Identifying brain targets for real-time fMRI neurofeedback in chronic pain: insights from functional neurosurgery

Abstract

Background: The lack of clearly defined neuromodulation targets has contributed to the inconsistent results of real-time fMRI-based neurofeedback (rt-fMRI-NF) for the treatment of chronic pain. Functional neurosurgery (funcSurg) approaches have shown more consistent effects in reducing pain in patients with severe chronic pain.

Objective: This study aims to redefine rt-fMRI-NF targets for chronic pain management informed by funcSurg studies.

Methods: Based on independent systematic reviews, we identified the neuromodulation targets of the rt-fMRI-NF (in acute and chronic pain) and funcSurg (in chronic pain) studies. We then characterized the underlying functional networks using a subsample of the 7 T resting-state fMRI dataset from the Human Connectome Project. Principal component analyses (PCA) were used to identify dominant patterns (accounting for a cumulative explained variance >80%) within the obtained functional maps, and the overlap between these PCA maps and canonical intrinsic brain networks (default, salience, and sensorimotor) was calculated using a null map approach.

Results: The anatomical targets used in rt-fMRI-NF and funcSurg approaches are largely distinct, with the middle cingulate cortex as a common target. Within the investigated canonical rs-fMRI networks, these approaches exhibit both divergent and overlapping functional connectivity patterns. Specifically, rt-fMRI-NF approaches primarily target the default mode network (P value range 0.001-0.002) and the salience network (P = 0.002), whereas funcSurg approaches predominantly target the salience network (P = 0.001) and the sensorimotor network (P value range 0.001-0.023).

Conclusion: Key hubs of the salience and sensorimotor networks may represent promising targets for the therapeutic application of rt-fMRI-NF in chronic pain.

Keywords

rt-fMRI-NF / brain stimulation / sensorimotor network / salience network

Ethics approval and consent to participate

Not applicable.

Supplementary Data

Supplementary data is available at Psychoradiology online.

Author contributions

D.L. (Conceptualization, Data curation, Formal analysis, Writing - original draft), Y.M. (Data curation, Project administration), M.L. (Data curation, Project administration), A.N. (Formal analysis, Writing - review & editing), M.G. (Formal analysis, Writing - review & editing), B.B. (Supervision, Writing - review & editing), and S.F. (Data curation, Formal analysis, Methodology, Project administration, Supervision, Writing - original draft, Writing - review & editing)

Conflict of Interest Statement

Professor Keith Kendrick serves as the editor-in-chief and Professor Benjamin Becker as the editorial board member of Psychoradiology. They were blinded from reviewing or making decisions on the manuscript.

Acknowledgments

This work was supported by Key R&D project of Science and Technology Department of the Sichuan Province (China), Grant number M112022YFWZ0003. The authors would like to thank Professor Ludovico Minati for his contribution to the identification of target coordinates extracted from the funcSurg studies and Dr Vincent Bazinet for his insights into some methodological aspects.

Availability of data and materials

Data files are available in the OSF directory: https://osf.io/cmgvq/

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