Efficacy of Biofeedback in Chronic back Pain: a Meta-Analysis

Abstract

Purpose: The aims of the present analysis were to investigate the short- and long-term efficacy and treatment moderators of biofeedback as a psychological treatment option for chronic back pain.

Method: A literature search using PubMed, PsycINFO, and the Cochrane Library identified 21 eligible studies including 23 treatment conditions and 1062 patients.

Results: Meta-analytic integration resulted in a significant small-to-medium effect size for pain intensity reduction (Hedges' g = 0.60; 95 % confidence interval (CI) 0.44, 0.76) that proved to be stable with a significant small-to-large effect size (Hedges' g = 0.62; 95 % CI 0.40, 0.84) over an average follow-up phase of 8 months. Biofeedback also proved to be effective in reducing depression (Hedges' g = 0.40; 95 % CI 0.27, 0.52), disability (Hedges' g = 0.49; 95 % CI 0.34, 0.74), reduction of muscle tension (EMG; Hedges' g = 0.44; 95 % CI 0.22, 0.65), and improving cognitive coping (Hedges' g = 0.41; 95 % CI 0.26, 0.57). These effects remained comparatively stable at follow-up and for controlled studies only. Moderator analyses revealed longer biofeedback treatments to be more effective for reducing disability and a greater proportion of biofeedback in the treatment to be more effective for reducing depression. Publication bias analyses demonstrated the consistency of these effects.

Conclusion: It is concluded that biofeedback treatment can lead to improvements on various pain-related outcomes in the short and long terms, both as a standalone and as an adjunctive intervention.

Keywords: Biofeedback; Chronic back pain; Meta-analysis; Psychological treatment.