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Neurofeedback for Management of Musculoskeletal Pain: A Randomized Control Trial Using DOMS
Katrine Aagaard Gregersen1, Julie Brink Vilsøe2, Felipe Rettore Andreis1
1Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark, aau.dk.
Introduction:
Chronic musculoskeletal (MSK) pain is associated with maladaptive neuroplasticity, often reflected in altered alpha activity (8-13 Hz). Neurofeedback may offer a way to modulate this activity, yet most protocols target alpha activity during rest, despite movement being a common pain trigger. This study investigated whether neurofeedback during movement could modulate alpha activity and reduce pain in healthy individuals experiencing induced pain via delayed onset muscle soreness (DOMS).
Method:
This experiment was a randomized, two-armed, parallel-group trial. Twenty-nine participants were included (15 females, mean age = 28 years). Exclusions included neurological, psychiatric, MSK conditions. Participants were randomly assigned to an intervention group (aiming to reduce alpha activity) or a control group (aiming to increase it). Alpha activity was assessed as the alpha power during rest and movement. DOMS was induced using eccentric exercise of muscle extensor carpi radialis in Session 1. Neurofeedback was administered in Session 2, where participants underwent three blocks of neurofeedback training, using individualized EEG-based visual feedback to modulate alpha activity. Session 3 assessed potential lasting neurofeedback effects. Pain was rated across the three sessions, which took place 24-48 h apart.
Results:
DOMS induction was confirmed by increased pain (p < 0.001, r = 0.82) and reduced alpha activity during movement (p = 0.017, r = 0.49). Neurofeedback did not significantly alter alpha activity (p = 0.114, W = 0.05 for the control group, p = 0.338, W = 0.037 for the intervention group).
Conclusion:
A single neurofeedback session was insufficient to modulate brain activity or pain perception. Methodological factors, including limited training duration and participants' strategies, may have contributed to the lack of an observable effect.
Significance:
Although neurofeedback did not result in significant changes after one session, the observed alpha modulation following DOMS highlights the relevance of targeting neuroplasticity during MSK pain. Future studies should optimize training protocols and consider multisession designs to enhance clinical applicability.
