- Cancer chemotherapy causes chronic
peripheral neuropathy or nerve damage, a painful condition that can impact
the patient's quality of life.
- Drugs approved to treat chemotherapy-induced
neuropathy (CIPN) have other side effects.
- Neurofeedback or functional brain
training helps reduce pain in CIPN without the side effects of drugs.
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
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.
‘Functional brain training reduces chemotherapy-induced peripheral neuropathy (CIPN) pain without the side effects of approved drugs.’
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.
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.
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
- Brain wave activity in targeted
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."
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
- Anxiety and depression
- 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
- 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