March 23, 2017
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Neurofeedback may ease pain of chemotherapy-induced neuropathy

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Functional brain training, known as neurofeedback, effectively reduced symptoms associated with chemotherapy-induced peripheral neuropathy, according to a randomized pilot study published in Cancer.

“The body has amazing healing capabilities, naturally,” Sarah Prinsloo, PhD, LPC, assistant professor of palliative, rehabilitation and integrative medicine at The University of Texas MD Anderson Cancer Center, told HemOnc Today. “Patients can be taught to modify brainwaves that are associated with chemotherapy-induced peripheral neuropathy, and that modification can result in a decrease of symptoms. We have an opportunity to turn toward novel treatments for conditions that have had limited responses to existing interventions, but that requires open mindedness of both researchers and practitioners.”

Sarah Prinsloo

Chronic chemotherapy-induced peripheral neuropathy (CIPN) is caused by damage to the nerves that control sensation and movement in a patient’s arms and legs. Between 71% and 96% of patients are estimated to experienced CIPN 1 month following chemotherapy treatment. Nearly one-third of patients continue to report pain, numbness, burning and tingling in their hands and feet 6 months after treatment.

Duloxetine has shown benefits for patients with painful neuropathy, but is associated with side effects, such as muscle aches, nausea and drowsiness.

Prinsloo and colleagues targeted brain areas active during pain episodes and, with the help of electroencephalogram (EEG) neurofeedback, sought to retrain patients’ brain activity. By attaching small metal discs with thin wires to the scalp, EEG neurofeedback charted brain wave patterns and displayed them to patients, who received visual and auditory rewards when they adjusted to brain wave patterns.

The program is like a computer game, where a graphic representation of the patient’s own brain waves, Prinsloo said.

“In other words, they are watching their own EEG, but it’s transformed into something that they can interpret, like a picture of a flower, a sunset, etc.,” she said, adding that a typical fee for a neurofeedback session is $120. “The principle is basically operant conditioning, where the ‘reward’ is a picture on the screen and an auditory sound like a ‘beep.’ The reward is contingent on the patient modifying their brainwaves according to the thresholds we have set for them. When they are unable to modify the waves, the game pauses, and no reward is given.”

The study included 62 patients (mean age, 62.5 years) from MD Anderson Cancer Center with all cancer types. Patients were at least 3 months from chemotherapy treatment and had at least grade 3 neuropathy.

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Researchers used the Brief Pain Inventory (BPI) assessment to measure the severity of pain and its impact on daily function.

Thirty patients were assigned the neurofeedback group and participated in 20 computer game sessions designed to modify brain wave activity in a targeted area. Members of the other cohort (n = 32) were placed on wait-list control group and were offered those same 20 sessions following the study.

After the completion of neurofeedback, participants repeated EEG measurements and pain assessments to determine change in pain perception, cancer-related symptoms, quality of life and brain wave activity in targeted areas.

At the beginning of the study, both groups reported no significant differences in neuropathy symptoms.

At the completion of the study, patients in the neurofeedback group demonstrated greater improvement on the BPI worst-pain item (mean change score, –2.43; 95% CI, –3.58 to –1.28 vs. 0.09; 95% CI, –0.72 to –0.9; P = .001), as well as significantly reduced BPI scores for worst pain, activity interference, numbness, tingling and unpleasantness.

“We observed clinically and statistically significant reductions in peripheral neuropathy following neurofeedback techniques,” Prinsloo said. “This research suggests that neurofeedback may be a valuable approach to reduce neuropathy symptoms and their impact on daily activities.”

Researchers noted the lack of a placebo group as a limitation of their study. Additionally, most participants were female breast cancer survivors, and researchers expressed the need for future research with a broader participant base.

In an accompanying editorial, Charles L. Loprinzi, MD, medical oncologist in the division of medical oncology at Mayo Clinic, and colleagues discussed whether there are benefits specific to neurofeedback, or if patients could use other approaches of self-regulation, such as yoga, progressive muscle relaxation, diaphragmatic breathing and self-hypnosis to achieve similar results.

Loprinzi and colleagues also proposed the use of scrambler therapy, in which electrical impulses are provided in dermatomes close to the site of pain.

“With repetitive sessions, data support the idea that long-term relief of pain/discomfort can be obtained,” Loprinzi and colleagues wrote. “The available pilot trials that are looking at scrambler therapy for treating CIPN support the idea that this approach decreases pain, tingling and numbness.” – by Chuck Gormley

For more information:

Sarah Prinsloo, PhD, LPC, can be reached at Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, TX 77030; email: sprinsloo@mdanderson.org.

Disclosure: The American Cancer Society, the Rising Tide Foundation and the National Center for Complementary and Integrative Health funded this study. The researchers reported no relevant financial disclosures. Loprinzi reports consulting roles with Cubist Pharmaceuticals, Coronado Biosciences, Mitsubishi Tanabe Pharma, PledPharma, Lpath and MundiPharma.