Biofeedback Therapy to Help Chronic Pain

Medically Reviewed
Woman receiving biofeedback therapy for chronic pain

Biofeedback has been shown to be effective for those with chronic back pain, knee pain, and more.

Batuhan Pehlivan/Shutterstock; Canva; Everyday Health

Biofeedback therapy offers a promising alternative to options like opioids for the estimated 50 million Americans living with chronic pain.?When it feels like your own body is working against you, biofeedback therapy can empower you to reclaim agency over it.

How Biofeedback Can Improve Chronic Pain

Without you even thinking about it, your body is constantly working on things like breathing and pumping blood. When you experience something stressful, like chronic pain, these unconscious processes go into overdrive: Your breath becomes shallow; your pulse quickens. With mindful interventions, though, it’s possible to reverse these automatic responses, providing yourself with physical and emotional relief in the process. Biofeedback therapy gives you bodily insights that can help you develop the skills to recognize and gain control of those unconscious physical reactions. It’s noninvasive and involves no medications.

RELATED:?8 Great Pain Relievers You Aren’t Using

Using electrical sensors attached to your body, a biofeedback provider can measure different functions depending on your pain and its potential source. That information can help reduce your chronic pain in several different ways. Biofeedback measurements can include:

  • Brain waves using electroencephalography (EEG)
  • Breathing using respiratory biofeedback
  • Heart rate using electrocardiography (ECG)
  • Muscle contractions using electromyography (EMG)
  • Sweat gland activity using electrodermography (EDG)
  • Body temperature using sensors

A biofeedback therapist can teach you techniques like mindfulness and breathing exercises to modify your otherwise involuntary reactions to stress and pain. For example, an EMG session could reveal that you have a particular muscle that’s very tight. That could suggest it’s a contributor to your pain, or possibly even the root cause. Over the course of multiple sessions, a biofeedback therapist can teach you techniques to relax that muscle.

Observing how the muscle untenses in response to these relaxation techniques can not only give you physical symptom relief, but also positive feelings of agency over pain that previously felt out of your control. Alternatively, you could receive that same information from an initial EMG session and then seek a physical therapist to help you loosen the troublesome area.

Chronic Pain Symptom Relief

Biofeedback has been well studied and found to be effective for those with chronic back pain. It has also been shown to help those with complex regional pain syndrome, temporomandibular joint pain (TMJ), headaches, fibromyalgia, osteoarthritis, phantom limb pain, cancer, lupus, knee pain, whiplash, and vulvar pain.

  • Back Pain A meta-analysis of 21 studies, published in 2017, found that biofeedback therapy provided “a significant small-to-medium” pain intensity reduction in those with back pain.

    It also found that biofeedback reduced patients’ symptoms of depression, disability, and muscle tension and improved their cognitive coping. All of this stayed stable over an average follow-up time of eight months.
  • Migraine, Headaches A meta-analysis of 94 studies, published in 2008, showed that biofeedback therapy resulted in an improvement of “medium-to-large mean effect sizes” in patients with migraine and tension-type headaches.

    Biofeedback interventions continued to help during an average follow-up phase of 14 months. Headaches became less frequent and patients experienced less depression and anxiety.
  • Fibromyalgia Pain?A meta-analysis of seven studies, published in 2013, found that biofeedback using EMG?was “effective for a (short-term) reduction of pain intensity” in fibromyalgia patients.

    This analysis did not show biofeedback improving sleep problems, depression, fatigue, or health-related quality of life measurements in comparison with the control groups.

Depending on where your pain presents, your biofeedback therapist may use different types of sensors in different areas for different reasons. Your pain could be caused by psychological stress, misaligned posture or skeletal structure causing muscle tension, or any number of other reasons, so not every back pain or headache patient will get the same treatment. Your biofeedback therapist may check to see if your hands get hot or cold with stress, for example, and guide you through meditation to calm yourself, or they may teach you to relax particular muscle groups one by one. It will all depend on the diagnosis of the cause of your chronic pain.

