Chronic Pain Management with Relaxation Training and Biofeedback

`Chronic Pain Disorders`
	Assessment of condition
		Overview If you have been suffering from chronic pain for any length of time, you have realized that that most effective way of treating your condition may be by consulting with clinicians representing many different types of healthcare specialties. Family physicians, internal medicine specialists, anesthesiologists, neurologists, psychiatrists, physiatrists, psychologists, pharamacologists, physical therapists, chiropractors, exercise physiologists, and other specialists may all have something to contribute to helping you to manage, lessen, and sometimes eliminate your pain. Patients referred to the Advanced Biofeedback Center typically have seen one or more of these specialists, and the purpose is often to empower the patient to harness skills and abilities that he or she did not even know were present! By the time that the biofeedback therapist is called for a consultation, the referring doctors begin to honor the notion that the patients must be actively involved in their improvement rather than a passive recipient of medication, surgery, or therapy. Sensors EMG biofeedback may be utilized initially to determine if you are unknowingly tensing certain muscles that contributing to your pain. Therefore, non-invasive, skin surface EMG sensors may be placed directly over the muscle or muscles that may be too tense. If your doctor feels that blood circulation is a problem, as in certain conditions like RSD (Reflex Sympathetic Dystrophy) or its newly conceptualized term "CRPS" (Complex Regional Pain Syndrome), thermal biofeedback may be helpful. A thermistor might be taped to your ankle, knee, toe, or finger. If you learn diaphragmatic breathing techniques (also called "abdominal breathing" or sometimes "yoga breathing" or "belly breathing"), your pain may be somewhat more manageable. Therefore, respiration biofeedback and heart rate variability biofeedback may be considered. Sensors may be gently placed on your index finger or around your abdomen. EEG biofeedback ("neurofeedback") may also be considered. You may be trained in that type of skill using non-invasive, comfortable, gold-plated EEG sensors. Where sensors are placed Depending upon the nature of the chronic pain, sensors may be placed over or near the are of the body that appears to be affected. If neurofeedback is thought to be helpful, then EEG sensors will be placed on your head.
	Behavioral intervention
		Learning and behavioral change If you wish to have your chronic pain treated effectively, you must begin by embracing the biopsychosocial model of health and illness. You must allow your treating physicians, therapists, and behavioral health therapists work together to design the best treatment regimen for you. You are also an important part of the treatment team! Health care personnal should not be viewed as people who "do something to you" to "make you better." Instead, you must see your active involvement in treatment and behavioral change as the "key" to your improvement. Can any health care professional guarantee that you will be "cured" of your pain, that your pain will entirely disappear? Probably not. By working with all members of your pain management team and by considering all of the factors that make your pain worse and those that can somewhat lessen your pain, can you learn to manage your pain better? Probably, yes! But you must accept the physical/medical, psychological/behavioral, and social/relationship issues that might be helping or hindering your ability to manage your pain. Biofeedback may be one component, but your clinician may also need to provide psychological counseling as well, depending upon your unique needs. There are some neurofeedback practitioners who encourage patients suffering from chronic pain to achieve extremely deep meditation, typically in the Theta range (that is, approximately 4 - 7 Hz [Hertz, or cycles per second]). The production of Theta wave activity has been likened to very deep meditation. Some people also liken this deep meditative state to "self-hypnosis." No matter how you may wish to view "Theta," many clinicians feel that Theta wave activity is the "great pain fighter." You may be recommended for Alpha-Theta training, a type of neurofeedback that allows you to achieve rather deep relaxation. Some people report "out of body experiences," feelings of great peace, and reduction of pain symptoms. Number of sessions Chronic pain treatment is a very "vexing" and complicated process. Because you are unique in your reaction to pain and your pain tolerance, there is no way of predicting how many sessions would be necessary to bring some initial relief. Pain syndromes associated with neurological issues may be quite different than those associated with orthopedic or oncological disorders. After beginning biofeedback training and attending a sufficient number of sessions, you can begin to determine if you may benefit and how many sessions will be necessary to obtain optimal benefit.
	Change in behavior Goals It is likely that your ultimate goal would be total eradication or elimination of the chronic pain. If that does not appear to be possible, then you may accept a lessening of the pain. A third choice --- perhaps objectively not the most desirable, but nonetheless accepted by many chronic pain patients --- is "learning to live with the pain." Among many techniques to achieve "pain management" is learning to distract yourself from the pain by immersing yourself in activities in which the focus is no longer on your own pain.

Advanced Biofeedback Center