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Low-Frequency Fluctuation Changes in Low Back Pain Patients Post EEG Alpha-Wave Synchronization

Presented During: Poster Session 3
Friday, June 27, 2025: 01:45 PM - 03:45 PM

Presented During: Poster Session 4
Saturday, June 28, 2025: 01:45 PM - 03:45 PM

Poster No:

2039

Submission Type:

Abstract Submission

Authors:

Fabricio Pereira¹, Adel Hachache², Yohan Attal³, Jean Paul Beregi⁴, Alexis Hom⁵, Arnaud Dupeyron⁴

Institutions:

¹University of Nimes, Nîmes, France, ²University of Nimes, Nimes, France, ³Cyrebro Neurosignals, Paris, France, ⁴CHU of Nimes, Nimes, France, ⁵CHU of Nimes, Nime, France

First Author:

Fabricio Pereira
University of Nimes
Nîmes, France

Co-Author(s):

Adel Hachache
University of Nimes
Nimes, France

Yohan Attal
Cyrebro Neurosignals
Paris, France

Jean Paul Beregi
CHU of Nimes
Nimes, France

Alexis Hom
CHU of Nimes
Nime, France

Arnaud Dupeyron
CHU of Nimes
Nimes, France

Introduction:

Low-back pain (LBP) is a common pathological condition, affecting approximately 23% of people and standing as a leading musculoskeletal disorder with a prevalence rate of 84%. This condition is marked by discomfort ranging from the T12 to S1 vertebrae, without a clearly identifiable pathological source. LBP occurs in three phases: the acute phase, which is a short episode lasting less than six weeks; the sub-acute phase, lasting from six to twelve weeks; and the chronic stage. Chronic low back pain (cLBP) is characterized by ongoing pain lasting more than three months, significantly impacting daily activities and work responsibilities. Prior studies have suggested that an increased power of alpha waves, which are neural oscillations in the 8 to 12 Hz range, may reduce pain intensity. Therefore, inducing alpha waves in individuals with cLBP could potentially enhance pain management, although the precise mechanisms remain a subject of ongoing research. In this longitudinal study, quantitative EEG was employed to induce alpha-wave synchronization in patients with cLBP through daily neurofeedback sessions. These patients were followed up with two fMRI to assess changes in brain connectivity

Methods:

The study was registered as Trial #NCT03929952, and all participants provided informed consent. Fifteen patients diagnosed with cLBP, aged 28 to 58 years, were enrolled. Their pain intensity, rated higher than 5 on the Visual Analog Scale (VAS), significantly impacted their daily functionality, as indicated by high scores on the Oswestry Disability Index (ODI). During the study, participants engaged in daily 30-minute sessions of an EEG-based closed-loop neurofeedback program for 30 consecutive days, focusing on a visual stimulus resembling a flame while real-time alpha-wave power was computed. They were rewarded based on achieving predominant EEG frequencies between 7 and 14 Hz. The collected EEG data underwent preprocessing, including file conversion, band-pass filtering, Independent Component Analysis (ICA), brain map generation, normalization, and statistical analyses, examining changes in alpha synchrony and its correlation with clinical assessments. Resting-state fMRI sessions were performed on both the initial and final days of the neurofeedback training. The imaging data were processed for noise mitigation following the Enigma protocol. The fractional Amplitude of Low-Frequency Fluctuations (fALFF) was computed using the AFNI toolbox. To assess the mean changes before and after the neurofeedback program, permutation tests were utilized.

Results:

Four brain regions had a significant increase in fALFF. Right Perirhinal Cortex [MNI: 22, 6, -32] (Fig.A), although known for its role in memory and sensory integration, recent studies have suggested its contribution to the emotional and cognitive aspects of pain by forming associations between environmental cues and painful experiences. Right Thalamus [MNI: 8, -4, -12] (Fig.B) acts as a central hub in pain processing, serving as a sensory relay that transmits nociceptive signals from the spinal cord and brainstem to the somatosensory cortex. It integrates these signals with inputs from emotional and cognitive brain regions, modulating pain perception and contributing to the conscious awareness of pain. Bilateral prefrontal cortex (Brodmann Area 9/46) [MNI: 38, 34, 20] (Fig.C) and [MNI: -56, 16, 36] (Fig.D) plays a crucial role in pain processing by modulating cognitive and emotional responses to pain, influencing attention and perception, and aiding in decision-making and behavioral responses related to pain management. These regions regulate emotional reactions to pain by interacting with other brain regions involved in emotion, and their involvement in cognitive strategies

·Modulation of Spontaneous Neural Activity through Alpha-Wave Synchronization in cLBP Patients

Conclusions:

These results suggest that alpha-wave synchronization can modulate spontaneous neural activity in cLBP patients. This approach could lead to innovative, non-invasive interventions that may improve patient outcomes and quality of life

Brain Stimulation:

Non-Invasive Stimulation Methods Other ²

Perception, Attention and Motor Behavior:

Perception: Pain and Visceral ¹

Keywords:

Electroencephaolography (EEG)

FUNCTIONAL MRI

Pain

Other - Neurofeedback

^1|2Indicates the priority used for review

Abstract Information

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Resting state

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Patients

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Were any human subjects research approved by the relevant Institutional Review Board or ethics panel? NOTE: Any human subjects studies without IRB approval will be automatically rejected.

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Functional MRI

EEG/ERP

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3.0T

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AFNI

FSL

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