Objective:

To evaluate the effectiveness of NFB interventions on primary outcomes (pain intensity and stress levels), as well as secondary outcomes (quality of life, anxiety/depression, neurophysiological markers, and adverse events)

Background:

Chronic pain, chemotherapy-induced peripheral neuropathy (CIPN), and psychological stress severely erode the quality of life of patients with cancer. Pharmacological treatments provide only partial relief and are often limited by adverse effects.  NFB has emerged as a non-pharmacological option for pain/stress modulation.

Design/Methods:

A PRISMA-compliant review was systematic review was conducted across of PubMed, Embase, and Scopus, having trials involving adults with cancer-referring to RCTs, cohort studies, or case-control studies. The primary outcomes investigated are pain intensity and stress levels; secondary outcomes are included quality of life (QoL), anxiety/depression, neurophysiological changes, and adverse events. The risk of bias was assessed using the Cochrane RoB 2 and the Newcastle–Ottawa Scale.

Results:

Twelve studies with 430 participants were included. EEG-based NFB reduced pain by 35–42% (Pain Quality Assessment Scale, Brief Pain Inventory) and improved fatigue and functioning, with benefits sustained ≥4 months. Real-time fMRI and brain–computer interface (BCI)-NFB achieved superior analgesia versus sham or waitlist controls (up to 42% pain reduction; Cohen’s d = 1.12). Symptom improvement correlated with increased beta-band power, normalized alpha asymmetry, and enhanced prefrontal–insula connectivity. Virtual reality (VR)-integrated NFB improved engagement and anxiety outcomes. Compared to gabapentin, NFB provided comparable pain relief with fewer side effects (5% vs. 32% dropout) and potential cost savings, though with slower onset. Barriers included high equipment costs, specialized training needs, and limited access for underserved populations.

Conclusions:

In treating cancer-related pain and stress, NFB offers a promising, safe, and durable adjunct treatment. In the future, research should prioritize the standardization of protocols, validation of biomarkers, and exploiting the advancements in wearable EEG, AI-personalized training, and home-based/VR platforms for equitably scalable deployment into supportive oncology care.