Neurofeedback-EEG-VR (NEVR) System for Non-opioid Pain Therapy

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Abstract Pain is one of the most common and debilitating symptoms of a wide range of injuries and diseases. Its treatment often relies on prescription or over-the-counter pharmaceutical medications and may include some non-pharmacological pain management methods such as transcutaneous electrical nerve stimulation (TENS) or acupuncture, which have poor support from the literature. Physicians typically iteratively explore these options as they strive to identify the most suitable methods for each patient. Unfortunately, one of the most commonly prescribed pain treatments, opioids, has a potential to lead to addiction, which has led to an epidemic of opioid over-prescription and abuse, with dangerous personal and societal consequences. This opioid crisis is a principal issue in public health with over 47,000 related annual deaths, as well as social and economic burden costing over $78.5 billion a year in the USA. Safe and effective alternatives for treating pain that reduce dependence on opioids are, therefore, a primary goal of the NIH, and are urgently needed to address this emergency. This project proposes a non-invasive, non-pharmacological alternative to treat pain by combining an innovative electroencephalography (EEG)-based Neurofeedback (NF) solution in an immersive virtual reality (VR) environment. NF and VR have been shown to independently produce ameliorative effects on pain, and it is hypothesized that a NF training in VR would have synergistic effects as VR would distract from pain perception to improve patient compliance in more engaging NF protocols that improve their ability to control pain perception. This NF+EEG+VR (NEVR) pain treatment system combines three promising non-pharmacological innovative technologies into a non-invasive pain therapy: 1) QUASAR's easy-to-use, non-invasive, dry electrode EEG headset, which enables rapid and easy acquisition of high fidelity EEG without the gels or skin preparation, integrated with 2) a VR display for cognitive immersion, which has been shown to distract from and suppress pain awareness in the short-term, both interfacing with 3) a NF protocol that has been shown to reduce cLBP with effects lasting greater than 6 months. This combined NEVR pain treatment system is designed to specifically address the underlying brain activity associated with perception of, or attention to, pain and is therefore expected to reduce both acute and chronic forms of pain. In the scope of this project, we will initially focus our work on chronic low back pain (cLBP) as this is a growing segment of chronic pain sufferers with a 39% worldwide lifetime prevalence, and whose sufferers have historically been a heavy user population of opiates; however, later stages of this project will expand this application to address other forms of pain.