Biofeedback for CRPS: Why Haven't I Tried That?
By Kenneth R. Lofland, PhD
CRPS is a painful disorder that continues to challenge
the medical community. The cause, course, treatment, and outcomes
are highly variable and remain a source of vigorous debate
among the brightest professionals specializing in chronic
Biofeedback is a non-drug intervention that is used to treat
patients with a variety of medical conditions. Taken simply,
biofeedback can be defined by breaking down the word as "bio,"
referring to the body, and "feedback," receiving
information about the body, that one would ordinarily not
be aware of. A simple example of how biofeedback can work
is the case of a patient with poor circulation to the extremities,
often referred to as Raynaud's disease. When this disorder
is severe, coldness, pain, and poor healing results in the
extremities due to decreased blood flow. It can increase the
risk of frostbite and minor cuts to fingers or toes becoming
infected, not healing properly, and even requiring amputation.
Improving blood flow to the extremities through thermal biofeedback
is one of the most effective treatments for this condition.
How does biofeedback work?
Although it sounds amazing that anyone can learn to alter
blood flow, it is actually quite easy to learn. We all have
a "flight or flight response." If I am to give a
presentation in front of 500 people, I will notice my hands
get cold and clammy. When physical or psychological stress
occurs, our bodies instantly secrete adrenaline, our breathing
rate changes, our blood pressure increases, our heart rate
increases, and our blood flows away from the periphery toward
the core of our body, thus the cold, clammy hands. When the
stressor is over, our bodies relax and these physiological
responses reverse. Learning deep relaxation techniques, in
combination with receiving feedback from machines measuring
small changes in temperature, can advance this process and
allow the blood vessels to dilate (open up) even more, allowing
more blood to flow out to the periphery. So in the case of
the Raynaud's sufferer, learning deep relaxation techniques
and biofeedback allows for increased blood flow to his or
her hands. This improved circulation increases hand temperature
to normal levels, decreases pain, and improves the body's
ability to heal any cuts or injuries naturally.
How can biofeedback help my CRPS?
Changes in blood flow often accompany CRPS. Learning deep
relaxation techniques can be paired with a biofeedback device
which measures skin temperature in order to help a CRPS sufferer
learn to relax deeply, increase blood flow to a part of the
body with a restriction in blood flow, increase the temperature
of that part of the body, and decrease the pain.
What does the science say?
Biofeedback has not been subjected to the same level of scientific
scrutiny as many medications. More, larger scale, and better
controlled research studies are needed in this area, as is
funding to support this type of research. Several studies
have been done evaluating biofeedback for pain and found positive
effects. For example, Grunert et al (1990), found that 20
patients with documented CRPS for 18 to 60 months and
who failed to respond to a variety of treatments underwent
thermal biofeedback with relaxation training as a part of
counseling treatment. The results found that patients were
able to significantly increase their blood flow and significantly
decrease their pain levels (p<.0001). This pain reduction
was maintained at 1-year follow-up assessment and 14 of the
20 patients had returned to work. The conclusion was that
this intervention was effective to reduce pain in CRPS/RSD
for the long term, even in patients who had failed prior treatments.
Multiple other case studies exist but I reiterate that additional
well-controlled treatment outcome studies are needed with
larger sample sizes.
As a clinician I am very enthusiastic about the use of thermal
biofeedback for the treatment of CRPS. Specific sources
for this enthusiasm include:
1. The number of case reports
indicating successful outcomes, even in cases where other
treatments have not helped the CRPS patient (see above)
2. The common sense aspect that at least one hallmark symptom
of CRPS, namely decreased blood flow and temperature in
the affected area of the body, can be reversed with thermal
3. My own clinical experiences, which have demonstrated
positive results using thermal biofeedback with CRPS sufferers
4. It is one of the few treatments in medicine that has
essentially no known negative side effects. There are very
few other treatments available to chronic pain sufferers with
no negative side effects.
How do I find a biofeedback provider?
First, some caution must be taken when identifying a biofeedback
provider. While being a licensed clinical psychologist requires
a specific doctoral degree and a license, and being a licensed
physician requires a specific medical degree and a license,
being a biofeedback therapist does not require a specific
degree or license. Therefore, practitioners at much different
levels of training and experience may be presenting themselves
as biofeedback therapists. It is always best to ask a prospective
provider to tell you about his or her training in general,
specific training in biofeedback, and what conditions he or
she specializes in when treating with biofeedback. Knowing
the individual's level of training, specialization, office
practices, etc., can make you a more informed client.
Several states have biofeedback societies with web sites,
such as the one in Illinois www.biofeedbacksocietyil.org.
These sites generally have a list of practitioners that are
members of the state biofeedback society. Membership in these
organizations does not indicate any level of training or expertise.
However, health care professionals with an interest in biofeedback
can be found there.
Also, a national organization exists,
the Biofeedback Certification Institute of America (BCIA) that certifies some individuals who chose to
learn biofeedback through this particular organization. Being
a member of this organization does indicate a certain basic
level of biofeedback training, but it does not guarantee the
degree to which a provider has specialized or the amount of
experience a provider has had. Further, not being certified
by this organization does not indicate a lack of training
or experience of those who may have gotten trained via other
routes, such as in graduate school.
1. Grunert, BK, Devine, CA, Sanger, JR, Matloub, HS, Green,
D. (1990). Thermal self-regulation for pain control in reflex
sympathetic dystrophy syndrome. Journal of Hand Surgery. 1990;
July 15(4): 615-618.
Dr. Lofland is the Director of Pain Studies and the Director
of Psychological Services at the Pain and Rehabilitation Clinic
of Chicago. He is past President of the Biofeedback Society
of Illinois and the current President of the Midwest Pain
Society. He is both a dedicated clinician, treating individuals
with pain syndromes such as CRPS, and an active scientist,
researching the most effective treatments for many chronic
pain syndromes. He can be reached for follow-up questions