Starts:

Friday, September 23rd
10:45am-12:15pm EDT

Category:

Topical Workshop

Tracks:

Treatment/Management

Room

715 B

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Non-Invasive Neuromodulation of Brain Rhythms – How Can We Translate Basic Insights into Novel Pain Treatments?

Neuronal oscillations, or brain rhythms, are a basic feature of neuronal signaling and communication. They can be recorded at different locations and frequencies from very low frequencies below 1 Hz up to 100 Hz. Recent studies in animals and humans have provided converging evidence that brain rhythms play a crucial role in the processing of pain. Moreover, evidence accumulates that abnormal brain rhythms figure prominently in the pathology of chronic pain. These basic science insights open up entirely novel perspectives for the treatment of pain by modulating brain rhythms. The current workshop will provide an up-to-date overview of novel treatment strategies of pain based on the non-invasive modulation of brain rhythms. We will specifically discuss most recent findings indicating how emerging transcranial alternating current stimulation (tACS) techniques, refined neurofeedback protocols, and sensory entrainment approaches can be used for the treatment of pain. Thus, the workshop will show how neuroscientific insights can translate into urgently needed novel therapeutic strategies for chronic pain.

Presentations

Time
10:45am EDT–12:15pm EDT

Analgesic Effects of Alpha Rhythm Entrainment Through Passive Visual Stimulation

Tracks: Treatment/Management
Categories: Topical Workshop
Presented By: Dr. Christopher A. Brown

The cortical alpha rhythm (7-14Hz) plays a central role in the top-down control (or “gating”) of somatosensory information. Based on knowledge that acute noxious stimuli induce a suppression of cortical alpha rhythms, we investigated whether therapeutically augmenting alpha rhythms have analgesic effects. The cortical alpha rhythm was augmented using external sensory stimuli using a process known as entrainment, in which neural oscillations naturally adapt to the frequency of the driving stimulus. In particular, visual entrainment at 10Hz can be observed widely throughout the cortex, potentially impacting the top-down modulation of nociceptive processing. Our studies provided the first evidence that visual alpha entrainment reduces the perceived intensity of experimental pain and suppresses acute nociceptive processing. EEG source modelling revealed that increased alpha power and decreased nociceptive processing overlapped in precuneus and posterior cingulate cortex, with further reductions in nociceptive processing in insula cortex. Extending this work, we conducted a proof-of-concept controlled study in 28 patients with chronic pain comparing 10 Hz (alpha) and 7 Hz (control) frequency blocks in a randomized cross-over design. Frontal alpha power increased when stimulating at 10 Hz when compared to 7 Hz, correlating with a reduction in chronic pain intensity and unpleasantness.

10:45am EDT–12:15pm EDT

Brain Rhythms and Pain

Tracks: Treatment/Management
Categories: Topical Workshop
Presented By: Prof. Markus Ploner

The chair will provide a brief introduction on the role of neuronal oscillations (or brain rhythms) in the brain processing of pain. This will provide the rationale for the three main presentations on different non-invasive neuromodulation techniques to modulate brain rhythms for the treatment of pain.

10:45am EDT–12:15pm EDT

Neurofeedback as a Tool to Understand and Manage Pain

Tracks: Treatment/Management
Categories: Topical Workshop
Presented By: Vanessa Hohn

EEG-based Neurofeedback is a well-established neuromodulatory approach which is increasingly used to identify causal relationships between oscillatory brain activity and behavior and perception. Moreover, it has been proposed to support the treatment of various neuropsychiatric disorders including pain. Neurofeedback is, however, associated with significant methodological challenges including blinding and the use of appropriate control conditions. Most likely, these challenges have contributed to the large variability in previous findings and could partially explain why a consensus regarding the efficacy of neurofeedback for pain management is still lacking. To address these shortcomings, an interdisciplinary board of leading scientists recently published guidelines on the conduct and reporting of neurofeedback studies (CredNF checklist). In combination with other open science practices, these can aid the development of robust experimental designs and help to further explore the potential of neurofeedback as a tool to understand and manage pain. In my talk, I will provide an overview of previous pain-related neurofeedback studies and introduce the CredNF checklist. Building on these insights, I will present first data from a current study conducted at the PainLabMunich, which exemplifies how open science practices can improve the study of pain using neurofeedback.

10:45am EDT–12:15pm EDT

Targeting Impaired Alpha Oscillations in Chronic Pain with Transcranial Alternating Current Stimulation

Tracks: Treatment/Management
Categories: Topical Workshop
Presented By: Flavio Frohlich

Alpha oscillations are a fundamental human brain rhythm that modulates engagement of cortical circuits with afferent input. We hypothesized that chronic low back pain is reflected in a pathological hyperexcitability of sensory-motor circuits that can be detected by EEG as a downregulation of alpha oscillations. We further hypothesized that tACS at 10 Hz (in the alpha frequency) can be used to restore these impaired alpha oscillations and thereby reduce the pain symptoms. To test these hypotheses, we performed a pilot double-blind placebo-controlled study in people with chronic low back pain. We found that pain symptoms correlated with impairment of alpha oscillations at baseline. Importantly, alpha-tACS enhanced and restored these alpha oscillations, which correlated with improved pain ratings. More studies are urgently needed to replicate and expand on our findings. Next-generation tACS strategies that use individualized stimulation waveforms and real-time feedback may further increase efficacy of this approach. Studies of multiday stimulation paradigms as we have recently used in clinical trials of tACS for the treatment of depression and schizophrenia represent a further, highly promising avenue towards targeted non-pharmacological treatments for chronic pain by modulating brain rhythms.

Presenters

Dr. Christopher A. Brown

Senior Lecturer
University of Liverpool

Flavio Frohlich

Professor
UNC – Chapel Hill

Vanessa Hohn

PhD student
Technical University of Munich

Prof. Markus Ploner

Professor of Human Pain Research
Technical University of Munich