Donald C.E. Ferguson, Ph.D., MPH
Research Professor, Department of Psychiatry
Uniformed Services University
Bethesda, Maryland
Health Care and/or Medical Interventions

Elsie L. Ferguson, Ph.D.
Medical Psychologist - Clinical Psychophysiologist - Private Practice
Chevy Chase, MD

HYPERLINK "mailto:dferguson@usuhs.mil"
dferguson@usuhs.mil

or HYPERLINK "mailto:pairofdocs@starpower.net"
pairofdocs@starpower.net

Neurofeedback and Pain

The use of biofeedback in treatment of many types of chronic pain is well established. Biofeedback has been found helpful and effective in chronic pain reduction either when used alone, or in combination with physical, medical, surgical, pharmacologic, or rehabilitative regimens as part of a comprehensive pain reduction and pain management treatment program.

Use of neurofeedback for pain management and control is a relatively recent addition to chronic pain treatment regimens. The purpose of this section is to provide background and to expand understanding of neurofeedback and its use with chronic pain problems. After describing neurofeedback itself, pain associated conditions for which neurofeedback has been found useful are detailed in paragraphs below.

What is Neurofeedback?

Neurofeedback has been in clinical use for roughly three decades. Limited, but growing numbers of neurofeedback specialists trained in the U.S. and elsewhere are experienced in the clinical use of neurofeedback in the treatment of a growing number of conditions. Specialists in neurofeedback, sometimes also called, neurotherapy, or EEG biofeedback, are now found in a number of medical centers and in university teaching hospitals. Office based private practitioners of neurofeedback therapy, though not evenly distributed through the nation are found around and in major metropolitan cities in the United States, Canada, and in some European centers.

Neurofeedback practitioners ordinarily begin as professionals originally trained in one several of several different professions. They later chose to become neurofeedback therapists and obtained additional postgraduate specialty training. Health related professions are foundations onto which neurofeedback training is added.

Neurofeedback is based on electroencephalography (EEG).  Electroencephalography is an established mainstream medical method used to gather information about ongoing brain function and brain wave patterns which are recorded on moving paper charts or stored digitally and then analyzed. Diagnostic electroencephalography has long been used by neurologists and neurosurgeons for help in diagnosing brain abnormalities, tumors, seizure disorders, and other neurological conditions. Clinical diagnostic electroencephalographers however are not ordinarily neurofeedback specialists, nor are they necessarily neurologists or neurosurgeons. Each comprises a different specialty with different goals, purposes, and settings and their training differs.

Neurofeedback therapy is not an invasive procedure, and neurotherapists are thus not required to be (and seldom are) physicians.

The Evidence Based Nature and Development of Neurofeedback

For many years it was believed brain waves were unmodifiable.  In the late 1950's and early 60's researchers discovered animal and human brain wave patterns can be modified and can be re-trained. When done correctly, changes in physical, physiological, psychophysiological, and psychological functioning follow.
After assessment, changing and modifying brain wave patterns towards more optimal patterns helps alleviate underlying problems resulting in significant alteration, mitigation, improvement of function, and often relieves symptoms in a number of medical conditions.  Pain reduction is one outcome of a treatment regimen tailored to an individual with this sort of problem.

Neurofeedback and neurotherapy are science and evidence based treatment modalities. Active research into new and additional uses for this treatment modality are ongoing at universities, medical centers, and medical schools throughout North America and abroad. A stream of promising and proven uses for neurofeedback has been forthcoming from research over the past five years. More clinical uses for it are certain to be discovered and added in coming years as experience accumulates and is documented.

Neurofeedback was developed from clinical application of research findings, and evaluation of what began as clinical and laboratory studies. Not a patented, proprietary, captive technique or method, it is an evidence-based method offered by credentialed neurofeedback specialists.

