Home-Use and Portable Biofeedback Lowers Anxiety and Pain in Chronic Pain Subjects

Abstract

In this study, we investigated the use of novel, home-use and portable biofeedback devices in a remote program for managing chronic pain. In three separate 4-week pilot studies, participants engaged in twice-daily, 10-minute biofeedback sessions, with self-assessed reductions in anxiety and pain levels using the 6-item State-Trait Anxiety Inventory (STAI-6) and Visual Analogue Scale (VAS), respectively, in Studies 2 and 3. Among these 113 (Study 2) and 237 (Study 3) biofeedback sessions, 81 (∼72%) and 130 (∼55%) showed reductions in pain, while 93 (∼82%) and 184 (∼78%) experienced reductions in anxiety. A positive relationship was found between anxiety and pain reduction, indicating that larger reductions in anxiety correspond to larger reductions in pain. In Study 1, only anxiety reductions were measured: across 143 biofeedback sessions, 127 experienced reductions in anxiety (∼89%). Participants in all studies demonstrated reductions in baseline to final results in pain, anxiety, and showed increases in satisfaction and recovery. Our results provide strong evidence that portable biofeedback devices can enhance pain management programs by helping to alleviate anxiety and pain in individuals living with chronic conditions. This study can provide a basis for the integration of biofeedback devices into the expanding research of lifestyle and integrative medicine.

Keywords: anxiety; biofeedback; chronic pain; portable.

Figure 1.

The device used in Study 1 was a home-use biofeedback device that has a temperature and pulse sensor strapped onto the finger. The data acquisition and biofeedback display is performed on a tablet. The left figure shows the display with temperature used to change the color of the segments sequentially. The right figure shows the breath pacer (segments expand and contract) with integrated magnitude of respiratory sinus arrhythmia used to change the color of the segments sequentially.

Figure 2.

(Left) The portable biofeedback devices used in Studies 2 and 3 had a temperature sensor measuring at the palm. (Middle) The device paired with a mobile app for temperature data collection. (Right) STAI-6 and VAS were recorded before and after each session.

Figure 3.

10-minute biofeedback sessions reduced anxiety across all three studies. Posterior predictive densities, derived via Bayesian hierarchical models, are shown for each study—giving the predicted estimates of pre- and post-biofeedback anxiety ratings. Anxiety was self-reported using the STAI-6, which ranged from 0 to 18. In these 493 biofeedback sessions (totaled across studies), 404 had reductions in anxiety (∼82%). The median pre/post differences, along with the posterior standard deviations and 95% credibility intervals, are given in the top left of each subplot.

Figure 4.

10-minute biofeedback sessions reduced pain across Studies 2 and 3. Posterior predictive densities, derived via Bayesian hierarchical models, are shown for each study—giving the predicted estimates of pre- and post-biofeedback pain ratings. Pain was self-reported using an 11-point visual analogue scale (VAS), which ranged from 0 to 10. In these 350 biofeedback sessions (totaled across studies), 211 had reductions in pain (∼60%). The median pre/post differences, along with the posterior standard deviations and 95% credibility intervals, are given in the top left of each subplot.

Figure 5.

Changes in anxiety before/after biofeedback predict changes in pain. In both Study 2 (left) and Study 3 (right), the pre/post difference in self-reported anxiety following each biofeedback session corresponded with changes in pain, such that larger reductions in anxiety were accompanied by larger reductions in pain. Here we plot the raw data entered into each Bayesian hierarchical model, where different colored datapoints correspond to different subjects in each study. The population-level slopes are displayed with various uncertainty intervals (shaded in red); in the top left, we provide the posterior median estimates, their standard deviations, and 95% credibility intervals.

Figure 6.

Inter-subject variability in the associations between anxiety and pain, before and after biofeedback. Here we display subject-specific estimates for the relationships between anxiety and pain reductions—that is, the random effects from the Bayesian hierarchical models shown in Figure 5. Subjects with many types of chronic pain were included in Studies 2 (top) and 3 (bottom), even subjects with Rheumatoid Arthritis, in which there was structural pain from a physical cause. For all these types of chronic pain, 10-minute biofeedback sessions usually decreased pain and anxiety (data points in the lower left quadrant).

Figure 7.

For all three studies, participants showed reductions in pain and anxiety together with increases in satisfaction and recovery from the baseline results before the study to the final results after the study. The measures obtained were maximum, average, and minimum pain using VAS, McGill Pain survey, trait anxiety from STAI, and SRI.