Biofeedback treatment for headaches, Raynaud's disease, essential hypertension, and irritable bowel syndrome: a review of the long-term follow-up literature

Temporomandibular Myofascial Pain Syndrome-Aetiology and Biopsychosocial Modulation. A Narrative Review

This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder.

Biofeedback Applications in the Treatment of Cardiovascular Diseases

Cardiovascular diseases impair the lives of millions of Americans each year. Researchers have studied a variety of nonpharmacologic interventions in an attempt to discover their use as therapies for these diseases. Various methods of biofeedback have shown promise in the treatment or management of several cardiovascular disorders. The literature relating to the use of biofeedback therapies for hypertension, cardiac arrhythmias, angina pectoris, cardiac ischemia, myocardial infarction, and Raynaud's phenomenon is reviewed. The number and types of studies in each of these areas vary widely, but research to date suggests that biofeedback could be a useful alternative or adjunct to more conventional forms of treatment. Further research to clarify the appropriate uses of biofeedback in the management of these disorders is recommended.

Use of alternative treatments by chronic fatigue syndrome discordant twins

Background: Patients with chronic fatigue syndrome (CFS) have been faced with difficulties in diagnosis and lack of effective treatments. Anecdotal evidence suggests that use of alternative treatments may be common in these patients. Our primary objective was to compare the prevalence and patterns of alternative medicine use among twins who met the Centers for Disease Control and Prevention (CDC) CFS criteria to that of their non-CFS co-twins. Secondary goals were to assess how often alternative medicine use was discussed with physicians and the perceived benefit of these therapies. Methods: Sixty-three twin pairs discordant for CFS completed a survey about their use of 22 alternative therapies. Matched pair odds ratios and 95% confidence intervals were used to examine differences in the use between CFS twins and their non-CFS co-twins. Results: 91% of twins with CFS and 71% of non-CFS twins had used at least 1 alternative treatment in their lifetime. Twins with CFS were more likely to use homeopathy, mega-vitamins, herbal therapies, biofeedback, relaxation/meditation, guided imagery, massage therapy, energy healing, religious healing by others, and self-help groups than their non-CFS counterparts. A large proportion of all twins found alternative therapies helpful; however, only 42% of those with CFS and 23% of those without CFS discussed their use of alternative medicine with a physician. Conclusions: Individuals with CFS frequently used alternative medical treatments yet rarely communicated this use to their medical doctor. Future research should ascertain the usefulness of alternative practices in the management of CFS.

Altered skin temperature and electromyographic activity in the irritable bowel syndrome

A prospective study to determine the presence or absence of any difference in skin temperature and electromyographic (EMG) activity in 20 patients with irritable bowel syndrome (IBS) compared with 20 age- and sex-matched controls was conducted. A representative digital temperature and EMG activity during 4 phases, baseline, mental activity (arithmetic), unpleasant thoughts and audio biofeedback relaxation, were recorded using standard biofeedback equipment. Results showed the IBS group to have a significantly lower digital temperature and significantly higher EMG activity during the baseline and arithmetic phases. No difference was found in EMG activity for the unpleasant thought or audio biofeedback relaxation phases. Indeed, the IBS group were able to achieve a level of EMG activity during the audio feedback relaxation phase that approximated very closely that of the control group. These results provide further evidence suggestive of altered autonomic nervous system function in IBS patients and indicate that further studies should be undertaken to determine whether the reduction achieved in EMG activity post-relaxation is sustained, and if so, if it is associated with a corresponding improvement in symptoms.

