Papers of the Week

This parallel, two-arm, blinded, randomized controlled superiority trial examined whether, when added to usual care, active- electroencephalography neurofeedback (EEG NFB) was safe and more effective than sham control-EEG NFB for chronic pain. 116 participants with chronic pain were randomly assigned (1:1) to usual care plus ≥ 32 sessions of active-EEG NFB upregulating relative alpha power over C4 or usual care plus ≥ 32 sessions of sham control-EEG NFB. Per protocol analyses revealed no significant between-group differences in the primary outcome, brief pain inventory (BPI) average pain (mean difference [95% CI]: -0.04 [-0.39 to 0.31], p=0.90), or any secondary outcomes. However, 44% of participants in the active-EEG NFB group and 45% in the control-EEG NFB group reported at least a moderate (≥30%), clinically important improvement in BPI average pain. The number of treatment emergent adverse events were similar in both groups (p = 0.83), and none were serious. Post-hoc analyses revealed similar upregulated relative alpha power in both groups during training, with concordant positive rewards delivered to the active-EEG group 100% of the time and the control-EEG group ~25% of the time, suggesting a partially active sham intervention. When added to usual care, the active-EEG NFB intervention used in this study was not superior to the sham control-EEG NFB intervention. However, a large proportion of participants in both groups reported a clinically important reduction in pain intensity. A partially active sham intervention may have obscured between-group differences. The intervention was free of important side effects, with no safety concerns identified. PERSPECTIVES: This study is the first attempt at an appropriately blinded, randomized, sham-controlled trial of alpha EEG NFB for the treatment of chronic pain. The findings may interest people living with chronic pain, clinicians involved in chronic pain management, and may inform the design of future EEG NFB trials. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000667819.