Biofeedback is a complementary and alternative pain therapy. Patients are trained to use their mind to control body functions that are typically involuntary, such as muscle tension and heart rate. It may be used to treat a large number of pain conditions, such as headaches, arthritis, fibromyalgia and lupus. It is also sometimes used to treat disorders such as anxiety, insomnia or depression.

Little is understood about how biofeedback works. Though the therapy appears to be effective for some individuals, other patients are not successful at mastering the techniques or can carry out the treatment but do not find relief.

During biofeedback training, sensors are placed on the body. The patient is given auditory or visual cues, such as “tense muscle,” to indicate body functions. The patient then learns to associate these functions with symptoms (e.g., pain) and learns to control the functions (e.g., relax the muscles) to ease the symptoms. Eventually, the patient learns to do this without help from a therapist.

Biofeedback may decrease side effects and medical costs by reducing patients’ need for medication. It puts patients in control of their own treatment. For most patients, biofeedback therapy is very safe. However, because it may interfere with some medications, it is important to discuss biofeedback thoroughly with a physician, particularly if suffering from certain conditions, such as endocrine disorders.

Biofeedback is a complementary and alternative pain therapy in which the patient gains partial or complete control over various typically involuntary body functions. It belongs to the category of mind-body therapies, which seek to strengthen communication between the mind and body. This therapy is non-pharmacological, meaning that it does not involve medications.

The goal of biofeedback is to use the mind to help control the body. Therapists teach patients how to control certain involuntary body responses using feedback from a variety of monitoring procedures and equipment. This equipment usually displays biological data (e.g., heart rate, muscle tension) in a visual or auditory form, which allows a patient to become aware of body processes that are otherwise controlled unconsciously. By slowly learning to control these responses, patients can overcome various mental and physical health issues, such as migraine or panic attacks. Eventually, patients may be able to control their body’s response without the aid of the visual or auditory cues.

Mastering relaxation techniques, whether in a specific body part or in the entire body, is often a large part of biofeedback. Controlling certain body functions, such as heart rate and muscle stress, can reduce tension and pain.

Patients who participate in biofeedback may learn to control many responses, including:

• Muscle tension
• Brain-wave activity
• Skin temperature
• Respiration
• Heart rate and circulation
• Blood pressure
  

Different methods of biofeedback training are used depending on the conditions and goals of the individual patient. Some of these methods include electromyography (EMG); neurofeedback, which employs an electroencephalogram (EEG); and galvanic skin response training, which measures perspiration. Diaries or journals may be useful in determining the effectiveness of an individual patient’s use of biofeedback.

Though mind-body integration is an ancient aspect of Eastern medicine, biofeedback techniques have been developed only within the last half-century, and much about them is still not understood. Patients who use biofeedback often cannot explain how they control their body functions to relieve their symptoms. Even physicians do not fully understand how biofeedback works. However, many patients who use it often say that they feel more in control and confident about their conditions and symptoms. Once the techniques are learned in a clinical setting, the patient may be able to control body functions without the assistance of a therapist.

Biofeedback may be used in conjunction with other treatments or therapies to improve their effectiveness. It may also be used as an independent treatment alternative, particularly for patients who do not respond to or have adverse effects with traditional therapies. Biofeedback certification is available from the Biofeedback Certification Institute of America (BCIA). Although this certification is not required, many biofeedback therapists in the United States choose to become certified.

The techniques used to teach biofeedback depend upon individual patients’ health problems and what they wish to accomplish. Methods and equipment that may be used include:

• Electromyography (EMG). Sensors (e.g., electrodes) are attached to the skin to measure the electrical activity of the muscles. This activity relates to muscle tension, which can influence or cause pain and stress. The patient learns to recognize tension early and control it right away.
  
  
• Neurofeedback. An electroencephalogram (EEG) is used to monitor brain-wave activity and teach patients to alter it. This activity may be linked to different mental states, such as wakefulness, relaxation, calmness and light or deep sleep.
  
  
• Thermal biofeedback. Sensors are attached to the patient’s fingers and feet to measure skin temperatures. These temperatures often drop when the patient is under stress, so a low reading can prompt the beginning of relaxation techniques.
  