You can then use these same techniques to reduce the intensity of pain or stress?any time you are experiencing it. The biofeedback is really just there to show you how these techniques cause real physiological changes in your body that lead to increased feelings of well-being.

Other Benefits

Biofeedback therapy is used to treat many other conditions besides chronic pain, including anxiety, depression, and substance abuse.

Biofeedback is sometimes categorized as a form of cognitive behavioral-based therapy itself. And since it can provide information about your health that you may not have known before, as well as referrals to new treatment, biofeedback is often used (and best used) as part of a holistic approach to the treatment of your mental health and physical health.

In many studies, not only did pain decrease with biofeedback therapy, but so did symptoms of depression.

It can be used to treat emotional and psychosomatic issues as well as physical ones, so if your chronic pain is either caused by or has caused psychological symptoms, biofeedback therapy can treat those too.

General Health and Wellness Benefits of Biofeedback Therapy

Biofeedback therapy can help you learn to manage stress responses that can trigger or worsen pain. Chronic pain itself can also increase your stress, and biofeedback therapy can teach helpful stress management skills.

A meta-review of biofeedback studies found that biofeedback was effective at treating not only chronic pain but also a variety of other conditions, including:

In many studies, biofeedback is combined with other treatments, like coping skills training, meditation, group therapy, hypnosis, exercise coaching, physical therapy, relaxation therapy, cognitive behavioral therapy, acupuncture, and nutritional education. However, while biofeedback is often used in conjunction with other modalities, studies have also shown it to be an effective tool in and of itself.

How to Find a Biofeedback Provider

When looking for a biofeedback practitioner, the most important thing to check is credentials. Biofeedback therapists are only required to have a bachelor’s degree, but they must be some kind of licensed medical professional, such as a physical therapist, nurse, physician, or psychologist.

A biofeedback therapist can be certified by the Biofeedback Certification International Alliance (BCIA), but that is not the same thing as being a licensed medical practitioner, which is required. A BCIA certification, while voluntary, is also highly recommended in a practitioner, since it designates a certain standardized level of training. That being said, if you already have a therapist, it couldn’t hurt to ask them if they can lead you through biofeedback exercises.

You can search for a local BCIA-certified practitioner on the BCIA website. You can also search for a physical therapist through the American Physical Therapy Association, or for a psychologist through the American Psychological Association, and so on, but their search engines may not indicate whether the providers offer biofeedback therapy. You could also ask your doctor, psychiatrist, or other medical professional treating your chronic pain for a referral to a local integrative medicine center.

What to Expect

Most types of biofeedback sessions involve the therapist placing electrical sensors on your skin to measure different involuntary body functions, such as brain waves, heart rate, breathing, temperature, and muscle tension.

The sensors will not hurt you, and you will not feel any electricity. They will stick to your body but will not cause pain when being removed. They may be placed in many different places on your body — meaning you may need to undress, depending on the location. Your hair could also get messy, if the sensors need to be placed on your head.

Other devices besides sensors might be used as well, such as a band that stretches around your chest to monitor your breathing. The therapist will see the information sent by the sensors on a screen. You may see the screen, hear beeping sounds, or see a flashing light that indicates how your body is responding to the different exercises.

A session typically lasts 20 to 60 minutes. Depending on your condition, the results of the testing, and the improvement of your symptoms, you will likely need several sessions, perhaps 10 or more. Neurofeedback may take 15 to 50 sessions.

Fees: Is Biofeedback Expensive, and Will Health Insurance Cover it?

Each insurance carrier/plan has its own policy about covering different types of biofeedback therapy, and it may have different requirements for coverage. Paul Lehrer of Rutgers Robert Wood Johnson Medical School wrote in 2016 that “payers are reluctant to reimburse for biofeedback services.”

In the case of Medicare, biofeedback therapy is covered only for certain instances of muscle reeducation or certain muscle abnormalities, not for muscle tension or psychosomatic conditions.

