537: EEG-Based Brain�Computer Interface Coupled with Immersive Virtual Reality for Phantom Limb Pain.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Non-pharmacological treatments, Artificial Intelligence/Machine Learning, Electrophysiology/Clinical neurophysiology (e.g. microneurography, EEG, MEG, OPMs, TMS)

Background and Aims: Phantom limb pain (PLP) after amputation or brachial plexus injury remains difficult to treat. Approaches aiming to re-engage sensorimotor networks (mirror therapy, motor imagery) show variable effects. We developed GHOST, a portable EEG-based brain–computer interface (BCI) coupled with immersive virtual reality (VR), enabling real-time neurofeedback through motor imagery–driven control of a virtual limb.

Methods: In this prospective, open-label, single-center pilot study, six adults with chronic upper-limb PLP (numeric rating scale [NRS] ≥3/10) underwent ten 2-hour sessions over 2 weeks. Daily pain diaries were collected for 1 month pre-intervention and 1 month post-intervention, distinguishing continuous pain (NRS) from paroxysmal pain episodes. Feasibility was assessed by participants’ ability to control the avatar during BCI-VR training and by safety monitoring. Follow-up continued up to 6 months. Motor imagery ability (MIQ-RS), anxiety/depression (HADS), and quality of life (SF-36) were also recorded.

Results: Six participants completed ≥8 sessions. All achieved BCI control of the virtual hand, maintaining high success rates (>70%) despite progressively increasing task difficulty. No adverse events occurred. Paroxysmal pain volume showed a marked short-term reduction, with median decreases of approximately 35% (week 1), 55% (week 2), 64% (week 3), and 86% (week 4) versus baseline. Mixed-effects modeling confirmed a significant reduction in the post-training phase (weeks 3–4) compared with baseline. Continuous pain intensity decreased modestly at the group level, with clinically meaningful improvement in several individuals, but effects were not sustained at 3–6 months.

Conclusions: EEG-BCI coupled with immersive VR is feasible and safe in patients with refractory upper-limb PLP and may provide short-term analgesic benefit, particularly for paroxysmal pain episodes. Controlled trials are warranted to confirm efficacy and optimize training dose and maintenance strategies.

References: ClinicalTrials.gov NCT03889353; EudraCT 2017-A03484-49

Presenting Author: Julien NIZARD
Submitting Author: Vincent ROUALDES

Senior Author: Vincent ROUALDES

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Aurelien VAN LANGHENHOVE - University Hospital Nantes
• Said MOUSSAOUI - Ecole Centrale Nantes
• Jean-Marie NORMAND - Ecole Centrale Nantes
• Emmanuelle KUHN - University Hospital Nantes
• Julien NIZARD - University Hospital Nantes