About this Research Topic

Background

Try non-pharmacological treatments before opioid medication, is the recent recommendation of the Center for Disease Control and Prevention. Escalating concerns over the addictive properties, adverse effects and unsatisfactory pain relief linked to opioid medication have been a catalyst for renewed interest in non-pharmacological interventions for pain. An estimated two million individuals in the US alone are addicted to prescription opioid analgesics, which has been linked to over 17,000 overdose deaths and over $78 billion annual costs. Furthermore, only a quarter of people with chronic pain may actually experience adequate pain relief from opioids.

In addition to existing non-pharmacological interventions such as cognitive behavioural therapy, opportunities for the development of novel non-pharmacological treatments have been provided by an improved understanding over the last few decades of the neural mechanisms underlying pain. If we are able to regulate activity in key areas of the brain identified as being involved in pain processing, this may also allow us to regulate the subjective experience of pain. Non-pharmaceutical interventions that modulate brain activity either directly (such as EEG-biofeedback) or indirectly (such as mindfulness meditation) have shown promise as non-invasive pain treatments. However, there is much that remains unknown on these neuromodulatory interventions and there is a lack of good quality evidence on: (a) the degree to which these interventions actually affect pain-related brain activity and, (b) their effectiveness for managing pain. In EEG-biofeedback for example, there is limited data on whether regulation of brain activity can be achieved and what might be the most effective intervention protocols for achieving this, and there are few studies examining whether therapeutic benefits extend beyond simple placebo effects. Similar limitations are applicable to other neuromodulatory interventions to varying degrees.

Overall, our current state of knowledge is inadequate to make firm conclusions on whether neuromodulatory interventions do result in changes in brain activity and the degree to which these treatments are effective for pain (here we define neuromodulatory as a non-invasive procedure or technique that results in changes to brain activity in areas likely to be involved in pain processing).

The purpose of this Research Topic is to clarify and advance our understanding of these interventions. We welcome original research studies, review, opinion and perspective submissions on mechanisms of action, evidence of modulation of brain activity and outcome efficacy.

Keywords: pain, pain intervention, pain treatment, neuromodulation

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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