Abstract
BackgroundCentral Neuropathic Pain (CNP) is a frequent chronic condition in people with spinal cord injury (SCI). Previously, we showed that using laboratory brain-computer interface (BCI) technology for neurofeedback (NFB) training, it was possible to reduce CNP in people with SCI. In this study, we show results of patient self-managed treatment in their homes with a BCI-NFB using a consumer EEG device.MethodsUsers: People with chronic SCI (17 M, 3 F, 50.6 ± 14.1 years old), and CNP ≥4 on a Visual Numerical Scale. Location: Laboratory training (up to 4 sessions) followed by home self-managed NFB. User Activity: Upregulating the EEG alpha band power by 10% above a threshold and at the same time downregulating the theta and upper beta (20-30 Hz) band power by 10% at electrode location C4. Technology: A consumer grade multichannel EEG headset (Epoch, Emotiv, USA), a tablet computer and custom made NFB software. Evaluation: EEG analysis, before and after NFB assessment, interviews and questionnaires.ResultsEffectiveness: Out of 20 initially assessed participants, 15 took part in the study. Participants used the system for 6.9 ± 5.5 (median 4) weeks. Twelve participants regulated their brainwaves in a frequency specific manner and were most successful upregulating the alpha band power. However they typically upregulated power around their individual alpha peak (7.6 ± 0.8 Hz) that was lower than in people without CNP. The reduction in pain experienced was statistically significant in 12 and clinically significant (greater than 30%) in 8 participants. Efficiency: The donning was between 5 and 15 min, and approximately 10–20% of EEG data recorded in the home environment was noise. Participants were mildly stressed when self-administering NFB at home (2.4 on a scale 1–10). User satisfaction: Nine participants who completed the final assessment reported a high level of satisfaction (QUESQ, 4.5 ± 0.8), naming effectiveness, ease of use and comfort as main priorities. The main factors influencing frequency of NFB training were: health related issues, free time and pain intensity.ConclusionPortable NFB is a feasible solution for home-based self-managed treatment of CNP. Compared to pharmacological treatments, NFB has less side effects and provides users with active control over pain.Trial registrationGN15NE124, Registered 9th June 2016.
Highlights
Central Neuropathic Pain (CNP) is a frequent chronic condition in people with spinal cord injury (SCI)
Brain computer interface usability studies with patients have been tested on several paradigms, including brain-computer interface (BCI) spellers, painting, gaming, environmental control and cognitive rehabilitation [30, 31, 34,35,36,37,38,39,40,41,42,43]
A “Back home” project, one of the largest of this kind, tested BCI designed for spelling, gaming and internet browsing on 9 patients at a hospital
Summary
Central Neuropathic Pain (CNP) is a frequent chronic condition in people with spinal cord injury (SCI). We showed that using laboratory brain-computer interface (BCI) technology for neurofeedback (NFB) training, it was possible to reduce CNP in people with SCI. A related secondary consequence of the injury is chronic neuropathic pain. As a consequence of this, patient’s sleep quality is reduced associated with high levels of anxiety and depression [4]. A combination of low self-efficacy and pain intensity has been associated with reduced quality of life in people with SCI [5]. The CNP following spinal cord injury affects patients’ health status and quality of life and has an economic impact on the patient and the wider society [4]
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