Poster Presentation Sydney Spinal Symposium 2025

Reliability and validity of an in-house developed EEG headset for the treatment of chronic pain (#37)

Joshua JR Rawsthorne 1 , Nahian NC Chowdhury 1 , Negin NH-S Hesam-Shariati 1 , Sylvia SG Gustin 1
  1. University of New South Wales, Sydney, NSW, Australia

Neuropathic pain affects approximately 50% of individuals with spinal cord injury (SCI), yet current treatment options often provide only limited relief(1). Electroencephalography (EEG) neurofeedback represents a promising non-pharmacological intervention, enabling individuals to modulate their own cortical activity in real time, typically targeting oscillatory patterns associated with reduced pain perception(2,3). However, standard neurofeedback protocols require multiple in-clinic sessions per week, posing significant accessibility challenges for individuals with impaired mobility(4,5). Consequently, there is a critical need for a validated, home-based EEG neurofeedback solution.

To address this, we have developed PainWaive, a lightweight, two-channel EEG headset designed for remote neurofeedback use. Prior to clinical implementation, it is essential to determine whether PainWaive can reliably and validly capture cortical signals comparable to those recorded by a high-density (64-channel) research-grade EEG system. Eighty healthy adults participated in two recording sessions. In each session, three minutes of resting-state EEG were recorded under both eyes-open and eyes-closed conditions using both the PainWaive and the laboratory system. We extracted spectral power in the theta (4–7 Hz), alpha (8–12 Hz), and beta (20–30 Hz) frequency bands, as well as peak alpha frequency (PAF), a key marker of dominant alpha rhythm.

PainWaive demonstrated strong test–retest reliability, with intraclass correlation coefficients (ICCs) ranging from 0.55 (theta power, eyes open) to 0.92 (PAF, eyes closed), indicating moderate to excellent temporal stability. Furthermore, the device showed high concurrent validity: frequency-resolved spectral power was nearly identical between devices (Pearson’s r = 0.99), supporting the fidelity of PainWaive’s signal acquisition.

These results confirm that PainWaive provides reliable and valid EEG measurements suitable for therapeutic neurofeedback. By delivering lab-grade signal quality in a home-based format, PainWaive has the potential to overcome major logistical barriers to neurofeedback access for people living with chronic neuropathic pain following SCI. Future research will assess the PainWaive's long-term clinical benefits fully.

  1. (1) Hunt C, Moman R, Peterson A, et alPrevalence of chronic pain after spinal cord injury: a systematic review and meta-analysisRegional Anesthesia & Pain Medicine 2021;46:328-336.
  2. (2) Birch, N., Graham, J., Ozolins, C., Kumarasinghe, K., & Almesfer, F. (2022). Home-Based EEG Neurofeedback Intervention for the Management of Chronic Pain. Frontiers in pain research (Lausanne, Switzerland), 3, 855493. https://doi.org/10.3389/fpain.2022.855493
  3. (3) Patel, K., Sutherland, H., Henshaw, J., Taylor, J. R., Brown, C. A., Casson, A. J., Trujillo-Barreton, N. J., Jones, A. K. P., & Sivan, M. (2020). Effects of neurofeedback in the management of chronic pain: A systematic review and meta-analysis of clinical trials. European journal of pain (London, England), 24(8), 1440–1457. https://doi.org/10.1002/ejp.1612
  4. (4) Li, Q., Zheng, Y., Xiao, J., Hu, K., & Yang, Z. (2025). Neural mechanisms of fairness decision-making: An EEG comparative study on opportunity equity and outcome equity. NeuroImage, 305, 120970. https://doi.org/10.1016/j.neuroimage.2024.120970
  5. (5) Hesam-Shariati, N., Alexander, L., Chen, K.Y. et al. A home-based self-directed EEG neurofeedback intervention for people with chronic neuropathic pain following spinal cord injury (the StoPain Trial): description of the intervention. Spinal Cord 62, 658–666 (2024).