  
• Galvanic skin response training. Sensors measure perspiration and sweat-gland activity. This method is useful in the treatment of emotional disorders (e.g., anxiety, phobias).
  
  
• Forced oscillation method. The patient breathes through a tube and pressure and flow of the breath are assessed using a device called a pneumotachometer. This method teaches control of respiration.
  
  
• Bowel training. A pressure-sensitive probe is inserted into the anus and rectum to register the strength and activity of the anal sphincter. This training allows patients to practice sphincter contractions and to learn to strengthen the rectal muscles.

Biofeedback has shown evidence of assisting in more than 100 conditions. Though physicians are unsure exactly how the mechanics behind biofeedback work, many people have found success with the therapy. Some of the conditions that biofeedback is used to treat include:

• Headaches. Biofeedback has been shown to be particularly effective in the treatment of headaches. Neurofeedback, electromyography (EMG) and thermal biofeedback are used to learn relaxation techniques and control over muscle tension, circulation and to gain brain wave patterns.
  
  
• Arthritis. Biofeedback may ease the pain associated with many types of arthritis, including rheumatoid arthritis (RA), osteoarthritis and psoriatic arthritis. Training employs EMG to teach patients to control muscle tension and circulation.
  
  
• Back pain, neck pain or other joint pain. Techniques such as EMG may help patients become aware of, and learn to control, painful muscle tension. Techniques such as EMG may help patients become aware of, and learn to control, painful muscle tension.
  
  
• Fibromyalgia. A chronic, widespread pain syndrome. Biofeedback may ease pain, increase energy levels, alleviate cognitive (mental) dysfunction and improve sleep through mental control over muscle tension, anxiety and heart rate. EMG, neurofeedback and galvanic skin response training may be used for this condition.
  

• Myofascial pain syndrome. A chronic, local pain syndrome. Feedback evaluates the affected muscles at rest and during activity. Patients attempt to gain control over this muscular behavior as a method of reducing pain. EMG is typically used for this condition.
  
  
Systemic lupus erythematosus (SLE). A chronic, inflammatory autoimmune disease. SLE patients using biofeedback seek to control muscle tension, anxiety and brain wave patterns with the assistance of EMG, neurofeedback and galvanic skin response training. Biofeedback therapy for SLE may ease pain, improve cognitive function and reduce stress and fatigue.


Chronic fatigue syndrome. A debilitating condition marked by profound weariness and long-term pain. Biofeedback may help relieve stress, promote sleep and improve coping.


TMJ disorder. A painful disorder affecting the temporomandibular joints connecting the lower jawbone to the skull. Biofeedback for this condition typically employs EMG to teach control over tension in the muscles along the jaw that make the mouth clench.


Peripheral neuropathy. A nervous-system condition, sometimes caused by diabetes, that can cause numbness, tingling and burning. Biofeedback can help a patient control and reduce these types of pain.



• Skin ulcers. These open sores can be due to diabetes or other conditions. Thermal biofeedback has shown some success at reducing the pain associated with these sores.

• Vulvodynia. A pelvic pain syndrome affecting the vulva. Biofeedback applied to this condition seeks to control pelvic muscle tension to ease pain. EMG is typically used in biofeedback training for this condition.
  
  
• Prostatitis. An inflammation of the prostate gland. Biofeedback training can help alleviate the pain in the perineum that is associated with this condition. It may also treat prostatodynia, a noninflammatory disorder that, like vulvodynia, is a form of chronic pelvic pain syndrome.
  
  
• Raynaud’s phenomenon. A condition where the fingers or toes become discolored and numb, particularly in cold conditions. Patients using biofeedback learn to control the temperature in their skin. Biofeedback therapy may decrease the severity and frequency of attacks and allow an individual to increase the temperature of the hands and feet. Training typically employs thermal biofeedback and occasionally EMG.

