Neurofeedback and pain management
A study conducted by Hasan and colleagues (2016) found that after 40 sessions of neurofeedback, paraplegic patients with central neuropathic pain in their legs (n=5) demonstrated a significant reduction in cortical overactivation in the alpha and beta band, but particularly in the theta band, which corresponded to a significant reduction in subjective pain ratings and a decrease in activity in the sensory-motor cortex during an imagined movement task – activity associated with increased pain perception. The researchers further noted that compared to pre-neurofeedback, the patients’ post-neurofeedback cortical activity resembled that of able-bodied and paraplegic participants who did not experience any pain. These findings suggest that neurofeedback training effectively reduced over-activation in brain regions associated with pain perception, and thus appears to be a potent treatment for reducing central neuropathic pain.
Prinsloo and colleagues (2016) from the MD Cancer Center in Houston, Texas, conducted a randomised control study examining the effectiveness of neurofeedback for chemotherapy-induced peripheral neuropathic pain. Compared to patients in the wait-list control group (n=36), significant reductions in pain and numbness were reported by patients who underwent 20 neurofeedback sessions (n=35), corresponding to increased activity in the alpha band and decreased activity in the beta band. These findings provide support for the use of neurofeedback training for treating chemotherapy-induced pain.
A double-blind randomised control study by Guan and colleagues (2015) from the Montreal Neurological Institute and Zhengzhou University, China, compared the effectiveness of real-time fMRI (rtfMRI) neurofeedback with a control procedure (‘sham’-neurofeedback) for patients with postherpetic neuralgia. The researchers found that patients who received neurofeedback (n=8) were able to significantly reduce over-activation in the rostral anterior cingulate cortex, an area associated with pain perception, and subsequently reported a significant reduction in pain after only one session. These findings provide evidence for the effectiveness of neurofeedback training as an alternative treatment for a wide variety of chronic pain conditions.
Burns (2015) from Western Michigan University conducted a case study of a 43-year old Caucasian female which examined the efficacy of neurofeedback training for reducing symptoms associated with hereditary angioedema (HAE). The neurofeedback protocol was designed to inhibit theta and high beta brainwaves as well as increase SMR brainwaves in the right dorsal posterior quadrant of the brain – an area responsible for sensory overload control, anxiety, body tension and pain. A reduction in blood levels of cortisol (a stress hormone), and theta and beta brainwaves was observed. Additionally, the patient reported an increase in overall quality of life, including improved sleep, increased calm focus and relaxation, decreased tension and pain, and the associated reduction in the use of HAE medication. These results provide further support for the use of neurofeedback training as a treatment for chronic pain conditions.
In a longitudinal case series study by Jensen and colleagues (2013) from the University of Washington in Seattle, 13 patients with spinal cord injuries underwent 12 neurofeedback sessions. It was found that compared to pre-treatment, patients experienced a significant post-treatment reduction in worst pain and pain unpleasantness, which was sustained at a 3-month follow-up assessment. Pre-post treatment brainwave changes (decreased theta frequencies and increased alpha frequencies) were also observed. Given that neurofeedback protocols generally involve a larger number of sessions, and given the highly refractory nature of spinal-cord injury pain, the results of this study highlight the potency of neurofeedback for chronic pain.
A randomised control trial conducted by Caro and Winter (2011) from University of California and North Central University, respectively, assessed the effectiveness of neurofeedback training in reducing pain associated with fibromyalgia. Patients (N=15) completed 40 sessions of a SMR neurofeedback protocol, which involved the inhibition of theta (4-7Hz) and high beta (22-30Hz) brainwaves, as well as the augmentation of SMR brainwaves (12-15Hz). Compared to a control group receiving standard care (n=63), patients who received neurofeedback training reported a substantial improvement on measures of tenderness, pain and fatigue, as well as improvement on a visual attention test. Attention deficits are commonly seen in fibromyalgia patients, thus the findings of this study suggest that the benefits of neurofeedback training extend to general cognitive functioning, as well as to pain reduction.
In a study conducted by Ibric and colleagues (2009), patients experiencing chronic pain with various etiologies (e.g. surgery, injury) that was refractory to standard care, underwent neurofeedback training. The researchers found that 92% of patients (68/74) reported a significant reduction in pain, and several reported a decrease in depressive symptoms and anxiety, following an average of 19 neurofeedback sessions. These findings highlight the applicability of neurofeedback training as a treatment for a wide variety of chronic pain conditions.
Jensen and colleagues (2007) explored the effectiveness of neurofeedback training for Complex Regional Pain Syndrome Type I (CRPS-I), a chronic pain condition that is generally unresponsive to standard care. 18 participants with CRPS-I completed a 30-minute neurofeedback session and subsequently reported a substantial reduction in pain intensity at the primary pain site. The researchers further noted that 50% of participants reported clinically meaningful reductions in pain intensity, providing further evidence that neurofeedback training is an efficacious treatment for chronic pain.
Siniatchkin and colleagues (2000) examined the effect of biofeedback training on slow cortical potentials (SCP) which characterise migraine patients. Results revealed a significant reduction of cortical excitability in concurrence with feedback training, as well as a significant improvements of reported days with migraine. These results imply that clinical improvements may result from levelling the threshold of cortical excitability during training.
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