Introduction to Biofeedback as Treatment for Chronic Pain

Chronic pain is pain that has persisted for at least 6 months. This often includes conditions such as Headache and Temporomandibular disorders. Fortunately, Biofeedback can help these conditions.Biofeedback uses body monitors to mirror your body’s performance and help you gain increased awareness and self-control. EEG biofeedback is also called neurofeedback or neurotherapy. Biofeedback training methods have been scientifically-validated for the treatment of adult headache and temporomandibular disorders (TMD).

What is biofeedback therapy?

Biofeedback instructions can teach you to manage chronic pain by providing you with immediate information about your brain’s electrical activity (EEG), skeletal muscle activity (EMG), and skin temperature (TEMP) from biofeedback electrodes using biofeedback equipment.

What is adult headache?

The major types of adult headache that are effectively treated by biofeedback devices include migraine, tension-type headache, and mixed headache.

Migraine symptoms include:

• painless neurological symptoms hours to days before the breakthrough headache
• throbbing moderate-to-severe pain on one side of the head
• nausea that may be accompanied by vomiting
• discomfort from light or sound

Tension-type headache symptoms include:

• dull mild-to-moderate pain that feels like pressure or tightness in the muscles of the front, sides, and the back of the head
• muscle tenderness in the shoulders, neck, and scalp
• depressive symptoms of difficulty sleeping, distraction, irritability, reduced appetite, and tiredness
• Mixed headache symptoms include features of both migraine and tension-type headaches.

Who is mainly affected?

Migraine is diagnosed in 6% of men and 15-18% of women in the United States and Europe. Tension-type headache is diagnosed in 30-80% of adults and is more common in women than men.

How do biofeedback and neurofeedback treat this disorder?

After a medical evaluation to determine the cause of your headache, a biofeedback practitioner may monitor your shoulder, neck, and facial muscles, finger temperature, and EEG with biofeedback instruments during the resting, mild stressor, and recovery conditions of a psychophysiological profile.

The resulting profile will enable your biofeedback provider to develop a training program to help you correct abnormal resting or stress-evoked physiological responses that may be associated with headache activity. Common findings from biofeedback stress tests include:

• contraction of muscles in the upper shoulders, neck, and forehead
• constriction of the small arteries of the fingers
• excessive activation in the EEG

Biofeedback providers may use multiple types of personal biofeedback techniques to treat headache symptoms, including

• EMG biofeedback
• temperature biofeedback
• EEG biofeedback

How effective is biofeedback therapy for adult headache?

Biofeedback clinical trials have confirmed the effectiveness of pain management biofeedback for adult headache. In one study, temperature biofeedback combined with relaxation training produced improvement in 52% of patient diagnosed with migraine or mixed headache.

The Association for Applied Psychophysiology and Biofeedback’s (AAPB) Evidence-Based Practice in Biofeedback and Neurofeedback, authored by Carolyn Yucha, PhD, and Christopher Gilbert, PhD, awarded biofeedback therapy for adult headache the second-highest rating of efficacious.

Who should treat this disorder?

Biofeedback practitioners who are experienced in treating headache and certified by the Biofeedback Certification Institute of America (BCIA) in General Biofeedback or EEG Biofeedback are qualified to treat adult headache using biofeedback.

What are temporomandibular disorders (TMD)?

Temporomandibular disorders are the second most common cause of orofacial pain after toothache. TMD, which is also called TMJ and bruxism, is a family of disorders characterized by:

• dull pain around the ear
• tender jaw muscles
• clicking or popping when opening or closing the mouth
• tooth sensitivity
• abnormal wearing of the teeth

Who is mainly affected?

More than 10 million Americans may suffer from TMD. The highest incidence is found among young adults, especially women between 20 and 40. The male-to-female ratio is 1 to 4.

How does biofeedback treat these disorders?

A dental professional should first evaluate you to determine whether excessive activity in your facial and/or jaw muscles contributes to your TMD.

A biofeedback specialist may perform a psychophysiological profile and monitor skeletal muscles in your neck, shoulders, face, and jaw during resting, mild stressor, and recovery conditions to identify abnormal patterns of muscle use. This profile will enable your clinician to develop an individualized training program reduce excessive muscle contraction and restore left/right symmetry in muscle tone.

Biofeedback training may combine stress management training with EMG biofeedback to retrain the affected muscle groups.

How effective is biofeedback therapy for temporomandibular disorders?

In a recent review of 13 studies that evaluated the effectiveness of EMG biofeedback and stress management training, 69% of patients receiving EMG biofeedback were either symptom-free or significantly improved. Follow-ups from 3-24 months showed that these patients did not relapse. Evidence-Based Practice in Biofeedback and Neurofeedback awarded biofeedback therapy for temporomandibular disorders the second-highest rating of efficacious.

Who should treat this disorder?

Biofeedback professionals who are experienced in treating TMD and certified by the Biofeedback Certification Institute of America (BCIA) in General Biofeedback are qualified to treat this disorder using biofeedback.

Is there insurance coverage for biofeedback?

Reimbursement for biofeedback services varies across insurance providers and geographic locations. Psychologists may code biofeedback services as psychotherapy to increase your likelihood of reimbursement.