A pioneering trial of an interactive gaming technology designed to train individuals to consciously alter their own brain waves has demonstrated significant promise as a treatment for chronic nerve pain. The breakthrough, led by a team of researchers from UNSW Sydney, offers a glimpse into a future where debilitating neuropathic conditions could be managed through drug-free, non-invasive interventions performed in the comfort of a patient’s own home. Known as PainWaive, the technology represents a potential paradigm shift in pain management, particularly for those seeking alternatives to traditional pharmacological treatments such as opioids.
The PainWaive system was developed by researchers at UNSW Sydney’s NeuroRecovery Research Hub to address the underlying neurological imbalances associated with chronic nerve pain. By teaching users how to regulate abnormal brain activity, the technology aims to restore healthy communication between different regions of the brain. The results of a recent pilot study, published in the Journal of Pain, suggest that this form of neuromodulation could provide relief comparable to, or even exceeding, the efficacy of powerful painkillers.
Chronic nerve pain, or neuropathic pain, is notoriously difficult to treat. Unlike the acute pain resulting from a temporary injury, neuropathic pain is often the result of damage to the somatosensory nervous system. It is frequently described by patients as a burning, stabbing, or electric shock-like sensation that persists long after an initial injury has healed. For many, this leads to a cycle of chronic suffering, sleep deprivation, and a significant decline in quality of life. The current gold standard for treatment often involves high-dose opioids or anticonvulsants, both of which carry the risk of severe side effects, dependency, and diminishing returns over time.
The PainWaive project, led by Professor Sylvia Gustin and Dr. Negin Hesam-Shariati, seeks to break this cycle by targeting the source of the pain: the brain itself. The study followed participants over a four-week period, during which they engaged with the interactive game app while wearing a specialized electroencephalogram (EEG) headset. The research team tracked hundreds of individual measures, focusing not only on the intensity of the pain but also on "pain interference"—the degree to which the pain hindered the participants’ daily activities and emotional well-being.
The findings were striking. Three out of the four participants in the initial trial reported significant reductions in their pain levels, with the most substantial improvements occurring toward the final stages of the month-long treatment. For these individuals, the relief achieved through the PainWaive system was equal to or greater than the relief they had previously experienced through opioid medication.
Despite these encouraging outcomes, the researchers maintain a cautious and rigorous scientific perspective. Dr. Hesam-Shariati, a lead researcher on the study, noted that the small sample size is a factor that must be considered when interpreting the data. "Restrictions in the study’s size, design and duration limit our ability to generalise the findings or rule out placebo effects," she explained. However, she emphasized that the pilot was intended to establish proof-of-concept, and in that regard, it succeeded. "The results we’ve seen are exciting and give us confidence to move to the next stage and our larger trial."
The foundation of the PainWaive technology lies in years of seminal research conducted by Professor Sylvia Gustin into the thalamus. Located deep within the brain, the thalamus acts as a central relay hub, responsible for processing and transmitting sensory information to the cerebral cortex. Professor Gustin’s research identified that individuals suffering from chronic neuropathic pain often exhibit distinct, abnormal patterns in their brain waves, specifically within the thalamocortical circuit.
"The brainwaves of people with neuropathic pain show a distinct pattern: more slow theta waves, fewer alpha waves, and more fast, high beta waves," Professor Gustin said. These fluctuations are not merely symptoms of the pain but are believed to be part of the mechanism that sustains it. "We believe these changes interfere with how the thalamus talks to other parts of the brain, especially the sensory motor cortex, which registers pain."
This realization led Professor Gustin to a pivotal question: could a treatment be developed that directly targets and normalizes these abnormal waves? If the brain could be "retrained" to produce a more balanced pattern of theta, alpha, and beta waves, it might be possible to reduce the perception of pain at its neurological source.