Extracranial and digital vascular events: an analysis of methods in BVP amplitude and biofeedback research

The purpose of the present study was to assess and compare the effects of within and between-session exposure to environmental context on left temporal artery pulse amplitude, right temporal artery pulse amplitude, and left digital pulse amplitude. Subjects were individually tested for 20 min daily over a period of eight consecutive days. A significant interaction was found for Position X Interval. These results show that exposure to the experimental context occurs with diametrically opposite effects on temporalis and digital pulse amplitude within session. Moreover, these results would support the hypothesis that controversial findings within the headache and biofeedback literature may be partially attributable to methodological differences where, for example, different authors use different transducer locations and/or evaluate pulse amplitude at different points within or among sessions. Indeed, research on the effects or lack thereof of therapeutic manipulations may have little or nothing to do with the intervention or experimental manipulations themselves. These effects may be masked or augmented by subject and methodological confounds during baseline and testing conditions.

The behavioral treatment of Raynaud's disease: a review

Raynaud's disease is a peripheral vascular system disorder characterized by episodes of vasoconstriction in the hands and feet resulting in a lowering of skin temperature and pain. Recent studies are reviewed that focus on the behavioral treatment of Raynaud's disease--in particular, biofeedback and autogenic training. Methodological problems and other difficulties include the measurement of skin temperature, schedules of reinforcement/feedback, and characteristics of the experimenter and subject. Studies in this area indicate some promise for certain behavioral interventions, especially finger temperature biofeedback under cold stress conditions. On the other hand, further research is needed to clarify the mechanisms, especially that of vasodilation, and the applications of temperature biofeedback, as well as the role of attitudinal, interpersonal, and cognitive factors.

Thermal feedback in Raynaud's phenomenon secondary to systemic lupus erythematosus: long-term remission of target symptoms

Thermal feedback shows promise when applied to Raynaud's phenomenon secondary to systematic lupus erythematosus (SLE). A female subject was followed over an 8-year period that included initial training, 1-year follow-up, and 8-year follow-up. Peripheral circulation was initially very poor, as evidenced by low basal fingertip temperatures and trophic lesions at the fingernails. An intensive 5-week training regimen in thermal self-regulation yielded evidence of hand warming, followed by an increase in basal finger temperature. Reported vasospasms were markedly reduced and the lesions healed in the ensuing weeks. As of the 1-year follow-up, the skill was intact. Symptoms remained in substantial remission throughout the 8-year period during which the subject practiced somatic relaxation and hand warming without electronic feedback. Objective temperature measurement at the 8-year juncture yielded results similar to the initial acquisition, gradual manifestation of control over the first 4 days. The subject also reported diminution of vascular headache, another symptom of SLE. While much of the biofeedback literature is focused on stress-related disease, research of this kind affirms the value of self-regulatory technique in illnesses whose causes are primarily physical.

Quieting response training: long-term evaluation of a clinical biofeedback practice

Clinical evidence for the long-term effectiveness of biofeedback related relaxation training is accumulating. The purpose of this report is to describe the population, self-regulation procedure, outcome criteria, and final outcome for patients who received Quieting Response (QR) training. Data from 340 patients who completed at least the first follow-up at 3 months is presented. Primary presenting symptoms were headaches, 72%; primary and secondary Raynaud's, 14%; hypertension, 4%; irritable colon, 4%; and miscellaneous, 6%. QR training integrated EMG and thermal feedback with deep breathing, progressive relaxation, and autogenic exercises presented on cassette tapes. Eight 1-hour weekly sessions were given, with emphasis on daily home exercises. Follow-up evaluations were at 3 months, 6 months, 1 year, and 2 years. Outcome was based on change in frequency, severity, and duration of symptoms; changes in medication; and secondary benefits. Quieting Response training was found to be most beneficial for patients with primary Raynaud's disease (18 of 23 patients, or 78% successful), classic migraines (9 of 13, or 69%), and common migraines (20 of 32, or 62%), followed by mixed headaches (79 of 131, or 60%), Raynaud's plus other symptoms (9 of 15, or 60%), and the irritable colon syndrome (7 of 13, or 54%). Less successful were patients with headaches plus other symptoms (16 of 37, or 43%), muscle contraction headaches (13 of 33, or 39%), secondary Raynaud's phenomenon (4 of 10, or 40%), and essential hypertension (5 of 15, or 33%). Speculations about the differing outcomes across symptom groups were made.