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      Electroencephalographic Patterns in Chronic Pain: A Systematic Review of the Literature

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          Abstract

          The main objective of this study is to review and summarize recent findings on electroencephalographic patterns in individuals with chronic pain. We also discuss recent advances in the use of quantitative Electroencephalography (qEEG) for the assessment of pathophysiology and biopsychosocial factors involved in its maintenance over time. Data collection took place from February 2014 to July 2015 in PubMed, SciELO and PEDro databases. Data from cross-sectional studies and longitudinal studies, as well as clinical trials involving chronic pain participants were incorporated into the final analysis. Our primary findings related to chronic pain were an increase of theta and alpha EEG power at rest, and a decrease in the amplitude of evoked potentials after sensory stimulation and cognitive tasks. This review suggests that qEEG could be considered as a simple and objective tool for the study of brain mechanisms involved in chronic pain, as well as for identifying the specific characteristics of chronic pain condition. In addition, results show that qEEG probably is a relevant outcome measure for assessing changes in therapeutic studies.

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          Most cited references59

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          Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits.

          Chronic pain conditions are associated with abnormalities in brain structure and function. Moreover, some studies indicate that brain activity related to the subjective perception of chronic pain may be distinct from activity for acute pain. However, the latter are based on observations from cross-sectional studies. How brain activity reorganizes with transition from acute to chronic pain has remained unexplored. Here we study this transition by examining brain activity for rating fluctuations of back pain magnitude. First we compared back pain-related brain activity between subjects who have had the condition for ∼2 months with no prior history of back pain for 1 year (early, acute/subacute back pain group, n = 94), to subjects who have lived with back pain for >10 years (chronic back pain group, n = 59). In a subset of subacute back pain patients, we followed brain activity for back pain longitudinally over a 1-year period, and compared brain activity between those who recover (recovered acute/sub-acute back pain group, n = 19) and those in which the back pain persists (persistent acute/sub-acute back pain group, n = 20; based on a 20% decrease in intensity of back pain in 1 year). We report results in relation to meta-analytic probabilistic maps related to the terms pain, emotion, and reward (each map is based on >200 brain imaging studies, derived from neurosynth.org). We observed that brain activity for back pain in the early, acute/subacute back pain group is limited to regions involved in acute pain, whereas in the chronic back pain group, activity is confined to emotion-related circuitry. Reward circuitry was equally represented in both groups. In the recovered acute/subacute back pain group, brain activity diminished in time, whereas in the persistent acute/subacute back pain group, activity diminished in acute pain regions, increased in emotion-related circuitry, and remained unchanged in reward circuitry. The results demonstrate that brain representation for a constant percept, back pain, can undergo large-scale shifts in brain activity with the transition to chronic pain. These observations challenge long-standing theoretical concepts regarding brain and mind relationships, as well as provide important novel insights regarding definitions and mechanisms of chronic pain.
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            Event-related potential studies of attention.

            Over the past 30 years, recordings of event-related potentials (ERPs) from normal individuals have played an increasingly important role in our understanding of the mechanisms of attention. This article reviews some of the recent ERP studies of attention, focusing on studies that isolate the operation of attention in specific cognitive subsystems such as perception, working memory, and response selection. Several conclusions are drawn. First, under some conditions attention modulates the initial feedforward volley of neural activity in intermediate visual processing areas. Second, these early effects can be observed for both the voluntary allocation of attention and for the automatic capture of attention following a peripheral visual transient. Third, these effects are present not only when attention is directed to a location in 2-dimensional space, but also when attention is directed to one of two spatially overlapping surfaces. Fourth, attention does not modulate sensory activity unless sensory systems are overloaded; when sensory systems are not taxed, attention may instead operate to influence memory or response processes. That is, attention operates to mitigate information overload in whichever cognitive subsystems are overloaded by a particular combination of stimuli and task.
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              Thalamocortical dysrhythmia: A neurological and neuropsychiatric syndrome characterized by magnetoencephalography.

              Spontaneous magnetoencephalographic activity was recorded in awake, healthy human controls and in patients suffering from neurogenic pain, tinnitus, Parkinson's disease, or depression. Compared with controls, patients showed increased low-frequency theta rhythmicity, in conjunction with a widespread and marked increase of coherence among high- and low-frequency oscillations. These data indicate the presence of a thalamocortical dysrhythmia, which we propose is responsible for all the above mentioned conditions. This coherent theta activity, the result of a resonant interaction between thalamus and cortex, is due to the generation of low-threshold calcium spike bursts by thalamic cells. The presence of these bursts is directly related to thalamic cell hyperpolarization, brought about by either excess inhibition or disfacilitation. The emergence of positive clinical symptoms is viewed as resulting from ectopic gamma-band activation, which we refer to as the "edge effect." This effect is observable as increased coherence between low- and high-frequency oscillations, probably resulting from inhibitory asymmetry between high- and low-frequency thalamocortical modules at the cortical level.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 February 2016
                2016
                : 11
                : 2
                : e0149085
                Affiliations
                [1 ]Graduate Program on Medicine and Health, School of Medicine, Federal University of Bahia, Salvador—BA, Brazil
                [2 ]Laboratory of Functional Electrostimulation, Institute of Health Sciences, Federal University of Bahia, Salvador—BA, Brazil
                [3 ]Research Institute on Health Sciences, University of Balearic Islands, Palma de Majorca, Spain
                [4 ]Department of Speech-Language Therapy & Audiology, Institute of Health Sciences, Federal University of Bahia, Salvador—BA, Brazil
                [5 ]Institute of Physics, Federal University of Bahia, Salvador—BA, Brazil
                [6 ]Graduate and Research Program, Bahiana School of Medicine and Public Health, Salvador—BA, Brazil
                Wadsworth Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: ESSP AFB. Performed the experiments: ESSP DBNS PM KNS AFB. Analyzed the data: ESSP FCQ CLS MAN CHI MS DBNS SB PM JGVM KNS AFB. Contributed reagents/materials/analysis tools: ESSP FCQ CLS MAN CHI MS DBNS SB PM JGVM KNS AFB. Wrote the paper: ESSP FCQ CLS MAN CHI MS DBNS SB PM JGVM KNS AFB.

                Article
                PONE-D-14-44671
                10.1371/journal.pone.0149085
                4767709
                26914356
                2f9a4c7f-1b3d-4222-aa1b-d28a81a49969
                © 2016 Pinheiro et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 October 2014
                : 27 January 2016
                Page count
                Figures: 1, Tables: 3, Pages: 26
                Funding
                PM and FQ were supported by fellowships from the Brazilian National Council for Scientific and Technological Development (CNPq)( http://www.cnpq.br/) and CAPES Foundation (CAPES/CNPq #2947/2013)( http://www.capes.gov.br/). PM was also supported by a grant from the Spanish Ministry of Economy and Competitiveness and European Regional Development Funds (#PSI2013-48260-C3-1-R). EP and CHI were supported by MSc fellowships from Foundation for Research Support of the Bahia State, Brazil (FAPESB)( http://www.fapesb.ba.gov.br/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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