New study to examine neuroimaging neurofeedback for pain after spinal cord injury

Jeanne Zanca, PhD, MPT, of Kessler Foundation received a $299,000 grant from the Craig H. Neilsen Foundation for a pilot study to develop new strategies for the management of neuropathic pain in individuals with spinal cord injury. This will be the first study to examine neurofeedback mediated by functional magnetic resonance imaging (fMRI) for facilitating the learning of self-management strategies for neuropathic pain post-spinal cord injury.

Dr. Zanca is senior research scientist in the Center for Spinal Cord Injury Research at Kessler Foundation, and co-investigator with the federally funded Northern New Jersey Spinal Cord Injury System.

Neuropathic pain is common among people with chronic spinal cord injury, is often severe, and can interfere significantly with daily life. Medications often provide only partial relief from pain and can produce side effects like constipation or sleepiness that reduce quality of life. Complementary therapies such as acupuncture and cognitive behavioral therapy have been tested with limited success. Developing effective non-pharmacologic ways to help individuals manage neuropathic pain will improve their quality of life and their participation at home, in the community, and the workplace.

This pilot study is based on a new approach - training individuals to use neurofeedback to modulate their pain using real-time fMRI of the anterior cingulate cortex --the area of brain associated with pain. This technique of fMRI neurofeedback has been studied in other populations with chronic nerve-based pain, according to Dr. Zanca, and has helped them reduce their pain sensations by self-controlling brain activity. "We will see whether this technique helps people with spinal cord injury learn thinking strategies that they can use in daily life to reduce the intensity and unpleasantness of their pain," she explained.

The study will use a randomized design with two groups of 15 participants. Both groups will receive identical instructions regarding cognitive strategies they may use to control brain activity, but feedback will differ in order to determine if different kinds of feedback produce different effects. Imaging studies will be conducted at the Rocco Ortenzio Neuroimaging Center at Kessler Foundation, a rehabilitation research-dedicated facility.