Introduction: Chronic low back pain (CLBP) is a major source of long‑term 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.
Methods: A systematic review and meta-analysis examined neurofeedback interventions in adults with CLBP. Searches of PubMed, Web of Science, Scopus, CINAHL, and EMBASE (2000–February 2025) identified 1,993 records, with five studies (four randomized trials and one case series) meeting inclusion criteria. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by a third. Pooled analyses used a random-effects model with REML estimation. Methodological quality was assessed using the PEDro scale and AMSTAR 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 alpha‑based 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 pain‑related 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 follow‑up assessments are required to clarify its clinical value.