Alpha-phase synchrony EEG training for multi-resistant chronic low back pain patients: an open-label pilot study

Eur Spine J. 2019 Nov;28(11):2487-2501. doi: 10.1007/s00586-019-06051-9. Epub 2019 Jun 28.


Purpose: Chronic low back pain (cLBP) affects a quarter of a population during its lifetime. The most severe cases include patients not responding to interventions such as 5-week-long in-hospital multi-disciplinary protocols. This document reports on a pilot study offering an alpha-phase synchronization (APS) brain rehabilitation intervention to a population of n = 16 multi-resistant cLBP patients.

Methods: The intervention consists of 20 sessions of highly controlled electroencephalography (EEG) APS operant conditioning (neurofeedback) paradigm delivered in the form of visual feedback. Visual analogue scale for pain, Dallas, Hamilton, and HAD were measured before, after, at 6-month and 12-month follow-up. Full-scalp EEG data were analyzed to study significant changes in the brain's electrical activity.

Results: The intervention showed a great and lasting response of most measured clinical scales. The clinical improvement was lasting beyond the 6-month follow-up endpoints. The EEG data confirm that patients did control (intra-session trends) and learned to better control (intersession trends) their APS neuromarker resulting in (nonsignificant) baseline changes in their resting state activity. Last and most significantly, the alpha-phase concentration (APC) neuromarker, specific to phase rather than amplitude, was found to correlate significantly with the reduction in clinical symptoms in a typical dose-response effect.

Conclusion: This first experiment highlights the role of the APC neuromarker in relation to the nucleus accumbens activity and its role on nociception and the chronicity of pain. This study suggests APC rehabilitation could be used clinically for the most severe cases of cLBP. Its excellent safety profile and availability as a home-use intervention makes it a potentially disruptive tool in the context of nonsteroidal anti-inflammatory drugs and opioid abuses. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Alpha-phase concentration; Alpha-phase synchronization; Chronic low back pain; Electroencephalograph; Neurofeedback; Nucleus accumbens.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Chronic Pain / therapy*
  • Conditioning, Operant
  • Electroencephalography*
  • Female
  • Humans
  • Low Back Pain / therapy*
  • Middle Aged
  • Neurofeedback / methods*
  • Pilot Projects
  • Visual Analog Scale
  • Young Adult