Efficacy of biofeedback in chronic back pain: a meta-analysis

Sielski, Robert; Rief, Winfried; Glombiewski, Julia Anna

doi:10.1007/s12529-016-9572-9

Cited by 143Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Mechanisms and Treatments

Efficacy of biofeedback in chronic back pain: a meta-analysis

Sielski, Robert, Rief, Winfried, Glombiewski, Julia Anna·2017·International Journal of Behavioral Medicine

DOI 10.1007/s12529-016-9572-9

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Abstract

Purpose The aims of the present analysis were to investigate the short- and long-term efficacy and treatment moderators of biofeedback as a psychological treatment option for chronic back pain. Method A literature search using PubMed, PsycINFO, and the Cochrane Library identified 21 eligible studies including 23 treatment conditions and 1062 patients. Results Meta-analytic integration resulted in a significant small-to-medium effect size for pain intensity reduction (Hedges' g = 0.60; 95 % confidence interval (CI) 0.44, 0.76) that proved to be stable with a significant small-to-large effect size (Hedges' g = 0.62; 95 % CI 0.40, 0.84) over an average follow-up phase of 8 months. Biofeedback also proved to be effective in reducing depression (Hedges' g = 0.40; 95 % CI 0.27, 0.52), disability (Hedges' g = 0.49; 95 % CI 0.34, 0.74), reduction of muscle tension (EMG; Hedges' g = 0.44; 95 % CI 0.22, 0.65), and improving cognitive coping (Hedges' g = 0.41; 95 % CI 0.26, 0.57). These effects remained comparatively stable at follow-up and for controlled studies only. Moderator analyses revealed longer biofeedback treatments to be more effective for reducing disability and a greater proportion of biofeedback in the treatment to be more effective for reducing depression. Publication bias analyses demonstrated the consistency of these effects. Conclusion It is concluded that biofeedback treatment can lead to improvements on various pain-related outcomes in the short and long terms, both…

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For BT, the review's findings differ from other reviews; for example, a recent non-Cochrane review of biofeedback in chronic back pain included 21 studies (none included in this review), did not exclude non-randomised or non-inferiority studies, calculated effects of treatment, had no inclusion criteria based on size of trial or credibility of therapy content (Sielski 2017), and reported very阳性?
“For BT, our findings diFer from other reviews. For example, a recent non-Cochrane review of biofeedback in chronic back pain included 21 studies (none included in this review); the authors did not exclude non-randomised or non-inferiority studies; they calculated eFects of treatment; and they had no inclusion criteria based on size of trial or the credibility of the therapy content (Sielski 2017).”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Sielski 2017

