What's Biofeedback?

Biofeedback is big business. There's tons of opinion on the WWW. Simply put, biofeedback is physiologic information that is used in the attempt to self-control a physiologic process not normally considered to be under conscious or voluntary control. It's been practiced for the treatment of incontinence, anxiety, headaches, hypertension, movement disorders, incontinence, pain, asthma, Raynaud’s disease, insomnia, and others.

There are different types of biofeedback, for example, blood pressure is monitored and the individual may practice relaxation exercises or routines for hypertension. However, biofeedback is much more commonly used to address neuromuscular and pain disorders where electromyographic (EMG) measurements of muscle contractions can be used. This usually involves a commercial EMG biofeedback gizmo to provide the feedback data. Some are simple current measuring devices, some are fancy office-based computer integrated with multiple electrodes.

Often, physiatrists, chiropractors and sometime physical therapists will use different types of EMG biofeedback data to assist in diagnosis and to develop or recommend a treatment plan. There is likely a biofeedback device in incontinence clinics where information is used to help patients identify muscles that can be used in training for better bladder control. EMG biofeedback data used by MD directed rehab, pain and incontinence clinics as part of an overall intensive treatment program may be helpful in selected cases. But I'll admit, the good comparative clinical studies done so far probably haven't demonstrated biofeedback measurements are necessary or integral in the diagnosis or treatment of any condition.

There are those who will advocate methods of EMG biofeedback and biofeedback training as the tell-all, cure-all of much in medicine. Biofeedback therapy clinics and programs are deep within the realm of alternative medicine and are not widely incorporated into mainstream medicine, or reimbursed by third-party payors.

You will be overwhelmed in MEDLINE. So, here are my favorite references, which are tech analysis by the NIH and one by Medicare, and some "good" studies that have a placebo control arm and can single out the individual effect of biofeedback-very few studies meet both these criteria:

NIH Technology Assessment Panel. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA 1996;276(4):313-8
Centers for Medicare and Medicaid Services. Medicare Coverage Policy: Biofeedback for urinary incontinence. http://cms.hhs.gov/
Burgio KL, Goode PS, Locher JL, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002 Nov 13;288(18):2293-9
Morkved S, Bo K, Fjortoft T. Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence.Obstet Gynecol. 2002 Oct;100(4):730-9
Bush C, Ditto B, Feuerstein M. A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain. Health Psychol 1985;4(4):307-21
Dursun N, Dursun E, Kilic Z. Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Arch Phys Med Rehabil 2001; 82(12):1692-5
Bales GT, Gerber GS, Minor TX et al. Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Urology 2000; 56(4):627-30