A surgery-informed precision approach to determining brain targets for real-time fMRI neurofeedback modulation in chronic pain

Objective Despite the promising results of neurofeedback with real-time functional magnetic resonance imaging (rt-fMRI-NF) in the treatment of various psychiatric and neurological disorders, few studies have investigated its effects in acute and chronic pain and with mixed results. The lack of clear neuromodulation targets, rooted in the still poorly understood neurophysiopathology of chronic pain, has probably contributed to these inconsistent findings. In contrast, functional neurosurgery (funcSurg) approaches targeting specific brain regions have been shown to reduce pain in a considerable number of patients with chronic pain, however, their invasiveness limits their use to patients in critical situations. In this work, we sought to redefine, in an unbiased manner, rt-fMRI-NF future targets informed by the long tradition of funcSurg approaches.