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No Pain – Just Gain! How Exsurgo is changing the treatment of chronic pain by Christine Ozolins, CSO, Exsurgo

Many of the world’s most well-known phrases about pain imply that it is helpful to experience it, that pain provides lessons for life or shows that we’ve made an effort, offering a point of comparison for our eventual happiness. After all, what doesn’t kill you makes you stronger, right?  While it’s true that difficulties do make us stronger, there is no reason why you should have to suffer needlessly in order to have a meaningful life.

It’s generally true that pain helps us navigate the world and is designed to protect us from harm. Unfortunately, that sentiment doesn’t apply when it comes to chronic pain – receiving too many of those pain messages can also be harmful to our physical and psychological wellbeing.

Humans feel pain when electrical signals travel through nerve fibres via the spinal cord to the brain, and the brain interprets those signals. Say you touch a very hot surface. Your brain will interpret the signals it receives from nerve cells in your finger tissue and decide what to do, based on what it thinks is happening. As part of its assessment, your brain may refer to memories of similar experiences.

If your brain believes you are at risk, you start to feel an unpleasant sensation – pain. The brain then sends messages to your central nervous system and your muscles to make you quickly take your fingers off the hot surface, as well as releasing chemicals (such as endorphins) to help your body cope with the pain. 

Pain relief drugs mostly work by binding to certain receptors in the brain and spinal cord and moderate the signals being interpreted, which temporarily increases our tolerance for pain.

Other drugs are anti-inflammatory and reduce the swelling in the damaged tissue, which in turn helps moderate the signals being sent from the nerve fibres to the brain.

These treatments can work for acute pain, but when it comes to treating chronic pain (usually defined as pain that lasts longer than three months), many of these treatment options are ineffective and, as the opioid crisis has shown us, some of them come with harmful side effects.

Health officials in the UK and the US are increasingly advising doctors against prescribing pharmaceuticals to treat chronic pain, and are instead suggesting other options, such as psychological interventions or exercise.

Chronic pain occurs when nerves become over-sensitive and over-stimulated, and send warning messages to the brain predicting pain, even when there is no injury, or after the original injury causing the pain has healed. The brain keeps reacting to these signals, predicting future pain, and generating pain sensations – a bit like a broken record, or a fire alarm that keeps going off even though the fire has been put out.

Chronic pain is one of the world’s most pressing health issues. It is estimated that one in five adults in the US live with some form of chronic pain, with similar figures (from 10-25%) estimated for many other countries. A recent US study showed the prevalence of chronic pain is increasing as the population ages. For some, the pain is in the background, like a constant hum, but for those with severe chronic pain, it can be very distressing and impact their emotional, physical, and psychological wellbeing.

The burden of chronic pain on individuals and society is significant in terms of direct health costs for appointments, drugs and other treatments, lost productivity among those experiencing pain (and their carers), and the intangible costs of suffering from an often debilitating condition. In the US, one study estimated the total costs of chronic pain ranged from US$560 to $635 billion. That was greater than the annual costs of heart disease, cancer, and diabetes.

If pain is not related to a current injury or trauma, it might seem like it is ‘all in the head’.  However, the sensations felt by a chronic pain sufferer are as real as the pain felt by someone who has recently suffered a traumatic injury. 

A good example of this is phantom limb pain. This occurs when a person has had a limb amputated. Even though the limb is no longer there, the person can still feel pain or itching where the limb once was. This is because the brain has a map of the body and uses it to send messages about sensations, such as pain. Just because the limb is no longer there, does not mean this map has changed, as changes such as these take time.

For those suffering from chronic pain life can seem hopeless, but there is hope!   Just like other parts of the body (such as our muscles) can be trained, our brains too can be trained and change the way they function. The trick to getting our brain to change, is to point it in the right direction and then it will make the changes itself. One of the ways to do this is through a scientific method called Operant Conditioning.

Operant Conditioning works by redirecting brain activity that has got into a negative state, into a positive state and then reinforcing that positive state with positive feedback until the brain learns to do it automatically. People can learn to respond differently to the nerve signals their brain interprets as pain – in essence, ‘retraining’ their brains. 

EEG Neurofeedback is a therapy that leverages the science of Operant Conditioning. Using small sensors placed on the scalp (either directly or within a headset), EEG (electroencephalography) monitors the electrical activity in the brain – in this instance, the frequencies associated with pain. The Neurofeedback component involves a patient undertaking neurological exercises in the form of simple animated games on a tablet or smartphone, that have been carefully calibrated to the patient’s EEG readings. When the patient generates the desirable brain activity, they are rewarded with audio and visual feedback that keeps the game moving and achieving goals.

Repeated sessions of Neurofeedback training can result in long-lasting changes in brain activity, which can affect how the brain functions and how it is structured. These changes can help the brain to send and receive different messages about pain, and these new messages can have positive effects on perception of pain, which in turn can help improve sleep, mood, and behaviour.  These changes can then influence each other positively, creating a new cycle of change that can lift a person out of the chronic pain state and back into an optimal cycle of brain activity.

EEG has been around for almost a century.  It has been used in Neurofeedback treatments since the early 1960’s (including by NASA) and it has been an established part of clinical evaluation and treatments since the 1970’s.  

However, conventional EEG Neurofeedback is complicated and costly for both patients and clinicians. It requires the patient to attend a specialist clinic for multiple sessions over several weeks, an expert clinician must be present to interpret the brain activity data, and the EEG Neurofeedback equipment has (until recently) cost many thousands of dollars to purchase.

Exsurgo’s Axon system represents a breakthrough for affordable, accessible EEG Neurofeedback. Instead of expensive EEG neurofeedback machines in hospitals and clinics, Axon patients 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, and the data is transmitted via Bluetooth to an app on the patient’s mobile device.

Exsurgo recently conducted a proof-of-concept trial in the UK with a group of patients who suffered from different types of chronic pain. The results showed that our proprietary Axon system did exactly what we hoped it would do and changed the way patients’ brains dealt with pain signals.

Patients reported significant reductions in their levels of pain, anxiety and depression, as well as improvements in sleep, mood and quality of life. And these improvements were sustained for four, 12 and 26 weeks. We’re confident that a larger trial set to take place soon in New Zealand will add to the evidence base for Axon. ‘No pain, no gain’ is an oft-used quote that promotes the role suffering plays in success. But at Exsurgo, we have a slightly different version: ‘No Pain – Just Gain!’. The brain is an amazing and powerful part of us that has infinite connections and infinite possibilities for patterns of change, and we can’t wait to see more people put their own brain to use to help treat their own pain and improve their lives.

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