Evidence map›Paper›PMID 40437825›Full record

Trial reportBrain and behavior2025

Can EEG-Neurofeedback Training Enhance Effective Connectivity in People With Chronic Secondary Musculoskeletal Pain? A Secondary Analysis of a Feasibility Randomized Controlled Clinical Trial.

Jerin Mathew, Divya Bharatkumar Adhia, Mark Llewellyn Smith, Dirk De Ridder, Ramakrishnan Mani

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Brain and behavior, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Jerin MathewCentre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.ORCID https://orcid.org/0000-0001-6002-9815
Divya Bharatkumar AdhiaPain@Otago Research Theme, University of Otago, Dunedin, New Zealand.
Mark Llewellyn SmithNeurofeedback Therapy Services, New York, USA.
Dirk De RidderPain@Otago Research Theme, University of Otago, Dunedin, New Zealand.
Ramakrishnan ManiCentre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.ORCID https://orcid.org/0000-0003-1255-5209

Funding

Centre for Health, Activity, and Rehabilitation Research (CHARR)
6 · The paper itself

Abstract

introductionPersistent musculoskeletal pain is associated with altered functional and effective connectivity (EC) between cortical regions involved in pain processing. Especially, disruptions in the infraslow fluctuation (ISF) frequency band can contribute to pain persistence. ISF electroencephalography-neurofeedback (EEG-NF) has emerged as a potential non-invasive neuromodulatory intervention targeting cortical brain regions to restore balance and modulate pain-related pathways. However, limited research explores its effect on EC, a measure of directional information flow critical to pain experience and modulation.

methodsA secondary analysis was performed using data from a randomized, double-blind, sham-controlled feasibility clinical trial. Participants with chronic painful knee osteoarthritis (OA) were randomized to receive either ISF-NF or sham-NF. Nine neurofeedback sessions targeted the pregenual anterior cingulate cortex (pgACC), dorsal anterior cingulate cortex (dACC), and bilateral primary somatosensory cortex (SSC: S1Lt & S1Rt). EEG data was collected at baseline and post-intervention. Granger causality was used to measure EC changes, and between-group statistical analyses were conducted with adjustments for multiple comparisons.

resultsTwenty-one participants (mean age: 61.7 ± 7.6 years; 62% female) completed the study. ISF-NF training significantly improved EC between pgACC and dACC, pgACC and SSC, and other targeted regions, while reducing EC from S1Rt to dACC. Changes were observed predominantly in the ISF frequency band, indicating enhanced cortical communication and modulation of pain pathways.

conclusionISF-NF training enhanced EC in cortical regions implicated in pain processing, supporting its potential as a neuromodulatory intervention for chronic musculoskeletal pain. Further trials are needed to confirm clinical efficacy and optimize protocol designs.

Indexed as

Chronic PainMusculoskeletal PainNeurofeedbackAgedDouble-Blind MethodElectroencephalographyFeasibility StudiesFemaleGyrus CinguliHumansMaleMiddle AgedOsteoarthritis, KneeSomatosensory Cortexclinical trialEEGeffective connectivityinfraslow fluctuationsknee osteoarthritisneurofeedbackpersistent pain

Identifiers

PMID40437825
PMCPMC12120195

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.