{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:28:36Z","timestamp":1781584116237,"version":"3.54.5"},"reference-count":50,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T00:00:00Z","timestamp":1628985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Fibromyalgia is related to central sensitization syndrome (CSS) and is associated with chronic pain and a decrease in general health. The aim of this study was to explore how changes in brain patterns of female fibromyalgia patients are shaped by neurofeedback therapy and how it affects pain perception and general health. A quasi-experimental study with pre- and post-tests was carried out with 37 female fibromyalgia patients referred by the Pain Unit of the National Health Service of Spain. The method involved applying a sensorimotor rhythm (SMR) protocol to monitor changes in brain waves under different conditions, taking pre-\/post-test measurements of perceived pain, general health and the impact on fibromyalgia. Measures included the Fibromyalgia Impact Questionnaire Revised (FIQR), the Visual Analogue Scale (VAS), the General Health Questionnaire (GHQ-28) and EEG (SMR, theta waves). During therapy, the SMR\/theta wave ratio increased significantly and after application of therapy, significant results were observed for the FIQR, VAS and GHQ-28. In conclusion, neurofeedback therapy increases the SMR\/theta wave ratio in fibromyalgia, helping to maintain a balance between brain functions. This is associated with the activation of inhibitory processes, which is related to the perceived improvement of pain in fibromyalgia patients.<\/jats:p>","DOI":"10.3390\/brainsci11081069","type":"journal-article","created":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T21:43:55Z","timestamp":1629063835000},"page":"1069","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical Findings in SMR Neurofeedback Protocol Training in Women with Fibromyalgia Syndrome"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2767-1536","authenticated-orcid":false,"given":"Carlos","family":"Barbosa-Torres","sequence":"first","affiliation":[{"name":"Department of Psychology, University of Extremadura, 10003 C\u00e1ceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8802-9980","authenticated-orcid":false,"given":"Sixto","family":"Cubo-Delgado","sequence":"additional","affiliation":[{"name":"Department of Educational Sciences, University of Extremadura, 06006 Badajoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2318","DOI":"10.3899\/jrheum.090367","article-title":"Fibromyalgia syndrome module at OMERACT 9: Domain construct","volume":"36","author":"Mease","year":"2009","journal-title":"J. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Nadal-Nicol\u00e1s, Y., Rubio-Arias, J.\u00c1., Mart\u00ednez-Olcina, M., Reche-Garc\u00eda, C., Hern\u00e1ndez-Garc\u00eda, M., and Mart\u00ednez-Rodr\u00edguez, A. (2020). Effects of Manual Therapy on Fatigue, Pain, and Psychological Aspects in Women with Fibromyalgia. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124611"},{"key":"ref_3","first-page":"1","article-title":"New and modified fibromyalgia diagnostic criteria: Ambiguity, uncertainty, and difficulties complicate diagnosis and management","volume":"29","author":"Garg","year":"2012","journal-title":"J. Musculoskel. Med."},{"key":"ref_4","first-page":"S145","article-title":"One year in review 2016: Fibromyalgia","volume":"34","author":"Bazzichi","year":"2016","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_5","first-page":"41","article-title":"Terapias psicol\u00f3gicas para el entrenamiento del dolor cr\u00f3nico","volume":"22","author":"Moix","year":"2011","journal-title":"Clin. Salud."},{"key":"ref_6","first-page":"573","article-title":"Disfunci\u00f3n cognitiva en la fibromialgia","volume":"56","author":"Gelonch","year":"2013","journal-title":"Rev. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"70","DOI":"10.2174\/157339711102150702112236","article-title":"Editorial review: An update on central sensitivity syndromes and the issues of nosology and psychobiology","volume":"11","author":"Yunus","year":"2015","journal-title":"Curr. Rheumatol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/0013-4694(72)90104-6","article-title":"Cortical-subcortical EEG correlates of suppressed motor behavior during sleep and waking in the cat","volume":"32","author":"Howe","year":"1972","journal-title":"Electroencephalogr. Clin. Neurophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S0304-3959(00)00432-2","article-title":"Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome","volume":"91","author":"Staud","year":"2001","journal-title":"Pain"},{"key":"ref_10","first-page":"394","article-title":"Neuroimagen en fibromialgia","volume":"67","year":"2018","journal-title":"Rev. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1002\/art.10893","article-title":"Neurophysiologic evidence for a central sensitization in patients with fibromyalgia","volume":"48","author":"Desmeule","year":"2003","journal-title":"Arthritis Rheum."