Effects of EEG-based neurofeedback training using brain computer interface on pain in spinal cord injury patients: A scoping review

Background Spinal cord injury results in chronic neuropathic pain (CNP) which adds on detrimental effects on loss of function, social participation and quality of life. Various non-invasive treatments such as rTMS, TENS, tDCS and neurofeedback are available but effects of neurofeedback seem to be superior as it involves active modulation of cortical activity but its effects on pain are studied less when it is implemented using brain computer interface. Thus, this review aims to evaluate effects of neurofeedback training through EEG using Brain Computer Interface on CNP in SCI patients. Methods Scopus, PubMed and web of science were searched for finding the studies on the basis of inclusion criteria. Participants included were chronic CNP patients of age 18 to 75 years with at least 6 months’ history of SCI and CNP intensity >4. Result Total 6 studies met the inclusion criteria: 4 clinical trials, 1 usability study, and 1 pilot study. Overall risk of bias was moderate. Significant reductions in pain intensity were reported, with >30% clinical improvement in about 80% of patients, mainly linked to increased alpha band activity. Conclusion EEG-based neurofeedback using BCIs can reduce pain, particularly through alpha band upregulation, though further high-quality research is needed to confirm these findings.