In the ongoing search to find a pain intervention that does away with the need for opioids – and bypasses drugs altogether – a new game-based system has shown huge promise in tackling chronic neuropathic pain. Using a game and a headset, it "trains" patients to rewire brain signals in order to relieve pain.
Researchers at UNSW Sydney have tested their brainwave-monitoring neural feedback game system on participants with corneal neuropathic pain (CNP), a condition in which dysfunctional eye nerves cause a suite of discomfort including light sensitivity, burning sensations, stabbing pain and broader discomfort around the face and skull.
They found that four weeks of gameplay with the animated program and accompanying brain-monitoring headset, showed that 75% of participants had a significant reduction in pain – and it matched a level that was either on par with opioids or even better. However, there is a catch: It was a very small trial, with just four people, so while the results are positive, they are just the first step.
“Restrictions in the study’s size, design and duration limit our ability to generalize the findings or rule out placebo effects,” said Dr Negin Hesam-Shariati from UNSW’s NeuroRecovery Research Hub. “But the results we’ve seen are exciting and give us confidence to move to the next stage and our larger trial."
The treatment in question is called PainWave, a novel therapy that combines a game-like app with a headset that monitors the brain, directly feeding back to the on-screen visuals. The visuals consist of a cute animated jellyfish underwater, and as brainwaves shift, the water changes color. The patient can see real-time feedback of brain activity – as the mind calms, the murky water turns light turquoise – which encourages the user to "train" their mind to regulate patterns associated with chronic nerve pain.
The patients completed 20 intervention sessions over four weeks, and were also assessed five weeks post-trial, after being encouraged to continue with the practices they'd been trained on using the game.
"This trial demonstrates the potential of EEG neurofeedback to reduce pain severity and interference in individuals with corneal neuropathic pain," the researchers wrote in their study. "It also highlights user preferences for technology-based interventions, emphasizing ease of use, accessibility, and self-administration to enhance adherence, especially for individuals with limited mobility or restricted healthcare access."
It uses electroencephalographic (EEG) neurofeedback to empower the patient to essentially reorganize those haywire neural pathways and in turn relieve the pain they're triggering.
The project is the latest step in UNSW Professor Sylvia Gustin’s research targeting the thalamus, a small region in the brain responsible for relaying information. In this case, the information it's handling relates to neuropathic (nerve) pain. Gustin has been working to unravel the mystery of the thalamus and neuropathic pain for more than a decade, and the latest developments can be traced back to a paper she authored in 2014.
“The brainwaves of people with neuropathic pain show a distinct pattern: more slow theta waves, fewer alpha waves, and more fast, high beta waves,” she said. “We believe these changes interfere with how the thalamus talks to other parts of the brain, especially the sensory motor cortex, which registers pain."
While the PainWave sessions were initially guided by researchers, before long the patients were able to conduct these assigned sessions with their tablet and headset on their own. At the same time, their brain data was relayed back to the UNSW team to monitor and assess.
“Everything except the open-source EEG board was built in-house,” said Hesam-Shariati. “And soon, even that will be replaced by a custom-designed board.”
Using 3D printing, the researchers were able to cut the cost of the EEG headsets to around AU$300 (US$200), which is a fraction of what commercial models are priced at.
“We’ve worked closely with patients to ensure the headset is lightweight, comfortable, and user-friendly,” said Gustin. “Owning the technology offers us the potential to one day offer PainWaive as a truly affordable, accessible solution for at-home pain management, especially for those with limited access to traditional treatments."
Now, the team has its sights on a randomized controlled trial that will test the system on 224 participants with neuropathic pain as a result of spinal cord injury. The researchers are actively recruiting for the Spinal Pain Trial, which will assess PainWave's ability to reduce chronic spinal pain, and the StoPain Trial, testing the system on people with chronic neuropathic pain from spinal cord injury.
“Many of our team are clinician-scientists, and we’re focused on developing practical treatments that can be integrated into the healthcare system,” said Gustin. “It’s incredibly inspiring to see results that help unlock the brain’s potential to heal itself and bring back hope to people living with pain.”
The study was published in The Journal of Pain.
Source: UNSW Sydney