Basic biofeedback in pain management

I’m no techno-whizz in biofeedback – you have to speak to one of my colleagues (she knows who she is!) to get the technical data on things like heart rate variability – but I do use several modalities reasonably often. So today I thought I’d discuss some of the ways I use biofeedback with the people I work with.

Biofeedback basically provides visual or auditory information about normally undetectable physiological processes. It ranges from temperature sensors through to skin conduction (galvanic skin response), and includes surface EMG, respiration, blood volume pulse and sometimes these are put together to provide feedback on heart rate variability. I’m not going into HRV yet, that’s for another day!

The most common sensors I use
everyday are GSR, which is a reasonably sensitive measure of general arousal level; respiration because it provides immediate feedback on the way the person is breathing and is helpful for developing diaphragmatic breathing; BVP because it responds quickly to respiration and can demonstrate to the person the effect of slowing their breathing down; and I often use surface EMG because it can provide immediate feedback on posture changes.

Sometimes biofeedback is helpful to demonstrate to an individual that they have control over what their body does – especially things like respiration and GSR. I’ll use it to help them understand the relationship between what they’re thinking (eg about the painful part of their body) and a rise in GSR, or the reverse – that they can reduce their GSR by thinking about something calming.

I’ve found this is a particularly potent tool when a person is very ‘out of touch’ with their body, or is quite skeptical about the relationship between body and mind.

I use it very often for training to help the person recognise the degree of control they can exert over their body even under provocation – for example, on a day when they’re feeling especially uncomfortable with a flare-up, or when I want to do some exposure therapy for feared movements.

This is very helpful prior to carrying out in vivo exposure, to help the person feel confident that they can reduce their anxiety and cope with a stressful situation. It doesn’t always mean down-regulating, sometimes it’s good to help the person recognise that they can up-regulate also or maintain a level of alertness across a situation.

For this I have been really enjoying using the Wild Divine Healing Rhythms programme. This programme has a range of activities that help develop self regulation, some of them are very challenging and require the person to achieve a certain state to complete a task, while others are for practice and can be continued for as long as required. I’m not sure how well-accepted this programme would be among some people because it does have a lot of ‘new age’ music and gorgeous graphics that are pretty, but perhaps not everyone’s cup of tea!

Another use is for me as a therapist to monitor depth of relaxation, for example when I’m doing some hypnosis with imagery and I want to see how relaxed a person is – I tend to monitor GSR at this point. If I’m introducing imagery such as imagining a CRPS limb, or some movements, this can be an opportunity to review GSR to see how bothered the person is, then use imagery to change the painful sensation, all the while monitoring to see whether the GSR has reduced. It’s great to be able to show a person the graph of their session to demonstrate their physiological state throughout – and compare graphs from week to week.

Biofeedback can be used as a comparison before and after a series of sessions on, for example, graded exposure. I’ve used it at the initial session as the person sorts through the PHODA pictures, then again after several weeks of doing the in vivo exposure, and it’s great to compare the graphs as a demonstration that their arousal level has reduced. Of course, it’s even more fun to see them actually doing the activities that they used to avoid!!

I don’t tend to use biofeedback as an end in itself. It’s not ‘real life’ to remain wired up and ‘do relaxation’. This is probably the main drawback to the Wild Divine Healing Rhythms set, which does encourage you to use it as a regular relaxation tool. I’m hoping that people who see me will get to the point where their self regulation becomes habitual, something that is portable and potent wherever they are. Biofeedback is simply a training tool, a way of providing information about progress that enhances learning. It’s a great way to learn – but shouldn’t be a substitute for developing portable skills.

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