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Boehme, R., van Ettinger-Veenstra, H., Olausson, H., Gerdle, B., and Nagi, S.S. (2020). Anhedonia to Gentle Touch in Fibromyalgia: Normal Sensory Processing but Abnormal Evaluation. Brain Sci., 10.","DOI":"10.3390\/brainsci10050306"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.pain.2009.03.017","article-title":"No consistent difference in gray matter volume between individuals with fibromyalgia and age-matched healthy subjects when controlling for affective disorder","volume":"143","author":"Hsu","year":"2009","journal-title":"Pain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/PSY.0b013e3182408f04","article-title":"Disrupted functional connectivity of the pain network in fibromyalgia","volume":"74","author":"Cifre","year":"2012","journal-title":"Psychosom. Med."},{"key":"ref_15","first-page":"116","article-title":"Fibromyalgia: A retrospective study of 252 consecutive referrals","volume":"5","author":"Donaldson","year":"1998","journal-title":"Can J. Clin. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"277","DOI":"10.4321\/S0213-61632015000400005","article-title":"Significant new quantitative EGG patterns in fibromyalgia","volume":"29","year":"2015","journal-title":"Eur. J. Psychiat."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Elvira, R., Oltra-Cucarella, J., Carrobles, J.A., Molt\u00f3, J., Fl\u00f3rez, M., Parra, S., Agudo, M., Saez, C., Guarino, S., and Costea, R.M. (2021). Enhancing the Effects of Neurofeedback Training: The Motivational Value of the Reinforcers. Brain Sci., 11.","DOI":"10.3390\/brainsci11040457"},{"key":"ref_18","unstructured":"Yucha, C., and Montgomery, D. (2008). Evidenced-Based Practice in Biofeedback and Neurofeedback, Association for Applied Psychophysiology and Biofeedback. [2nd ed.]."},{"key":"ref_19","first-page":"143","article-title":"Methodological Note: Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications","volume":"7","author":"Marzbani","year":"2016","journal-title":"Basic Clin. Neurosci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jpain.2007.11.003","article-title":"New Insights Into Neuromodulatory Approaches for the Treatment of Pain","volume":"9","author":"Jensen","year":"2008","journal-title":"J. Pain"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Budzynski, T. (2009). Introduction to Quantitative EEG and Neurofeedback, Elsevier.","DOI":"10.1016\/B978-0-12-374534-7.00020-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.neubiorev.2013.09.015","article-title":"EEG-neurofeedback for optimising performance. I: A review of cognitive and affective outcome in healthy participants","volume":"44","author":"Gruzelier","year":"2014","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.clinph.2014.03.031","article-title":"Shutting down sensorimotor interference unblocks the networks for stimulus processing: An SMR neurofeedback training study","volume":"126","author":"Kober","year":"2015","journal-title":"Clin. Neurophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1109\/5.939829","article-title":"Motor imagery and direct brain-computer communication","volume":"89","author":"Pfurtscheller","year":"2001","journal-title":"Proc. IEEE Inst. Electr. Electron. Eng."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3389\/fnbeh.2018.00321","article-title":"SMR Neurofeedback Training Facilitates Working Memory Performance in Healthy Older Adults: A Behavioral and EEG Study","volume":"12","author":"Garcia","year":"2018","journal-title":"Front Behav. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"478","DOI":"10.3389\/fnhum.2013.00478","article-title":"Control beliefs can predict the ability to up-regulate sensorimotor rhythm during neurofeedback training","volume":"7","author":"Witte","year":"2013","journal-title":"Front Hum. Neurosci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4155","DOI":"10.1097\/00001756-200112210-00058","article-title":"Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans","volume":"12","author":"Egner","year":"2001","journal-title":"Neuroreport"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00296-004-0443-3","article-title":"Auditory Event-related brain potentials in fibromyalgia syndrome","volume":"25","author":"Vural","year":"2005","journal-title":"Rheumatol. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s100670200005","article-title":"Relationship between Chest Expansion and Respiratory Muscle Strength in Patients with Primary Fibromyalgia","volume":"21","author":"Ozgocmen","year":"2002","journal-title":"J. Clin. Rheumatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1136\/ard.62.6.551","article-title":"Auditory P300 even trelated potentials and serotonin reuptake inhibitor treatment in patients with fibromyalgia","volume":"62","author":"Ozgocmen","year":"2003","journal-title":"Annals. Rheum. