Efficacy of Biofeedback in Chronic back Pain: a Meta-Analysis

Purpose The aims of the present analysis were to investigate the short-and long-term efficacy and treatment moderators of biofeedback as a psychological treatment option for chronic back pain. A literature search using PubMed, PsycINFO, and the Cochrane Library identified 21 eligible studies including 23 treatment conditions and 1062 patients. Meta-analytic integration resulted in a significant small-to-medium effect size for pain intensity reduction (Hedges' g = 0.60; 95 % confidence interval (CI) 0.44, 0.76) that proved to be stable with a significant small-to-large effect size (Hedges' g = 0.62; 95 % CI 0.40, 0.84) over an average follow-up phase of 8 months. Biofeedback also proved to be effective in reducing depression (Hedges' g = 0.40; 95 % CI 0.27, 0.52), disability (Hedges' g = 0.49; 95 % CI 0.34, 0.74), reduction of muscle tension (EMG; Hedges' g = 0.44; 95 % CI 0.22, 0.65), and improving cognitive coping (Hedges' g = 0.41; 95 % CI 0.26, 0.57). These effects remained comparatively stable at follow-up and for controlled studies only. Moderator analyses revealed longer biofeedback treatments to be more effective for reducing disability and a greater proportion of biofeedback in the treatment to be more effective for reducing depression. Publication bias analyses demonstrated the consistency of these effects. It is concluded that biofeedback treatment can lead to improvements on various pain-related outcomes in the short and long terms, both as a standalone and as an adjunctive intervention.