Discussion
chronic pain, disability, pain
CHRONIC PAIN, SECONDARY, RECRUITMENT
Re-training cortical activity through real-time EEG-based source localised ISF-NF is a novel approach for treatment of chronic painOur results demonstrate that a fully powered trial to test efficacy of EEG-based ISF-NF training for treatment of CLBP is feasible. A sizable number of individuals with CLBP were interested and willing to participate in EEG-NF intervention. Our recruitment rate was comparable to other CLBP intervention studiesStudy findings also confirms safety of EEG-based ISF-NF training for treatment of CLBP. Our study used an extensive DESS scaleAlthough treatment was acceptable and participants were moderate-to-highly satisfied, some important recommendations were made. A few participants indicated that they were unsure of mental strategies to use and would have benefited from some examples. While some studiesExploratory findings on clinical measures demonstrated a decreasing trend in pain and disability in all treatment groups. Our results are comparable to the previous NF studies in chronic pain conditions, who also demonstrated significant reductions in pain and disability following trainingOur pilot study results showed that ISF-NF treatment targeting pgACC had the highest proportion of participants who exhibited sustained clinically meaningful decrease in both pain and disability and had improved global perceived effect at 1-month follow-up. EEG FC measures also demonstrated highest magnitude of changes in the pgACC group, demonstrating the specificity of EEG-NF training. Further, in a recent secondary analysis of our data, we also demonstrate that the ISF-NF uptraining the pgACC increases the effective connectivity from the pgACC to SSC and this is correlated with greater reductions in pain severityThe greatest clinical effects demonstrated in the pgACC uptraining group could also be attributed to the simplicity of the protocol and ease in learning (i.e., uptraining CD of a single brain region). Previous NF studies in chronic pain conditions have demonstrated that complex training protocols (e.g., adding beta down training to the protocol of uptraining of sensorimotor rhythm and down training of theta) reduced training effectiveness, and increasing the number of training sessions increased pain reduction for such protocolsWe also observed a time course effect in several clinical measures, where the pain and function continued to improve over time. These findings have also been observed previously