Neurofeedback for Chronic Pain Management: Discussing the Latest Research

By Hannah Friedman | September 15, 2025 | Comments Off on Neurofeedback for Chronic Pain Management: Discussing the Latest Research

Chronic pain remains one of the most pressing challenges in modern healthcare, affecting nearly 20% of adults worldwide and imposing profound physical, psychological, and economic burdens. Traditional treatment strategies—often relying heavily on pharmacological interventions—are associated with limited efficacy, side effects, and risks of dependency. Against this backdrop, neurofeedback (EEG biofeedback) has emerged as a promising non-invasive, non-pharmacological tool for chronic pain management.

A recent narrative review by Diotaiuti and colleagues (2024) provides a comprehensive synthesis of current evidence on neurofeedback in chronic pain. This blog post highlights key findings and clinical implications for healthcare providers. You can find the article: here

Understanding Neurofeedback in Pain Modulation

Neurofeedback is a technique in which patients learn to self-regulate brain activity through real-time feedback on their neural oscillations. By training specific brainwave patterns (e.g., alpha, theta, or sensorimotor rhythm), individuals may alter pain perception pathways, leveraging the brain’s neuroplasticity.

  • Mechanisms: Studies indicate that neurofeedback can normalize dysfunctional brain oscillations linked to chronic pain, particularly in regions such as the prefrontal cortex and thalamus, which are central to pain processing.
  • Clinical Goal: To reduce pain intensity while improving quality of life, functional ability, and psychological well-being.

Evidence Across Pain Conditions

The review synthesized findings across diverse pain conditions (see Table 2, p. 6 of the article):

  • Fibromyalgia: Randomized controlled trials (Kayiran et al., 2010; Lee et al., 2014) show EEG biofeedback and low-energy neurofeedback systems (LENS) significantly reduce pain intensity compared with sham treatments.
  • Tension-Type Headaches: Infra-low frequency and QEEG-guided neurofeedback demonstrated reductions in headache frequency and promise as preventive interventions (Arina et al., 2022; Stokes & Lappin, 2010).
  • Chronic Low Back Pain: Alpha-wave neurofeedback, combined with conventional therapy, produced clinically meaningful reductions in pain severity (Shimizu et al., 2022).
  • Complex Regional Pain Syndrome (CRPS): Pilot studies show short-term improvements in pain relief and symptom management (Hassan et al., 2015).
  • Central Neuropathic Pain (Paraplegia): Experimental studies using EEG-based neurofeedback revealed reductions in pain intensity and cortical overactivity (Hasan et al., 2016; Vuckovic et al., 2019).
  • Cancer Pain: Evidence remains limited and mixed, with some systematic reviews suggesting varied effectiveness, highlighting the need for further studies.

Practical Considerations for Providers

  • Treatment Structure: Protocols range widely—from 10 sessions for headaches to 40 or more for fibromyalgia—with individual sessions lasting 20 to 45 minutes.
  • Efficacy: Meta-analyses suggest a medium effect size in favor of neurofeedback compared with controls (Hesam-Shariati et al., 2022).
  • Adverse Effects: Generally mild and transient, including fatigue or symptom fluctuation. Notably, such side effects are often common in chronic pain conditions irrespective of neurofeedback.
  • Integration with Other Therapies: Combining neurofeedback with physical therapy or CBT may offer synergistic benefits, improving both physical function and psychological resilience.

Limitations and Future Directions

While early findings are encouraging, the field faces several challenges:

  1. Heterogeneity of Protocols – Standardization of neurofeedback techniques is lacking.
  2. Sample Size Concerns – Many studies involve small or pilot cohorts, limiting generalizability.
  3. Need for Long-Term Data – Sustained efficacy and durability of treatment effects remain under investigation.
  4. Technology and Access – Advances in wearable devices and AI-driven personalization may increase accessibility and optimize outcomes.

Clinical Implications

For healthcare providers, neurofeedback represents a viable adjunctive therapy for chronic pain, particularly in patients seeking alternatives to pharmacological management. While it should not yet be considered a standalone gold standard, integrating neurofeedback into multidisciplinary pain management programs—alongside physical rehabilitation, psychological support, and selective pharmacotherapy—may significantly enhance patient outcomes.

Conclusion

Neurofeedback is rapidly emerging as a scientifically grounded, non-invasive strategy for chronic pain management. Although further high-quality trials are needed, current evidence supports its potential to reduce pain intensity, improve quality of life, and empower patients through self-regulation. Healthcare providers should remain informed on its developments and consider its integration within patient-centered care models.

 

References

  • Diotaiuti, P., Corrado, S., Tosti, B., Spica, G., Di Libero, T., D’Oliveira, A., Zanon, A., Rodio, A., Andrade, A., & Mancone, S. (2024). Evaluating the effectiveness of neurofeedback in chronic pain management: a narrative review. Frontiers in Psychology, 15:1369487. https://doi.org/10.3389/fpsyg.2024.1369487 
  • Kayiran, S., Dursun, E., Dursun, N., Ermutlu, N., & Karamürsel, S. (2010). Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater-blind clinical trial. Applied Psychophysiology and Biofeedback, 35(4), 293–302.
  • Lee, C., Crawford, C., & Hickey, A. (2014). Mind-body therapies for self-management of chronic pain symptoms. Pain Medicine, 15(S1), S21–S39.
  • Shimizu, K., Inage, K., Morita, M., Kuroiwa, R., Chikubu, H., Hasegawa, T., et al. (2022). New treatment strategy for chronic low back pain with alpha wave neurofeedback. Scientific Reports, 12, 14532.
  • Hesam-Shariati, N., Chang, W., Wewege, M., McAuley, J., Trost, Z., Lin, C., et al. (2022). The analgesic effect of electroencephalographic neurofeedback for people with chronic pain: A systematic review and meta-analysis. European Journal of Neurology, 29(3), 921–936.
  • Vuckovic, A., Al-Taleb, M., Fraser, M., McGeady, C., & Purcell, M. (2019). EEG correlates of self-managed neurofeedback treatment of central neuropathic pain in chronic spinal cord injury. Frontiers in Neuroscience, 13, 762.
  • Additional references as listed in Diotaiuti et al. (2024).