Neurofeedback Could Reduce Chemotherapy-Induced Neuropathy Pain

Cancer patients who have received chemotherapy might benefit from neurofeedback or functional brain training to reduce pain due to CIPN, according to a study by scientists at the University of Texas MD Anderson Cancer Center. The authors claim that their pilot study is the biggest till date that has assessed the benefits of neurofeedback in cancer patients who received chemotherapy.

Neurofeedback – The Basis of the Study

The basis of the study is employing biofeedback or functional brain training to achieve a desired positive response in the patient /participant.

Sarah Prinsloo, the lead investigator in her earlier research had identified areas of brain involved in physical and emotional responses to pain and targeted those areas in this study to train participants to understand and respond to pain differently.

The research team created training regimens that permit the patient to alter their brain activity through electroencephalogram (EEG) neurofeedback. The EEG machine tracks and records brain wave patterns in the patient continuously through electrodes attached to the scalp. The recordings are then transmitted to a computer which displays the wave patterns (signals) to the participants.

The participants are taught to alter their reactions that bring about targeted changes in their wave patterns. When they succeed in achieving the correct response and the desired wave pattern, they receive visual and auditory rewards.

Details of the Study

The randomized, controlled study enrolled 71 patients with various cancer types from MD Anderson; all had received at least 3 months of cancer chemotherapy and reported a score of more than 3 on the National Cancer Institute’s neuropathy rating scale. The Brief Pain Inventory (BPI) assessment was employed to estimate the severity of pain and degree of impact on daily functioning.

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Patients included in the neurofeedback group attended 20 sessions where they played a computer game that trained them to alter their brain wave activity in the targeted area.  Initially, the correct patient behavior which brought about the desired brain wave pattern elicited visual and auditory rewards but over time the volunteers learnt to produce the correct response even without the reward. The control group was offered the same neurofeedback intervention at the end of the trial.

At the end of the trial, EEG measurements and pain assessments were once again repeated to see if there were any changes in

• Pain perception
• Quality of life
• Cancer-related symptoms
• Brain wave activity in targeted areas

Findings of the Study

At the start of the study, both groups reported no significant differences in neuropathy and pain symptoms.

• At the end of the study, patients in the neurofeedback group reported significant reduction in  BPI scores for worst pain, numbness, tingling, and unpleasantness, and activity interference, compared to the control group.
• Patients with CIPN also showed specific and predictable EEG patterns in the targeted brain regions whose activity and wave pattern altered with neurofeedback.

"We observed clinically and statistically significant reductions in peripheral neuropathy following neurofeedback techniques," said Prinsloo lead investigator of the study. "This research suggests that neurofeedback may be a valuable approach to reduce neuropathy symptoms and their impact on daily activities."

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What is Chemotherapy-Induced Peripheral Neuropathy or CIPN?

Chronic chemotherapy-induced peripheral neuropathy (CIPN) is caused by damage to the nerves that are responsible for sensation and movement in arms and legs. It is believed to affect between 71 and 96 percent of patients one month after chemotherapy treatment. Symptoms of CIPN include pain, burning, tingling and loss of feeling (numbness).

Currently certain drugs are used to treat CIPN but they also have adverse effects. "There is currently only one approved medication to treat CIPN and it has associated muscle aches and nausea," said Prinsloo. "Neurofeedback has no known negative side effects, can be used in combinations with other treatments and is reasonably cost-effective."

Uses of Neurofeedback in Medicine

Neurofeedback has been tried as a potential treatment option in several disorders that include

• Headaches
• Epilepsy
• Anxiety and depression
• Addiction
• Sleep disorders
• Autism spectrum disorders

Possible Limitations of the Study

• Lack of a placebo group though the authors feel that placebo effect will not be the only factor  to influence improvement in symptoms.
• Most patients were women and breast cancer survivors; future studies plan to include more types of cancer and a larger population base to study the effects of neurofeedback.

Though more research may be needed, the current study shows neurofeedback to hold promise in pain management in cancer chemotherapy patients without the adverse effects of drugs. This is especially important when cancer patients already might have many underlying co-morbidities.

References:

1. Sarah Prinsloo, Diane Novy, Larry Driver, Randall Lyle, Lois Ramondetta, Cathy Eng, Jennifer McQuade, Gabriel Lopez, Lorenzo Cohen. Randomized controlled trial of neurofeedback on chemotherapy-induced peripheral neuropathy: A pilot study. Cancer, 2017; DOI: 10.1002/cncr.30649

Source-Medindia