A recent UK study has confirmed the exciting potential of a breakthrough treatment for chronic pain management developed by neuroscience company, Exsurgo.
Chronic pain (defined as pain that persists for longer than three months) affects up to 1 in 5 people around the world and is a massive burden on healthcare systems and economies.
Chronic pain (defined as pain that persists for longer than three months) affects up to 1 in 5 people around the world and is a massive burden on healthcare systems and economies. Approximately 8 million adults in the UK report chronic pain that is moderate to severely disabling, with back pain alone costing the UK economy £10 billion a year.*
Exsurgo’s ‘Axon’ system uses EEG (electroencephalography) neurofeedback to train chronic pain sufferers to manage their pain – and avoid or reduce the use of pharmaceutical drugs that bring risks of addiction or side effects.
In the UK study, conducted from mid 2020 until early 2021, patients reported significant reductions in their levels of pain as well as in anxiety and depression. At the same time, they reported improvements in sleep, mood and quality of life. Furthermore, the improvements from the eight weeks of neurofeedback training were sustained at follow up points – 4, 12 and 26 weeks. See below for further details. The full results of the trial are expected to be published shortly in a medical journal.
The UK study was intentionally small-scale, involving 16 patients, to serve as a proof-of-concept for the Axon system and lay the groundwork for further research. A much larger clinical trial is due to start in New Zealand shortly.
EEG neurofeedback is a non-invasive therapy that works by monitoring brain activity and using that data to help the patient ‘retrain’ how their brain responds to nerve signals from the body.
The science of electroencephalography (EEG) has been around for almost a century and has been used in neurofeedback research since the early 1960’s, including by NASA – who used neurofeedback to train pilots^.
However, conventional EEG neurofeedback is complicated and costly for both patient and doctor – requiring regular attendance at a specialist clinic and equipment costing up to hundreds of thousands of dollars, and so it has not been used extensively for treatment of chronic pain and other ailments. Exsurgo plan to change this with the Axon system. harnessing the latest science and AI technology to make EEG neurofeedback therapy faster, better and much cheaper.
Dr Nick Birch FRCS (Orth), a Consultant Spinal Specialist at East Midlands Spine Ltd who was the trial’s Principal Investigator and acts as a Clinical Advisor to Exsurgo commented: “Through 30 years’ clinical work and research, I recognise that chronic pain and the conditions associated with it – including sleep disturbance, functional loss, depression and anxiety – place a huge toll on patients and their families. Chronic pain is not only highly prevalent, but also notoriously difficult to manage in primary and secondary care. The excellent results from this trial show that Axon neurofeedback ‘brain training’ may provide an easy-to-use, very-low-risk home-based solution for managing chronic pain and its associated disorders.”
Exsurgo’s Chief Science Officer Christine Ozolins said while the company had been confident the UK trial would deliver a positive outcome, the results had exceeded expectations.
“We always believed in the power of Axon and EEG neurofeedback to enable people to self-manage their chronic pain, but we were pleasantly surprised by the strength of the related benefits such as improved sleep, mood and quality of life. The fact that these positive changes have continued for an extended period is an excellent indication that EEG neurofeedback therapy can deliver sustainable benefits to chronic pain sufferers.
“It is also noteworthy that this study took place during the disruptions caused by the COVID-19 pandemic – a time when chronic pain sufferers were experiencing an increase in their symptoms#. With clinic-based forms of treatment much more problematic during this time, Axon neurofeedback training at home proved to be easy to use. Remote interventions like this may represent the future of healthcare delivery to chronic pain sufferers.”
Exsurgo CEO Richard Little said the positive UK trial results were the next important step in the company’s ongoing five-year journey to develop, validate and then commercialise its neuroscience technologies. “As we’d hoped, this trial shows us that we have a solution that can change lives and makes EEG neurofeedback therapy much more affordable and accessible.”
HOW THE AXON SYSTEM WORKS
- Once prescribed by their clinician, the patient can conduct the treatment at their convenience in the comfort of their own home, with remote clinical supervision.
- The patient wears a custom-designed EEG headset that passively reads the electrical activity associated with pain in their brain.
