Innovative Study Uses Mobile Tech for Pain Management in Veterans

By Cameron Cucuzzella 

Neurosky Headset and Headset on ManMilitary veterans with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) often suffer from chronic pain, which tends to lead to other adverse, sometimes devastating, physical and emotional health conditions. Seeking new ways to help veterans address chronic pain, Duke Psychiatry & Behavioral Sciences professor Dr. Eric Elbogen and his team have paired a tried-and-true technique used for pain management—neurofeedback—with mobile technology.

Elbogen and his colleagues recently published a study in Pain Medicine that provides strong evidence suggesting that veterans can self-manage and even significantly improve their own chronic pain using mobile neurofeedback. 

Elbogen, one of a number of Duke Psychiatry researchers who specialize in veterans’ mental health, studies the psychosocial effects of PTSD and TBI on Iraq and Afghanistan veterans. More specifically, his research lab investigates how mobile technology can be used to manage and improve impaired functioning in veterans. Impaired functioning from PTSD and TBI can drastically impact a veteran’s overall well-being and lead to greater risk of suicidal ideation and chronic pain. 

In Elbogen’s most recent study, mobile neurofeedback was self-administered by veterans with chronic pain, PTSD and TBI. Neurofeedback has been around for decades, but it is only recently being used outside of a clinical setting. Neurofeedback uses electroencephalography (EEG) to report the electrical activity of different brain waves. With this information, users can learn how to increase the activity of specific brain waves by changing their behaviors, for example by adjusting their posture or breathing. 

In this study, veterans used an EEG headset connected to an iPod touch via Bluetooth to engage in mindfulness exercises informed by neurofeedback. During self-administered 10-minute sessions, veterans used information about their own brain waves to learn how to better manage their pain. 

The team found that veterans were able to successfully manage their own pain at home with minimal help from a clinician. By administering the treatment themselves, veterans were able to take charge of their own healing and avoid costly obstacles to treatment such as the need to make multiple trips to faraway clinics. After the treatments, veterans reported lower pain, fewer sleep disturbances, lower levels of anger, less pain interference with daily functioning, lower depression scores and even lower suicidal ideation. 

Although this study shows that something about this treatment lowers chronic pain in veterans, the researchers don’t know exactly what that something is. Elbogen and his colleagues plan to conduct a randomized clinical trial to try to determine what specific component of mobile neurofeedback explains these treatment benefits for veterans. 

Overall, Elbogen’s research provides a promising new treatment option for veterans who are facing obstacles to traditional treatment or who want to be more engaged in their own health. Sharing his excitement about the potential significant impact of these findings, he notes that it’s been among the most gratifying research he’s conducted. “There’s just something about harnessing technology that has been around for decades and using our own brains to inform us about pain,” he says. “The fact that this can be done and might really help veterans is exciting. I think there’s a lot of potential.”

Other Duke Psychiatry & Behavioral Sciences researchers who contributed to this study include Amber Alsobrooks, Sara Battles, Kiera Molloy, Paul Dennis and Jean Beckham. Co-authors also include Samuel McLean of the University of North Carolina-Chapel Hill School of Medicine, Julian Keith of the University of North Carolina-Wilmington and Carmen Russoniello of East Carolina University.

Elbogen, Dennis and Beckham also hold faculty appointments at the Durham Veterans Affairs Health System in Durham, North Carolina.

The study was funded by the National Center for Complementary and Integrative Health at the National Institutes of Health.

Read the article in Pain Medicine.