Specific Biofeedback Applications
There are numerous conditions for which biofeedback can be useful. In the following section, several key application areas are treated in depth. One of the largest areas of application has been to management of pain and stress, whereas for neurofeedback the primary areas of application are to ADHD, seizures, head trauma, and addictions.

Biofeedback for Stress Management
There are many ways to accomplish stress management. There are courses offered in every community, either privately or in community colleges and churches. There are meditation tapes with music, verbal phrases, subliminal phrases, binaural beats available in every store and library. Recently, the health insurance companies have begun to add alternative classes to their clients. These can vary from exercises, yoga, organization techniques, relaxation skills, imagery tools, self-hypnosis, etc. These are usually very excellent ways to learn how to make lifestyle changes appropriate to mild or moderate levels of stress. The goal is prevention of more stress- related diseases or to learn management of problems such as headaches, gastric distress, irritable bowel, chronic muscle spasm, hypertension, etc.

Biofeedback for Anxiety and Panic
Traditional and neurofeedback techniques can be extremely helpful with anxiety. The anxiety response is another way in which a stressed nervous system can overreact. Of course there is also a normal anxiety response. The difficulty comes when the anxiety becomes chronic and habitual. A related phenomenon is panic reaction, in which there is a strong nervous system overreaction to a particular event or situation, and this overreaction becomes learned, possibly even becoming uncoupled from particular triggers. Often, anxiety and panic can be caused or accelerated by poor breathing. The calming effects of conventional biofeedback techniques can be quite helpful in mastering anxiety conditions, whereas neurofeedback can often be quickly helpful in stabilizing a nervous system so that it no longer makes excursions into panic. Anxiety disorders are among the most common referrals for biofeedback.

Biofeedback for Pain Management
Biofeedback has become well known for its role in pain management. The degree to which it is effective depends on the severity of the symptom, in combination with the dedication of the individual and the body's receptivity to the learning process. The measurement of the arousal or relaxation of the body through feedback gives a guide to the individual as to his progress. All kinds of biofeedback are helpful here, with different techniques being particularly appropriate for various kinds of pain. For example, using EMG to measure the state of tension in muscles can guide the person as he works with a chronic muscle condition such as back or neck problems. The additional measures of temperature and GSR give an indication of the effectiveness of the relaxation. For instance, "relaxing" on the couch watching TV may still leave your hands cold, which indicates that the body has not reached a deep enough state of relaxation or homeostasis..

One’s psychological state influences the pain sensitivity directly. Fear and anxiety can heighten one’s pain sensitivity. One of the manifestations of the anxiety response is shallow breathing. For example, if one has rapid or shallow breathing, has long pauses in breathing or hyperventilates, the oxygen-carbon dioxide ratios in the blood are affected and thereby cause increases in pain or at least cause a decrease in personal pain management. Therefore another part of good biofeedback training is through breath training.

Brainwave biofeedback appears to be effective in addressing the mechanism of pain originating within the nervous system itself. This includes chronic pain attributable to errors in pain threshold, to nerve pain, and to migraines. In this regard, it should be recognized that pain is not an absolute quantity like blood oxygen level. Rather, pain is what the central nervous system calls pain. Pain relief may be little more than getting the pain system regulated again. Such regulation may require us to focus on other systems that are disregulated, beyond the pain system itself.

There are many kinds of pain, ranging from minor to conditions so severe that the person considers suicide. They all can be helped with self-regulation techniques. Headaches are an example of how pain can be helped by biofeedback. Below is a multi-faceted program that has been used successfully.

Vulvar Pain (Vulvadynia)

This particular pain is singled out by the authors because so few people recognize that there can be relief.

Vulvadynia is part of a multi-dimensional connective tissue disorder. Usually women with this condition have generalized vulvar skin pain and discomfort, including pain and/or itching, stinging, parchedness, drying, swelling, and drawing sensations all over the vulvar skin, or only certain parts of it, as well as in the rectal, or anal skin. It is characteristically a burning pain that usually occurs primarily in response to pressure or stretching. There may be urological symptoms, deep boring or piercing pain, or shooting pain across the buttocks. Vestibulitis is one particular type of vulvar pain referring to pain in the entrance to the vagina.

What to do?

Currently, there is a regimen of treatment that provides relief. This can include specific medications (i.e., Guaifenesin), estrogen cream, calcium citrate, dietary changes (low oxalate diet), relaxation, and biofeedback.

