When a game is more than play

How gamification can support treatment for chronic pain and other neurological conditions Whether it’s smoking, drinking, eating unhealthy food or even mindlessly scrolling through social media, people can’t resist a quick hit of pleasure despite knowing the long-term pitfalls of such behaviour. Through a healthcare lens, this can be dangerous because many of us make quick decisions that appear to go against our long-term self-interest. But that motivation for reward can also be used to nudge people in a more positive direction. Due to the rise of video games, the ubiquity of smartphones and the growing body of evidence around behavioural economics, gamification is gaining momentum in healthcare. “The premise is rather simple: People enjoy playing games and winning,” says a paper in the American Journal of Managed Care. And that can be harnessed to create new, more beneficial behaviour and potentially engrain it as a habit. Gamification in healthcare has largely been used to motivate people and improve their lifestyles, by focusing on preventing illness and disabilities as well as treating existing ailments.[1] And research has shown promising signs that it can help. Gamification as a treatment method is which is exactly what we’re doing at Exsurgo. We combine miniaturised technology with consumer-friendly apps and games (developed with neuroscience) to treat chronic pain and other neurological conditions. Operant conditioning, also known as instrumental conditioning, is a process where humans and animals learn to behave in a way that gives them rewards and avoids punishments. Or as BF Skinner, the man who coined the term in 1937 defined it, “behaviour that is controlled by its consequences”. There has been a long history of research into this area, and many of the studies involved animals that were rewarded with food for displaying certain behaviour, like pulling levers or flicking switches. One of the most important studies was done by Barry Sterman, a young researcher at UCLA. Sterman who dribbled milk into cats’ mouths when there was a burst of a brainwave called a “sensory motor rhythm (SMR)” – which is associated with a relaxed yet alert focus – and withheld the milk when they were not producing SMR. Using milk as a reward, Sterman trained the cats to control their brainwaves by tapping into their instinct to obtain a reward. This study was the first to show that neurofeedback could change brain behaviour and 70 years later, this method is at the root of Exsurgo’s Axon solution. Exsurgo is using gamification to harness operant conditioning and electroencephalography (EEG) neurofeedback with a wearable medical device (the Axon) that can alleviate chronic pain and other neurological conditions. The Axon system combines gamification with neuroscience through EEG neurofeedback, enabling patients to self-treat pain in the comfort of their own home, with clinical oversight from doctors that can check in on the patient’s progress remotely through the Axon Connect platform. Axon users retrain their brains to interpret pain signals in a different way. Brain activity is directed away from predicting and experiencing pain towards predicting and experiencing relaxation, positivity and sustained focus. This is done using a simple interface (with foundations in neuroscience) such as a video or animated game, and real-time visual feedback. As the dangers of opioids become increasingly clear, many health authorities are recommending doctors move away from the prescription of pharmaceutical treatments to deal with chronic pain and look for new approaches. Combining neuroscience with the human desire for instant gratification through winning games is part of our solution to this problem. The quick (and seemingly innocuous) decisions made during these games can have truly long-term (and life enhancing) benefits. [1] https://www.sciencedirect.com/science/article/pii/S2214782916300380