Identifying and learning how to change your brain's response to pain could help ease your back pain. Biofeedback is an alternative medicine tool that can help you do this.

If a qualified expert could help you identify the patterns in your brainwaves that occur in response to pain, and help you control or change some of those patterns, you might be able to reduce your back pain. This is the basic idea behind biofeedback, an alternative medicine technique that is used by some patients for pain management.

What Is Biofeedback?

“Biofeedback is very simply a method of directing biological information from your body back to your brain ... in such a way that a learning loop is created and you learn to control those parameters,” explains biofeedback specialist George H. Green, PhD, director of the Biofeedback Center in Reno, Nev.

Historically, people used biofeedback methods to control muscle tension, skin temperature, and heart rate. Today it can be used for pain management, including back pain. “If I can identify a pattern in your brainwaves in response to a problem, you learn a new response and the problem changes,” Dr. Green explains.

When you visit a biofeedback specialist, you will likely be connected by sensors (electrodes) to machines that monitor your brainwaves and vital signs, such as heart rate and skin temperature. In the office, you will probably be interacting with a visual display — a movie or graphic demonstration — that responds to your brainwaves. As you learn to control your responses, the visual will change.

Biofeedback and Pain

“Pain is a very special situation because it exists in levels,” says Green. He defines the levels of pain as:

• Core response. The first level is the body’s announcement to your brain that it has been injured or has another problem causing discomfort. This is intended to draw attention to a problem.
• Awareness. The second level of pain is the awareness that you have had that physiological response. “As soon as the cognitive portion of your brain acknowledges it, it focuses on it and amplifies it,” says Green. Your brain can multiply your experience of pain many times over at this stage.
• Emotional. The third level involves concerns over the implications of pain, such as missing work or being unable to play with your children. This level can also amp up your experience of pain, says Green.
• Social. The fourth and final level plays out at the level of social interactions — how is your pain affecting your relationships? This level also can multiply your perceived pain.

“With biofeedback we start addressing all four levels of discomfort simultaneously,” says Green. “The effect that biofeedback can have on pain is very real. At the very least it can peel away and diminish the second, third, and fourth levels substantially, which in many cases leaves you with a physical level of discomfort that is tolerable. Then you can deal with super spinal control, which means you can diminish the first level of discomfort.”

Biofeedback and Research

Biofeedback techniques have not been thoroughly studied, so the data supporting their use in pain management are scarce. In a recent study of 128 adults with chronic back pain and significant disability, biofeedback was shown to be a possible complementary technique to psychological pain management training.

A second study examining the use of biofeedback in headache pain found that biofeedback might be a good complement to relaxation techniques, but noted that biofeedback is a costly and lengthy process that does not appear to result in proportionate gains in pain management.

Selecting a Biofeedback Specialist

As with many alternative medicine approaches, it is not always easy to find out who is a qualified practitioner and who is not. Green strongly advises looking for a practitioner who:

• Is certified by the Biofeedback Certification Institute of America
• Has many years of experience
• Has a diverse background as a health practitioner

You may also want to consider your personal interaction with the practitioner you choose. Green says that you’ll probably need 15 sessions to manage mild back pain and up to 70 sessions for chronic pain — in other words, you want to choose someone you can work with over a long period.

However, according to Green, biofeedback appears to provide long term pain relief — and he advises against using a practitioner who recommends coming in for a six-month “tune up.” This is not necessary if the biofeedback specialist provided appropriate treatment to begin with, he says.

Costs of Biofeedback

While some health insurance programs cover biofeedback, Green says he has stopped taking insurance. Although there are no national data on biofeedback costs, Green describes his fees as moderate: $425 for an initial evaluation and $135 per hour thereafter.

Pros and Cons of Biofeedback

The benefits of biofeedback therapy are:

• Non-narcotic pain management
• Lasting, long-term results if correctly applied
• Greater awareness of your own habits and responses to pain

The drawbacks to biofeedback therapy are:

• It can take a long time to be effective.
• It may be costly.
• Not all biofeedback specialists are qualified to treat pain.

Deciding how to address your back pain can be difficult — but you can add biofeedback to your list of possible tools that could help.