pain intensity
Research Papers
Neuroscience Education as Therapy for Migraine and Overlapping Pain Conditions: A Scoping Review
BACKGROUND: Neuroscience education therapy (NET) has been successfully used for numerous overlapping pain conditions, but few studies have investigated NET for migraine. OBJECTIVE: We sought to 1) review the literature on NET used for the treatment of various pain conditions to assess how NET has been studied thus far and 2) recommend considerations for future research of NET for the treatment of migraine. DESIGN/METHODS: Following the PRISMA guideline for scoping reviews, co-author (TR), a medical librarian, searched the MEDLINE, PsychInfo, Embase, and Cochrane Central Clinical Trials Registry databases for peer-reviewed articles describing NET to treat migraine and other chronic pain conditions. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS: Overall, a NET curriculum consists of the following topics: pain does not equate to injury, pain is generated in the brain, perception, genetics, reward systems, fear, brain plasticity, and placebo/nocebo effects. Delivered through individual, group, or a combination of individual and group sessions, NET treatments often incorporate exercise programs and/or components of other evidence-based behavioral treatments. NET has significantly reduced catastrophizing, kinesiophobia, pain intensity, and disability in overlapping pain conditions. In migraine-specific studies, when implemented together with traditional pharmacological treatments, NET has emerged as a promising therapy by reducing migraine days, pain intensity and duration, and acute medication intake. CONCLUSION: NET is an established treatment for pain conditions, and future research should focus on refining NET for migraine, examining delivery modality, dosage, components of other behavioral therapies to integrate, and migraine-specific NET curricula.
View Full Paper →Efficacy of EMG- and EEG-Biofeedback in Fibromyalgia Syndrome: A Meta-Analysis and a Systematic Review of Randomized Controlled Trials
Objectives . Biofeedback (BFB) is an established intervention in the rehabilitation of headache and other pain disorders. Little is known about this treatment option for fibromyalgia syndrome (FMS). The aim of the present review is to integrate and critically evaluate the evidence regarding the efficacy of biofeedback for FMS. Methods . We conducted a literature search using Pubmed, clinicaltrials.gov (National Institute of Health), Cochrane Central Register of Controlled Trials, PsycINFO, SCOPUS, and manual searches. The effect size estimates were calculated using a random-effects model. Results . The literature search produced 123 unique citations. One hundred sixteen records were excluded. The meta-analysis included seven studies (321 patients) on EEG-Biofeedback and EMG-Biofeedback. In comparison to control groups, biofeedback (BFB) significantly reduced pain intensity with a large effect size (; 95% CI: 0.22–1.36). Subgroup analyses revealed that only EMG-BFB and not EEG-BFB significantly reduced pain intensity in comparison to control groups (; 95% CI: 0.11–1.62). BFB did not reduce sleep problems, depression, fatigue, or health-related quality of life in comparison to a control group. Discussion . The interpretation of the results is limited because of a lack of studies on the long-term effects of EMG-BFB in FMS. Further research should focus on the long-term efficacy of BFB in fibromyalgia and on the identification of predictors of treatment response.
View Full Paper →Neurofeedback Treatment for Pain Associated with Complex Regional Pain Syndrome Type I
Introduction. Complex Regional Pain Syndrome Type I (CRPS-I) is a devastating pain condition that is refractory to standard care. Preliminary evidence suggests the possibility that neurofeedback training might benefit patients with chronic pain, including patients with CRPS-I. The current study sought to address the need for more information about the effects of neurofeedback on pain in persons with chronic pain by (1) determining the average decrease in pain in patients with CRPS-I following neurofeedback training, (2) identifying the percent of patients reporting pain decreases that are clinically meaningful, and (3) documenting other benefits of neurofeedback training. Method. Eighteen individuals with CRPS-I participating in a multidisciplinary treatment program were administered 0-10 numerical rating scale measures of pain intensity at their primary pain site, as well as pain at other sites and other symptoms, before and after a 30 minute neurofeedback training session. A series of t-tests were performed to determine the significance of any changes in symptoms observed. We also computed the effect sizes and percent change associated with the observed changes in order to help interpret the magnitude of observed improvements in symptoms. Results. There was a substantial and statistically significant pre- to post-session decrease in pain intensity at the primary pain site on average, with half of the study participants reporting changes in pain intensity that were clinically meaningful. Five of seven secondary outcome measures also showed statistically significant improvements following neurofeedback treatment. Conclusions. The findings suggest that many patients who receive neurofeedback training report significant and substantial short-term reductions in their experience of pain, as well as improvements in a number of other pain- and nonpain-specific symptoms. The findings support the need for additional research to further examine the long-term effects and mechanisms of neurofeedback training for patients with chronic pain.
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