Steps Toward Developing an EEG Biofeedback Treatment for Chronic Pain

Abstract

Chronic pain, usually refractory to analgesics, is a significant problem for many individuals with spinal cord injury (SCI). Preliminary studies suggest that electroencephalography (EEG) biofeedback (also known as neurofeedback, NF) has the potential to help patients with otherwise refractory chronic pain. However, there remain many unanswered questions about the effects and mechanisms of this treatment. We studied 13 individuals with SCI and chronic pain with NF. Ten of the 13 individuals completed 4 sessions each of three different neurofeedback protocols assigned in random order for a total of 12 NF sessions. All three protocols had similar immediate effects on pain intensity. In addition, the participants reported modest pre- to post-treatment decreases in worst pain and pain unpleasantness following completion of the 12 NF sessions. These improvements were maintained at 3-month follow-up. The majority of the participants felt they benefited from and were satisfied with the treatment. No significant effects on measures of other outcome domains (sleep quality, pain interference and fatigue) were observed, although there was a non-significant trend for an increase in fatigue. Finally, pre- to post-treatment changes in EEG bandwidth activity, consistent with the training protocols, were observed in θ and α but not β frequencies. The findings provide preliminary support for the potential efficacy of NF for the treatment of SCI-related pain, and suggest that further clinical studies are warranted.

Neuromodulatory treatments for chronic pain: efficacy and mechanisms

“…105 Three protocols (four sessions each) were used for all participants, although they each involved reinforcement of the amplitude of slower oscillations (alpha and sensory motor rhythm frequencies) and suppression of both beta and theta power. The participants reported modest pre-treatment to post-treatment reductions in worst pain and pain unpleasantness, which were maintained at 3-month follow-up.…”

Brain Oscillations, Hypnosis, and Hypnotizability

“…In this case, clinicians could potentially increase response to hypnotic suggestions among “lows” – that is, individuals who do not generally respond well to classic hypnotic inductions – by using one or more of a growing number of strategies that have been shown to increase theta activity, such as music or monochrome sounds (Lee, Bhattacharya, Sohn, & Verres, 2012), some (but not necessarily all) meditation training practices (Lutz et al, 2009), and neurofeedback (Batty, Bonnington, Tang, Hawken, & Gruzelier, 2006; Jensen, Gertz, et al, 2013). Depending on the results of research examining the effects of additional clinical practices on enhancing slow wave oscillations, briefly alluded to above, these practices could be systematically added to clinician repertoires.…”

Challenges in clinical applications of brain computer interfaces in individuals with spinal cord injury

“…It was shown in patients with a chronic thoracic SCI that imagination of foot movements three times a day for a period of 7 days increases neuropathic pain (Gustin et al, 2008). In contrast to this, preliminary studies suggest that neurofeedback has the potential to help patients with otherwise refractory chronic pain (Jensen et al, 2013a). Recent findings indicate that certain EEG activity patterns may be associated with more pain or a vulnerability to experience chronic pain in persons with SCI.…”