Closed-loop neurofeedback reshapes preparatory brain states to bias subsequent pain processing

Pain perception is strongly influenced by neural states preceding stimulus onset, yet whether such preparatory states can be causally reshaped remains unclear. Using a double-blind design, we tested whether closed-loop neurofeedback can reconfigure preparatory brain dynamics to influence subsequent pain processing. Real, but not sham, feedback enabled learning-dependent enhancement of pre-stimulus oscillations in primary somatosensory cortex and their trans-hemispheric propagation. Training also selectively reduced transitions between EEG microstates associated with salience and attentional control, indicating reorganization of preparatory brain states. These neural changes were accompanied by attenuated pain-evoked cortical responses and reduced pain perception. Sequential mediation analyses further revealed that somatosensory enhancement predicted microstate reorganization, which in turn suppressed pain-evoked responses. Together, these findings demonstrate that closed-loop neurofeedback can causally reshape preparatory brain states to bias subsequent sensory processing.