Chronic back pain is a well spread phenomenon affecting as many as 2% of the French population with a conservative estimate of 1.5m chronic patients just in France for whom all therapeutic options have failed. The direct cost for the payer is estimated to a yearly €1.6b for France, turning a relatively small population into a public health issue. Neurofeedback (NFB) is a self-paced brain neuromodulation technique that represents one’s brain activity in real-time using auditory or visual modulations, on which the subject can exerts voluntary control, or which is used to “condition” certain neural mechanisms. Brain activity is captured using an electro-encephalographic (EEG) device.
The goal of this pilot study is to evaluate the efficiency of alpha synchrony based NFB, applied to n=16 chronic low back pain patients with whom all available therapeutic options have failed. The intervention investigated is 20 thirty-minute-long alpha synchrony neurofeedback session using an EEG cap of 21 electrodes. It is an open-label study with no control group. Patients were included after failing all other therapeutic options including a two-week-long pluri-disciplinary approach dispensed at a tertiary hospital.
First, progression of clinical scores (before and after intervention) such as pain, anxiety, depression, and quality of life are shown to have been reduced by more than 25% in most of patients. Likewise, electromyographic (EMG) signals show a statistically significant increase of the median frequency, associated to a gain of motor units of bigger diameters and more dynamic, the opposite that one can observe during muscle fatigue. Finally, alpha synchrony neuromarkersTM extracted from EEG signals at each session show progressions along blocks and sessions. More interestingly, the slope progression over sessions is correlated with the decrease of clinical score, which indicates specificity of the trained neuromarker with respect to clinical outcomes.
Future works involves the analysis of 6 and 12 months clinical and EEG follow-up data to investigate the long-term efficacy of neurofeedback. The results of this pilot project would ultimately be the clinical and technical foundations of a high-impact RCT to limit use of analgesics and non-steroidal anti-inflammatory drugs (NSAID) and promote quick return to work for these patients.
