Biofeedback can be a powerful tool for some patients and for people who are not finding relief with conventional medications or physiotherapy it is probably worth a try.
Like hypnotherapy, acupuncture, EMDR, and other "experimental" therapies, it doesn't work for everyone and we don't fully know why it works when it does and why it doesn't work when it doesn't. From a patient's point of view, it really doesn't matter - if it works for you, that's all you are going to care about, not why or how.
It could be bad news for the makers of painkillers. A small study suggests that people can learn to suppress pain when they are shown the activity of a pain-control region of their brain.
This new biofeedback technique might also turn out to be useful for treating other conditions.
Biofeedback techniques based on electroencephalogram (EEG) recordings of brainwave patterns, in which electrodes are placed on the scalp, are used with some success to treat epilepsy and attention problems such as ADHD.
But no one has found a way to use this method for controlling pain in people, said Peter Rosenfeld of Northwestern University in Chicago, one of the pioneers of biofeedback.
Twenty years ago Rosenfeld found that he could change the pain threshold in mice by training them to alter their brainwave patterns through a process called conditioned learning, where an altered brainwave state was rewarded by direct stimulation of the reward centers in their brains. Since this meant placing an electrode into the brain, however, his team never tried the technique on people.
Now Fumiko Maeda, Christopher deCharms and their colleagues at Stanford University in California have tried showing people real-time feedback from a functional magnetic resonance imaging (fMRI) scanner, according to the May 1, 2004, issue of the New Scientist.
The difference between EEGs and fMRI, said Rosenfeld, is that fMRI allows you to show volunteers how much activity there is in specific areas of their brains. "From scalp recordings, you don't really know what you are recording," he said.
The eight volunteers saw the activity of a pain-control region called the rostral anterior cingulate cortex represented on a screen either as a flame that varied in size, or as a simple scrolling bar graph.
This brain region is known to modulate both the intensity and the emotional impact of pain. During the scans the volunteers had to endure painful heat on the palm of their hand. They were asked to try to increase or decrease the signal from the brain scanner and to periodically rate their pain sensations.
It took just three 13-minute sessions in the scanner for the eight volunteers to learn to vary the brain activity level, and thus to develop some control over their pain sensations, the researchers reported at the Cognitive Neuroscience Society meeting in San Francisco.
The effect seemed to last beyond the sessions in the scanner, although the researchers have yet to determine how strongly and for how long. The volunteers could not explain how they did it. The researchers ruled out other explanations for the effect through a series of controls. They gave people false feedback data, no feedback at all, or feedback from a part of the brain unrelated to pain control. They also sometimes asked people to pay attention to the pain or distracted their attention away from it.
The technique might prove useful not only for training patients to control pain, but perhaps also for treating other illnesses where brain activity is altered, such as depression or dementia. It might even help boost normal brain function. It could also prove a valuable research tool, helping establish links between specific patterns of brain activity and behavior. But its use is likely to be limited by the high cost of fMRI scanners.