Biofeedback has also been used to treat other chronic pain conditions, such as sickle cell anemia, advanced Lyme disease, irritable bowel syndrome and repetitive strain injuries. The National Institutes of Health is studying it in the treatment of high blood pressure. Biofeedback is also used for:

• Addictions, including alcoholism and smoking
• Attention deficit hyperactivity disorder (ADHD)
• Depression, anxiety, obsessive-compulsive disorder and phobias
• Insomnia
• Urinary and fecal incontinence
• Nausea and vomiting
• Asthma
• Hot flashes
• Bruxism (grinding of teeth)
• Learning disabilities
• Stuttering
• Head injuries
• Arrhythmia (irregular heartbeat)
• Stroke
• Epilepsy and seizures

Many physicians encourage patients to find the right therapist for biofeedback. The Biofeedback Certification Institute of America (BCIA) certifies therapists throughout the United States. To receive certification, the therapist must be a licensed healthcare professional or work under the guidance of such a professional. These therapists are accustomed to dealing with patients and typically have a good bedside manner. If a BCIA-certified therapist is not available, a medical expert may be able to recommend a non-certified therapist.

If neurofeedback is to be employed, a quantitative electroencephalogram (QEEG) brain map is typically generated before biofeedback begins. This is used to evaluate the patient’s brain function and determine in a scientific, objective manner if brain wave patterns are significantly abnormal and whether the patient is a good candidate for neurofeedback training. It also allows the therapist to individualize training much more precisely.

QEEG  takes about 90 minutes. A snug cap is placed on the head. This cap contains electrodes to measure the electrical patterns of the brain. No current is delivered to the brain. Brainwave pattern is recorded and compared to that of a healthy and mentally normal person who is the same age as the patient.

Biofeedback training can occur in a variety of facilities, such as physical therapy clinics and medical centers. It typically lasts for 30 to 60 minutes.

The therapist applies electrical sensors (electrodes) to parts of the patient’s body. These electrodes are connected to monitors that give feedback in the form of auditory (e.g., beeping, clicking sounds) or visual (e.g., flashing light, changing color) cues. The patient begins to associate the body’s responses (symptoms) with certain physical functions (e.g., tense muscles, elevated heart rate). In this manner, the patient learns how to make positive physical changes (e.g., relax muscles, reduce heart rate) to alleviate the symptoms. Relaxation helps the patient to learn this control.

The eventual goal of biofeedback training is for the patient to exercise this control alone, without the help of a therapist or technology. Depending on the condition, biofeedback typically involves as few as 10 or as many as 50 sessions over several weeks, and after learning self-regulation a patient may need no further therapy or only an occasional refresher session, according to the Biofeedback Certification Institute of America.

Many patients find it useful to assess the effectiveness of biofeedback by keeping a diary to monitor their use of the treatment. They record how they feel before, during and after the therapy. Therapists often conduct a similar profile of their patients, recording physiological values during the tests and after the tests as well as the extent of the patient’s recovery. These records can assist in pain assessment.

The results of biofeedback vary by individual. In successful treatments, biofeedback may allow patients to reduce or even eliminate their need for medication. The therapy also has the potential to increase the effectiveness of other treatments or help conditions when the patient fails to respond to other treatments. In some instances, it may decrease medical costs by removing the cost of other pain medications or therapies.

Biofeedback can also have psychological benefits. It may give patients control of their own healing and allow them to better monitor their own progress.

Biofeedback is considered very safe. However, it is wise for patients to be cautious and discuss the therapy with their physician thoroughly if they are suffering from depression, psychosis or endocrine disorders such as diabetes. This is because biofeedback may interfere with some medications for these conditions.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about biofeedback:

1. Am I a good candidate for biofeedback?
   
   
2. Which body functions should I seek biofeedback control over to help my condition?
   
   
3. Do you recommend a particular therapist or facility?
   
   
4. How often will I have biofeedback, and for how long a period? How long does each session last?
   
   
5. Which methods of biofeedback training should I use?
   
   
6. Should I use a journal to record my experiences with biofeedback?
   
   
7. Could biofeedback improve the effectiveness of other treatments I am undergoing?
   
   
8. Will biofeedback interfere with any of the medications I am taking?
   
   
9. Should I restrict my use of biofeedback in any way because of my condition?
   
   
10. When should I see an improvement? What are other treatment options if biofeedback doesn’t help me?