PORTLAND, OR – Biofeedback can be a helpful treatment for headache pain, as well as possibly other conditions such as urinary and fecal incontinence.

The technique also might aid in stroke recovery, according to a literature review by a team at the VA Portland, OR, Healthcare System and Oregon Health & Science University.

“We are encouraged by the positive findings and the additional findings of potential benefits for a wide range of conditions,” explained first author Karli Kondo, PhD, of the VA Evidence Synthesis Program and OHSU. “Biofeedback is a low-risk, cost-effective intervention. We hope that this report will help to make biofeedback more widely available to veterans across the U.S., and that it will serve as a roadmap for future research in the field.”

Results of the study were published online by the Journal of General Internal Medicine.1

The article pointed out, “Biofeedback is increasingly used to treat clinical conditions in a wide range of settings; however, evidence supporting its use remains unclear. The purpose of this evidence map is to illustrate the conditions supported by controlled trials, those that are not, and those in need of more research.”

The authors searched multiple data sources — MEDLINE, PsycINFO, CINAHL, Epistemonikos, and EBM Reviews through September 2018– for good-quality systematic reviews examining biofeedback for clinical condition. Included were highest quality, most recent review representing each condition, according to the researchers, who added that they included only controlled trials from those reviews.

Relying on quality ratings reported in included reviews, the study focused on outcomes of interest, such as condition-specific, secondary, global health outcomes, and harms.

Analyzed were 16 good-quality systematic reviews examining biofeedback alone or as an adjunctive intervention.

“We found clear, consistent evidence across a large number of trials that biofeedback can reduce headache pain and can provide benefit as adjunctive therapy to men experiencing urinary incontinence after a prostatectomy,” the authors wrote. “Consistent evidence across fewer trials suggests biofeedback may improve fecal incontinence and stroke recovery.”

The researchers found, however, that there is insufficient evidence to draw conclusions about effects for most conditions, including bruxism, labor pain, and Raynaud’s.

In addition, biofeedback was found to not be beneficial for urinary incontinence in women, nor for hypertension management, although those conclusions were limited by small sample sizes and methodologic limitations of these studies.

The authors called for further controlled trials across a wide range of conditions.

Biofeedback increasingly is being used as a complementary or alternative treatment for a wide range of conditions. In 2017, about 70 VA facilities reported offering some form of biofeedback, according to background information in the article.

The researchers point out that their evidence map can help pinpoint areas of uncertainty where more research is needed, including balance and gait training, fibromyalgia, and intradialytic hypotension.

1.    Kondo K, Noonan KM, Freeman M, Ayers C, Morasco BJ, Kansagara D. Efficacy of Biofeedback for Medical Conditions: an Evidence Map. J Gen Intern Med. 2019 Dec;34(12):2883-2893. doi: 10.1007/s11606-019-05215-z. Epub 2019 Aug 14. Review.  PubMed PMID: 31414354; PubMed Central PMCID: PMC6854143.