Biofeedback
Does it work ?
Although some of the studies included in this summary indicate an improvement in pain relief and chemotherapy-related nausea and anxiety, these studies have not been independently replicated and have considerable methodological limitations. Evidence is therefore insufficient to document the effectiveness of biofeedback for people with cancer.
Most biofeedback studies are confounded by being combined with relaxation techniques, so it is not possible to be confident that the treatment effect is due to the relaxation technique itself or the biofeedback procedures3. Due to the difficulty in creating appropriate and credible placebo conditions double-blind studies are difficult to complete for this intervention.
Different types of biofeedback have been widely used in a variety of health care and rehabilitation settings. Reported effects from randomised controlled trials include a reduction in chronic pain2. Other reported benefits from case reports and uncontrolled trials include relief of stress and tension5.
Controlled clinical trials
Four controlled clinical trials have assessed the effectiveness of biofeedback for cancer patients3,5,6,7.
A well-performed randomised clinical trial (RCT) assessed the effectiveness of electromyography (EMG) biofeedback, skin-temperature (ST) biofeedback and relaxation training in reducing the aversiveness of cancer chemotherapy (n=81)3. Results showed that patients who undertook relaxation training experienced a reduction in nausea and anxiety during their chemotherapy, when compared to the no-intervention group. Although the EMG and skin temperature biofeedback reduced levels of physiological arousal in participants, this did not alter the chemotherapy side-effects. Results suggest that relaxation training, but not biofeedback is effective in reducing adverse effects of chemotherapy.
A small RCT investigating the effectiveness of relaxation training supplemented with visual and auditory electromyography (EMG) biofeedback signals found a reduction in pain intensity in people with advanced cancer (n=12) compared to the control group (n=12)5. This study is limited by its small sample size.
Another small RCT explored changes in the immune system and psychological profile of women with breast cancer who had recently undergone radical mastectomy (n=13). Patients were randomised to either an intervention group who were trained in relaxation, guided imagery and biofeedback over a 24 week period or a waiting list control. Results indicate that relaxation, guided imagery and biofeedback interventions can be correlated with immune system and anxiety measures6. Due to the small participant number and the use of a multi-modal intervention it is impossible to determine the efficacy of biofeedback.
Another small RCT investigating the effectiveness of electrodermal (skin conductance) and electromyographic (EMG) biofeedback for people with advanced cancer found reduced pain levels in the intervention group (n=12). However, only six of the 12 participants completed the trial. Five participants died and one moved away from the area. The study results are limited by the small sample size and lack of an adequate control group7.
Citation
Helen Cooke, CAM-Cancer Consortium. Biofeedback [online document]. http://www.cam-cancer.org/CAM-Summaries/Mind-body-interventions/Biofeedback. August 25, 2011.Document history
Summary first published in August 2011, authored by Helen Cooke.
References
- Association for Applied Psychophysiology and Biofeedback USA website. http://www.aapb.org [Accessed 17/08/11].
- Sellick SM and Zaza C. Critical review of 5 nonpharmacologic strategies for managing cancer pain. Cancer Prev Control. 1998; 2(1):7-14. Ref ID: 2545
- Burish TG and Jenkins RA. Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy. SO: Health Psychology: Official journal of the Division of Health Psychology, American Psychological Association. 1992; (1): 17-23.
- Payne R and Donaghy M. 2010. 4th Edition. Payne’s Handbook of Relaxation Techniques: a practical guide for the health care professional. London: Churchill Livingstone, Elsevier.
- Tsai PS, Chen PL, Lai YL, Lee MB, Lin CC. Effects of electromyography biofeedback-assisted relaxation on pain in patients with advanced cancer in a palliative care unit. Cancer Nursing. 2007; 30(5):347-53.
- Gruber BL, Hersh SP et al. Immunological responses of breast cancer patients to behavioral interventions. SO: Biofeedback and self-regulation. 1993; (1): 1-22.
- Fotopoulos SS, Cook MR, Graham C, Cohen H, Gerkovich M, Bond SS, Knapp T: Cancer pain: evaluation of electromyographic and electrodermal feedback. Prog Clin Biol Res. 1983; 132D:33-53. Ref ID: 25675
- Ernst E, Pittler M, Wider B and Boddy K. Oxford Handbook of Complementary Medicine. Oxford: Oxford University Press, 2008.
The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it contains. This information is designed for health professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.
