Neurofeedback as a non-pharmacological strategy for pain and gut-brain axis disorders: clinical relevance in inflammatory bowel disease

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic conditions associated with gastrointestinal inflammation and a wide range of extraintestinal manifestations. While conventional treatments primarily address intestinal inflammation, many patients continue to experience chronic pain, psychological comorbidi-ties, and functional gastrointestinal symptoms, highlighting the need for integrated therapeutic strategies. This narrative review explores the potential of neurofeedback (NFB) as a non-invasive therapeutic approach for managing symptoms frequently observed in IBD, including musculoskeletal pain, anxiety, depression, post-traumatic stress symptoms (PTSS), and gut-brain axis dysfunction. In the absence of direct evidence on neurofeedback in IBD populations, we examined data from clinical trials conducted in conditions that are frequently comorbid with or symptomatically overlap with inflammatory bowel disease, including fibromyalgia, irritable bowel syndrome (IBS), chronic pain syndromes, and af-fective or trauma-related disorders. We focused on outcomes related to chronic pain, psychological well-being, and gastrointestinal function, examining NFB protocols primarily targeting alpha, theta, and sensorimotor rhythms, which have shown promising results in improving symptom severity and autonomic regulation. These findings support the ra-tionale for investigating NFB as a potential adjunctive therapy in IBD, particularly for patients with residual or refractory extraintestinal symptoms. However, as none of the available studies specifically involve patients with IBD, the evidence base remains indirect. Moreover, current findings are limited by small sample sizes, heterogeneous methodologies, and variable outcome measures in the studied populations, making it difficult to draw definitive conclusions regarding the ef-ficacy of NFB in this context. Future research should include large-scale, randomized controlled trials conducted directly in IBD cohorts, along with protocol standardization and individualized approaches based on neurophysiological profiles. Clarifying the therapeutic potential of NFB in this population could open new avenues for non-pharmacological, patient-tailored interventions within integrative care frameworks.