Changes in Resting-State Brain Activity After Cognitive Behavioral Therapy for Chronic Pain: A Magnetoencephalography Study

Atsuo Yoshino; Toru Maekawa; Miyuki Kato; Hui-Ling Chan; Naofumi Otsuru; Shigeto Yamawaki

doi:10.1016/j.jpain.2024.104523

Changes in Resting-State Brain Activity After Cognitive Behavioral Therapy for Chronic Pain: A Magnetoencephalography Study

J Pain. 2024 Apr 4:104523. doi: 10.1016/j.jpain.2024.104523. Online ahead of print.

Authors

Atsuo Yoshino¹, Toru Maekawa², Miyuki Kato³, Hui-Ling Chan⁴, Naofumi Otsuru⁵, Shigeto Yamawaki²

Affiliations

¹ Health Service Center, Hiroshima University, Minami-Ku, Hiroshima, Japan; Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Minami-Ku, Hiroshima, Japan.
² Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Minami-Ku, Hiroshima, Japan.
³ Department of Psychiatry and Neurosciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Hiroshima, Japan.
⁴ Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Minami-Ku, Hiroshima, Japan; Department of Computer Science and Information Engineering, Institute of Medical Informatics, National Cheng Kung University, Tainan City, Taiwan.
⁵ Department of Physical Therapy, Niigata University of Health and Welfare, Kita-Ku, Niigata, Japan.

PMID: 38582288
DOI: 10.1016/j.jpain.2024.104523

Abstract

Cognitive behavioral therapy (CBT) is believed to be an effective treatment for chronic pain due to its association with cognitive and emotional factors. Nevertheless, there is a paucity of magnetoencephalography (MEG) investigations elucidating its underlying mechanisms. This study investigated the neurophysiological effects of CBT employing MEG and analytical techniques. We administered resting-state MEG scans to 30 patients with chronic pain and 31 age-matched healthy controls. Patients engaged in a 12-session group CBT program. We conducted pretreatment (T1) and post-treatment (T2) MEG and clinical assessments. MEG data were examined within predefined regions of interest, guided by the authors' and others' prior magnetic resonance imaging studies. Initially, we selected regions displaying significant changes in power spectral density and multiscale entropy between patients at T1 and healthy controls. Then, we examined the changes within these regions after conducting CBT. Furthermore, we applied support vector machine analysis to MEG data to assess the potential for classifying treatment effects. We observed normalization of power in the gamma2 band (61-90 Hz) within the right inferior frontal gyrus (IFG) and multiscale entropy within the right dorsolateral prefrontal cortex (DLPFC) of patients with chronic pain after CBT. Notably, changes in pain intensity before and after CBT positively correlated with the alterations of multiscale entropy. Importantly, responders predicted by the support vector machine classifier had significantly higher treatment improvement rates than nonresponders. These findings underscore the pivotal role of the right IFG and DLPFC in ameliorating pain intensity through CBT. Further accumulation of evidence is essential for future applications. PERSPECTIVE: We conducted MEG scans on 30 patients with chronic pain before and after a CBT program, comparing results with 31 healthy individuals. There were CBT-related changes in the right IFG and DLPFC. These results highlight the importance of specific brain regions in pain reduction through CBT.

Keywords: Chronic pain; cognitive behavior therapy; dorsolateral prefrontal cortex; inferior frontal gyrus; magnetoencephalography.