Content of review 1, reviewed on March 12, 2025
This is a really clearly written manuscript that has a very elegant hypothesis and data analysis structure. The graphs are clear and informative and the writing is easy to follow in most places. I only have a few questions / recommendations which are listed by section below:
General comments:
- Given Brain and Behaviour’s open science practice it would be beneficial for the data to be publicly accessible if possible, and if this is not possible for the reason for this to be explicitly stated.
Introduction:
- MSK acronym is not defined at first use.
- It is mentioned that “Previous studies investigated activity changes over targeted brain regions following EEG-NF training.” But there is no reference given for this and no statement about what they found, so it reads as though something is missing?
- The rational for this study is slightly confusing, which is likely just down to how the text reads. My understanding is that previous work has already shown modulating EC between the pgACC and the SCC by using ISF-NF can improve pain, and this study is aiming to investigate whether using ISF-NF can alter EC between the pgACC, SCC and the dACC. Has ISF-NF not already been found to alter EC between these regions in the previous work? I am sure I am misunderstanding something here, but it just doesn’t read clearly to me. Also, what is the rational for including the dACC? This area is previously mentioned in the introduction but a clear rational for inclusion is not given.
- Neuropathic pain is mentioned but is not given a description, perhaps a very brief one would help readers who are not familiar with different components to chronic pain - maybe detailing how it differs from nociceptive / nociplastic pain would be helpful, but just a suggestion.
- From the introduction different types of chronic pain conditions are mentioned, and some slight rationale for the use of this ISF-NF training in MSK OA knee pain would be helpful since MSK pain can be quite different from chronic pain experienced with conditions such as endometriosis.
Methods / Results:
- I appreciate this is not the focus of the work within this manuscript, but were there any pain ratings taken from participants before and after the training? If none were taken then I think it would be helpful to explicitly mention this, whereas if some were taken then it would be helpful to know these ratings to see if the ISF-NF training resulted in a reduction in pain alongside the changes in EC found.
Source
© 2025 the Reviewer.
Content of review 2, reviewed on April 01, 2025
The authors have made great adjustments to the introduction which I think really helps improve the clarity of the rational for the study.
I appreciate the authors comment about data being available upon reasonable request, but since this statement is used often in papers and very often authors do not give reproducible data when asked, it would be appreciated if the authors could reflect on their ability to share data, and if it is really not possible to upload the data to a public repository then to be clearer about what specific ethical considerations make the data not shareable and to mention this explicitly in the manuscript.
Whilst the introduction has been improved, I think it would be helpful if the pain condition for reference 10 was mentioned as neuropathic pain but a short description of this was given. It would read better, and create a stronger rational, if all previous work in chronic pain conditions were mentioned as this is a developing field and having explicit mention of the conditions currently studied would be helpful. It mentioned later in the paragraph that "comparable findings extend beyond MSK conditions", but it is not clear that the neuropathic pain for reference 10 is indeed MSK related.
I appreciate that the manuscript's findings are not dependent on the above changes, so would be happy to recommend the manuscript for acceptance without these changes, but I do think that they would really help improve the quality of the data availability and introduction sections.
Source
© 2025 the Reviewer.
References
Jerin, M., Bharatkumar, A. D., Llewellyn, S. M., Dirk, D. R., Ramakrishnan, M. 2025. Can EEG-Neurofeedback Training Enhance Effective Connectivity in People With Chronic Secondary Musculoskeletal Pain? A Secondary Analysis of a Feasibility Randomized Controlled Clinical Trial. Brain and Behavior.
