The Analgesic Effect of Electroencephalographic Neurofeedback for People With Chronic Pain: Protocol for a Systematic Review and Meta-analysis

Abstract

Background Chronic pain is a global health problem, affecting around 1 in 5 individuals in the general population. The understanding of the key role of functional brain alterations in the generation of chronic pain has led researchers to focus on pain treatments that target brain activity. Electroencephalographic neurofeedback attempts to modulate the power of maladaptive electroencephalography frequency powers to decrease chronic pain. Although several studies have provided promising evidence, the effect of electroencephalographic neurofeedback on chronic pain is uncertain. Objective This systematic review aims to synthesize the evidence from randomized controlled trials to evaluate the analgesic effect of electroencephalographic neurofeedback. In addition, we will synthesize the findings of nonrandomized studies in a narrative review. Methods We will apply the search strategy in 5 electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycInfo, and CINAHL) for published studies and in clinical trial registries for completed unpublished studies. We will include studies that used electroencephalographic neurofeedback as an intervention for people with chronic pain. Risk-of-bias tools will be used to assess methodological quality of the included studies. We will include randomized controlled trials if they have compared electroencephalographic neurofeedback with any other intervention or placebo control. The data from randomized controlled trials will be aggregated to perform a meta-analysis for quantitative synthesis. The primary outcome measure is pain intensity assessed by self-report scales. Secondary outcome measures include depressive symptoms, anxiety symptoms, and sleep quality measured by self-reported questionnaires. We will investigate the studies for additional outcomes addressing adverse effects and resting-state electroencephalography analysis. Additionally, all types of nonrandomized studies will be included for a narrative synthesis. The intended and unintended effects of nonrandomized studies will be extracted and summarized in a descriptive table. Results Ethics approval is not required for a systematic review, as there will be no patient involvement. The search for this systematic review commenced in July 2020, and we expect to publish the findings in early 2021. Conclusions This systematic review will provide recommendations for researchers and health professionals, as well as people with chronic pain, about the evidence for the analgesic effect of electroencephalographic neurofeedback. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42020177608; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=177608 International Registered Report Identifier (IRRID) PRR1-10.2196/22821

The analgesic effect of electroencephalographic neurofeedback for people with chronic pain: A systematic review and meta‐analysis

“…Inclusion of a wide variety of pain conditions increased the likelihood of conclusive evidence about the analgesic effect of EEG neurofeedback. We followed our prospectively registered protocol [28] and reported the review in line with the recommended guidelines [27]. We undertook a comprehensive search by exploring relevant reviews, receiving alerts from Google Scholar, and searching trial registries.…”

“…We searched five electronic databases (Cochrane CENTRAL, MEDLINE, Embase, PsycInfo, and CINAHL) for published studies and clinical trial registries (e.g., ClinicalTrials.gov and WHO Clinical Trial Registry) for completed unpublished studies [28]. Only studies on humans and in English language were included, with no restriction on the publication years.…”

“…The PRISMA checklist is provided in Appendix 1. We registered the protocol of this systematic review in PROSPERO (CRD42020177608) and the published protocol can be found here [28].…”

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

“…Additionally, rt-fMRI neurofeedback has been suggested as a potential treatment for chronic pain, showing beneficial effects іn patients with chronic pain ( Guan et al, 2015 ). While the evidence іs promising, іt іs important tо note that the field оf neurofeedback for chronic pain іs still evolving, and there іs a need for further research tо establish its efficacy and mechanisms оf action ( Jensen et al, 2014 ; Hesam-Shariati et al, 2020 ).…”

“…Neurofeedback therapy for chronic pain іs progressing quickly, with a growing emphasis оn using EEG neurofeedback and brain–computer interface technology tо address abnormal brain activity that contributes tо chronic pain ( Hesam-Shariati et al, 2020 ; Patel et al, 2020 ). Furthermore, neurofeedback has been recommended for pain management, and its potential benefits іn combination with physical therapy for chronic pain have been highlighted ( Marzbani et al, 2016 ; Trullinger et al, 2017 ).…”