufficient pain-relief - or worse - they may experience adverse effects of the accessible medicine. A novel treatment paradigm may offer an alternative to the expensive, and often insufficient pharmaceutical treatment.
What is neurofeedback?
Neurofeedback is a method, which measures brain activity in real-time to train the brain’s ability to gradually regulate adverse behavior, as, for example, an oversensitive pain response.
The researchers Natalie Mrachacz-Kersting and Sabata Gervasio from Dortmund and Aalborg University, respectively, have released several independent publications, which proves a connection between pain reaction and a certain brain activity, known as “alpha-activity”. Alpha-activity can be described as the brain’s “pulse at rest” and it can be characterized as communication between Thalamus and the somatosensory cortex, which processes sensory impulses - including pain. Alpha-activity studies suggest that people, who suffer from chronic pain often have an altered alpha-activity, compared to people without chronic pain.
One form of neurofeedback is to measure alpha-activity and use the results to train the patient’s experience of pain. Scientists have proved an established connection between high levels of alpha-activity and a “dormant” nervous system. This is why we often see a reduced alpha-activity with people, who suffer from chronic pain because their nervous systems are often in “alert mode”
Neurofeedback is able to measure the activity in that specific part of the brain, which handles pain treatment in a particular body part. This is important to teach patients self-manipulating of sensation of pain; the objective is to train the patients’ alpha-activity, to regulate their pain experience towards a level similar to people without chronic pain. The concept is based on a well-renowned psychological approach, the so-called operant conditioning.
The word “operant” comes from the Latin operari: (to work) and operant conditioning is built upon a behavioral-psychological connection between an action/stimulus and a consequence - within behavioral psychology known as enhancer. Perhaps you have heard the story of Pavlov’s dogs, who were taught to connect the sound of a bell with a reward. The concept of RELEARN is, somewhat, similar; The patient does a line of exercises, which triggers a (painful) stimuli. By creating a visual image of how the patient’s brain responds to pain, the patient will, gradually, learn to produce a more appropriate pain response.
How does RELEARN work?
RELEARN offers the possibility to train the patient’s pain response, the same way a heart rate monitor watch can help you target your workout and improve your fitness. The treatment takes place at a healthcare-clinic where an EEG-cap is applied to the patient’s head and electrodes are applied to the patient’s area of pain affliction (e.g., the elbow).
The patient experiences pain-stimuli by performing multiple exercises that triggers a pain response, which is visualized on a screen. Neurofeedback will be administered for a number of sessions, wherein the patient may gradually learn to control their pain response by reading feedback while performing exercises. The regimen is not a quick fix, but may over time help the patient reduce their pain. Do you want to know more about chronic pain, click here!
The psychology behind pain
The psychological behavior is an important element of chronic pain, as people, suffering from chronic pain often, quite subconsciously, will adapt to the pain by changing their behavior in their daily lives. If one suffers from pain in the right foot, for example, one might compensate by using the left foot. In this way, operant behavior does not differ much from what you could call a habit. This also explains why people with, (especially) muscle- and joint pain quickly adapt new (bad) behavioral habits, to compensate for the pain.
The complex nervous system
Our bodies are advanced networks, which use nerve cells to send signals between the brain and the muscles, organs, and the skin. The nerve cells which deal with our sensory impulses are known as nociceptors. Nociceptors are found in the peripheral nervous system, meaning our limbs and skin. When we experience, e.g., tissue damage or enhanced heat, the nociceptors pass the signal on to the spinal cord, a part of the central nervous system. From here, the signal is transmitted to the pain centres of the pain. Only when the signal reaches the core area of the brain known as Thalamus, does the brain begin to interpret what type of signal is transmitted. Thalamus functions as the brain’s “relay station”, which transmits signals from the spinal cord to the cortex. Pain is, thus, a result of how the brain processes the electrical impulses of the nociceptors.
When we continuously experience pain over a longer period of time, our nervous system will begin to adapt to its new environment. When this adaptation has been going on for too long, changes manifest as the nervous system will begin to react adversely towards the experienced pain. Frequently, when a person is diagnosed with chronic pain, their entire nervous system is sensitized. This means that the person will experience pain, however, the measures, which the body normally implements to relieve pain, do not work. A smaller pain impulse, e.g., a simple touch, will, simultaneously, start a greater pain reaction, simply because the patient’s nervous system is sensitized, and the pain may spread to other parts of the body.