The Pain Project - a research and treatment project headed by Dr. Clive Solomons, in Denver, Colorado - has since 1986 treated over 2000 women. The key to this care has been the testing of urine for the individual’s abnormal oxalate excretion pattern within the 24 hours. Of those who have abnormal levels, the women who take calcium citrate in advance of their daily surges of oxalate excretion experience pain reduction. The low oxalate diet, combined with timed calcium citrate, usually produces significant relief in symptoms (burning, itching, swelling, hypersensitivity, and urinary urgency and frequency). It usually is the most effective when used in conjunction with other treatments as recommended by a Vulvar Pain specialist. A Low Oxalate Cookbook is now available (see Vulvar Pain Foundation listed below).

The obstetrics and gynecology clinic at Scripps in La Jolla, California endorses this program and refers all patients for biofeedback evaluation of the pelvic floor muscles. There is always bracing in reaction to the pain. Rehabilitating the muscles is critical in resolving pain when muscle spasms are present. Kegel exercises done with biofeedback instrumentation (described below under incontinence), is one major part of this treatment plan. The exercises are prescribed incrementally to teach relaxation of the spasmed or bracing muscles, and must be continued at home. Relaxation exercises are also an important piece of the treatment and healing imagery is included and should be specifically designed for each patient. These exercises must be done regularly to be effective.

Vulvar Pain Foundation - As with many other kinds of pain, there is a very well organized group who provides support nationally to sufferers of vulvar pain. There are support groups, networking organizations, lectures, and monthly newsletters (see resources below).

Biofeedback for Incontinence

It is not possible to discuss every condition successfully treated with biofeedback. However, incontinence represents one of the prominent applications, and also one of the most successful. It therefore deserves special mention. As well, it is one of the diagnoses using biofeedback that is usually covered by insurance.

Incontinence is the involuntary loss of bladder or bowel control. It is a major clinical problem and a significant cause of disability and dependence. Urinary incontinence, for example, affects all age groups and is particularly common in the elderly. More than 75% of urinary incontinence sufferers are women. The most recent survey indicates that at least 10 million Americans suffer from urinary incontinence and the average incontinent person spends $900 for adult diapers and other products with a total national treatment expenditure of some $10 billion. These include medical costs for care of persons in the community and in nursing homes. Indirect costs such as loss of income from inability to work, or cost of home care, were difficult to estimate.

There are four types of urinary incontinence. They include stress incontinence, urge incontinence, overflow incontinence, and reflex incontinence. In addition, there is fecal (stool) incontinence, for which no subtypes have yet been identified. Incontinence is a symptom of some other disorder and is not a disease itself. It can occur for many reasons such as loss of muscle control due to aging, childbirth, bladder infection, side effects of medication, spinal cord injury, prostate and/or other surgery, overweight conditions,, nervous system disorders (such as Multiple Sclerosis) and diabetes.

Despite its prevalence and implications people often do not report urinary incontinence and often physicians do not treat it comprehensively. Most forms can be cured or significantly improved. Biofeedback is used very successfully and should be considered before surgery.

What to do!

The first thing to do is acknowledge the problem and have it checked out by a professional. There is help available. One way of helping the problem is through biofeedback-assisted muscle re-education. This has no side effects and no contra-indications. However it is important to have a thorough medical examination before biofeedback when incontinence is at issue.

What to expect with biofeedback

You are initially evaluated for pelvic floor muscle activity and strength with a sensor (periometer). You are shown how your pelvic floor muscles work and how to do a series of "Kegel exercises." These muscle strengthening exercises, which help control the leakage of urine and stool, are initially practiced with the sensor in place, which gives feedback on a monitor as to your muscle activity and strength. You will be sent home with pelvic muscle exercises that will increase in difficulty weekly. Probably, you will rent a portable biofeedback device to assist you in the initial weeks. As well, it will be necessary to keep a diary of bladder and bowel activity and it will include dietary intake.

How much you improve depends on how much time you devote to the exercises, how well you learn to do them properly, and your own unique physical situation. The training will require, at a minimum, three to six office visits and eight weeks of home training.

Self-help for urinary incontinence

If you have a mild problem and you have checked with your doctor, then you can often help the problem by practicing Kegels yourself. Many women have been taught these before and after childbirth. The motion consists of contracting your pelvic floor muscles as if you were going to stop the flow of urine. You must be careful not to use any other muscles such as your abdomen, buttocks or thigh muscles.

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