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Cheng, Z., Ly, F. S., Santander, T., Turki, E., Zhao, Y., Yoo, J., Lonergan, K., Gray, J., Li, C., Yang, H. T., et al. (2022) · PAIN Reports · doi:10.1097/pr9.0000000000001039 · Cited by 3 · see citing works
Biofeedback
Schwartz, M. S. (2018) · InTech eBooks · doi:10.5772/intechopen.71738 · Cited by 6 · see citing works
“Sielski (2017) published a SR evaluating the impact of biofeedback for chronic back pain.[23] Twenty-one studies met all inclusion criteria, one of which had to be biofeedback at least 25% of the time.”
Evaluating the effectiveness of integrating biofeedback in the treatment of aggressive outbursts (BRET-IA2): A study protocol
Molina-Cantero, A. J., Rojas-Pérez, I., de Terreros-Guardiola, M. G., Gómez-González, I., Vidosa-Batllés, J. C., Bermejo-González, T. D. J., & Merino-Monge, M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0327361 · Cited by 2 · see citing works
“Other biofeedback methods have included the use of electromyography (EMG) to allow managing pain conditions sucessfully [29].”
Contemporary Approaches to Multidisciplinary Pain Management
Gross, J. B., Stacey, B. R., & Stanos, S. P. (2025) · Neurologic Clinics · doi:10.1016/j.ncl.2025.04.006 · Cited by 2 · see citing works
Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale
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Home-Use and Portable Biofeedback Lowers Anxiety and Pain in Chronic Pain Subjects
Ly, F. S., Santander, T., Pavlov, S., Zhao, J., Zhang, M., Arroyo, D., Sokolovskiy, S., Iyer, A., Yankauskas, Y., Chen, J. L., et al. (2023) · American Journal of Lifestyle Medicine · doi:10.1177/15598276231221112 · Cited by 3 · see citing works
Application of Patient-Reported Outcomes in Back Pain in Adults: Part 1
Trefilova, V., Shnayder, N., Novitsky, M., Ovdienko, O. A., & Nurgaliev, Z. A. (2022) · Personalized Psychiatry and Neurology · doi:10.52667/2712-9179-2022-2-2-34-46 · Cited by 2 · see citing works
Biofeedback in sport and education
Liparoti, M., & Lopez, E. T. (2021) · Winter Conferences of Sports Science · doi:10.14198/jhse.2021.16.proc3.09 · Cited by 6 · see citing works
“…on a condition of a purely mental nature such as anxiety states, it can also be applied directly to the physical component, as in cases of health prevention and rehabilitation and motor re-education (Hsu et al., 2012; Polverino et al., 2020; Pourmomeny et al., 2014; Sielski et al., 2017).”
Background
Biofeedback: Its function, effects on organism and utility in sports sciences
Çelik, E., & Sarı, İ. (2021) · Spor Hekimligi Dergisi · doi:10.47447/tjsm.0566 · Cited by 2 · see citing works
Psychotherapie in der interdisziplinären multimodalen Schmerztherapie: Update
Müller, M., & Bräscher, A.-K. (2020) · AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie · doi:10.1055/a-1022-3051 · Cited by 2 · see citing works
“D Die Wirksamkeit von IMST bei chronischem Rückenschmerz ist durch Metaanalysen belegt.”
BackgroundInfluential
The Effects of Acceptance and Commitment Therapy and Biofeedback on Chronic Psychosomatic Low Back Pain
Mousavi, S. M., Shabahang, R., & Khodadadi-Hassankiadeh, N. (2019) · Caspian Journal of Neurological Sciences · doi:10.32598/cjns.5.18.118 · Cited by 2 · see citing works
“This method is used to manage LBP, headache, anxiety disorders, muscular injuries, and urinary incontinence [14].”
BackgroundMethod
The Effects of Intentional Abdominal Muscle Contraction Through Real-Time Feedback on Sensed Changes in Waist Circumference on Pain, Functional Capacity and Neuromuscular Control in Adults With Lumbar Spinal Stenosis
Seong, J.-H., Kim, C.-B., & Choi, J.-D. (2018) · Physical Therapy Korea · doi:10.12674/ptk.2018.25.1.001 · Cited by 2 · see citing works
A Dual Control Approach to Solve Exploration Versus Exploitation Trade-Offs in the Design of Personalized Physical Exercise Sessions
Jackson, R. R., Varagnolo, D., & Knorn, S. (2023) · IEEE Control Systems Letters · doi:10.1109/lcsys.2023.3287138 · Cited by 1 · see citing works
“This approach has become an effective tool in the treatment of stress and anxiety-related disorders [2] as well as chronic pain [3], irritable bowel syndrome [4], and incontinence [5].”
The Process of Developing Technological Solutions for Healthcare
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Psychological Methods of Chronic Non-Speciﬁc Pain Treatment
Kuzminova, T. I., Mukhametzyanova, A., & Magomedkerimova, L. V. (2020) · Russian neurological Journal · doi:10.30629/2658-7947-2020-25-2-12-21 · Cited by 1 · see citing works
