Guest Article: What Is Biofeedback Therapy for Chronic Pain?

Thanks to Dr. Lawrence Thomas, Direc­tor of The Brain Clin­ic, for today’s arti­cle.

Biofeedback for Chronic Pain

The term chron­ic pain cov­ers a vast area, from very spe­cif­ic sites of pain to more glob­al pain expe­ri­enced by the patient all over their body.  More than one-third of the pop­u­la­tion expe­ri­ences chron­ic pain in their lives at some notice­able lev­el (Bon­i­ca, 1992).  Biofeed­back has been found to help at both lev­els of chron­ic pain, some­times with tech­niques that are under­stood to influ­ence the whole phys­i­ol­o­gy, and some meth­ods are more focused on the para­me­ters of the par­tic­u­lar dis­or­der.

Flor and Bir­baumer (1993) report­ed that in treat­ing back pain and tem­poro­mandibu­lar joint pain with both biofeed­back and relax­ation ther­a­py, biofeed­back had the great­est pos­i­tive effect on sev­er­al aspects of pain that last­ed at a 24 month fol­low-up.  Stin­son (2003) reviewed 18 ran­dom­ized, con­trolled stud­ies in a meta-analy­sis (from Eccle­ston, Mor­ley, Williams, et al., 2002), and patients in the treat­ment groups had greater than 50 per­cent reduc­tion in pain com­pared to the con­trols.

In a study by Qi and Ng (2007), two treat­ment groups were cre­at­ed for patellofemoral pain patients — one with exer­cise only and one with exer­cise plus biofeed­back.  After the eight week home pro­gram, the biofeed­back group had sig­nif­i­cant­ly reduced pain.

In a study (Voer­man, Vol­len­broek-Hut­ten, & Her­mens, 2006) involv­ing pain patients wear­ing an ambu­la­to­ry mon­i­tor for four weeks, mea­sures of mus­cle acti­va­tion and relax­ation were record­ed, and feed­back was pro­vid­ed when relax­ation was less than it should be.  Pain in the neck, shoul­ders and upper back, as well as acti­va­tion pat­terns in typ­ing, rest, and stress tasks were mea­sured.  The inten­si­ty of the pain reduced after the train­ing.

Lebovits (2007) sum­ma­rized a com­pre­hen­sive review by the Nation­al Insti­tutes of Health Tech­nol­o­gy of sev­er­al behav­ioral approach­es, and the over­all con­clu­sion was that spe­cif­ic relax­ation meth­ods (includ­ing relax­ation train­ing, biofeed­back, hyp­no­sis, med­i­ta­tion and guid­ed imagery) had the high­est rat­ings for effec­tive­ness.

As not­ed before, it is hard to tease out the exact con­tri­bu­tion of biofeed­back in many of these stud­ies due to com­bined treat­ment modal­i­ties in many of the exper­i­men­tal con­di­tions.

There are sig­nif­i­cant lim­i­ta­tions in much of the med­ical treat­ment of chron­ic pain accord­ing to Singh (2005), who states: “The ther­a­peu­tic response of phar­ma­col­o­gy in chron­ic pain at the present time remains unsat­is­fac­to­ry at best and refrac­to­ry at the worst.  Mul­ti­dis­ci­pli­nary pain man­age­ment has not only brought new hope, but has also increased the ther­a­peu­tic response in gen­er­al.”  The ref­er­ences cit­ed in this chap­ter, and in this sec­tion in par­tic­u­lar, should give an indi­ca­tion that behav­ioral meth­ods should be includ­ed in the med­ical treat­ment of chron­ic pain.


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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods. His website,, provides more information about his approach. Please contact him at or at 212-400-9663.
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