Biofeedback in pain therapy

In addition to the general treatment of Stress and burnout the work on chronic pain using biofeedback can rightly be regarded as one of the superstars of the biofeedback world.

Why is that?

• The method is drug-free
• The client experiences himself as active and effective and not at the mercy of the pain
• Biofeedback gives many test subjects access to a multi-factorial disease model (bio-psycho-social) in the first place
• The objective feedback allows the client to see their progress in concrete terms and is often more motivating than „unverified“, generic relaxation training

The benefits are likely to go even further, but in general it can be said that the use of biofeedback is highly effective and popular, especially for chronic pain. This is also the case with the users themselves - for example, Dr Müller-Schwefe from the Göppingen Pain Centre reports:

Mr Dr Klaus-Jörg Münzer explains in this interview, how he Biofeedback in pain therapy.

Types of pain

Biofeedback is used for many different forms of chronic pain, but some indications are the most common in practice. These will be discussed in more detail here.

 

Typical characteristics of tension headaches are: a dull, pressing pain that usually affects the whole head globally. The pain is of low to moderate intensity and is not aggravated by physical activity. It does not occur as an attack, but gradually over a period of 30 minutes until a permanent headache develops. A distinction is made between episodic and chronic courses.

Headaches are one of the most common pain disorders. 40% of people who suffer from headaches have tension headaches. Biofeedback is an effective method for both the supercategory of headaches and the subcategory of tension headaches.

Causes

The causes of tension headaches are varied: however, a major factor for many sufferers is increased muscle tension in the neck, head and shoulder muscles, which occurs particularly strongly in stressful situations. However, poor posture or one-sided strain also play a role.

However, social trigger factors can also play a significant role. These are often stressful situations that are accompanied by a lack of adequate coping mechanisms - and therefore trigger a psychological and, in this case, above all physical stress reaction.

One characteristic of such a physical stress reaction is additional muscular tension, which can cause pain, especially if there is a generally high level of tension.

Muscle strain can favour such tensions.

This permanent tension in a muscle area leads to reduced blood flow to the tissue in the affected muscles, which in turn results in an undersupply of oxygen to the tissue. This undersupply and a lack of removal of metabolic products ultimately cause the pain.

Treatment of tension headaches with biofeedback

Tension headaches are treated using biofeedback primarily (almost exclusively) by reducing muscle tension. This is regarded as an essential factor influencing the pain. The frontalis muscle is usually trained here¹.

This is done using EMG electrodes, which are applied to the corresponding part of the muscle. Using visual or acoustic feedback, clients can then learn to influence this tension. The aim is often to break the vicious circle of pain - stress - tension - more stress - more pain. Biofeedback can also be used to identify the causes of tension. Another aim of biofeedback training is to improve body awareness and maintain relaxation even in stressful situations.

Effectiveness

A summarised evaluation of studies (including meta-analyses) clearly demonstrated the effectiveness of training in which biofeedback was a key component.

Migraine is a neurological disorder that affects millions of people worldwide. Around 6 to 8 % of all men and 12 to 14 % of all women suffer from this type of headache, which is characterised by severe, often one-sided, pulsating and throbbing pain and accompanying symptoms such as nausea, loss of appetite, sensitivity to light and other symptoms.³ In addition, there is a proven comorbidity between migraine and clinical depression, which further increases the complexity of the disease.⁴

Migraine is not only a considerable burden for those affected, but also a significant factor in the healthcare system, as it often leads to recurring and prolonged sick leave.

Treatment of migraine with biofeedback

In recent years, biofeedback has established itself as a promising method for the non-drug treatment of migraines. In particular, vasoconstriction training in combination with hand warming training is considered the gold standard in biofeedback therapy for migraine. These methods aim to influence the dilation of blood vessels, a process that plays a central role in the development of migraines.

Vasoconstriction training: control of the temporal artery

During vasoconstriction training, those affected learn to consciously constrict the temporal artery. Targeted training enables those affected to constrict the temporal artery in a controlled manner in the event of an impending attack and thus possibly avert the attack. Interestingly, this technique can also be used preventively. If the client experiences signs of an aura - a frequent harbinger of migraine - he/she can counteract extreme arterial dilation and thus the migraine by consciously widening the temporal artery.¹

Hand warming training: reduction of sympathetic tone

Hand warming training trains the ability to increase the peripheral temperature, which results in dilation of the peripheral blood vessels. This process is accompanied by a reduction in sympathetic tone, i.e. a reduction in the activity of the sympathetic nervous system. By learning this technique, sufferers can not only improve peripheral blood circulation, but also achieve deeper relaxation, which helps to alleviate migraine symptoms.¹

Effectiveness

The effectiveness of biofeedback in the treatment of migraine is well documented. A comprehensive literature review shows that biofeedback can significantly reduce the frequency and intensity of migraines. In many cases, the effects achieved remain stable even after the training has ended and can even continue to improve over time.¹