Indications for the Use of Neurotherapy

Neurotherapy has been and is used successfully in treatment of a number of pain control, pain management, and chronic pain control treatment programs. Alone or in combination with other treatment methods, fibromyalgia, cancer pain, arthritis pain, muscle pain from tension states, several types of headache pain, and chronic pain conditions associated with a number of medical disorders give evidence of benefit from neurofeedback treatment. Some of these conditions benefit most from combinations of biofeedback, and neurofeedback treatment since each method works with different aspects, components or attributes of central (CNS) or peripheral nervous system (PNS) dysfunction.

It is not uncommon to use both medication and neurotherapy simultaneously in a pain reduction program. Treatment is most often carried out independently, but concurrently in collaboration with a referring physician specialist. In many, if not most cases the need for side-effect inducing medications can be gradually reduced, and in many cases eliminated entirely over time using this method alone or adjunctively. An additional benefit of neurotherapy is (that properly administered) there are no negative or adverse side effects, which is seldom the case with many medications and pharmacologic agents in current use.

Where pain medication usage is accompanied by unpleasant, adverse side effects or hypersensitivity, neurofeedback treatment provides additional benefit through making dosage level reduction possible and yet tolerable. Reduction in dosage levels of pain medications can often be achieved through concurrent or sequential use of neurofeedback and biofeedback.

A number of conditions beyond the scope of this review also achieve dramatic benefit from condition-tailored neurofeedback treatment. Sleep disorders, Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD), and rehabilitation of traumatic brain injury, and obsessive compulsive disorders (OCD) besides chronic pain problems have been demonstrated to derive significant benefit from neurofeedback therapy. More conditions are being added to the list each year as study results support their use.

For a growing number of biological states in which autonomic hyper arousal contributes negatively to underlying illness, neurotherapy has been found to yield considerable benefit. Medical conditions in which autonomic hyper arousal plays a dysfunctional role are many. Stress related disorders, presently of almost epidemic proportion, given the demands, pace, complexity and rate of change in our industrial and post-industrial society also benefit remarkably.

Hyper arousal which amplifies pain can be "dampened" with medication. However, medication can be only a palliative for hyper-arousal.  If medication is stopped, the hyper arousal returns. With some medications there may also be compensatory "overshoot" or "rebound" when medication is discontinued.   Functional, though not physiological addiction to some medications may result in requiring continuous and chronic use of the medication.  Biofeedback and neurofeedback are non pharmacologic methods, and so pose no risk of chemical dependence.

What is Neurofeedback Treatment?

Electrical activity in the brain is monitored and measured by using externally attached electrodes to the scalp, in much the same way an electrocardiogram (EKG) uses externally attached electrodes attached with electrode paste to the chest. No electrical stimulation is put into the head or the brain. This is a non-invasive technique. Only detection, measurement and active monitoring of brain waves is done by the electronic equipment.

Patients voluntarily self-regulate brain wave modification through using visual information about their own ongoing brain activity which is presented to them on a computer screen in a number of ways. They can see ongoing patterns, and changes as they occur visually, and hear tones indicating the direction of changes they are making while happening in real time. This represents feedback to the patient of information from their own brain. Through monitoring, coaching and custom, individually tailored design of brain information presented on the screen, whose content is programmed by the therapist, patients are able to learn to modify components of their own brain's electrical activity patterns through their voluntary efforts in directions that are known to be beneficial. Discussion of matters such as beta-theta ratios and the like will have little meaning to most readers and will not be not pursued here.

While this task may sound impossible, it is readily accomplished using the purpose designed equipment, associated computers, and software coupled with coaching and expert professional guidance from the therapist. Space age technology and software is incorporated into the equipment used, and only a very few persons who attempt neurotherapy prove incapable of accomplishing this seemingly impossible task. As might be surmised it had been impossible to build such needed instrumentation until very recently. Electroencephalography has been used for many decades in medicine, but the signal processing, electronic computerized equipment, and complex software necessary for neurofeedback is of much more recent vintage.