CoBreath: Designing a VR-Based Dyadic Biofeedback System to Support Breathing Exercise for Breast Cancer Survivors
Wang, Q., Yan, Y., Fang, S., An, Q., Luo, X., Jia, J., & Yu, B. (2026) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3772318.3791096
“As a stress management tool [53, 119], biofeedback has been widely applied across domains such as sports, cognitive performance, chronic pain, headaches, anxiety, and depression [61, 80, 100, 110], and more recently for managing physical symptoms among cancer survivors [36].”
Evaluating a Group-Based Temperature Biofeedback and Pain Education Intervention: Preliminary Report on Effects on Peripheral Temperature and Pain Outcomes
Penman, J. C., Flegge, L. G., Bogdan, K. M., & Bushey, M. A. (2025) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-025-09740-y · Cited by 1 · see citing works
Evaluating Player Stress and Motivation Through Biofeedback-Controlled Dynamic Difficulty Adjustment
Oner, A., & Kucukkulahli, E. (2025) · Electronics · doi:10.3390/electronics14193870 · Cited by 1 · see citing works
Biofeedback in complex therapy of pain syndromes
Raevskaya, A., Vyshlova, I., Mnatsakanyan, G., & Karpov, S. (2025) · Russian Journal of Pain · doi:10.17116/pain20252302170 · Cited by 1 · see citing works
Complementary and integrative health approaches used for pain management by U.S. adults with chronic fatigue syndrome/myalgic encephalomyelitis: Findings from the 2022 National Health Interview Survey
Adamowicz, J. L., Sirotiak, Z., Thomas, E. B. K., Lund, B. C., Hadlandsmyth, K., & Driscoll, M. (2025) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2025.102443 · Cited by 1 · see citing works
Going Beyond Medications for Chronic Pain: Exploring the Alternatives
Patidar, S. M., LaRowe, L. R., Goetzinger, A. M., & Margolies, S. O. (2025) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/23727322241307834 · Cited by 1 · see citing works
Reinforcement Learning for Exploration vs. Exploitation Problems in Medical Exercise Sessions
Jackson, R. R., Varagnolo, D., & Knorn, S. (2024) · Australian & New Zealand Control Conference (ANZCC) · doi:10.1109/anzcc59813.2024.10432847
“…the patient’s behaviour through visual, tactile, or auditory cues, [1], and it has proven to be a non-invasive and effective tool in the treatment of chronic pain, anxiety disorders, irritable bowel syndrome, incontinence, and, recently, in personalising training for aerobic fitness, see [2]–[6].”
Background
Application of Patient-Reported Outcomes in Back Pain in Adults: Part 2
Trefilova, V., Shnayder, N., Novitsky, M., Ovdienko, O. A., & Nurgaliev, Z. A. (2023) · Personalized Psychiatry and Neurology · doi:10.52667/2712-9179-2023-3-1-7-21 · Cited by 1
“In recent years, chronic BP has received much attention both in domestic [5,6,7,8] and foreign [9,10,11,12] literature.”
Background
Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers
Edwards, K. A., Reed, D. E., Anderson, D. R., Harding, K. A., Turner, A. P., Soares, B., Suri, P., & Williams, R. M. (2023) · PM&R · doi:10.1002/pmrj.12912 · Cited by 2 · see citing works
“Biofeedback interventions that were combined with physical therapy or CBT demonstrated better outcomes compared to standard biofeedback programs, although treatments with a greater proportion of biofeedback were associated with greater reductions in depression.(104) Preliminary results from a meta-analysis examining t…”
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Women and Chronic Pain: Understanding the challenges and empowering for change
Hill, J. C., & Harrell, L. S. (2020) · Journal of Feminist Family Therapy · doi:10.1080/08952833.2020.1755168 · Cited by 1 · see citing works
Physiological aspects of non-pharmacological treatment of musculoskeletal pain syndrome
Sorokina, N. D., Pertsov, S., Selitsky, G. V., Korpan, M., & Savin, L. A. (2023) · Russian Journal of Pain · doi:10.17116/pain20232104149 · Cited by 1 · see citing works
Nonpharmacological Control of Pain
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Use of Complementary and Integrative Health for Chronic Pain Management
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PSYCHOLOGICAL METHODS OF CHRONIC MUSCULOSKELETAL PAIN THERAPY: A CONTEMPORARY PERSPECTIVE ON THE BIOPSYCHOSOCIAL MODEL AND EVIDENCE-BASED INTERVENTIONS
Osipov, V. (2026) · Ukrains'kyi Visnyk Psykhonevrolohii · doi:10.36927/2079-0325-v34-is3-2026-14
