New treatment strategy for chronic low back pain with alpha wave neurofeedback

Abstract

The lifetime prevalence of low back pain is 83%. Since there is a lack of evidence for therapeutic effect by cognitive behavioral therapy (CBT) or physical therapy (PT), it is necessary to develop objective physiological indexes and effective treatments. We conducted a prospective longitudinal study to evaluate the treatment effects of CBT, PT, and neurofeedback training (NFT) during alpha wave NFT. The early-chronic cases within 1 year and late-chronic cases over 1 year after the diagnosis of chronic low back pain were classified into six groups: Controls, CBTs, PTs, NFTs, CBT-NFTs, PT-NFTs. We evaluated the difference in EEG, psychosocial factors, scores of low back pain before/after the intervention. Therapeutic effect was clearly more effective in the early-chronic cases. We found that the intensity of alpha waves increased significantly after therapeutic intervention in the NFT groups, but did not have the main effect of reducing low back pain; the interaction between CBT and NFT reduced low back pain. Factors that enhance therapeutic effect are early intervention, increased alpha waves, and self-efficacy due to parallel implementation of CBT/PT and NFT. A treatment protocol in which alpha wave neurofeedback training is subsidiarily used with CBT or PT should be developed in the future.

Exploring electroencephalographic infraslow neurofeedback treatment for chronic low back pain: a double-blinded safety and feasibility randomized placebo-controlled trial

“…Previous EEG-NF studies, including case reports/non-randomised/open-label studies, targeted training higher frequency bands at specific electrode levels in individuals with chronic pain conditions 15 – 17 . Studies investigating the effect of EEG-NF training on CLBP outcomes are lacking; only two pilot studies have been reported to date 18 , 19 targeting the alpha frequency at the sensor level rather than training specific brain regions at the source level. Higher frequency bands are believed to be nested on the infraslow frequency (ISF) bands (0.0–0.1 Hz) 20 , 21 .…”

Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review

“…The types оf neurofeedback used іn the studies considered include electroencephalographic (EEG) neurofeedback, infra-low frequency (ILF) neurofeedback, volitional limbic neuromodulation, SMR-based neurofeedback, alpha-wave neurofeedback, and rt-fMRI neurofeedback ( Jensen et al, 2013 ; Guan et al, 2015 ; Hassan et al, 2015 ; Goldway et al, 2019 ; Terrasa et al, 2020 ; Arina et al, 2022 ; Demarest et al, 2024 ). These studies have shown promising results, with notable reductions іn non-pain-related symptoms and pain relief іn patients with chronic pain ( Terrasa et al, 2020 ; Barbosa-Torres and Delgado, 2021 ; Shimizu et al, 2022 ) and with a significant impact оn pain intensity іn the immediate period ( Hesam-Shariati et al, 2022 ).…”

“…Neurofeedback has gained attention as a potential treatment for chronic low back pain. Shimizu et al (2022) conducted an intervention study combining alpha-wave neurofeedback training with conventional treatments for chronic low back pain, reporting a clinically meaningful effect оn pain intensity іn the short term. Roy et al (2020) emphasized the potential оf neurofeedback іn pain management, highlighting the association оf neurophysiological abnormalities with pain and the rationale for treatments targeting these factors.…”

“…While some studies have reported positive outcomes іn reducing pain intensity ( Jensen et al, 2007 ; Shimizu et al, 2022 ), others have highlighted potential adverse effects such as transient exacerbation оf symptoms like fatigue and pain ( Luctkar-Flude and Groll, 2015 ). It has also been observed that neurofeedback treatment can occasionally be linked tо temporary side effects and more severe adverse effects ( Hammond, 2009 ; Rogel et al, 2015 ).…”

“… Shimizu et al (2022) further substantiated the value of neurofeedback in chronic pain treatment through their intervention study targeting alpha-wave neurofeedback training in individuals with chronic low back pain. They found that this specific neurofeedback protocol had a significant and clinically meaningful impact on reducing pain severity.…”