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EEG-Neurofeedback targeting amygdala activity reduces disease impact and improves sleep in Patients with Fibromyalgia

Noam Goldway1, 2*, Jacob N. Ablin3, 4, Eti Ben-Simon1, 3, Libat Weizman1, 2, Marc Cavazza5, Fred Charles6, Talma Hendler1, 2, 3 and Haggai Sharon1, 3, 7
  • 1 Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Israel
  • 2 Tel Aviv University, Sagol School of Neuroscience, Israel
  • 3 Tel Aviv University, Sackler School of Medicine, Israel
  • 4 Tel Aviv Sourasky Medical Centre, Institute of Rheumatology, Israel
  • 5 University of Kent, School of Engineering and Digital Arts, United Kingdom
  • 6 Faculty of Science and Technology, Bournemouth University, Department of Creative Technology, United Kingdom
  • 7 Tel-Aviv Sourasky Medical Center, Institute of Pain Medicine, Israel

Background: Fibromyalgia syndrome (FMS), a condition characterized by widespread pain and chronic fatigue, has been suggested to represent a prototype of central nervous system hypersensitivity (central sensitivity-CS) (Cagnie et al., 2014 ) While the mechanisms underlying CS remain incompletely understood, a role for limbic dysregulation has been argue (Neugebauer et al., 2004). The aim of the current study was to examine the feasibility of fMRI-inspired Electrical Finger Print (EFP) of the amygdala as a probe for NeuroFeedback (amyg-EFP NF) training for FM patients. We expected improved pain symptoms and sleep quality among trainees successful in downregulating amygdala activity. Method: 13 patients (1M:12F, average age 32.4 SD=12.1) underwent 10 sessions of amyg-EFP-NF, targeting down-regulating of the amygdala. Two interfaces was used to give the feedback-Auditory feedback and multi-modal virtual realty feedback (see fig.1) Successful sessions were indicated by significantly lower amyg-EFP activity in the feedback condition comparing to rest. Outcome measures included: Sleep quality (objective & subjective measures), pain (clinical evaluation & self-reports) and emotion regulation (questionnaires). Measurements were taken before and after NF training (see fig. 2). Results: Following NF Training, patients displayed an improved clinical status as indicated by reduction in FMS symptoms (FIQ, T=3.081 P=0.004). Improvements in self-reported pain (SF 36, R=0.81, p=0.001), social function (SF 36, R=0.7, p=P=0.007) and physical health (SF 36, R=0.839, p=0.0003) were correlated with measures of amygdala down-regulation (see fig. 4). Affective and anxiety scores (STAI-T, beck depression inventory) remained unchanged. Moreover, patients demonstrated reduced sleep latency (T=2.71, P=0.02) and normalised REM latency (T=1.9, P=0.04). Notably, despite time in bed was reduced (T=3.01, P=0.005), fatigue level was decreased (Stanford sleepiness scale, T=2.7, P=0.009). (See fig. 5.) Discussion: We targeted the amygdala, an emotional hub of the brain, rather than classic parts of the so-called "pain matrix" in order to improve the suffering and overall wellbeing of patients with a chronic pain syndrome. We show that amygdala downregulation improved disease and pain related suffering, sleep latency and sleep architecture in chronic pain patients.

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References

Cagnie, B., Coppieters, I., Denecker, S., Six, J., Danneels, L., & Meeus, M. (2014, August). Central sensitization in fibromyalgia? A systematic review on structural and functional brain MRI. In Seminars in arthritis and rheumatism (Vol. 44, No. 1, pp. 68-75). WB Saunders
Neugebauer, V., Li, W., Bird, G. C., & Han, J. S. (2004). The amygdala and persistent pain. The Neuroscientist, 10(3), 221-234.‏
Clauw, D. J. (2014). Fibromyalgia: a clinical review. Jama, 311(15), 1547-1555.‏
Moeller‐Bertram, T., Strigo, I. A., Simmons, A. N., Schilling, J. M., Patel, P., & Baker, D. G. (2014). Evidence for acute central sensitization to prolonged experimental pain in posttraumatic stress disorder. Pain Medicine, 15(5), 762-771.‏.
Yunus, M. B. (2007, June). Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. In Seminars in arthritis and rheumatism (Vol. 36, No. 6, pp. 339-356). WB Saunders.‏

Keywords: amydgala, Chronic Pain, Fibromyalgia, nuerofeedback, EEG-fMRI integration, central sensitization

Conference: SAN2016 Meeting, Corfu, Greece, 6 Oct - 9 Oct, 2016.

Presentation Type: Poster Presentation in SAN2016 Conference

Topic: Posters

Citation: Goldway N, Ablin JN, Ben-Simon E, Weizman L, Cavazza M, Charles F, Hendler T and Sharon H (2016). EEG-Neurofeedback targeting amygdala activity reduces disease impact and improves sleep in Patients with Fibromyalgia. Conference Abstract: SAN2016 Meeting. doi: 10.3389/conf.fnhum.2016.220.00112

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Received: 29 Jul 2016; Published Online: 01 Aug 2016.

* Correspondence: Mr. Noam Goldway, Center for Brain Functions, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, noamgoldway@gmail.com