Brain Oscillations and Neuromodulation in Experimental and Clinical Pain – Future Pain Management?

Innovative, non-invasive approaches to pain management must address pain-related alterations within the central nervous system. Chronic pain disrupts the neuronal oscillations that underpin inter-regional brain communication, either through direct effects on brain morphology or via changes in neuronal plasticity and connectivity, resulting in abnormal network function and altered oscillatory activity. Non-invasive brain stimulation techniques can deliver oscillatory or perturbatory inputs to brain networks to modify these abnormal oscillations. Such interventions have been shown to correlate with pain reduction in some patients. The speakers in this workshop represent the forefront research on the topic from a preclinical, human experimental, and clinical perspective, offering a comprehensive view of this rapidly advancing field.

Prof. Graven-Nielsen will present recent human studies showing how experimental tonic pain influences brain communication assessed by cutting-edge neurophysiological techniques (e.g., transcranial magnetic stimulation evoked electroencephalographic responses) as well as how non-invasive brain stimulation techniques (e.g., repeated transcranial magnetic stimulation or transcranial direct current stimulation [tDCS]) can modulate brain oscillations and potentially influence pro-nociceptive and anti-nociceptive pain mechanisms. Dr. May will continue and present the current state of research on the use of rhythmic non-invasive neuromodulation techniques to reduce experimentally induced pain in humans. The presentation will focus on studies employing transcranial alternating current stimulation (tACS) and recent approaches based on sensory entrainment.

Following the human-experimental studies, Prof. Kuner will discuss the latest insights from mouse models on mechanisms of analgesia evoked by cortical neurostimulation. The talk will present data from in vivo imaging studies showing how specific populations of neurons undergo functional plasticity over the course of establishment and maintenance of chronic neuropathic pain and how these changes are influenced by non-invasive tDCS. Modulation of structural connectivity ranging from synaptic to circuit level will be presented. The talk will also describe newest advances in electrophysiological techniques that disambiguate cellular origins of pain-related oscillatory activity and unravel their coordination across distinct brain areas in conjunction with specific pain-related behaviours, which provide a basis for development of neurostimulation-based closed loop approaches for pain relief.

Finally, Prof. Attal will share new insights on non-invasive neuromodulation in chronic pain patients. Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex has been found effective for a variety of chronic pain conditions and is now included in guidelines for selected cases of refractory neuropathic pain (Soliman et al., Lancet Neurol 2025). This presentation will focus on methods aiming to optimise efficacy, such as deep rTMS using a novel coil for stimulation, theta burst stimulation, and clinical algorithms for better patient selection.

Overall, attendees will gain a comprehensive understanding of how oscillatory brain dynamics can be harnessed for clinical benefit, learn about emerging neuromodulatory tools, and have the opportunity to discuss important future directions in the field.