An Interdisciplinary Approach: Reducing Pain

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An Interdisciplinary ApproachReducing Pain
the Effects of Stress and TraumaBiofeedback,
Neurofeedback Alpha-stimfor the Patients of
Primary Care Physicians

• Melanie Berry, MS, BCB, BCBS, FAIS
• Carolinas Biofeedback Clinic, LLC
• www.CBFclinic.com
• 888.317.5605

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Agenda 10, 4, 30

• Get to know Biofeedback for your patients with 10
  Interactive Questions, covering 4 Categories, in
  30 minutes
• Define it
• Teach you what conditions it is used for
• Help you select the right patients
• Help set your expectations for results
• Lets begin with 3 questions

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Interactive Question 1

• Which of these complementary or alternative
  medicines would you be most likely to consider
  for your complex pain patients?
• Acupuncture
• Chiropractic
• Medical nutrition therapy
• Biofeedback (includes neurofeedback)
• Medications
• Hypnosis
• Meditation, Yoga or Tai Chi
• Massage
• 9. Exercise Therapy
• 10. None of these

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Interactive Question 2

• Is the following statement true or false?
• Board Certification is available for biofeedback
  specialists.
• True
• False

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Interactive Question 3

• Which of these is NOT a type of biofeedback
• EMG Training
• EEG Training
• Temperature Training
• Hemoencyphalography (pirHEG) Training
• Heart Rate Variability (HRV) Training
• Skin Conductance Training
• Respiration Training
• None of these are types of Biofeedback
• All of these are types of Biofeedback

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Theoretical Framework of Health
Mind Body Connection
Biomedical
Psychological
Physiology Pathology Biochemistry
Thoughts Emotions Behaviors
Applied Psychophysiology
Biological, Psychological, and Social All play a
roll in human functioning, disease, illness, and
chronic pain
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Overview of Biofeedback Modalities
Modality Description
Brainwave (EEG) Uses scalp sensors to monitor the brains electrical activity using (EEG) sensors
Breathing Uses bands placed around the abdomen/chest to monitor breathing pattern and pace and calculate resonant breathing frequency.
Heart Rate Variability (HRV) Uses a finger/earlobe sensor to measure heart rate and calculate heart rate variability and coherence.
Muscle (EMG) Uses sensors placed over skeletal muscles to monitor the electrical activity that causes skeletal muscle contraction.
Sweat Gland (GSR) Uses sensors placed around the fingers to monitor changes in skin moisture produced by sweat glands.
Temperature Uses a finger sensor to measure changes in blood flow controlled by dialating and constricting blood vessels.
Source BCIA
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Psychosomatics and Psychopathology

• Autonomic Imbalance and
• Decreased Parasympathetic Tone in particular may
  be the final common pathway linking negative
  affective states and dispositions, including the
  indirect effects via poor lifestyles, to numerous
  diseases and conditions as well as increased
  mortality, and it may also be implicated in
  psychopathological conditions.
• Thayer Brosschot, 2005, p. 1053

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What is Biofeedback?

• BASIC Biofeedback is a technique that enables an
  individual to learn how to change maladaptive
  physiological activity and correct dysfunctional
  Autonomic Nervous System (ANS) activity
• SCIENTIFIC Biofeedback instruments are used to
  feed back information about physiological
  processes, assisting the individual to increase
  awareness of these processes and to gain
  voluntary control over body and mind.
• HOLISTIC Biofeedback is based on the recognition
  that changes in the mind and emotions affect the
  body, and changes in the body influence the mind
  and emotions.
• RESILIENCE Biofeedback emphasizes training
  individuals to self-regulate, gain awareness,
  increase control over their bodies, brains, and
  nervous systems, and improve flexibility in
  physiologic responding.

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Interactive Question 4

• Is the following statement true or false?
• All Biofeedback techniques are non-invasive.
• True
• False

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Interactive Question 5

• Is the following statement true or false?
• Biofeedback is an evidence-based practice.
• True
• False

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Interactive Question 6

• Based on meta-analysis of current scientific
  biofeedback
• studies, for which of the following diagnoses is
  biofeedback
• rated as an efficacious treatment of choice?
• Anxiety
• Migraine and/or tension-type headaches
• Chronic Pain Syndromes
• Insomnia
• Neuromuscular disorders
• Irritable bowel syndrome (IBS)
• Essential hypertension
• None of these
• All of these

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Interactive Question 7

• What do you do with the patient that does not get
  better despite all your efforts and continues to
  return to your practice?
• I tell them there is nothing more I can do for
  them
• I tell them to keep trying what we are already
  doing, give it time
• I tell them to come back in six months, and hope
  things have resolved on their own
• I tell them medicine cant help, seek a
  psychologist
• I would refer them to a complementary/alternative
  medicine expert

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Who is the Ideal Patient for Biofeedback?

• Individuals who want a more active role in their
  own health care
• Ones looking for non-invasive treatment options
• Those who WANT or NEED alternatives to meds
• Cases involving past trauma
• Patients who express hopelessness or helplessness
• Multi-symptom, complex cases in which
  conventional interventions have minimal success
• Pain patients with secondary anxiety, depression,
  insomnia, PTSD, etc.
• NOTE Skeptics are welcome!

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What it Looks Like in the Individual

• Camp Pendelton, Neurofeedback, PTSD Veteran

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Benefits of Biofeedback
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Interactive Question 8

• Have you ever had a patient who is experiencing
  unrelenting pain, but for whom there is no
  apparent anatomical origin (i.e., via X-ray, MRI,
  CT scan, etc.)?
• Yes
• No

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Benefits of Biofeedback
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Substantiated Results in the Literature

• Reduces blood pressure in hypertension (McCraty,
  2001)
• Improves asthma (Lehrer, 2000)
• Increases calmness and well-being (Friedman,
  2000)
• Increases emotional stability (McCraty, 2001)
• Improves cognitive performance (McCraty, 2001)
• Improves hormonal balance (McCraty, 1998)

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• The greatest revolution of our time is the
  knowledge that human beings, by changing the
  inner attitudes of their minds, can transform the
  outer aspects of their lives.
• -William James

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Interactive Question 9

• How likely are you to think of biofeedback as a
  possible intervention for one of your pain
  patients?
• Definitely
• Likely
• Unsure/Still Skeptical
• Not likely
• Not at all

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Interactive Question 10

• I have a much better understanding of how
  Biofeedback Training contributes to positive
  outcomes with pain patients.
• Yes
• No

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Hands-on Mock Client Session

• You are invited
• to a
• Live Action Demo