Download Biofeedback-Managing Chronic Pain -Anthony

Biofeedback:
Harnessing the Power of the Mind &
Body to Improve Chronic Pain
Management
Disclosure:
• Nothing to disclose
ANTHONY WHITNEY, MS, LMHC, BCB
Behavioral Therapist
Licensed Mental Health Counselor
Board Certified in General Biofeedback
St. Luke’s Rehabilitation Institute
711 South Cowley St. Suite 310
Spokane, WA 99202
(509) 473-6942
[email protected]
Objectives:
• Acquaint the audience with the benefits of
integrating mind and body based treatment
modalities to increase an individual’s internal locus
of control and recovery.
• Describe biofeedback techniques that are
incorporated in the treatment of chronic pain to
increase functioning and quality of life.
• Identify and analyze potential warning signs
frequently associated with the development of pain
disorders.
• A brief but detailed demonstration of one or more
biofeedback modalities will be completed.
3-Legged Stool of Health &
Well-Being
• Pharmaceuticals
• Surgery
• Diet, Exercise,
Stress
Management,
Psychology,
Biofeedback, etc.
Chronic Pain
• The International Association for the Study of
Pain (IASP) defines pain as “an unpleasant
sensory and emotional experience associated
with actual or potential tissue damage” *1
• Chronic pain is a unique to the individual
– The same issues, symptoms or findings can
cause significant chronic pain in one
individual, and little or none in another
• Chronic pain includes both sensory and
emotional experiences
*1 Classification of Chronic Pain, Second Edition, IASP
Internal vs. External Locus of
Control
• People who base their success on their
own work and believe they control their
life have an internal locus of control.*2
• In contrast, people who attribute their
success or failure to outside influences
have an external locus of control.*2
*2 http://education-portal.com/academy/lesson/locus-of-control-definition-andexamples-of-internal-and-external.html#lesson
Mind-Body Connection
• Each person is unique
• We need to remind ourselves
that pain is a symptom and
does not define the person
• Most individuals need to
rebuild/recreate their sense of
identity
• As long as the mind and body
are disconnected or in conflict
healing is limited or at a stand
still
Biofeedback/Behavioral
Therapy
BIOFEEDBACK DEFINITION
The following definition has been approved by:
• Association for Applied Psychophysiology
and Biofeedback (AAPB)
• Biofeedback Certification International
Alliance (BCIA)
• International Society for Neurofeedback and
Research (ISNR)
*3 http://www.aapb.org/
BIOFEEDBACK:
• Is a process that enables an individual
to learn how to change physiological
activity for the purposes of improving
health and performance. Precise
instruments measure physiological
activity such as brainwaves, heart
function, breathing, muscle activity,
and skin temperature. (Cont.) *3
Biofeedback Definition Cont.
• These instruments rapidly and
accurately "feed back" information to
the user. The presentation of this
information - often in conjunction with
changes in thinking, emotions, and
behavior -supports desired
physiological changes. Over time,
these changes can endure without
continued use of an instrument. *3
Biofeedback/Behavioral
Therapy
• Individuals learn to make behavioral
changes to increase desirable
responses and improve their physical,
emotional and mental health
• Educational with the focus on
increasing the individual’s internal locus
of control and reducing the unknown
• Develop a home program to work
toward life changes
Biofeedback & Chronic Pain
• Creates a window into the body/brain and
provides objective data
• Allows both the person receiving biofeedback
and the therapist awareness of:
• The body’s functional state: i.e. stressed,
tensed, relaxed, abnormal, symmetry
• Real time changes in the body: muscle
tension, brain waves, heart rate variability,
temperature, etc.
• Changes are tracked over time
Biofeedback & Chronic Pain
• Used to increase the person’s
body and mind awareness
• Increased awareness can allow
the person to make immediate
adjustments striving for optimal
results
Biofeedback & Chronic Pain
• Facilitate an increased internal
locus of control
• Decrease the unknown
• Develop self-sufficient coping
skills and auto-regulation
What Biofeedback Does Not Do
• Provide independent medical or
psychological diagnoses
• Using biofeedback equipment only is
not an optimum treatment
• It does not measure or show pain
• It is not a stand alone curative
treatment
• It does not cause change
Keys to Success:
• When engaging in Mind-Body
based treatment such as
biofeedback it is important to aid
the individual in identifying and
progressing through the following
six stages of recovery:
EXAMINE
RECOGNIZE
RESPONSIBILITY
CHANGE
ACCEPT
COMMIT
Biofeedback Techniques
•
•
•
•
•
•
Respiration Training
Surface Electromyography (sEMG):
Galvanic Skin Response (GSR)
Skin Temperature
Electroencephalogram (EEG)
Blood Volume Pulse (BVP):
• Heart Rate, Heart Rate Variability (HRV) &
Blood flow
Respiration Biofeedback
• Respiratory Belt:
Applied to mid-chest
and/or abdomen
• Respirations are
under both voluntary
and involuntary
control.
