keefektifan neurofeedback terhadap peningkatan kadar norepinefrin dan penurunan skor depresi pada nyeri kronis

Santi Yuliani, Prof. Dr. dr. Sri Sutarni, Sp.N.Subsp.Ped (K); Dr. dr. Carla Raymondalesxas Marchira, Sp.KJ (K); dr. Irwan Supriyanto, Ph.D., Sp.KJ

2026 | Disertasi | S3 Kedokteran Umum

ABSTRAK

Latar Belakang: Nyeri kronis dan depresi merupakan kondisi yang sering terjadi secara bersamaan dan dapat saling memperburuk manifestasi klinis, menurunkan fungsi pasien, serta memengaruhi respons terhadap terapi. Norepinefrin berperan dalam patofisiologi depresi serta modulasi nyeri melalui jalur inhibisi desenden. Neurofeedback merupakan intervensi yang melatih regulasi aktivitas otak dan berpotensi memperbaiki depresi serta nyeri kronis. Namun, efektivitasnya dibandingkan cognitive behavioral therapy (CBT), terutama terhadap kadar norepinefrin, masih perlu dikaji.

Tujuan: Menganalisis efektivitas neurofeedback dibandingkan CBT terhadap penurunan skor depresi dan nyeri serta perubahan kadar norepinefrin pada pasien nyeri kronis. 

Metode: Penelitian eksperimental dengan desain randomized controlled trial (RCT) dilakukan pada pasien nyeri kronis yang direkrut secara consecutive sampling dan dialokasikan menjadi kelompok neurofeedback dan CBT. Kelompok neurofeedback mendapat lima sesi latihan gelombang alfa pada area F3 dan F4, masing-masing selama 30 menit, sedangkan kelompok CBT mendapat enam sesi terapi masing-masing selama 30 menit. Depresi dinilai menggunakan PHQ-9, nyeri menggunakan VAS, dan kadar norepinefrin diukur dengan metode ELISA. Analisis dilakukan menggunakan uji t, analisis korelasi, dan regresi linear menggunakan SPSS.

Hasil: Terdapat perbedaan yang signifikan p = 0,000 skor depresi antara sebelum dan sesudah perlakuan neurofeedback dan terdapat perbedaan yang signifikan p = 0,006 kadar norepinefrin antara sebelum dan sesudah perlakuan neurofeedback. Tidak terdapat perbedaan skor depresi p = 0,428 dan tidak terdapat perbedaan kadar norepinefrin p = 0,363 antara perlakuan neurofeedback dan CBT setelah perlakuan. Didapatkan korelasi negatif (r = -0,425; p = 0,027) antara nyeri dan kadar norepinefrin setelah perlakuan neurofeedback.

Kesimpulan: Terdapat perbedaan yang signifikan skor depresi dan kadar norepinefrin antara sebelum dan sesudah perlakuan neurofeedback. Tidak terdapat perbedaan skor depresi dan kadar norepinefrin antara neurofeedback dan CBT sesudah perlakuan. Terdapat korelasi negatif antara nyeri dan kadar norepinefrin sesudah perlakuan neurofeedback

Keywords: cognitive behavior therapy, depresi, neurofeedback, norepinefrin, nyeri kronis

ABSTRACT

Background: Chronic pain and depression frequently coexist and may mutually exacerbate clinical manifestations, impair patient functioning, and affect treatment response. Norepinephrine plays an important role in the pathophysiology of depression and pain modulation through descending inhibitory pathways. Neurofeedback is an intervention designed to facilitate self-regulation of brain activity and has the potential to improve depression and chronic pain. However, its effectiveness compared with cognitive behavioral therapy (CBT), particularly in modulating norepinephrine levels, remains to be further investigated.

Objective: To analyze the effectiveness of neurofeedback compared with CBT in reducing depression and pain scores and altering norepinephrine levels in patients with chronic pain.

Methods: This experimental study employed a randomized controlled trial (RCT) design involving patients with chronic pain recruited through consecutive sampling and allocated to either the neurofeedback or CBT group. The neurofeedback group received five 30-minute sessions of alpha-wave training targeting the F3 and F4 regions, whereas the CBT group received six 30-minute therapy sessions. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), pain using the Visual Analog Scale (VAS), and norepinephrine levels using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using t-tests, correlation analysis, and linear regression with SPSS.

Results: Depression scores decreased significantly following neurofeedback (p<0 p=0.006). p=0.428) p=0.363). r=?0.425; p=0.027).>

Conclusion: Neurofeedback resulted in significant changes in depression scores and norepinephrine levels in patients with chronic pain. However, no significant differences in depression scores or norepinephrine levels were observed between neurofeedback and CBT following treatment. Pain scores were negatively correlated with norepinephrine levels following neurofeedback.

Keywords: chronic pain, cognitive behavioral therapy, depression, neurofeedback, norepinephrine

Kata Kunci : cognitive behavior therapy, depresi, neurofeedback, norepinefrin, nyeri kronis