First Non-Contingent Respiratory Biofeedback Placebo versus Contingent Biofeedback in Patients with Chronic Low Back Pain: A Randomized, Controlled, Double-Blind Trial

Abstract

Previous studies reported that respiratory feedback (RFB) aids in alleviating chronic pain. However, to date, this adjunct treatment has not been rigorously tested against non-contingent (placebo) feedback. Forty-two patients with chronic low back pain were randomized to either RFB or non-contingent RFB. Both groups performed a daily 30-min home training for 15 consecutive days. A respiratory associated relaxation index (RI) was measured. Pain levels and a somatosensory profile were assessed before and after intervention. Additionally, pain levels were assessed 3 months after the end of intervention. Secondary outcome parameters included daily functioning, psychopathology, and suggestibility. T-tests showed higher and significant pain reductions for RFB, compared to non-contingent RFB. Between-group comparisons reached no significance. However, changes were more pronounced in the RFB condition, which was also true for the course of the RI and the psychopathological scores. This is the first study using a non-contingent respiratory placebo feedback in a randomized, controlled design. Within this design previous positive findings of symptom reductions in patients treated with RFB could partially replicated. Nonetheless, tendencies suggest that contingent feedback patients compared to placebo patients profit more from RFB in the long run regarding reduction of chronic pain and psychological distress.

Complementary and alternative medicine therapies for chronic pain

“…Both studies showed efficacy of biofeedback for improving symptoms of chronic back pain and headaches, respectively. (89,90) …”

Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study

“…It has been suggested that resonance frequency breathing (i.e., the breathing frequency that causes the largest HR oscillation amplitude) may strengthen baroreflexes, thus improving the autonomic functioning (Vaschillo et al 2002;Lehrer et al 2003). HRV BF has shown to be useful in treating symptoms in various disorders characterized by aberration of the ANS (Wheat and Larkin 2010), including posttraumatic stress disorder (PTSD) (Zucker et al 2009), depression (Siepmann et al 2008) and heart disease (Nolan et al 2005) as well as musculoskeletal pain (Hasset et al 2007;Kapitza et al 2010). However, further controlled studies are needed on muscle pain.…”

The Effect of Biofeedback as a Psychological Intervention in Multiple Sclerosis: A Randomized Controlled Study

“…Despite a large evidence base for effective outcomes in other conditions such as tensiontype headache, 19 chronic pain, 20 and anxiety, 29 biofeedback has been overlooked in interventions designed to improve mood, coping, and fatigue in MS. Promisingly, in this study, biofeedback was shown to be effective in reducing fatigue, stress, and anxiety. The biofeedback group also demonstrated improved control of breathing rate and muscle tension, indicating that they could be easily taught how to self-regulate these two physiological After controlling for baseline and normality, ANOVA showed a trend toward breathing rate difference between groups for breathing rate at t3 as follows: F 1,39 = 3.347, P = .07, h 2 = .083.…”

“…Interventions that improve perceived selfcontrol and coping strategies in MS are needed. [15][16][17][18] Biofeedback, an intervention that promotes better selfregulation, has been found to improve coping strategies in headache and chronic pain 19,20 and foster positive beliefs about self-control.…”

“…20,26,27 During the first 30-second period of biofeedback recording, the breathing rate was recorded and labeled "base rate." Breathing rate was recorded in the 30-second period after PMR, at the end of the first visit, and labeled "breathing rate t1."…”