Biofeedback: Learning to Change Physiological Activity to Improve Pain Control

LAS VEGAS—If you have taken your temperature, stepped on a scale, or had your blood pressure or cholesterol checked, you have experienced biofeedback. The information gained can be used to make changes, adjustments, or assess functional status. Biofeedback itself, however, does not create the change, an important distinction to remember when faced with resistance regarding its use.

During his presentation, Anthony A. Whitney, MS, LHMC, BCB, a behavioral therapist and biofeedback specialist at St. Luke's Rehabilitation Institute, Spokane, Washington, said the Association for Applied Psychophysiology and Biofeedback, Biofeedback Certification International Alliance, and the International Society for Neurofeedback and Research have approved this definition:

Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately “feed back” information to the user. The presentation of this information—often in conjunction with changes in thinking, emotions, and behavior—supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.

Surface electromyography (sEMG) biofeedback is one of several modalities used to detect action potentials from underlying skeletal muscles. sEMG is most often used in the treatment of musculoskeletal movement (eg, inefficient or asymmetrical movement, muscle reeducation) and pain problems (eg, back pain, myofascial pain, tension headache, repetitive strain).

sEMG assessments provide information about muscular behavior and activity that can be compared to normative data and interpretations identified; for example, high or low tension levels, asymmetry, and abnormal activation patterns.

One practical application of biofeedback is to assess myofascial pain. In a case study, a patient presented with chronic neck and shoulder pain, muscle spasms, headaches, and pain radiating down both arms; however, pain levels were significantly greater on her left side. sEMG sensors were applied to her upper trapezium muscles for assessment and training. Two to three months following initial assessment and training, she was able to relax when cued.

Whitney explored several myths of relaxation, including that it is like being deeply asleep; that all relaxation techniques produce the same results/effects; that biofeedback may cause harm or create changes against one's will; that relaxation is something you need to learn to make yourself and body do; and that biofeedback is a curative treatment.

He emphasized early intervention is critical in referring patients for biofeedback. Diagnoses with increased efficacy for sEMG biofeedback include cervical and lumbar strain, repetitive strain injury, headaches (especially tension-type), jaw and/or facial pain, myofascial pain syndrome, and chronic pain. Warning signs or red flags suggesting referral include pain complaints with progressive worsening, discontinuation of physical or other therapy due to too much pain, high levels or increasing use of pain medication, overly limited activity levels, the presence of muscle tension, and a dominant focus on finding “the smoking gun” or being “fixed.”

Finally, to overcome resistance to biofeedback, he recommended education to reduce the unknown, noting, “be patient: sometimes it starts with a seed.”