{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:02:59Z","timestamp":1772118179073,"version":"3.50.1"},"reference-count":97,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Persistent musculoskeletal pain is associated with altered functional and effective connectivity (EC) between cortical regions involved in pain processing. Especially, disruptions in the infraslow fluctuation (ISF) frequency band can contribute to pain persistence. ISF electroencephalography\u2010neurofeedback (EEG\u2010NF) has emerged as a potential non\u2010invasive neuromodulatory intervention targeting cortical brain regions to restore balance and modulate pain\u2010related pathways. However, limited research explores its effect on EC, a measure of directional information flow critical to pain experience and modulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A secondary analysis was performed using data from a randomized, double\u2010blind, sham\u2010controlled feasibility clinical trial. Participants with chronic painful knee osteoarthritis (OA) were randomized to receive either ISF\u2010NF or sham\u2010NF. Nine neurofeedback sessions targeted the pregenual anterior cingulate cortex (pgACC), dorsal anterior cingulate cortex (dACC), and bilateral primary somatosensory cortex (SSC: S1Lt &amp; S1Rt). EEG data was collected at baseline and post\u2010intervention. Granger causality was used to measure EC changes, and between\u2010group statistical analyses were conducted with adjustments for multiple comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010one participants (mean age: 61.7 \u00b1 7.6 years; 62% female) completed the study. ISF\u2010NF training significantly improved EC between pgACC and dACC, pgACC and SSC, and other targeted regions, while reducing EC from S1Rt to dACC. Changes were observed predominantly in the ISF frequency band, indicating enhanced cortical communication and modulation of pain pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ISF\u2010NF training enhanced EC in cortical regions implicated in pain processing, supporting its potential as a neuromodulatory intervention for chronic musculoskeletal pain. Further trials are needed to confirm clinical efficacy and optimize protocol designs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.70541","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T02:29:43Z","timestamp":1748485783000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Can EEG\u2010Neurofeedback Training Enhance Effective Connectivity in People With Chronic Secondary Musculoskeletal Pain? A Secondary Analysis of a Feasibility Randomized Controlled Clinical Trial"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6002-9815","authenticated-orcid":false,"given":"Jerin","family":"Mathew","sequence":"first","affiliation":[{"name":"Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy University of Otago Dunedin New Zealand"},{"name":"Department of Anatomy, School of Biomedical Sciences University of Otago Dunedin New Zealand"},{"name":"Pain@Otago Research Theme University of Otago Dunedin New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Divya Bharatkumar","family":"Adhia","sequence":"additional","affiliation":[{"name":"Pain@Otago Research Theme University of Otago Dunedin New Zealand"},{"name":"Division of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine University of Otago Dunedin New 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