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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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