Biofeedback

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Biofeedback is a type of mind-body therapy and is considered a type of complementary and alternative medicine. Biofeedback helps individuals use their thoughts to control their bodies, in order to aid in treating medical conditions or improving physical performance. It can also be used as a method for inducing relaxation. Biofeedback has been used to treat anxiety and stress, asthma, side effects of chemotherapy, constipation, heart problems, high blood pressure, urinary incontinence, irritable bowel syndrome, pain, Raynaud’s disease, and to improve physical performance.

Biofeedback has a number of appealing features, including its non-invasive nature. It also has the potential to eliminate the need for medications, or be used as a substitute treatment for individuals who cannot tolerate medications due to particular side effects. Sessions are typically short in duration, lasting an hour or less, however the number of sessions required is often dictated by the condition being treated and individual adaptation and response to biofeedback. Biofeedback is generally considered safe, with no side effects. Biofeedback should always be performed by a doctor or therapist trained in its proper administration.

During biofeedback, electrical sensors are attached to various parts of the body. They monitor the body’s physiologic processes, such as brain waves, temperature, and muscle tension. The information is then fed back to the patient by way of visual or audible cues, such as a flashing light or a beeping sound. This enables the patient to adjust or control their body’s physiological reactions by changing their thoughts, emotions, and behaviors in response to the biofeedback that they receive. For example, an individual who experiences chronic neck pain might utilize biofeedback to pinpoint the neck and shoulder muscles that are overly tense. They can then learn how to relax those muscles in order to reduce their neck pain. The techniques learned through biofeedback can eventually be practiced outside of therapy, in the home setting. This is fundamentally a process aimed at re-training the process of how the brain is influenced by and how it responds to different bodily stimulus.

Biofeedback can be administered using one of several different techniques. Electromyography biofeedback (EMG) is used to provide information regarding muscle tension in order to facilitate relaxation. Electroencephalogram biofeedback (EEG), or neurofeedback, measures the electrical activity of the brain and is useful at improving attention and cognitive deficits. Temperature biofeedback, or thermal biofeedback, utilizes sensors attached to the fingers or feet, which then measure skin temperature. Since the body’s temperature rises and falls in response to stress, this type of biofeedback can help individuals learn to identify when they are under stress and thus promote relaxation. Galvanic skin response training measures the activity of sweat glands and sweat on the skin, which enables individuals to identify anxiety. Finally, heart rate variability biofeedback (HRV) can help individuals control their heart rate. This type of biofeedback is useful in treating high blood pressure, improving lung function, and for treating stress and anxiety.

Biofeedback and Fibromyalgia

A variety of biofeedback methods have been studied for use in treating fibromyalgia symptoms. Among these include EEG biofeedback (neurofeedback), EMG biofeedback, and HRV biofeedback.

The use of neurofeedback in treating fibromyalgia has shown mixed results. Several studies have found variants of neurotherapy to be useful in improving a variety of fibromyalgia symptoms (Kayiran et al., 2007; Mueller et al., 2001). A recent study by Caro & Winter (2011) evaluated the effects of 40 sessions of EEG biofeedback on pre-existing attention deficits and various physical symptoms in 15 fibromyalgia patients,. all of whom met the American College of Rheumatology (ACR) criteria for diagnosis. The researchers compared their findings to measures of attention and physical symptoms in 63 fibromyalgia patients who were not treated with EEG biofeedback. The study found that visual attention improved significantly among those treated with biofeedback when compared to the control subjects. Furthermore, those in the biofeedback group also experienced improvements in pain, tenderness, and fatigue, while those in the control group did not. In their discussion, the authors stress the importance of continued research on the use of biofeedback as a treatment for attention deficits among fibromyalgia patients (Caro & Winter, 2011). Nelson et al. (2010) recently evaluated the use of a novel type of biofeedback known as LENS – low energy neurofeedback system. LENS does not teach patients how to gain voluntary control over their brainwave activity similar to other forms of neurofeedback. Rather, LENS essentially interprets the biofeedback for the patient, and sends small impulses back to the brain in order to change the way in which the brain responds to various stimuli. In their study, Nelson and colleagues administered 22 LENS sessions to 17 female fibromyalgia patients, and an identical number of sham LENS sessions as a placebo treatment to another group of 17 fibromyalgia patients (one of whom was male). Data analysis at the conclusion of the study found no significant differences between either group with regard to overall functioning, nor did it reveal any significant differences between groups for number of tender points, cognitive dysfunction, fatigue, or global distress. The authors therefore concluded that LENS could not be recommended as a stand-alone treatment for fibromyalgia-related symptoms, however it should be investigated further to determine if it is beneficial when combined with other therapies (Nelson et al., 2010).