Surface Electromyography
(sEMG)
• sEMG
biofeedback is
most often used in
the treatment of
musculoskeletal
movement and
chronic pain
http://drepabst.com/site/faqs/
Dr. Eugénie Pabst, Psy.D.
Galvanic Skin Response (GSR)
• GSR monitors your
stress levels by
translating tiny
tension-related
changes in skin
pores
• The individual
learns to decrease
or increase the
feedback and thus
decrease stress
levels or increase
energy levels
Skin Temperature
• Temperature
biofeedback
empowers the
individual to learn
to increase and/or
decrease blood
flow into the
extremities to
facilitate healing
and self-regulation
Electroencephalogram (EEG):
AKA - Neurofeedback
• Neurofeedback (NFB),
also called neurotherapy or
neurobiofeedback, is a
type of biofeedback that
uses real-time displays of
electroencephalogram
(EEG) or
hemoencephalography
(HEG) to illustrate brain
activity and teach selfregulation. *4
BREATHING!
Linda Causey 2011, www.aperfectworld.org
Breathing Rate:
• Average 12 breaths per minute
(B/M)
• 20-24 B/M: Early stages of
hyperventilation
• 10<: Beginning of therapeutic
benefits
• 6 + or – 1: resonant frequency &
increased heart rate variability
Breathing Like Keys?
Even the smallest
difference is
important!
Breathing
Demonstration
Pain Disorder Warning Signs
Red Flags
• Consistently high pain complaints
• Pain complaints that get worse with
time
• Discontinues physical therapy
because it causes too much pain
• High level of narcotic use
• Family stress, separation, divorce
• Substance abuse (alcohol, drug, Rx)
Pain Disorder Warning Signs
Red Flags
• Consistently high pain complaints
• Pain complaints that get worse with
time
• Discontinues physical therapy
because it causes too much pain
• High level of narcotic use
• Family stress, separation, divorce
• Substance abuse (alcohol, drug, Rx)
MEDICATIONS
Red Flags
•
•
•
•
Limited activity level.
High levels of anger
Frequent pain behaviors
Overly solicitous or protective family
members
• Strong focus on finding out what is
wrong or on being fixed
• Doctor shopping
Red Flags
• History of trauma or abuse
• Job dissatisfaction
• Family members who are disabled or
receiving benefits from L&I or SSI.
• Legal involvement.
• Lack of social support
Working With Individuals Who
Have Chronic Pain
• Attempt to start by meeting the person
where he or she is at and then assist them
with change
• A good provider/patient relationship is
essential for a successful outcome
• Remember to track/measure changes
– This is just as important, if not more, for
the person struggling with chronic pain
to do
Working With Cont.
• Think multidisciplinary
–Explore referral options
–Build active
communication within the
treatment team
Finding A Quality
Biofeedback Specialist
• Recommend seeking providers who are
certified by the Biofeedback Certification
International Alliance (BCIA)
• The website has a “find a
practitioner” tool that
searches the globe:
– For a specific provider
– By country, state or x-miles
within a zip code
•
http://www.bcia.org
Biofeedback
Demonstration
sEMG of Bilateral Upper Trapezuis Muscles
Shrug
Flex.
Rest
AB/AD
Relax
Rest
Relax-2
Rest
Rest
Post Assessment
Shrug
Flex.
AB/AD
Cued to “Relax”
Relax
REFERENCES:
1.
"Part III: Pain Terms, A Current List with Definitions and Notes on
Usage" (pp 209-214) Classification of Chronic Pain, Second Edition,
IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk,
IASP Press, Seattle, ©1994.
2.
Education Portal. Available at: http://educationportal.com/academy/lesson/locus-of-control-definition-andexamples-of-internal-and-external.html#lesson /. Accessed May 17,
2014.
3.
Dictionary.com. relaxation. (n.d.). The American Heritage® Stedman's
Medical Dictionary.
http://dictionary.reference.com/browse/relaxation. Accessed May
17, 2014.
4.
Wikipedia. Neurofeedback. Wikimedia Foundation, Inc. Available at:
http://en.wikipedia.org/wiki/Neurofeedback. Accessed May 18,
2014.