Biofeedback for Pain Control

Biofeedback is often used as a therapy for chronic pain, such as low back pain.1 Biofeedback involves becoming more aware of physiological processes and learning to control some of them. There are 2 common forms of biofeedback.

  • Neuromuscular biofeedback. This technique can be used to treat many musculoskeletal conditions and uses either electromyography (EMG) or real-time ultrasound imaging (RTUS). An EMG translates muscles contracting and relaxing into numbers or on a graph. RTUS works similarly and muscles can be seen on a screen contracting and relaxing in real time.
  • Cardiovascular biofeedback. This type of biofeedback involves tracking heart rate, blood pressure, and other cardiovascular functions. A therapist will often use an electrocardiogram—where wires are attached to the chest—to monitor heart rate variability (HRV), which measures the time between each heartbeat. Generally, this technique focuses on learning to control breathing.

Another therapy, neurofeedback, provides information about the brain. This is typically used for people with neurological disorders but may be suggested for people with chronic pain.

Generally, the first biofeedback session goes as follows:

  1. Sensors are attached to the body to track heart rate, temperature, blood pressure, muscle tension, perspiration, or other functions.
  2. The therapist uses the data from this monitoring and helps the patient develop techniques to control unconscious body processes.

Biofeedback usually has 3 phases.

  1. The first phase of biofeedback training typically shows the body’s negative physiological reactions to certain stressors.
  2. In the next phase, techniques to respond to the signals from the machine(s) are taught.
  3. During the final stage, skills to recognize triggers on their own are developed.

Daily practice of the response techniques is often recommended.

Biofeedback has been used for many years to help improve physical functioning in people with musculoskeletal conditions, such as low back pain, and those recovering from a stroke or cardiovascular problem.

Feedback from the machine(s) can be conveyed in various ways.

  • Visual feedback is displayed on a TV screen or computer monitor. The patient is able to see the feedback, such as his or her heart rate, and watch it change as the therapist coaches them through various techniques.
  • Haptic feedback uses a vibrotactile device which can be attached to the body and provides feedback in the form of vibrations. This is often used to correct posture that may be causing back pain.
  • Video games are the newest iteration of biofeedback. Some video games have been designed so that they pull the player's biorhythms, such as pulse, and use it in a way that it affects the game.

Biofeedback can be a powerful and freeing experience for people with chronic pain.


  • 1.Jones AL, Wolf SL. Treating chronic low back pain. EMG biofeedback training during movement. Phys Ther. 1980;60(1):58