Neurofeedback and attention modulate somatosensory alpha oscillations but not pain perception

Pain is closely linked to alpha oscillations (8 < 13 Hz) which are thought to represent a supra-modal, top-down mediated gating mechanism that shapes sensory processing. Consequently, alpha oscillations might also shape the cerebral processing of nociceptive input and eventually the perception of pain. To test this mechanistic hypothesis, we designed a sham-controlled and double-blind electroencephalography (EEG)-based neurofeedback study. In a short-term neurofeedback training protocol, healthy participants learned to up- and down-regulate somatosensory alpha oscillations using attention. Subsequently, we investigated how this manipulation impacts experimental pain applied during neurofeedback. Using Bayesian statistics and mediation analysis, we aimed to test whether alpha oscillations mediate attention effects on pain perception. The results showed that attention and neurofeedback successfully up- and down-regulated the asymmetry of somatosensory alpha oscillations. However, attention and neurofeedback did not modulate pain ratings or related brain responses. Accordingly, somatosensory alpha oscillations did not mediate attention effects on pain perception. Thus, our results challenge the hypothesis that somatosensory alpha oscillations shape pain perception. A causal relationship between alpha oscillations and pain perception might not exist or be more complex than hypothesized. Trial registration: Following Stage 1 acceptance, the study was registered at ClinicalTrials.gov NCT05570695.