This paper is in the following e-collection/theme issue:

Letters to the Editor (4) New Methods (1149) Chronic Conditions (458) Digital Pain Assessment and Management (243) Brain-Machine Interfaces (23) Cognitive and Neurorehabilitation (366) Neurotechnology in Clinical Studies (26) Methods and Feasibility Studies (481) Pilot studies (non-ehealth) (113)

Published on in Vol 15 (2026)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/89007, first published .
Authors’ Reply: Bridging Neurofeedback and Structural Connectivity in Chronic Pain

Authors’ Reply: Bridging Neurofeedback and Structural Connectivity in Chronic Pain

Authors’ Reply: Bridging Neurofeedback and Structural Connectivity in Chronic Pain

Authors of this article:

Luke Spencer Bialostocki1, 2 Author Orcid Image ;   Divya Bharatkumar Adhia2 Author Orcid Image ;   Damith Rathnayake Mudiyanselage1 Author Orcid Image ;   Mark Llewellyn Smith3 Author Orcid Image ;   Yusuf Ozgur Cakmak1 Author Orcid Image ;   Dirk De Ridder2 Author Orcid Image ;   Ramakrishnan Mani4 Author Orcid Image ;   Jerin Mathew1 Author Orcid Image
Article Authors Cited by Tweetations Metrics

    1Department of Anatomy, Faculty of Biomedical Sciences, University of Otago, 270 Great King Street, Dunedin, Otago, New Zealand

    2Department of Surgical Sciences, Faculty of Medicine, University of Otago, Dunedin, Otago, New Zealand

    3Neurofeedback Services of New York, New York, NY, United States

    4Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Otago, New Zealand

    Corresponding Author:

    Jerin Mathew, PhD



    We appreciate the opportunity to respond to the letter [1] written in response to our recent publication “Neurofeedback Training for Managing Neuropathic Pain–Like Features in Chronic Musculoskeletal Pain: Protocol for an Open-Label Pilot Feasibility Clinical Trial” [2]. The paper outlines a protocol for a novel electroencephalography-based neurofeedback approach, which aims to simultaneously downregulate infraslow activity in the right insula and the dorsal anterior cingulate cortex.

    We thank the authors for their interest in our publication and for suggesting the incorporation of diffusion tensor imaging (DTI) to assess neuroplastic alterations in the cingulum bundle. We agree that DTI could provide valuable complementary information on the structural substrates underlying functional changes induced by electroencephalography-based neurofeedback. While we recognize the merit of this proposal, particularly the possibility that structural differences could influence training outcomes, we are unfortunately unable to incorporate DTI into the present study. Access to DTI is not available within the scope or resources of this project, as medical imaging technologies such as DTI are costly to implement and limited to specialized centers with the necessary equipment and trained personnel. In addition, our study has now completed its recruitment and data collection phase. For these reasons, integrating DTI into this particular study is not feasible.

    Structural imaging techniques such as DTI may indeed be incorporated into future studies to further elucidate the neurophysiological changes associated with endogenous neuromodulation. These suggestions underscore a promising direction for integrating neuroanatomical perspectives with neuromodulatory approaches, offering a more complete understanding of the anatomical processes involved. Integrating DTI also represents a promising direction for future research aiming to link functional neuromodulation with white matter pathways [3]. However, it is also important to note that structural and functional connectivity often show weak correlations [4].

    Conflicts of Interest

    MLS is the owner of Neurofeedback Services of New York.

    1. Acar A, Yahya D, Tekirdaş E. Bridging neurofeedback and structural connectivity in chronic pain. JMIR Res Protoc. 2026;15:e87420. [CrossRef]
    2. Bialostocki LS, Adhia DB, Mudiyanselage DR, et al. Neurofeedback training for managing neuropathic pain–like features in chronic musculoskeletal pain: protocol for an open-label pilot feasibility clinical trial. JMIR Res Protoc. Nov 4, 2025;14:e78806. [CrossRef] [Medline]
    3. Silva NA, Barrios-Martinez J, Yeh FC, et al. Diffusion and functional MRI in surgical neuromodulation. Neurotherapeutics. Apr 2024;21(3):e00364. [CrossRef] [Medline]
    4. Huang H, Ding M. Linking functional connectivity and structural connectivity quantitatively: a comparison of methods. Brain Connect. Mar 2016;6(2):99-108. [CrossRef] [Medline]

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    DTI: diffusion tensor imaging

    Edited by Amy Schwartz; This is a non–peer-reviewed article. submitted 04.Dec.2025; accepted 08.Dec.2025; published 28.Jan.2026.

    Copyright

    © Luke Spencer Bialostocki, Divya Bharatkumar Adhia, Damith Rathnayake Mudiyanselage, Mark Llewellyn Smith, Yusuf Ozgur Cakmak, Dirk De Ridder, Ramakrishnan Mani, Jerin Mathew. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 28.Jan.2026.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.