A Guide to How Biofeedback Can Help Young Chronic Pain Patients

This is part one of five.

Biofeedback training is a learning process using equipment that enables individuals to learn how to alter physiological activity within their bodies to reduce pain and improve function.

How Biofeedback Addresses Pain
Pain is a normal sensation designed as a protective mechanism. When pain persists, it loses its protective value and interferes with function, such as the ability to attend school, play sports, or participate in family activities. Pain is processed throughout the brain. The brain processes all the arriving information and then determines the pain response. When an individual experiences pain, the body experiences a stress response. This response can trigger elevated muscle activity which results in general muscle tension, circulatory changes resulting in cold hands and feet, and elevated sweat gland activity resulting in sweaty hands. These parameters can all be measured, which allows the individual to become more mindful of these changes and learn how to change the parameters. When the body is quieted, the pain cycle can be altered.

How Biofeedback Works
The therapist utilizes biofeedback instrumentation that measures body responses such as muscle tension, sweat gland activity, and external temperature. The highly sensitive equipment gives the child immediate visual and auditory feedback. For example, using sound, a light bar, and/or a numerical reading can measure one-hundredth of a degree with temperature training. When these subtle changes occur, the child becomes more aware of their body and can learn to achieve a quieting response and control their pain.

Children learn quickly how a thought can cause an immediate elevation of their sweat gland activity, a temperature drop, or increased muscle tension, reinforcing how a quieting response helps them understand how to control their pain. Breathing and relaxation techniques can help alter the biofeedback readings, allowing the child to learn how to quiet the nervous system. The success of biofeedback is dependent on the child taking an active role and incorporating the new skill into their daily routine.

What Biofeedback Can Address
Biofeedback training is recommended for children with headaches, widespread pain, central pain, CRPS, fibromyalgia, and musculoskeletal pain. Increased muscle tone causes constant muscle contraction, which shortens muscles and makes them tender and stiff. This continuous state of muscle contraction contributes to headaches, neck and back pain, and abdominal pain. Biofeedback training teaches the child how to reduce muscle tension.

Reduced temperature readings in the hands are often found with stomach pain, migraine headaches, and Raynaud’s syndrome. Altered sweat gland activity is often found in stress-related symptoms, changed breathing patterns, centralized pain, and stomach symptoms.

What Happens in a Typical Biofeedback Session?
A typical biofeedback session consists of guided practice using the biofeedback instrumentation. As the child understands the goals of biofeedback training, they are encouraged to alter the parameters independently and experiment to find ways to change the readings. Children feel empowered as they learn to control their physiological parameters. Once they can change the parameters consistently, they can identify within themselves when their bodies are becoming tense and develop the skill to relax their bodies. Once children understand changing the parameters, it becomes a game.

The concepts of self-regulation may also be taught through games utilizing the biofeedback equipment. Some biofeedback units have computer games designed to promote body awareness and a relaxation response through which children naturally learn to quiet. This may be done by applying electrodes on the forearm and allowing the child to alter muscle tension levels by closing and then relaxing their hands. The child is then asked to achieve a specific reading, allowing the child to learn what it feels like when the muscle is tense and when the muscle is relaxed. Electrodes can also be placed on the forehead, and the child can make funny faces while observing the changes. Children are encouraged to experiment independently, leading to an accelerated learning response.

How is the Biofeedback Equipment Attached?
Small electrodes are placed on the skin over a muscle to measure muscle activity. A small probe attached to the end of a finger or toe measures temperature. A small attachment on a finger measures sweat gland activity. A belt placed below the rib cage measures breathing.

Using Relaxation Exercises with Biofeedback
To further enhance the child’s learning, instruction is provided in various relaxation techniques that they can practice at home. Relaxation techniques promote a quieting response within the child and can be varied to emphasize a specific biological regulation, such as reducing muscle tension or warming the hands. The child is taught to associate their breathing with the relaxation response, allowing them to learn to calm themselves at school, while engaged in sports, or during social activities. This calming response empowers the child to control their pain symptoms. Adolescents are encouraged to practice their skills daily for at least 10 minutes. (Examples of relaxation techniques will be provided in follow-up blogs.)

Using Mindfulness Techniques with Biofeedback
Mindfulness techniques are also valuable and work well with biofeedback training. Mindfulness is simply being aware of the present moment, which includes not only our thoughts but also the sensations within our bodies.

Finding a Biofeedback Practitioner
Biofeedback is not governed or regulated by the state. There is no license required to practice biofeedback, but the Biofeedback Certification Institute of America provides testing of clinicians to establish basic competency of skills. When looking for a biofeedback therapist, finding one with a license in some form of health care is recommended. Most biofeedback practitioners have a state-regulated license and practice in medicine, psychology, nursing, occupational therapy, speech therapy, or physical therapy. You may find a practitioner at the Biofeedback Certification International Alliance website (www.bcia.org).

References

• Basmajian, J.V. Biofeedback: Principles and Practice for Clinicians. Oxford, England: Williams & Wilkins, 1979.
• Blume H.K., et al. “Biofeedback therapy for pediatric headache: factors associated with response.” Headache 52 (9) (2012): 1377-1386.
• Brown, B. Stress and the Art of Biofeedback. Oxford, England: Harper & Row, 1979.
• Budzynski, T., et al. “EMG Biofeedback and Tension Headache: A Controlled Outcome Study." Psychosomatic Medicine 35 (1973): 461-549.
• Ferraccioli G., et al. “Biofeedback/relaxation training and exercise interventions for fibromyalgia: A prospective trial.” The Journal of Rheumatology 14(4) (1987): 820-825.
• Masek B.J., et al. “Behavioral approaches to the management of chronic pain in children,” Arthritis & Rheumatism 11 (1998): 196-209.