Biofeedback – or Things that go ‘beep’!

Biofeedback is an approach to revealing the inner states of human functioning so that people can develop control. In pain management it can take many different forms from surface electro-myography (sEMG), skin conductance (SC), blood volume pulsimetry (BVP), respiration rate, and heart rate variability. It can even be as simple as readings on two scales (left foot, right foot); video recording; a mirror; taking your pulse; temperature or weight!

Why does it work? Well, that’s a question that a lot of people have asked! There are several reasons that spring to my mind.

1. For some people, unless they can see it, it doesn’t exist!

2. It provides very concrete recordings of effort and change.

3. Feedback of physical responses such as skin temperature and muscle tension provides information to help patients recognize a relaxed state. The feedback signal may also act as a kind of reward for reducing tension.

4. It can divert the attention from boring ‘exercises’ on to groovy computer-based games!!

For an interesting set of articles, go to Association for Applied Psychophysiology and Biofeedback , although the best person to look up is Herta Flor who has published so much information that has helped to refine our strategies for pain management and movement!

Some practical tips

I use sEMG and SC reasonably frequently. I like to use sEMG to help people recognise the difference between using a muscle and relaxing a muscle. Many people with persistent pain are very good at tensing a muscle, but not so good at relaxing it, so this can be a great way to help them see that they do have control over their own bodies.

I usually apply the electrodes to the bulky part of an appropriate muscle, and then ask the person to start doing ‘normal’ activities, such as making a cup of coffee, walking, reaching for things forward and to one side of the body, and then to sit quietly and relax.

I’ll have started some relaxation training at or around the time I start using EMG, so when the person is relaxing, I’ll be asking him or her to start diaphragmatic breathing, systematic relaxation and then possibly some visualisation. If the EMG unit is attached to a computer, I’ll be recording the entire session so the person can review his or her own activities and the EMG response. If not, the portable unit I use will have an audible beep or an LED display that can be used.

If I’m using SC, it’s usually because it can reflect changes of arousal state over a slightly longer period of time than heart rate or respiration or EMG. So I find it helpful for a person who finds it really difficult to tell whether a longer relaxation actually ‘relaxes’ them. I’ll often set the equipment up, then start recording while talking to the person about their day, and any events that have occurred since the last time we met. I’ll then go through a relaxation technique, ending with a period of quiet while the person just relaxes. I will at times use the SC recording to help me shape the way I phrase the relaxation induction, and to gauge whether the person is really relaxed.

At the end of the session I’ll go through the SC recording and the person and I will discuss features that are evident on the SC graph. Most times there is a clear reduction in SC from the commencement of the relaxation to the end. If there have been any more difficult issues to discuss, or perhaps I have been working with the person to visualise a painful movement, an increase in SC can often be observed – this can be very helpful both as a way to monitor progress, and to help the person recognise their own increased arousal when they encounter something painful or that they fear.

Recordings such as video (or even using a mirror!) can be a really powerful tool to help people identify movement patterns that they are not aware of. The advantage of video is that it is not a reflection, so it’s a little easier to identify the movements that need to be altered (and do it!), and it’s possible to take repeated recordings to demonstrate progress. Mirrors, however, can be simpler to set up, even though the feedback is in reverse. Recordings of many types (minutes sitting, weight on each foot on a set of scales, number of minutes walking etc) are another form of feedback – and all feedback can be used to shape behaviour.

I’ve used biofeedback regularly throughout my pain management career – and although I don’t use it all the time, it has some really useful aspects that I find especially helpful for people who don’t ‘do’ feelings. If you have an experience, or a story with biofeedback, drop me a line (or comment) – it’ would be great to include some ‘real life’ stories of how clinicians incorporate ‘high tech’ in daily practice.

BTW did you know that biofeedback has the dubious reputation of being included in the ‘alternative’ therapies??!!

Oh that? That’s a CAT scan…

I don’t endorse any specific brands, but I do use Thought Technology modules, and I also use HeartMath . The Myotrac or Myopace is a unit I’ve used for years – a great wee unit, about the size of a pack of cards – here is the webpage for it.

Date last modified: 1 March 2008