Digitally created image of brain in skull

The STOPain Study: Using brain-computer-interface intervention for people with neuropathic pain

Researchers: A/Prof Sylvia Gustin, Dr Negin Hesam-Shariati, A/Prof James McAuley, A/Prof Toby Newton-John, Prof Chin-Teng Lin, Dr Avinash Singh, Dr Jimmy Cao, Dr Ian Skinner, Prof Mark Jensen, Prof Niels Birbaumer

Chronic pain is a significant problem worldwide affecting nearly 8 million Australians. Unfortunately, despite the availability of analgesics and other pain therapies, no treatment has been found that benefits the majority of individuals, and most of the available treatments have significant side effects or risks for serious adverse events, e.g. kidney failure. The growing number of overdoses and deaths caused by opioids in the treatment of chronic pain demonstrates the urgent need worldwide to develop and evaluate novel chronic pain treatments. Our research will address this need by developing and evaluating interventions that can provide pain relief via the primary source of pain: the brain.

We have developed a new approach that targets the thalamus and adapted it for use with chronic neuropathic pain. Our research identified thalamic ‘biomarkers’ of neuropathic pain and we were the first to develop the thalamocortical (dysfunction) model for the generation of chronic neuropathic pain. We demonstrated that thalamocortical dysfunction can be modulated by Brain-Computer Interface Neuromodulation (BCI-N) – a non-invasive therapy that teaches patients to have direct control over their brain activity via EEG neurofeedback in a way that reduces their pain. The pilot studies are highly promising and we are now ready to comprehensively test this new therapy in a randomised controlled trial. Our primary aim is to definitively test whether a course of BCI-N offers sustained pain relief for chronic neuropathic pain patients.

Critically, we will also determine whether changes induced in the thalamus by BCI-N mediate reductions in pain intensity and whether our intervention is cost-effective. These aims will be tested by a randomised double-blind controlled trial with an a priori, nested causal mediation analysis using state-of-the-art brain imaging. This will lead to a fundamental change in the way that chronic pain is currently managed