LAS VEGAS—When biofeedback techniques are used to treat chronic pain, patient functioning and quality of life improve because the mind and the body are integrated, said Anthony Whitney, MS, LMHC, BCB, a behavioral therapist and licensed mental health counselor at St. Luke’s Rehabilitation Institute in Spokane, Washington, who is board certified in general biofeedback.

“We need to remind ourselves that pain is a symptom and does not define the person,” said Whitney to attendees at PAINWeek 2014. “Most individuals need to rebuild/recreate their sense of identity. As long as the mind and body are disconnected or in conflict, healing is limited or at a standstill.”

The definition of biofeedback, approved by several national and international organizations, 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.”

Whitney explained that biofeedback creates a window into the body/brain, providing objective data that allows both the person receiving biofeedback and the therapist to be aware of the body’s functional state (eg, stressed, tensed, relaxed, abnormal, symmetrical), with real-time body changes that can be tracked over time. Increasing a person’s body/mind awareness using these physical changes promotes behavioral changes “to increase desirable responses and improve physical, emotional, and mental health,” he said.

When engaging in mind-body–based treatment such as biofeedback, Whitney said it is important to assist individuals in identifying and progressing through six stages of recovery: examine, recognize, responsibility, change, accept, commit. Pain disorder warning signs, or “red flags,” that may alert clinicians to patients whose treatment may require beyond what biofeedback can offer are summarized in the Table.

Table. Pain Disorder ‘Red Flags’

 Consistently high pain complaints
 Pain complaints that get worse in time
 Discontinues physical therapy because it causes too much pain
 High level of narcotic use
 Family stress, separation, divorce
 Substance abuse (alcohol, drug Rx)
 Limited activity level
 High levels of anger
 Frequent pain behaviors
 Overly solicitous or protective family members
 Strong focus on finding out what is wrong or on being fixed
 Doctor shopping
 History of trauma or abuse
 Job dissatisfaction
 Family members who are disabled or receiving benefits
 Legal involvement
 Lack of social support

He advised participants to “attempt to start by meeting the person where he or she is at and then assist them with change,” adding that “a good provider/patient relationship is essential for a successful outcome.” Education should focus on increasing the patient’s internal locus of control to reduce the unknown. Home programs may be developed to help work toward life changes, with the patient tracking and measuring change. Referrals within a multidisciplinary team may also be explored.

Whitney was clear on what biofeedback does not do: provide independent medical or psychological diagnoses, measure or show pain, stand alone as a curative treatment, or cause change. In addition, “using biofeedback equipment only is not an optimum treatment.”

Biofeedback practitioners may be found by visiting