The Association for Applied Psychophysiology and Biofeedback provides advice on third-party reimbursement for biofeedback.

Without insurance, the cost of a session varies greatly, depending on the type of biofeedback, your location, and other factors. Keep in mind that you may need multiple sessions and that sometimes they can be bought as a package. Sessions can be as low as $35 and as high as $1,250 — with an average price of around $150.

If seeing a specialist isn’t possible, there are consumer wearables and home biofeedback devices on the market, though it’s important to note that these devices have varying degrees of accuracy. One example is the HeartMath Inner Balance sensor, which monitors heart rate variability (HRV). Guided exercises through the companion app can help regulate your HRV, leading to improved feelings of wellness. Devices like these can be an entry point for those who can’t pay for biofeedback but may have a therapist or pain doctor, since the device can be added as a complementary approach. Just make sure to do some research beforehand.

Considerations

Biofeedback is generally considered safe. The lack of risk is one of its main advantages over other treatments.

However, some types of biofeedback testing are not appropriate for every patient. For example, people with certain heart conditions or skin conditions should not use certain biofeedback methods. Your doctor can recommend the safest biofeedback therapy for you.

When considering using biofeedback therapy, keep in mind that you will be an active participant in your therapy, and that the skills you learn are meant to be practiced regularly to see results. The insights from your initial evaluation will likely require your follow-up and home practice for any improvement in your chronic pain to occur.

Editorial Sources and Fact-Checking

Association for Applied Psychophysiology and Biofeedback. Certification Information.

Association for Applied Psychophysiology and Biofeedback. New Guidelines for Third Party Reimbursement for Biofeedback.

Association for Applied Psychophysiology and Biofeedback. Standards for Performing Biofeedback.

Biofeedback Certification International Alliance. What is Certification and Who Recognizes It?

Centers for Disease Control and Prevention. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. September, 14, 2018.

Centers for Medicare & Medicaid Services. Biofeedback Therapy.

Yucha C, Montgomery D.?Evidence-Based Practice in Biofeedback and Neurofeedback?[PDF].?Association for Applied Psychophysiology and Biofeedback. 2008.

Ehde DM,?Dillworth TM, Turner JA.?Cognitive-Behavioral Therapy for Individuals With Chronic Pain. American Psychologist. February–March 2014.

Frank DL, Khorshid L, Kiffer JF, et al. Biofeedback in Medicine: Who, When, Why and How??Mental Health in Family Medicine. June 2010.

Glombiewski JA, Bernardy K, H?user W.?Efficacy of EMG- and EEG-Biofeedback in Fibromyalgia Syndrome: A Meta-Analysis and a Systematic Review of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine. 2013.

Lehrer P. Biofeedback: An Important but Often-Ignored Ingredient in Psychotherapy. Policy Insights From the Behavioral and Brain Sciences. March 2017.

Mayo Clinic. Biofeedback. March 18, 2021.

Nestoriuc Y, Martin A, Rief W, Andrasik F. Biofeedback Treatment for Headache Disorders: A Comprehensive Efficacy Review. Applied Psychophysiology and Biofeedback. September 2008.

Peake JM, Kerr G, Sullivan JP.?A Critical Review of Consumer Wearables, Mobile Applications, and Equipment for Providing Biofeedback, Monitoring Stress, and Sleep in Physically Active Populations. Frontiers in Physiology. June 28, 2018.

Roy R, De La Vega R, Jensen MP, Miró J. Neurofeedback for Pain Management: A Systematic Review. Frontiers in Neuroscience. July 16, 2020.

Sielski R, Rief W, Glombiewski JA,?Efficacy of Biofeedback in Chronic Back Pain: A Meta-Analysis. International Journal of Behavioral Medicine. February 2017.

Yu B, Funk M, Hu J, Qi W, Feijis L. Biofeedback for Everyday Stress Management: A Systematic Review. Frontiers in ICT. September 7, 2018.

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