Prinsloo, S., Novy, D., Driver, L., Lyle, R., Ramondetta, L., Eng, C., . . . Cohen, L. (2018). The long-term impact of neurofeedback on symptom burden and interference in patients with chronic chemotherapy-induced neuropathy: Analysis of a randomized controlled trial. Journal of Pain and Symptom Management, 55, 1276–1285.

To explore the long-term effects of electroencephalographic neurofeedback (NFB) to treat CIPN and other symptoms in cancer survivors.

NFB was given in 20 sessions over a maximum of 10 weeks with rewards for voluntary changes in electroencephalography. For the NFB, sensors were placed on participants scalp in areas deemed important via the EEG assessment. During the sessions, the participants were seated in a comfortable chair and instructed to watch a computer monitor. Feedback occurred when patricians were able to keep the amplitude of a desired EEG waveform above a certain threshold, while inhibiting amplitude of other less-desired waveforms, resulting in emotionally neutral pictures. When thresholds did not match, the game paused, and no feedback was given. Over time, the brain learns to modify its activity under the sensors without input from the NFB system.

• N = 71 (62 with final data for analysis)
• AGE: Mean age = 62.5 years (SD = 10.3)
• MALES: 13%  
• FEMALES: 87%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Any cancer type was eligible
• OTHER KEY SAMPLE CHARACTERISTICS: Participants had at least grade 3 neuropathy rating based on the NCI grading criteria or had severe pain without grade 3 neuropathy but had symptoms of neuropathy for a minimum of three months after chemotherapy completion. All post treatment.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Houston, TX

PHASE OF CARE: Late effects and survivorship

Randomized controlled trial

Symptom measurements were assessed at baseline, end of treatment, and 1 and 4 months later. They included the BPI-SF, pain quality assessment scale, MDASI, MOS-SF, BFI, Pittsburgh Sleep Quality Index. Each patient had an EEG at baseline and end of treatment.

The NFB group had greater improvement in worst pain and symptoms such as numbness, cancer-related symptom severity, symptom interference, physical functioning, general health and fatigue compared to patients in the wait list control group. There was a significant difference in pain at end of treatment (p < 0.05) and 1 month (p < 0.05) for the NFB group, no significance at 4 months. NFG group reported significant improvement in physical component subscale (p = 0.035); physical functioning (p = 0.037); and general health (p = 0.04) by the end of treatment, no difference at 1 or 4 months. There was also a significant group difference in fatigue at the end of treatment (p = 0.005). There was no effect of NFB on sleep at any timepoint. Large and moderate effect sizes were seen in neuropathic symptoms and QOL measures.

NFB has the potential to have lasting effects on CIPN symptoms as well as symptom burden, QOL, fatigue, and symptom interference.

• Small sample (< 100)
• Risk of bias (no control group)
• Intervention expensive, impractical, or training needs
• Missing data in both groups

NFB can significantly reduce symptoms without the adverse effects that medications may have. These results are promising and warrant further research.