Objective Chronic low back pain (CLBP) is a major source of longterm disability among adults worldwide, while the effectiveness of many conventional treatments remains limited and often transient. Neurofeedback has emerged as a neuromodulation approach aimed at facilitating voluntary regulation of brain activity, with potential implications for pain processing and functional outcomes. This study aimed to systematically evaluate and synthesize the available evidence on the effects of neurofeedback interventions on pain intensity, functional disability, and psychological outcomes in individuals with CLBP.
Materials & Methods A systematic review and meta-analysis examined neurofeedback interventions in adults with CLBP. Search in PubMed, Web of Science, Scopus, CINAHL, and EMBASE (January 2000–February 2025) identified 1993 records, with 5 studies (4 randomized trials and 1 case series) meeting the inclusion criteria. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by a third one. Pooled analyses used a random-effects model with REML (restricted maximum likelihood) estimation. Methodological quality was assessed using the PEDro (the Physiotherapy Evidence Database) scale and AMSTAR (the measurement tool to assess systematic reviews) 2. Pain outcomes were reported as standardized mean differences (SMDs, 95% CI), and heterogeneity was evaluated using the I² statistic.
Results Most included studies employed alphabased neurofeedback protocols and compared neurofeedback with control conditions, physiotherapy, cognitive behavioral therapy, or sham interventions. The pooled analysis showed no significant reduction in pain intensity following neurofeedback treatment (SMD=−0.11; 95% CI, −0.39 to 0.16; P=0.83), with no detectable heterogeneity across studies (I²=0%). Although individual trials reported improvements in functional disability and selected psychological outcomes, quantitative synthesis of these measures was not feasible due to heterogeneity in outcome assessment tools. The overall certainty of evidence was rated as moderate, with key limitations, including small sample sizes, variability in neurofeedback protocols, and differences in treatment duration. Publication bias was not assessed because of the limited number of included studies.
Conclusion Although preliminary findings suggest that neurofeedback may influence painrelated and functional outcomes in individuals with CLBP, the results of this systematic review and meta-analysis do not provide conclusive evidence for its effectiveness in pain reduction. Future well designed trials with larger sample sizes, standardized neurofeedback protocols, longer intervention periods, and rigorous followup assessments are required to clarify its clinical value.