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"236","DOI":"10.3389\/fnins.2020.00236","article-title":"Self-Regulation of SMR Power Led to an Enhancement of Functional Connectivity of Somatomotor Cortices in Fibromyalgia Patients","volume":"14","author":"Terrasa","year":"2020","journal-title":"Front Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"762","DOI":"10.3389\/fnins.2019.00762","article-title":"EEG Correlates of Self-Managed Neurofeedback Treatment of Central Neuropathic Pain in Chronic Spinal Cord Injury","volume":"13","author":"Altaleb","year":"2019","journal-title":"Front Neurosci."},{"key":"ref_33","first-page":"47","article-title":"Neurofeedback in fibromyalgia syndrome","volume":"19","author":"Dursun","year":"2007","journal-title":"Agr\u0131"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s10484-010-9135-9","article-title":"Neurofeedback Intervention in Fibromyalgia Syndrome; a Randomized, Controlled, Rater Blind Clinical Trial","volume":"35","author":"Dursun","year":"2010","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_35","unstructured":"Coben, R., and Evans, J.E. (2011). Neurofeedack and Neuromodulation. Techniques and Applications, Academic Press."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1002\/acr.22034","article-title":"Dimensionality, reliability, and validity of the Revised Fibromyalgia Impact Questionnaire in two Spanish samples","volume":"65","author":"Luciano","year":"2013","journal-title":"Arthritis Care Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/1477-7525-11-132","article-title":"Validation of a Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR)","volume":"11","author":"Salguerio","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1213\/ANE.0b013e3181c3119e","article-title":"The use of the Behavioral Pain Scale to assess pain in conscious sedated patients","volume":"110","author":"Ahlers","year":"2010","journal-title":"Anesth. Analg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1017\/S0033291700002579","article-title":"Validity of the scaled version of the General Health Questionnaire (GHQ-28) in a Spanish population","volume":"16","author":"Lobo","year":"1986","journal-title":"Psychol. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Chakrabarti, A., and Chakrabarti, D. (2017). Research into Design for Communities, Vol 1. Smart Innovation, Systems and Technologies, Springer.","DOI":"10.1007\/978-981-10-3518-0"},{"key":"ref_41","unstructured":"(2021, June 11). ProComp Infiniti System. Available online: https:\/\/thoughttechnology.com\/procomp-infiniti-system-w-biograph-infiniti-software-t7500m\/."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/ar2094","article-title":"Biology and therapy of fibromyalgia. Functional magnetic resonance imaging findings in fibromyalgia","volume":"8","author":"Williams","year":"2006","journal-title":"Arthritis Res. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s10484-011-9159-9","article-title":"EEG Biofeedback Treatment Improves Certain Attention and Somatic Symptoms in Fibromyalgia: A Pilot Study","volume":"36","author":"Caro","year":"2011","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_44","first-page":"45","article-title":"Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant Conditioning","volume":"31","author":"Sterman","year":"2000","journal-title":"Clin. EEG Neurosci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3109\/10582452.2014.883037","article-title":"A Systematic Review of Neurofeedback as a Treatment for Fibromyalgia Syndrome Symptoms","volume":"22","author":"Santoro","year":"2014","journal-title":"J. Musculoskelet. Pain"},{"key":"ref_46","first-page":"20","article-title":"Effectiveness of Biofield Therapy for Patients Diagnosed With Fibromyalgia","volume":"6","author":"Sarmento","year":"2019","journal-title":"Altern. Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1002\/jclp.1060","article-title":"Treatment of fibromyalgia incorporating EEG-driven stimulation: A clinical outcomes study","volume":"57","author":"Mueller","year":"2001","journal-title":"J. Clin. Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1111\/j.1526-4637.2010.00862.x","article-title":"Neurotherapy of fibromyalgia?","volume":"11","author":"Nelson","year":"2010","journal-title":"Pain Med."},{"key":"ref_49","first-page":"99","article-title":"Influencia del entrenamiento en rehabilitaci\u00f3n psicol\u00f3gica de las emociones negativas y calidad de vida en pacientes con dolor cr\u00f3nico","volume":"25","author":"Hao","year":"2016","journal-title":"Rev. Argent Cl\u00edn. Psicol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s10484-015-9289-6","article-title":"Transient Adverse Side Effects During Neurofeedback Training: A Randomized, Sham-Controlled, Double Blind Study","volume":"40","author":"Rogel","year":"2015","journal-title":"Appl. Psychophysiol. Biofeedback"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/8\/1069\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:46:31Z","timestamp":1760165191000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/8\/1069"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,15]]},"references-count":50,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["brainsci11081069"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11081069","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,15]]}}}