- This data is transmitted wirelessly to an app on the patient’s mobile device (tablet or smartphone) and visually represented in the app via neurological exercises (in the form of simple animated games) played by the patient. Each session takes 35 minutes and sessions are repeated several times a week in the first 8 weeks in order to get the best results.
- Through real-time visual feedback, the patient learns to self-regulate their brain activity, and change how their brain interprets pain signals, thereby reducing their pain.
- The Axon app settings can be fine-tuned via AI machine learning of the data stream, which is also monitored remotely by the patient’s clinician
UK TRIAL – SUMMARY OF KEY RESULTS
- 69% of participants reported an improvement in pain (a)
- 50% of participants achieved a clinically relevant pain reduction (b)
(i.e. of at least 30%, considered to be a clinically significant threshold)
- 94% of participants reported an improvement in sleep (a)
- 81% of participants reported an improvement in quality of life (a)
- 90% of participants reported an improvement in anxiety (c)
- 100% of participants reported an improvement in depression (c)
- 94% of participants reported an improvement in central sensitisation
(a) based on patient VSR (verbal self-reporting) methodology
(b) based on VNS (Visual Numerical Scale) methodology
(c) based on HADS (Hospital Anxiety and Depression Scale). Prior to Axon treatment 10 out of 16 participants presented with anxiety, and 6 out of 16 with depression
UPDATE AS OF MAY 2022
The full results of the Axon UK clinical have been published in research publisher and open science platform, Frontiers.
Home-Based EEG Neurofeedback Intervention for the Management of Chronic Pain
PATIENT STORIES FROM THE UK TRIAL
Psoriatic arthritis is a condition with no known cure that leads to severe swelling and pain in hands and fingers (known as “sausage fingers”).
Doris*, 68, had swelling in her fingers so severe “you couldn’t see the individual knuckles”.
“It doesn’t hurt when I write anymore and I can cook things again. I’m having the best sleep I ever remember having in my entire life. The swelling is going down so there is loose skin. I’m really happy with my life at the moment.”
Chronic neuropathic pain causes symptoms such as shooting or burning pain, numbness or pins and needles, or hypersensitivity to pain. Neuropathic pain does not usually get better with common painkiller drugs.
Harley*, 56, suffered chronic neuropathic pain following a back operation. She lost confidence and became anxious and fearful. She could no longer ride a bike or garden.
“I feel stronger and more confident … I feel like I can do more … I feel more in control again.
“Before I did the training I couldn’t get on a bike. I just didn’t want to be in any more pain. But now I can again.”
Fibromyalgia syndrome (FMS) is a long-term condition that causes widespread pain, fatigue, muscle stiffness and issues with concentration / memory (’brain-fog’). There is currently no cure and symptoms are usually relieved by numerous medications.
Derrell*, 53, has been suffering from FMS for 15 years. As well as chronic pain, Derrell experienced difficulty with many daily activities that most people take for granted.
“I now have no chronic pain. It has gone and I can lift my arms.
“I can wash my hair in the shower with my hands up. I can even put on mascara now.
“That was the first time I realised [that my memory had returned], I didn’t have to look at my notepad. I had total recall.”
Ehlers-Danlos syndrome (EDS) is a group of rare inherited conditions that affect connective tissue providing internal support in the body, such as for organs and joints. EDS leads to chronic pain and complications (such as unstable joints). EDS is often associated with sleep disruption, mood disorders, migraines and reduced functionality. There is no specific treatment, except symptom management.
Sophie*, 57, felt resigned to living with chronic pain from EDS, anxiety and poor sleep for the rest of her life until she tried Axon.
In particular, Sophie enjoyed the relaxing effect of the Axon games.
“I have no more neck pain, absolutely.”
“I suddenly thought: ‘wow, I haven’t had a migraine for ages’.”
“I haven’t had sleep this good for years and years and I’m starting to dream, which I wasn’t doing before.”
“I have got my energy levels back which has really helped. I feel so grateful and lucky to be alive now.”
* Names have been changed for privacy reasons.