Biofeedback for Pain Management

Biofeedback is a therapeutic technique that uses electronic instruments to measure physiological functions and provide real-time feedback, helping individuals learn to voluntarily regulate those functions. It is commonly used as part of drug-free approaches to manage pain, stress, and various neuromuscular or autonomic conditions.

There are several types of biofeedback, including:

• EMG (electromyography) biofeedback: Measures skeletal muscle activity and helps identify and retrain patterns of muscle tension or dysfunction that may contribute to pain, headaches, pelvic floor disorders, or movement impairments.
• Thermal biofeedback: Monitors skin temperature to help patients learn to increase peripheral blood flow, often used for migraine, Raynaud’s disease, and stress-related conditions.
• Heart rate variability (HRV) biofeedback: Tracks beat-to-beat heart rate changes and teaches breathing or relaxation techniques to improve autonomic balance, stress resilience, and cardiovascular regulation.
• Electrodermal activity (EDA) or galvanic skin response biofeedback: Measures changes in skin conductance related to sweat gland activity, used to help regulate anxiety and stress responses.
• Respiratory biofeedback: Provides feedback on breathing rate and pattern to help patients develop more efficient, relaxed breathing, especially in conditions like panic disorder, asthma, and chronic pain.

By making these physiological processes visible, biofeedback enables patients to understand how their mind and body respond to stress, pain, or dysfunction—and to learn skills that can improve symptoms and overall well-being.

In a biofeedback therapy session, electrodes or sensors will be placed on you to measure physical changes in your body. The biofeedback device will collect data about your body’s reactions, and show you how your body is affected by pain or stress. A common example is to measure muscle electrical activity, to identify areas of tension.

A therapist trained in biofeedback therapy will help analyze and explain this data, and facilitate training to achieve the intended goals. For example, a therapist specialized in EMG biofeedback therapy can help you identify when your muscles tense up in a problematic location, so that you can relax them before feeling pain. The aim of biofeedback therapy is to help you become more aware of how your body works, enabling you to train yourself to reduce your body’s pain response.

Your therapist may suggest techniques to regulate your breathing rate, in order to help you relax. For example, an image of a balloon might be used to represent your breathing rate. The balloon would inflate and deflate, according to your breathing rate. With the help of this animation, you would then practice how to consciously slow your breathing rate, and monitor how this eases your pain.

With time, you should develop better control over this technique to reduce your pain, and eventually no longer require the device. A biofeedback treatment course may take a few months to complete. The goal of biofeedback therapy is to help you to understand your body better, and learn how to manage your symptoms on your own, in a drug-free manner.

However, it’s important to note that biofeedback therapy should only be undertaken after proper assessment and recommendation by your doctor, in order to ensure that it is suitable and safe for you.

Biofeedback therapy may be used for managing stress, hypertension, anxiety and depression, amongst other ailments. It also has its use for athletes – through peak performance training.

Beyond that, biofeedback therapy can help manage physical health issues involving muscle control and tension. A few examples include incontinence (e.g. urine leaking), migraines, headaches, back pain or pelvic pain. In some cases, it’s able to reduce one’s reliance on medication for pain relief.

Lower back pain

The most common musculoskeletal issue affecting most adults is lower back pain. With biofeedback therapy, stress reduction training can encourage muscle relaxation to reduce tension, pain and inflammation over time. EMG biofeedback has been studied as a way to reduce chronic lower back pain for over fifty years.

In a recent 2023 pilot study by Harvard Medical School, a new portable EMG biofeedback device by JOGO Digital Therapeutics was tested on 81 participants with lower back pain for eight weeks. Researchers found that together with biofeedback training, the device was able to help reduce muscle tension and pain intensity for those with chronic lower back pain, confirming the results of other clinical trials in the past two decades.

Migraines

In another study by Harvard Medical School researchers, migraine sufferers tested an at-home biofeedback device for six weeks. It was found that biofeedback reduced improved daily functioning, quality of life, and reduced anxiety.

While preliminary, the results of current research look promising, and will set the stage for larger randomized controlled trials in the future.

It’s important to recognize that biofeedback therapy is only one part of the story – relying on established evidence-based primary treatments is still critical for a full recovery. Your biofeedback therapist should also be experienced and well-trained in how to best use this method to benefit you.

In addition, other well-documented alternative drug-free therapies for pain management are also available, including acupuncture, massage therapy and yoga.

In cancer patients, biofeedback can help improve physical and mental health. It may help cancer pain management, or difficulties with stress and anxiety. The use of biofeedback therapy helps patients to become more independent during the recovery process.

Some examples of pain that biofeedback may help include:

• Neck pain and stiffness (e.g. cervical syndrome)
• Back pain
• Leg pain (e.g. sciatica)
• Migraines or tension headaches

It can also be used for preparation before surgery, to build your strength before undergoing a major operation. For example, it can be used to improve your respiratory health through breathing exercises, or build your urinary control through pelvic floor exercises.

Incontinence and pelvic pain may be common for some patients, especially those facing prostate cancer. Here, EMG biofeedback offers a targeted, non-invasive therapeutic approach to manage urinary incontinence after prostate removal by helping patients regain voluntary control of their pelvic floor muscles.

Using surface electromyography (sEMG) sensors, EMG biofeedback systems like JOGO can provide real-time visual feedback that guides patients through pelvic floor muscle activation patterns, enhancing motor learning and strengthening muscles weakened by surgery. This individualized feedback loop accelerates neuromuscular re-education, improves continence outcomes, and empowers patients with objective progress tracking, reducing reliance on pads and improving quality of life after prostatectomy.

Back in 2007, a study by Taipei Medical University also established that EMG biofeedback and relaxation training was effective in reducing pain in advanced cancer patients, alongside their usual medications.

In end-of-life care for cancer patients, biofeedback has been studied as a method to manage sleep quality or pain. This is achieved through heart rate variability biofeedback, as heart rate variability has been found to be a measure of pain intensity. Lower heart rate variability has been linked to higher levels of pain, especially chronic pain.

Communication may be harder in the end stages of cancer, but biofeedback therapy can provide a way to manage pain medication doses, even when it gets difficult to communicate due to tiredness or fatigue.

Biofeedback is a promising potential therapy for reducing pain and providing relief to those facing cancer and other ailments. However, it should be utilized only after recommendation by a doctor, and together with existing treatment regimens. Additionally, patients would also need to continue training even without the device, in order to sustain the positive results from the treatment.

This article was created as an educational collaboration with JOGO and is not sponsored.