Alpha Rhythms in Pain: Linking Brain States, Traits, and Individualized Interventions

Alpha oscillations – regular brain rhythms in the 8–12 Hz range – are a dominant feature of human EEG and provide critical insight into how the brain regulates sensory information. Once considered merely an “idling rhythm”, alpha activity is now recognized as a key modulator of sensory and cognitive processing, including pain perception. Emerging evidence positions alpha oscillations as promising biomarkers that could transform how we predict and treat chronic pain. In this workshop, we will examine how alpha activity can inform individualized, mechanism-based pain interventions by integrating biomarker discovery, theoretical frameworks, and clinical translation.

Ali Mazaheri will open the session by introducing alpha oscillations as neurophysiological biomarkers of pain vulnerability. Drawing on both experimental and clinical evidence, he will highlight how the peak alpha frequency (PAF) – the dominant rhythm within the alpha band – emerges as a reliable marker of individual pain sensitivity. He will discuss how variations in alpha rhythms can predict not only acute pain responses but also persistence and treatment outcomes. Presenting results from a large-scale longitudinal study of surgical patients, he will show how PAF can help identify those at heightened risk of chronic postoperative pain and prolonged opioid use. By integrating EEG-derived PAF with cognitive profiles and immunological markers from flow cytometry, his talk will illustrate how alpha activity can drive biomarker-informed stratification and enable early, targeted intervention strategies

Karen Davis will then examine how oscillatory biomarkers within specific regions of the dynamic pain connectome should be interpreted within the broader state–trait framework of pain. She will show that chronic pain is shaped by both transient “states” (momentary fluctuations) that reflect the individual’s condition at the moment, as well as more stable brain oscillatory activity linked to the general and more enduring “traits” of a chronic pain condition as its associated pain, cognitive and attentional features. Using examples from fMRI and MEG studies, she will discuss how regional alpha oscillatory features may reflect either momentary features and symptoms of chronic pain (i.e., pain states) or chronic pain traits depending on the timing and context of data collection. Her talk will emphasize why distinguishing between these dimensions, especially for patients whose chronic pain fluctuates throughout the day, is essential to develop reliable and interpretable biomarkers, and for translating them into diagnostics and treatment planning in individuals with chronic pain tailored to their abnormalities in specific brain regions.

Finally, Giulia Liberati will show how oscillatory biomarkers can guide individualized brain stimulation for pain relief. Specifically, she will present three complementary lines of research: tACS protocols targeting each individual’s PAF; real-time, phase-dependent tACS; and real-time, phase-dependent rTMS. Moreover, she will discuss sex differences in alpha-related pain modulation. Together, these studies highlight how understanding endogenous alpha rhythms can move the field from descriptive neuroimaging to closed-loop, adaptive interventions that respect individual neurophysiology.