Biofeedback for pain

Biofeedback teaches you how to control your body’s nervous system in order to reduce pain and stress and promote relaxation. Biofeedback can sometimes relieve musculoskeletal pain such as neck, back, and shoulder pain. It also may work for migraines and stress- and tension-induced headaches.

Biofeedback is a method in which electrical sensors connected to your body (“bio”) provide information (“feedback”) that enables you to use your mind to consciously control bodily functions such as heartbeat and breathing. This includes the ability to reduce pain by relaxing associated muscles (Mayo Clinic). Biofeedback is being used in the military for various medical or psychological conditions such as PTSD/TBI, and for performance enhancement.1

Different methods of biofeedback monitor different physiological activities such as muscle tension, sweating, temperature, blood pressure, or brainwaves. A popular form of biofeedback measures heart rate variability (HRV). Greater HRV (we’re talking milliseconds here) has been linked to improved cognitive performance.1-4 Reduced HRV has been associated with heart problems and increased mortality, among other things. Stress can decrease your HRV, and if your stress remains high, your HRV could be reduced permanently. Information from biofeedback machines can be used to make changes in behaviors, breathing, and/or muscle tension—all of which can help you reduce stress and pain, increase HRV, and increase relaxation.

You can practice biofeedback on your own, but it requires special equipment and training. The equipment can be purchased without a prescription, but it can be expensive, so you should consult a healthcare provider for recommendations and training beforehand.

What we know

Biofeedback is used to reduce stress, increase relaxation, and reduce pain. It can be used for muscle-based pain such as headaches, back pain, and neck pain. Research indicates that biofeedback may reduce the frequency of migraines and how well you cope with them and improve neck and shoulder pain from computer work.5,6 Biofeedback that targets brain wave retraining may help reduce anxiety, which can improve mood and fears about future pain.

The Association for Applied Psychophysiology and Biofeedback (AAPB) describes biofeedback as "possibly efficacious" (that is, it might work) for many pain conditions and "efficacious" (that is, it works) for headache and jaw pain.7 It also can help reduce anxiety, which in turn can reduce pain. In addition, there is little evidence that biofeedback will help acute or chronic low back pain, and biofeedback does not work well for pain related to arthritis.8-10

Concerns

Biofeedback is non-invasive and has few side effects. As mentioned above, biofeedback equipment can be expensive, so your out-of-pocket cost can be high if they are not covered by health insurance. It also can take a significant amount of time to learn and practice. Always check with a healthcare provider and get proper training before starting a program.

Debrief

Below are some of the ways the DoD and VHA are using biofeedback:

  • Biofeedback can be used to increase HRV1 and relaxation, which could be helpful for pain, PTSD/TBI, and performance enhancement.11
  • The DHA Connected Health has developed some mobile biofeedback apps specifically for the military:
    • Biozen provides users with live, graphic biofeedback so that they can see their body's responses in real time. This application uses biosensors that wirelessly transmit changes in the body to the app.
    • Breathe2Relax is a portable stress management tool that monitors diaphragmatic breathing while the user records stress level.
    • The Institute of HeartMath has created tools for biofeedback that are available for free to veterans, service members, and their families to achieve a greater awareness of the connection between our emotions, physiology, and behavior.
    • Biofeedback is being explored by some Army ROTC cadets to promote resilience.
    • Biofeedback will be integrated into pain treatment by the DoD's Pain Management Task Force, so Warfighters will have access to biofeedback treatments at their local MHS.

This InfoReveal was created in collaboration with the Defense & Veterans Center for Integrative Pain Management.

Published on: February 7, 2017

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References

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  1. Moore M, Brown DG, Money NN, Bates M. Mind-Body Skills for Regulating the Autonomic Nervous System. Silver Spring, MD: Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; June 2011 2011.
  2. Luque-Casado A, Zabala M, Morales E, Mateo-March M, et al. Cognitive performance and heart rate variability: the influence of fitness level. PLOS One. 2013;8(2):e56935.
  3. Paul M, Garg K. The effect of heart rate variability biofeedback on performance psychology of basketball players. Applied Psychophysiology and Biofeedback. 2012;37(2):131-44.
  4. Sutarto AP, Wahab MNA, Zin NM. Effect of biofeedback training on operator's cognitive performance. Work: A Journal of Prevention, Assessment and Rehabilitation. 2013;44(2):231-43.
  5. Ma C, Szeto GP, Yan T, Wu S, et al. Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: a randomized controlled trial. Arch Phys Med Rehabil. 2011;92(6):849-58.
  6. Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain. 2007;128(1):111-27.
  7. Yucha C, Gilbert C. Evidence-Based Practice in Biofeedback and Neurofeedback: AAPB;2004.
  8. Hall H, McIntosh G. Low back pain (acute). Clinical Evidence. 2008;10(1102).
  9. Hall H, McIntosh G. Low back pain (chronic). Clinical Evidence. 2008;10(1116).
  10. Macfarlane GJ, Paudyal P, Doherty M, Ernst E, et al. A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: osteoarthritis. Rheumatology (Oxford). 2012;51(12):2224-33.
  11. Tan G, Fink B, Dao TK, Hebert R, et al. Associations among Pain, PTSD, mTBI, and Heart Rate Variability in Veterans of Operation Enduring and Iraqi Freedom: A Pilot Study. Pain Medicine. 2009;10(7):1237-45.