The use of EMG feedback and progressive relaxation in the treatment of a woman with chronic back pain

Relaxation Training Techniques — A Review Part Two: How Effective is Relaxation Training?

This article is part two of a literature review of relaxation training techniques. Part one presented descriptions of the major relaxation training techniques, and part two deals with their evaluation. Firstly, the general limitations and difficulties affecting research studies on the effectiveness of relaxation training methods are discussed. Secondly, brief critical appraisals of some examples of outcome studies on different relaxation training techniques are given, together with comments on their clinical application.

Applied Relaxation in the Management of Chronic Pain

Seventeen chronic pain patients at a rehabilitation center participated in an investigation of the effects of applied relaxation on chronic pain. The experimental group received regular rehabilitation treatment plus intensive training in applied relaxation. One control group received the regular rehabilitation treatment only, while another control group consisted of patients waiting for treatment. Results indicated that the applied relaxation group did significantly better than the control group(s) on measures of subjective pain, medication intake, activity, and overall evaluation of the treatments. This suggests that applied relaxation can be a valuable addition to chronic pain treatment programs.

The relationship of extraneous movements to lumbar paraspinal muscle activity: implications for EMG biofeedback training applications to low back pain patients

Within recent years clinicians and researchers have applied paraspinal EMG biofeedback procedures during static and dynamic movement retraining of chronic low back pain patients. Most of these applications make use of surface electromyography, an approach complicated by the fact that the erector spinae muscles are deeply situated. This descriptive study reveals that extraneous movements, such as neck flexion and pelvic rotation, can elicit profound activity from percutaneously placed EMG electrodes while little change is seen at the skin surface. The implications of these observations for the use of EMG feedback to remediate low back pain are discussed.

Long-term efficacy of EMG biofeedback for chronic rheumatic back pain

Short-term effects of EMG biofeedback for chronic rheumatic back pain have been documented, however, the long-term efficacy of this treatment modality has not yet been established. Twenty-two patients of an original sample of 24 patients who participated in a treatment outcome study [6] were followed up 2.5 years after they had been treated with either EMG biofeedback, pseudotherapy, or conventional medical treatment alone. The results indicate that patients treated with EMG biofeedback maintained beneficial effects and differ significantly from the control groups both on behavioral and cognitive responses to the pain, but not global pain intensity ratings. These data support the long-term utility of biofeedback for chronic rheumatic back pain.

Comments on the reliability of muscle activity comparisons in EMG biofeedback research with back pain patients

The underlying assumption in comparing muscle activity levels in back pain research is the reliability of the documented biological record. Surface-recorded EMG data are often used as "objective" indicators in treatment outcome studies. The present paper questions the reliability of this somatic measure. Three sources of error variance that interfere with the reliability of the recorded biological signal are discussed: movement of the body, replacement of electrodes, and electronic equipment instability. It is argued that surface-recorded EMG activities of the back are unreliable and unsuited for comparing the efficacy of a back pain treatment program.

The relationship between paraspinal EMG and chronic low back pain

Two models of the relationship between paraspinal EMG and low back pain have been proposed. Specific predictions arising from these are listed and the literature relating to them reviewed. Recent research on patterns of EMG rather than absolute levels is also discussed. It is concluded that there is no consistent evidence that low back pain patients have elevated paraspinal EMG, or that its reduction is likely to be an active ingredient in biofeedback therapy. Research on paraspinal EMG patterns is still preliminary, and therefore treatment based on their modification is experimental.

Etiological theories and treatments for chronic back pain. II. Psychological models and interventions

This is the second part of an extended review of the etiology and treatment of chronic back pain (CBP). The first paper dealt with somatic factors and interventions, this paper will examine psychological theories on the etiology of CBP and psychological treatments for CBP. Finally common problems of both the somatic and the psychological approaches will be discussed and suggestions for treatment and research will be made.

Mechanism of biofeedback in the treatment of chronic back pain: an hypothesis

Although EMG biofeedback has been successfully used in the treatment of headache, its application to back pain has been sparse, with meager to moderate success. This paper deals with some of the specific problems encountered in EMG biofeedback training of patients with chronic back pain. It questions whether treatment outcome can be related to a change in muscle tension and whether relaxation will be accompanied by reduction of the pain. An alternative view of the application of EMG biofeedback in the treatment of back pain is suggested.

Electromyographic (EMG) feedback in chronic musculoskeletal pain: a controlled trial

The literature regarding the application of EMG feedback training in musculoskeletal pain disorders is reviewed. A within-subject control trial of EMG feedback using a counterbalanced design in patients with chronic musculoskeletal pain is reported here. Eighteen subjects (12 females and 6 males) were studied in terms of subjective reports of pain and EMG activity measurement under standardised conditions. Both EMG feedback and a control condition were active in reducing subjective pain levels, which increased during a waiting list conditions in certain sequences. EMG activity declined during both EMG feedback and control conditions but only EMG feedback resulted in an orderly reduction in EMG baseline measurements with a highly significant linear trend when presented before the control condition in sequence. A significant correlation between subjective pain levels and surface EMG activity was found. These data suggest that EMG feedback is superior to a control condition in training muscle relaxation but not in reducing subjective pain levels despite a high correlation between these two parameters. Non-specific factors may well affect pain scores and further research is required before the specific biofeedback training effect can be accepted as superior to its non-specific effects in reducing subjective pain.

Efficacy of EMG biofeedback, pseudotherapy, and conventional medical treatment for chronic rheumatic back pain

Twenty-four patients suffering from chronic rheumatic back pain were treated with EMG biofeedback, a credible pseudotherapy, or conventional medical treatment alone during a 4 week inpatient stay at a Rheumatology Clinic. At the end of the treatment phase and at the 4 month followup the patients in the biofeedback group showed significant improvements in the duration, intensity, and quality of their back pain as well as their EMG levels, negative self-statements, and utilization of the health care system. In contrast, the pseudotherapy group showed minimal, but non-significant improvements, and the medically treated group remained unchanged.

EMG scanning in the diagnosis of chronic pain

A surface EMG diagnostic protocol was developed to assess the neuromuscular/postural contributions to pain states. The EMG activity of the right and left aspects of 11 muscle groups were monitored while the patient was in the sitting and standing positions. The diagnostic protocol was evaluated by comparing the patterns of EMG activity in four diagnostic groups: headache only, neck/shoulder/upper back pain only, low back pain only, and mixed pain states. The results suggest that (1) bilateral levels of EMG activity in the frontalis and masseter groups are of primary importance for the headache patients, (2) the discrepancy between the right and left EMG activity in the lumbar and cervical paraspinal muscle groups are of primary importance for low back pain patients, (3) position (sit/stand) may provide important diagnostic information, and (4) the data appear to support the notion of a postural disturbance as a contributing factor in low back pain.