Pain Management

Biofeedback

Biofeedback involves training individuals to gain control over brain states through electroencephalography (EEG) in order to help improve pain intensity. Biofeedback has been previously been shown to improve pain intensity in individuals with fibromyalgia and migraines (Jensen et al. 2013).

Author YearCountry

PEDro Score

Research Design

Total Sample Size

 Methods Outcome
Middaugh et al. 2013

USA

RCT

PEDro=5

N=15

 Population: Mean age=38yr; Gender: males=12, females=3; Level of injury: paraplegia=13, quadriplegia=2; Mean time post injury=16yr; Type of pain: musculoskeletal (cervical and shoulder).

Intervention: Individuals using wheelchairs were randomized to an exercise program alone (control, n=7) or with EMG biofeedback (treatment, n=8). Exercise programs were taught in two 90min sessions and were to be performed at home (1x/d, 5d/wk, 10wk). EMG biofeedback training was provided in 4 sessions (90min). Outcomes were assessed at baseline, 10wk, and 6mo.

Outcome Measures: Wheelchair User Shoulder Pain Index (WUSPI).

 1.      The treatment group had a significant reduction in WUSPI score at 10wk (Δ=64%, p=0.02) while the control group did not (Δ=27%, p=0.42).

2.     There were significant reductions in WUSPI score at 6mo in both the control group (Δ=63%, p=0.03) and treatment group (Δ=82%, p=0.004).
Jensen et al. 2009

USA

RCT

PEDro=5

N=37

 Population: Mean Age=49.6yrs; Sex: males=28, females=9. Type of pain=neuropathic.

Intervention: Participants were randomized to receive either hypnosis or biofeedback. Individuals receiving hypnosis underwent 10 sessions of training daily or weekly. While the biofeedback group received 10 sessions of Electromyography biofeedback.

Outcome Measures: Numeric Rating Scale (NRS).

 1.     Individuals with neuropathic pain a significant decrease in daily pain intensity was seen in the hypnosis group post-session (p<0.01) but not the biofeedback group.

2.     Neither treatment was effective in reducing pain for individuals without neuropathic pain.
Jensen et al. 2013

USA

Pre-Post

N=10

 Population: Mean Age=46.1yrs; Sex: males=7, females=3; Time since injury=12.3yrs Type of pain=neuropathic and musculoskeletal.

Intervention: SCI individuals with chronic pain were provided with 4 sessions of electroencephalography (EEG) Biofeedback for pain management.

Outcome Measures: Numeric Rating Scale (NRS).

 1.     Significant improvement in worst pain intensity (p=0.01) and pain unpleasantness (p=0.026) was seen post treatment and at 3 month follow up.

2.     No significant improvement in average pain intensity or sleep was seen.

Discussion

A pre-post study (Jensen et al. 2013) found biofeedback improved worst pain intensity but not average pain intensity among individuals with SCI pain. Jensen et al. (2009) randomly allocated participants into hypnosis or the biofeedback treatment group. Participants in the hypnosis group reported a significant decrease in neuropathic pain intensity compared to those in the biofeedback group (p<0.01). However, no such effect was seen between the two groups in individuals without neuropathic pain. Middaugh et al. (2013) found that exercise and EMG biofeedback training resulted in significant reduction in WUSPI scores post intervention and at 6 month follow up.

Conclusion

There is level 4 evidence (from one pre-post study: Jensen et al. 2013) that biofeedback may reduce worst pain intensity post SCI but not average pain intensity.

There is level 1b evidence (from 1 RCT: Middaugh et al. 2013) that combined EMG biofeedback and exercise may reduce pain post SCI.

There is level 1b evidence (from 1 RCT: Jensen et al. 2009) that biofeedback is not as effective as hypnosis in reducing neuropathic pain post SCI.

Biofeedback may reduce neuropathic and musculoskeletal pain intensity post SCI.

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