Duschek S. "Modulation of brain activity to alleviate pain“ (Spanisches Ministerium für Wissenschaft und Innovation)

Principal Investigator: Pedro Montoya Jimenez (Universität der Balearischen Inseln)

Cooperation partner: Universität Valencia (Beatriz Rey), Universität Granada (M. Munoz), UMIT TIROL (S. Duschek), Institut für Medizinische Psychologie und Verhaltensneurobiologie (N. Birbaumer)

Amount of funding: € 200.000,--

Project period: 03/2015 - 02/2019

Chronic pain is the primary reason people seek medical care, but also one of the largest economic burden for the health system in the developed world. Nevertheless, current therapies are yet either inadequate for certain types of pain (e.g., fibromyalgia) or cause intolerable side effects (e.g., opioids). Understanding the neurophysiological basis of pain is crucial for the assessment and management of chronic pain. In the last decade, pain research has identified plastic changes in the brain as a key factor for the maintenance of pain over time. Thus, our research and findings from several labs have shown that chronic pain patients display an abnormal brain processing of bodily information and that negative emotional states may alter brain functioning and amplify suffering associated with pain. On the other hand, it has been suggested that strengthening emotion regulation skills through positive reappraisal and suppression of negative emotions as it is used in cognitive-behavior therapy or mindfulness may help to regulate pain and emotion in chronic pain patients. However, brain mechanisms involved in those regulatory processes should be still elucidated, before it can be transferred into clinical practice. In this context, recent findings have demonstrated that individuals can be trained to gain voluntary control of brain activity with high specificity by operant training. Thus, it could be very helpful to analyze the possibility of whether chronic pain patients could be also trained to volitionally regulate brain functioning to enhance the modulatory influence of specific brain areas over pain and, thus, to alleviate pain perception. This research aims to analyze the feasibility of neurofeedback training to self-regulate different parameters of the brain activity extracted by using three recording techniques (fMRI, EEG, transcranial Doppler sonography) to reduce pain in healthy controls and chronic pain patients. For this purpose, we will test the effects of the neurofeedback training by comparing pain intensity, pain unpleasantness, pain sensitivity and brain activity at rest before and after the training. The coordinated project is aimed to examine the following two main objectives: 1) To assess the feasibility of different extraction methods to characterize brain activity at rest, and to analyze its clinical application for neurofeedback training with chronic pain patients and healthy controls. 2) To compare the effects the different neurofeedback training protocols on pain and brain activity by analyzing the possible covariation among the different parameters of the brain activity and its relevance for the alleviation of chronic pain. In summary, the coordinated research project will provide important insights into the causal links between specific patterns of neural activity and pain perception, and will open fascinating perspectives on the possibility to modulate self-regulation of brain processes by operant training for alleviating pain in chronic pain patients. Such results could have a major impact on current theories about plastic changes associated with the maintenance of pain over time. By doing so, this research will also be instrumental in developing innovative treatments for chronic pain.