Patient Experiences of Neurofeedback for Chemotherapyinduced Peripheral Neuropathy: A Case Series Comparing Real and Placebo Treatment

Background: A major concern in interventional studies is the inability to accurately link patient report with objective measures. In this study, we associated functional brain measures with self-reported pain after patients underwent a neuromodulatory intervention. Specifically, Chemotherapy-Induced Peripheral Neuropathy (CIPN) adversely affects many cancer patients but few effective treatment options are available, and mechanisms are not well understood. Objectives: We present three representative cases from a doubleblind, randomized, placebo-controlled trial which examined the efficacy of a targeted therapy of Electroencephalogram (EEG) Neurofeedback (NFB), in attenuating symptoms of CIPN. The primary outcome of the trial was efficacy of neurofeedback versus control groups. In this case series we explore mechanism, by linking patient reported outcomes with objective measures. Methods: Symptom descriptions and EEG data were collected for patients enrolled in neurofeedback, placebo feedback, and waitlist conditions. Subjective pain ratings and EEG data were compared before and after the 10-week intervention. Results: A patient receiving neurofeedback demonstrated decreased beta oscillations in Brodmann Area 6 (BA6) and reported noticeable decreases in numbness and temperature sensitivity. A patient receiving placebo demonstrated increased beta in BA6 and increased alpha oscillations in Brodmann areas 3 and 7 with improvement of symptoms. A waitlist participant showed no change in BA6 and reported increased neuropathic symptoms while on waitlist but subsequently received NFB treatment and reported symptom improvement. Conclusions: This case series indicates that NFB may be used to achieve targeted reduction in beta oscillations to treat CIPN. Possible mechanisms of action and implications for CIPN treatment are discussed.