EMG biofeedback has also been evaluated in fibromyalgia patients. Babu et al. (2007) demonstrated reduced pain and number of tender points, as well as improved overall functioning and exercise capacity, in 15 fibromyalgia patients who received six days of treatment with EMG biofeedback. Another group of 15 fibromyalgia patients who received a placebo treatment with sham-EMG did not show significant improvements (Babu et al., 2007). An earlier study of EMG biofeedback compared its utility when administered to 24 fibromyalgia patients with (12) and without (12) underlying psychological problems. Among those without psychological problems, the study found that EMG biofeedback was useful at inducing long-term improvements in pain as related to tender point sensitivity, overall well-being, and mental health. Those who had psychological problems showed improvement in additional variables, including clinical symptoms, various pain components, and quality of life following treatment with EMG biofeedback. In their discussion, the authors suggest that EMG biofeedback may be a useful adjunct treatment for fibromyalgia patients with pre-existing psychological problems, and that determination of pre-existing psychological status may therefore improve treatment outcomes (Drexler et al., 2002). An earlier study found EMG biofeedback to only be useful in fibromyalgia patients without psychological disturbances (Ferraccioli et al., 1987). Buckelew et al. found that biofeedback, when combined with relaxation training and various exercise interventions was also useful in improving self-efficacy for physical functioning among fibromyalgia patients. Other studies have demonstrated no significant effects of EMG in the treatment of fibromyalgia symptoms (van Santen et al., 2002).

A small study in 12 female fibromyalgia patients investigated the use of HRV biofeedback on a variety of fibromyalgia symptoms. Following 10 weekly sessions (20 minutes in duration) in the research setting, plus two daily practice sessions at home, data analysis revealed clinically significant improvements in depression and pain among the participants. Improvements were also sustained when measured again at the three month follow-up appointment. The authors did note the possibility of a placebo effect of the treatment (a phenomenon by which a patient’s symptoms are relieved by an ineffective treatment due to the patient’s own perception of the treatment as effective). This may have occurred due to the fact that all patients were aware of the nature of their treatment and its intended purpose. As a result, the authors cite the need for additional studies of HRV biofeedback in larger samples of fibromyalgia patients, using adequate control methods and more rigorous study design (Hassett et al., 2007).

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References

1.        Caro XJ. Winter EF. EEG biofeedback treatment improves certain attention and somatic symptoms in fibromyalgia: a pilot study. Appl Psychophysiol Biofeedback. 2011;36:193-200.

2.        Nelson DV, Bennett RM, Barkhuizen A, Sexton GJ, Jones KD, Esty ML, Ochs L, Stuart Donaldson CC. Neurotherapy of fibromyalgia? Pain Med. 2010;11:912-919.

3.        Kayiran S, Dursun E, Ermutlu N, Dursun N, Karamursel S. Neurofeedback in fibromyalgia syndrome. Agri. 2007;19(3):47-53.

4.        Babu AS, Mathew E, Danda D, Prakash H. Management of patients with fibromyalgia using biofeedback: a randomized control trial. Indian J Med Sci. 2007;61(8):455-461.

5.        Hassett AL, Radvanski DC, Vaschillo EG, Vaschillo B, Sigal LH, Karavidas MK, Buyske S, Lehrer PM. A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fibromyalgia. Appl Psychophysiol Biofeedback. 2007;32(1):1-10.

6.        Drexler AR, Mur EJ, Gunther VC. Efficacy of an EMG-biofeedback therapy in fibromyalgia patients. A comparative study of patients with and without abnormality in (MMPI) psychological scales. Clin Exp Rheumatol. 2002;20(5):677-682.

7.        van Santen M, Bolwijn P, Verstappen F, Bakker C, Hidding A, Houben H, van der Heijde D, Landewé R, van der Linden S. A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia. J Rheumatol. 2002;29(3):575-581.

8.        Mueller HH, Donaldson CC, Nelson DV, Layman M. Treatment of fibromyalgia incorporating EEG-Driven stimulation: a clinical outcomes study. J Clin Psychol. 2001;57(7):933-952.

9.        Buckelew SP, Conway R, Parker J, Deuser WE, Read J, Witty TE, Hewett JE, Minor M, Johnson JC, Van Male L, McIntosh MJ, Nigh M, Kay DR. Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res. 1998;11(3):196-209.

Ferraccioli G, Ghirelli L, Scita F, Nolli M, Mozzani M, Fontana S, Scorsonelli M, Tridenti A, De Risio C. EMG-biofeedback training in fibromyalgia syndrome. J Rheumatol. 1987;14(4):820-825.

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