To answer this question, an interdisciplinary team was formed, bringing together experts from UNSW Science and Neuroscience Research Australia (NeuRA). The result of their collaboration was the PainWaive system, a combination of hardware and software designed to facilitate neurofeedback. Neurofeedback is a process where a person receives real-time information about their brain activity and uses that information to attempt to change it. In the case of PainWaive, the "information" is delivered through the mechanics of a video game.
During the trial, participants were provided with a comprehensive kit that included a custom-designed EEG headset and a tablet preloaded with the PainWaive app. The app is designed to be responsive; as the headset detects shifts in brainwave patterns, the game reacts in real time. To succeed in the game, the user must successfully steer their brain activity toward a more "normal" or healthy state.
To assist in this process, the researchers provided participants with various mental strategies. These included techniques such as deep relaxation, mindfulness, or focusing on positive, happy memories. By experimenting with these mental states and observing the immediate feedback from the game, users learned which internal strategies were most effective at suppressing the abnormal brain waves associated with their pain.
One of the most significant aspects of the PainWaive system is its accessibility. Traditionally, neurofeedback therapy requires expensive equipment and frequent visits to a specialized clinic. PainWaive was designed from the ground up to be a telehealth-compatible, at-home solution. Participants in the study were able to master the system quickly.
"After just a couple of Zoom sessions, participants were able to run the treatment entirely on their own," Dr. Hesam-Shariati said. This autonomy is a critical component of the treatment’s success, as it allows patients to take control of their own recovery. "Participants felt empowered to manage their pain in their own environment. That’s a huge part of what makes this special."
The hardware itself is a product of necessity and innovation. When the project began, the team explored existing commercial EEG systems but found them lacking. Most were either prohibitively expensive—costing anywhere from $1,000 to $20,000—or did not provide the high-quality signal required for medical-grade neurofeedback. Consequently, the UNSW team decided to build their own.
"Everything except the open-source EEG board was built in-house," Dr. Hesam-Shariati explained. The team utilized 3D printing technology to manufacture the headsets, which allowed them to iterate on the design rapidly and keep costs low. Currently, the team has managed to bring the cost of each headset down to approximately $300. They are also in the process of replacing the open-source components with a custom-designed circuit board to further optimize performance.
The headset utilizes a saline-based wet electrode system, which Professor Gustin notes is essential for maintaining a high-quality signal. These electrodes target the sensorimotor cortex, the area of the brain responsible for processing sensory input from the body. "We’ve worked closely with patients to ensure the headset is lightweight, comfortable, and user-friendly," she added.
The long-term vision for PainWaive is to provide a truly affordable and accessible solution for chronic pain management, particularly for populations that have traditionally faced barriers to care. This includes people living in rural or remote areas, as well as those whose physical disabilities make frequent travel to medical centers difficult or impossible. "Owning the technology offers us the potential to one day offer PainWaive as a truly affordable, accessible solution for at-home pain management, especially for those with limited access to traditional treatments," Professor Gustin said.
Building on the success of the initial four-person pilot, the researchers are now expanding their scope. They are currently calling for participants to register their interest in two new, larger clinical trials. The first, the Spinal Pain Trial, will investigate the technology’s potential to alleviate chronic spinal pain, a condition that affects millions of people worldwide. The second, the StoPain Trial, will focus specifically on chronic neuropathic pain in individuals who have suffered a spinal cord injury.
These upcoming trials will provide the robust data necessary to further validate PainWaive’s efficacy and move it closer to widespread clinical use. By focusing on larger groups and specific patient populations, the researchers hope to confirm that the neurological retraining offered by PainWaive can serve as a cornerstone of modern, drug-free pain management.
As the medical community continues to grapple with the complexities of the opioid crisis and the limitations of current pain medications, the development of technologies like PainWaive offers a promising alternative. By harnessing the brain’s own plasticity and its ability to learn and adapt, the UNSW team is opening a new frontier in the treatment of chronic pain—one where the patient is no longer a passive recipient of medication, but an active participant in their own neurological healing.
