BACKGROUND Chronic neuropathic pain associated with peripheral neuropathies cannot be attributed solely to lesions of peripheral sensory axons and likely involves alteration in the processing of nociceptive information in the central nervous system in most patients. Few data are available regarding EEG correlates of chronic neuropathic pain. The fact is that effective cortical neuromodulation strategies to treat neuropathic pain target the precentral cortical region, i.e. a cortical area corresponding to the motor cortex. It is not known how these strategies might modulate brain rhythms in the central cortical region, but it can be speculated that sensorimotor rhythms (SMRs) are modified. Another potent way of modulating cortical rhythms is to use EEG-based neurofeedback (NFB). Rare studies previously aimed at relieving neuropathic pain using EEG-NFB training. METHODS/DESIGN The objective of this single-centre, single-blinded, randomized controlled pilot study is to assess the value of an EEG-NFB procedure to relieve chronic neuropathic pain in patients with painful peripheral neuropathy. A series of 32 patients will be randomly assigned to one of the two following EEG-NFB protocols, aimed at increasing either the low-β(SMR)/high-β ratio (n=16) or the α(μ)/θ ratio (n=16) at central (rolandic) cortical level. Various clinical outcome measures will be collected before and one week after 12 EEG-NFB sessions performed over 4weeks. Resting-state EEG will also be recorded immediately before and after each NFB session. The primary endpoint will be the change in the impact of pain on patient's daily functioning, as assessed on the Interference Scale of the short form of the Brief Pain Inventory. DISCUSSION The value of EEG-NFB procedures to relieve neuropathic pain has been rarely studied. This pilot study will attempt to show the value of endogenous modulation of brain rhythms in the central (rolandic) region in the frequency band corresponding to the frequency of stimulation currently used by therapeutic motor cortex stimulation. In the case of significant clinical benefit produced by the low-β(SMR)/high-β ratio increasing strategy, this work could pave the way for using EEG-NFB training within the armamentarium of neuropathic pain therapy.

中文翻译：

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通过基于EEG的神经反馈，通过增加中枢皮质区域中的低β活性高于高β活性的功率比来缓解周围神经性疼痛：一项受控先导试验的研究方案（SMRPain研究）。

背景技术与周围神经病相关的慢性神经性疼痛不能仅归因于周围感觉轴突的损伤，并且可能涉及大多数患者中枢神经系统中伤害性信息处理的改变。关于慢性神经性疼痛的脑电图相关性的数据很少。事实是，治疗神经性疼痛的有效皮层神经调节策略以中央前皮层区域（即与运动皮层相对应的皮层区域）为目标。尚不清楚这些策略如何调节中央皮层区域的脑节律，但可以推测感觉运动节律（SMRs）已被改变。调节皮质节律的另一种有效方法是使用基于EEG的神经反馈（NFB）。以前很少有研究旨在通过EEG-NFB训练减轻神经性疼痛。方法/设计这项单中心，单盲，随机对照试验研究的目的是评估EEG-NFB手术对减轻周围神经病患者的慢性神经痛的价值。一系列32位患者将被随机分配到以下两个EEG-NFB方案中的一个，旨在提高低β（SMR）/高β比（n = 16）或α（μ）/θ比（n = 16）在皮质中枢（水平）。在4周内进行12次EEG-NFB疗程之前和之后的一周，将收集各种临床结果指标。在每个NFB会话之前和之后，还将立即记录静止状态的EEG。主要终点将是疼痛对患者日常功能的影响的变化，根据简短痛苦清单的简短形式的干扰量表进行评估。讨论很少研究EEG-NFB手术减轻神经性疼痛的价值。这项初步研究将尝试显示在与治疗性运动皮层刺激目前使用的刺激频率相对应的频带的中央（大脑）区域内脑节律的内源性调节值。在通过低β（SMR）/高β比增加策略产生显着临床益处的情况下，这项工作可以为在神经性疼痛疗法的武器库中使用EEG-NFB训练铺平道路。这项初步研究将尝试显示在与治疗性运动皮层刺激目前使用的刺激频率相对应的频带的中央（大脑）区域内脑节律的内源性调节值。在通过低β（SMR）/高β比增加策略产生显着临床益处的情况下，这项工作可以为在神经性疼痛疗法的武器库中使用EEG-NFB训练铺平道路。这项初步研究将尝试显示在与治疗性运动皮层刺激目前使用的刺激频率相对应的频带的中央（大脑）区域内脑节律的内源性调节值。在通过低β（SMR）/高β比增加策略产生显着临床益处的情况下，这项工作可以为在神经性疼痛疗法的武器库中使用EEG-NFB训练铺平道路。