The German Society for Neurology mentions biofeedback in its report on the acute treatment and prophylaxis of migraine and refers to meta-analyses that show a reduction in migraine frequency of 35 % to 45 % through relaxation techniques and various biofeedback methods. These results are comparable to the effect size of propranolol, a commonly used medication for migraine prophylaxis. In addition, the effects of biofeedback can be further enhanced by combining it with other methods such as progressive muscle relaxation (PMR). Studies have shown that the combination of PMR, temperature biofeedback and propranolol can lead to an improvement in migraine activity of 50 % to 70 %, while the use of PMR and temperature biofeedback alone achieved an improvement of 33 % to 50 %.⁵

Conclusion: Biofeedback as a valuable alternative for migraines

Biofeedback offers a valuable alternative or supplement to drug therapies in the treatment of migraines. Through targeted training, sufferers learn to better control their physical reactions and thus prevent migraine attacks or reduce their intensity. Especially in combination with other non-drug methods such as progressive muscle relaxation, biofeedback is highly effective and comparable to the effects of established medication. For many migraine patients, biofeedback could therefore be an effective and side-effect-free approach to long-term control of their condition.

Chronic back pain is one of the most common health complaints affecting people of all ages. This pain often develops over a long period of time and can have a significant impact on everyday life. The so-called „vicious circle“ of muscle tension and pain is particularly problematic: the pain leads to unconscious muscle tension, which in turn intensifies the pain. This cycle can be difficult to break without targeted intervention. In recent years, biofeedback has proven to be an effective method of breaking this cycle and providing lasting relief from chronic back pain.

Treatment of back pain with biofeedback

Biofeedback for chronic back pain is primarily based on the application of the Surface EMG (electromyography). The aim is to teach patients to voluntarily reduce muscle tension. This is achieved by recording and visualising the electrical activity of the muscles directly from the site of pain.¹ This feedback enables patients to develop a better awareness of their own muscle tension and to relax in a targeted manner.

A typical biofeedback setup for back pain involves attaching electrodes to the affected areas, such as the lower back. These electrodes record the muscle activity and send the data to a Device, which displays the results visually on a screen. Patients can see how their muscle tension changes in real time and learn how to consciously influence it.

Effectiveness

The effectiveness of biofeedback in the treatment of chronic back pain is well documented. The comprehensive review by the Association for Applied Psychophysiology and Biofeedback „Evidence-Based Practice in Biofeedback and Neurofeedback“ rates the treatment of muscle-related back pain with biofeedback as „effective“.²

A large number of studies have confirmed the positive effect of EMG biofeedback on chronic back pain. These studies show that patients who regularly undergo biofeedback training experience a significant reduction in pain and an improvement in their quality of life. On average, 8 to 10 sessions are recommended to achieve lasting success.¹

 

Temperomandibular disorders (TMS) are primarily characterised by pain in the face, especially in the area of the jaw muscles and joints, but the pain can also radiate to other areas.

Currently, multifactorial models are assumed for the development of this disorder (interaction of structural, functional and psychological factors), whereby psychological and emotional factors appear to play a major role in this disorder pattern¹.

Bruxism as non-functional grinding and clenching of the teeth is usually the cause of chewing joint and facial pain and can also be involved in the development of tinnitus. The incorrect use of the masticatory system can lead to signs of tooth wear, gum recession and other permanent changes to the structure of the teeth and blood vessels.

The treatment of TMS, facial pain and bruxism with biofeedback

Dysfunctional muscle activity is particularly relevant in biofeedback in connection with temperomandibular disorders¹. The test subjects' muscles show increased activity under stress, for example (compared to a control group)⁶. EMG biofeedback is used for treatment, which is sometimes combined with other feedback options to promote the general ability to relax.

The aim is to gradually reduce ineffective muscle activity, improve the speed of relaxation and enhance body awareness¹.

In the case of bruxism, the approach of recording the muscle tension of the chewing muscle and signalling it back to the subject by means of a sound, for example, is often used. This allows the subject to become aware of their action and „unlearn“ the behaviour“⁷ (e.g. with signalling tones even at night⁸). The aim is to ensure that this impulse can later be recognised and interrupted even without a signal.

Effectiveness

A meta-study supports the efficacy of EMG biofeedback in TMS and also reported that 69% of subjects were considered cured or at least clinically improved after biofeedback treatment, while this was only the case for 35% of subjects under placebo conditions. The number of sessions varied between 6-12 units in the analysed literature⁹. Another study showed that EMG biofeedback was superior to treatment with a bite splint and the result in an untreated control group¹⁰.
In a case study on bruxism, nocturnal use of a biofeedback device reduced daily bruxism by 78% and nocturnal bruxism by 66%¹¹.

To summarise, biofeedback for temperomandibular disorders was rated with the second highest level of effectiveness in the Association for Applied Psychophysiology and Biofeedback's biofeedback review „Evidence-Based Practice in Biofeedback and Neurofeedback“².

Tip from the field
If the test person has already been prescribed a bite splint to protect the enamel, they should wear it during biofeedback.

Biofeedback measurements can also help to optimise the fitting of dentures, splints or braces so that the foreign body in the mouth does not cause unnecessary discomfort. muscle tension in the facial area.