Biofeedback’s Role in Reducing Pain

July 13, 2015

justDoes biofeedback therapy reduce pain? Salonpas sat down with Dr. Nancy Just, a psychologist who specializes in pain management to learn more about biofeedback’s role in reducing chronic pain.

Dr. Just holds a Doctorate in Clinical Psychology from Temple University.  She is a Fellow of the American Academy of Clinical Psychology and holds a Diplomate in Clinical Psychology from the American Board of Professional Psychologists.  Dr. Just is a past Director of Psychology at the UMD-New Jersey Medical School Pain Management Center.  Her areas of specialty include the evaluation and treatment of chronic pain disorders and the psychological management of illness.

Dr. Nancy Just is Director of Advanced Psychological Specialists, LLC (APS) and assigns each new patient based on their needs. APS is comprised of a group of doctoral level psychologists whose goal is to help people understand and address emotional distress, cognitive difficulties and life issues.

While completing her internship at UMDNJ-New Jersey Medical School (now Rutgers), Dr. Just did a rotation in Pain Management.  That is where she was introduced to biofeedback as a tool to help patients manage chronic pain conditions.  Following her internship, she joined the faculty and continued her work in this area:

biofeedback-nycWhat is biofeedback?

Biofeedback is a treatment technique in which people are taught to control certain physical responses by using signals from their own bodies. This is accomplished by using a machine to make specific bodily signals accessible (such as muscle tension or temperature) through mapping them on a computer screen (sound is sometimes used with visual feed back or instead of visual feedback).  Once you can see what your body is doing, you can learn techniques to change these patterns.  In this way, you can increase your control over seemingly uncontrollable problems and reduce or eliminate your symptoms.

What happens during a biofeedback session?

During your first appointment, the doctor will conduct a comprehensive evaluation to determine if you are an appropriate candidate for biofeedback therapy.  Thereafter, a typical biofeedback session lasts thirty to forty-five minutes.  During each session, computer sensors will be applied to different parts of your body.  These sensors will monitor different physiological processes like circulation, muscle tension, perspiration and brain waves.  The doctor will then teach you ways to alter these processes and you will be able to track your efforts visually on a monitor and by sound cues.

The doctor will at times make audio recordings of your sessions so that you can practice your newly learned skills between sessions.  In certain situations, you will be fitted with a mobile unit that will serve as a teaching aide between sessions.

Comprehensive biofeedback treatment incorporates many techniques in addition to the use of computer sensors.  It is likely that your doctor will try to help you identify the triggers of your symptoms, correct muscle use, and change maladaptive habits that may be contributing to or maintaining your symptoms.

What types of ailments do clients come to you for help with?

BiofeedbackPic.267150555_stdDifferent types of biofeedback can be used to address certain pain problems directly.  For example, Temperature Biofeedback is used to treat migraine headaches, high blood pressure, insomnia, pain, stress, digestive disorders, and many other ailments.

Surface EMG biofeedback can be used to help patients recognize misuse of muscles (often in an attempt to protect a painful area of the body).  For example, a patient can visually see that when they engage their lower trapezius muscle, an over active upper trapezius muscle will “turn off.”  They can also be fitted with mobile SEMG units so that they will receive an auditory signal when they unconsciously tense a muscle that should be at rest.

Also, biofeedback can be used to teach and enhance a general relaxation response. A general relation response helps to “close the neuro-chemical gates” in the spinal column that allow pain signals transportation to the brain.   Therefore, a general relaxation response is relevant to all pain conditions that are not centrally mediated (originating in the spinal column or brain).

How many sessions are needed to get results from the therapy?

Depending on the type of biofeedback, even one session can be helpful.  Take the example above, visually seeing how engaging your lower trapezius can “turn off” an over active upper trapezius can lead a patient to begin using those muscles more appropriately.

When teaching a general relaxation response, I often make a tape of the imagery that was  used so that the patient can practice at home, when not hooked up to the biofeedback machine.

Is biofeedback therapy a lifetime commitment, or can people take a set amount of sessions over a set period of time to achieve good results?

Depending on the type of biofeedback and the goals, as little as one session can be useful.  But additional sessions can be helpful for mastery.

Are there any side effects of biofeedback therapy?

With neuromuscular biofeedback, there may be some soreness as muscles are taught to operate correctly.  For example, often the upper trapezius muscles become shorter because of hunching or guarding in response to pain.  As these muscles are stretched and learn to operate correctly, there may be some minor discomfort.

Neurofeedback can cause headaches, tiredness, and dizziness in some people.  It has not been studied in people with epilepsy.  Therefore, it is not recommended for use with this population. Otherwise, there are no side effects to biofeedback.

Tell me about the primary types of biofeedback therapy and how they are individually best used?

Neuromuscular Retraining:  Neuromuscular retraining utilizes sensors to measure muscle use and tension.  During neuromuscular retraining, you are taught to recognize which muscles are being used properly and which are being over-used or under-used.  With feedback, you can learn to use your muscles properly and thereby decrease pain and other symptoms caused by muscle imbalance and misuse.

Temperature Biofeedback:  Temperature biofeedback utilizes sensor readings from fingers and feet to provide feedback regarding skin temperature.  Skin temperature is a measure of circulation and circulation is implicated in several medical conditions including Raynaud’s syndrome and migraine headache.  By learning to alter your circulation, you can often decrease the frequency and intensity of these and other painful episodes.

Galvanic Skin Response Training:  Galvanic skin response training utilizes sensors that measure the activity of sweat glands and the amount of skin perspiration present.  Perspiration is associated with anxiety and learning to identify the early signs of anxiety and its triggers can be useful in treating such disorders as phobias, anxiety, and stuttering.

Neurofeedback:  Neurofeedback uses electroencephalogram technology (EEG) in which brain waves are monitored.  By interacting with the computer and learning to enhance certain brainwaves, you can learn to achieve and maintain more beneficial brainwave patterns.  Neurofeedback is used in treating conditions such as attention deficits, anxiety disorders, depression, headaches, and chronic pain.  NOTE:  We do not do neurofeedback training because I do not believe the research is robust enough.

Where can someone find a qualified biofeedback therapist? 

As reported by the Association for Applied Psychophysiology and Biofeedback organization, “most states do not restrict who can perform biofeedback services.”  The association reports that “the only way for you to have any assurance that the provider can actually perform biofeedback based interventions is if they have had formal training in biofeedback of the type required to treat your problem and training in assessment and treatment of your problem.”  The organization recommends reviewing their site’s Practitioner Directory.

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