Alpha oscillations in pain neuromodulation: From resting rhythms to reactive networks

pain alpha oscillations transcranial magnetic stimulation (TMS) Chronic pain remains a major clinical challenge.Pharmacological treatments, while central to current care, often provide only partial and unsatisfactory relief [1].This therapeutic gap has fueled increasing interest in non-invasive brain stimulation approaches, particularly repetitive transcranial magnetic stimulation (rTMS) [1][2][3].In this context, a central goal is to identify neurophysiological processes that mediate analgesia.Alpha oscillations are prominent candidates, with resting-state power and peak frequency consistently linked to pain sensitivity [4][5][6].Yet, a key question persists: are alpha rhythms merely a marker of ongoing pain states, or are they mechanistically relevant targets for neuromodulation?In this issue of Neurotherapeutics [7], Chowdhury and colleagues advance this debate by moving beyond resting-state measures to perturbation-evoked alpha dynamics.Using combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) in a capsaicin-induced tonic pain model, they tracked event-related spectral perturbations (ERSP) and inter-trial coherence (ITC) before and after posterior insula-proximal rTMS.In this perspective, alpha oscillations are not static features of brain state, rather they are dynamic, perturbation-sensitive properties of neural systems.Chowdhury et al. [7] re port that posterior insula-proximal rTMSshown to produce analgesia in their prior study [8], was associated with a more positive pre-to-post change in frontocentral alpha ERSP following active compared to sham stimulation, although within-session changes were not significant.This pattern reflects a difference-in-differences interaction rather than a clear increase after