Comparing the Effect of Written and Biofeedback Device‐Guided Breathing Exercises on the Severity of Irritable Bowel Syndrome Symptoms
Chakraborty, S. (2026) · Lifestyle Medicine · doi:10.1002/lim2.70069
“In patients with chronic pain, both written biofeedback and DGB improved pain but DGB was suggested as offering greater patient engagement and ease of use [ 55 ].”
Feasibility and Acceptability of a Virtual Single-Session Biofeedback Intervention Targeting Circulation, Heart Rate, and Anxiety for Rural Patients With Chronic Pain
Flegge, L. G., Penman, J. C., Tracy, C., & Bushey, M. A. (2026) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130261456244
“5 Systematic reviews further highlight its benefits, including reductions in depression, disability, and muscle tension, positioning bio-feedback as a valuable adjunct to traditional pain management.”
Beliefs about non-pharmacological treatment for chronic pain among non-treatment seeking Veterans who are prescribed opioids
Rodriguez, T. R., Monahan, Z., Cho, G. Y., Allan, N. P., Brown, D. G., Ashrafioun, L., & Stecker, T. A. (2026) · Journal of Health Psychology · doi:10.1177/13591053261448990
Mental Health: The Invisible Challenge and the Opportunity.
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Regional, multimodal, and opioid-sparing strategies after trauma: a review
Hancin, E., Patel, P., & Egodage, T. (2026) · Trauma Surgery & Acute Care Open · doi:10.1136/tsaco-2026-002273
Limited evidence examining visual feedback in rehabilitation for generalised knee pain: a scoping review and call for further research
Klausing, M. R., Junk, J., & Subialka, J. A. (2026) · Advances in Rehabilitation · doi:10.2478/advrehab-2026-0003
Benefits and side effects of rehabilitation therapies used for patients with chronic non-specific low back pain
Son, Е. А., & Isaikin, A. I. (2026) · Реабилитология. · doi:10.17749/2949-5873/rehabil.2025.44
Single-Session Group Breathwork Intervention for Chronic Pain: A Proof-of-Concept Study of Guided Respiration Mindfulness Therapy
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Cannabis Use Frequency is Associated with Emotion Dysregulation Among Persons Receiving Long-Term Opioid Therapy for Chronic Pain: A Psychophysiological Study
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Analysing the Optimum Number of Cupping Points for Selected Diseases by Utilising Graph Colouring
Aziz, N. A., Yusof, Y., Radzuan, H. M., Sulaiman, W. A. W., & Noviantri, V. (2025) · Journal of Advanced Research in Applied Sciences and Engineering Technology · doi:10.37934/araset.65.1.168184
“First disease that will be discuss in this paper is chronic back pain leads to physical, psychological, and economical impact, as well as a high consumption of medications and medical services as mention by Sielski et al., [13] and Gore et al. , [14].”
Rehabilitation of athletes with neurological disorders
Nikulenkova, Y. V., & Grigoreva, K. (2025) · Journal of Medical Rehabilitation · doi:10.17749/2949-5873/rehabil.2024.28
ПРИМЕНЕНИЕ ПАРАМЕТРИЧЕСКИХ И ОПРОСНИКОВЫХ МЕТОДОВ ИССЛЕДОВАНИЯ ДИСКОГЕНННОГО БОЛЕВОГО СИНДРОМА У ВЗРОСЛЫХ
Трефилова, В. В., & Шнайдер, Н. А. (2023) · Вестник Северо-Восточного федерального университета имени М.К. Аммосова. Серия: Медицинские науки · doi:10.25587/svfu.2023.50.14.006

Authors: Sielski, R., Rief, W., & Glombiewski, J. A.
Affiliations: Philipps University of Marburg (DE)
Corresponding author: Sielski, Robert
ORCID: Rief, Winfried
Glombiewski, Julia Anna
Venue: International Journal of Behavioral Medicine
Publisher: Springer Science and Business Media LLC
Published: 2016-06-15
Volume: 24
Issue: 1
Pages: 25-41
ISSN: 1070-5503 (ISSN-L)
1532-7558
DOI: 10.1007/s12529-016-9572-9
OpenAlex: W2430553295
Cited by: 143
References: 0
Citations by year: 2026: 12 · 2025: 23 · 2024: 12 · 2023: 17 · 2022: 12 · 2021: 19 · 2020: 20 · 2019: 12 · 2018: 9 · 2017: 4 · 2016: 3
FWCI: 1.07
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (unspecified)
Locations: International Journal of Behavioral Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords: biofeedback, chronic back pain, pain intensity, depression, disability, muscle tension, electromyography, coping, psychological intervention, treatment moderators, adjunctive intervention
MeSH terms: Back Pain, Biofeedback, Psychology, Depression, Humans, Chronic Pain

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Efficacy of biofeedback in chronic back pain: a meta-analysis

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