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Efficacy of Biofeedback in Chronic back Pain: a Meta-Analysis
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, 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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“[11] In addition, functional electrical stimulation (FES) therapy is widely used in rehabilitation training to promote muscle activation by inducing muscle contraction signals in paralyzed muscles, which prevents disuse atrophy and parallel functional movement training.”
BackgroundPratscher, S. D., Sibille, K. T., & Fillingim, R. B. (2023) · Pilot and Feasibility Studies · doi:10.1186/s40814-023-01247-9 · Cited by 9
“For example, clinical trials of breathing exercises typically involve daily practice for at least 4 weeks and often up to 8 or 12 weeks [24, 25, 185].”
BackgroundMethodMa, T., Qi, H., Mao, Y., Wang, Y., Duan, B.-L., & Ma, K. (2023) · Journal of clinical pharmacology · doi:10.1002/jcph.2365 · Cited by 6
Chojnacka-Szawłowska, G., Kloc, W., Zdun‐Ryżewska, A., Basiński, K., Majkowicz, M., Leppert, W., Kurlandt, P., & Libionka, W. (2019) · Pain Management Nursing · doi:10.1016/j.pmn.2019.02.009 · Cited by 6
Hurt, R., Ganesh, R., Schroeder, D. R., Hanson, J. L., Fokken, S. C., Overgaard, J., Bauer, B. A., Thilagar, B. P., Aakre, C. A., Pruthi, S., et al. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251325639 · Cited by 5
Kalderon, L., Kaplan, A., Wolfovitz, A., Gimmon, Y., & Levy‐Tzedek, S. (2024) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2024.103356 · Cited by 7
Folchert, M. D., Breuner, C. C., & Steinman, S. E. (2020) · The Journal Of Hand Surgery · doi:10.1016/j.jhsa.2020.09.005 · Cited by 7
Effektivität von Biofeedback bei Patienten mit chronischem Rückenschmerz
Eichler, J., Rachinger-Adam, B., Kraft, E., & Azad, S. C. (2019) · Der Schmerz · doi:10.1007/s00482-019-0393-z · Cited by 5
Chronic Pain Psychology in Neurology Practice
Serdarević, M. (2024) · Continuum · doi:10.1212/con.0000000000001471 · Cited by 4
Fundoiano-Hershcovitz, ., Horwitz, D. L., Tawil, C., Cohen, O. M., & Goldstein, P. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.958033 · Cited by 4
“The (lower) back is the most common site for chronic pain, with a lifetime prevalence of 30–40% (Sielski et al., 2017), which has annual costs in the hundreds of billions of dollars in the United States (Kotlarz et al.”
BackgroundInfluentialPain Assessment and Treatment for the Trauma and Burn Patient
Drummond, S., Ackerman, R. S., & Somasundaram, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-39982-5_1 · Cited by 4
Digital Therapeutics in the Management of Chronic Pain
Rogozinski, B., Greenleaf, W., Sackman, J., & Cahana, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-95369-4_30 · Cited by 7
Xie, Q., Goldberg, S. B., Jacobson, N. A., Rakel, D. P., & Quanbeck, A. (2025) · Journal of Pain Research · doi:10.2147/jpr.s568016 · Cited by 4
Biofeedback in Pediatric, Adolescent, and Young Adult Cancer Care: A Systematic Review
Barnett, M., Langer, S. A., Matsoukas, K., Dugad, S., Mdleleni, A., & Khazan, I. (2025) · Children · doi:10.3390/children12080998 · Cited by 3
“Neuromuscular Biofeedback: Using surface electromyography (sEMG), this modality measures muscle tension and can be used to manage pain and improve physical function [21–23].”
Recker, K., Silliman, J., Gifford, K., Patel, P., Santana, L., Hildenbrand, A., Palit, S., & Wasserman, R. M. (2024) · JMIR Rehabilitation and Assistive Technologies · doi:10.2196/66352 · Cited by 3
“Biofeedback is among the most effective behavioral interventions for chronic pain; with biofeedback training, individuals learn how to control and self-regulate ANS responses such as respiratory rate or heart rate (HR) [16,17].”
Knobel, S. E. J., Oberson, R., Räber, J., Schütz, N., Egloff, N., Botros, A., Gerber, S. M., Nef, T., & Heydrich, L. (2024) · JMIR Serious Games · doi:10.2196/52340 · Cited by 4
“Others have used biofeedback, including heart rate variability–based biofeedback in order to treat chronic pain [8,9].”
Preliminary study: quantification of chronic pain from physiological data
Cheng, Z., Ly, F. S., Santander, T., Turki, E., Zhao, Y., Yoo, J., Lonergan, K., Gray, J., Li, C. H., Yang, H. T. Y., et al. (2022) · PAIN Reports · doi:10.1097/pr9.0000000000001039 · Cited by 4
Schwartz, M. S. (2018) · InTech eBooks · doi:10.5772/intechopen.71738 · Cited by 6
“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.”
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
“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
Psychophysiologic symptom relief therapy for chronic back pain: hypothesis and trial rationale
Paschali, M., Thompson, G. S., Mehta, S. M., Howard, P. M., Yamin, J. B., Edwards, R. R., & Donnino, M. W. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2024.1328495 · Cited by 1
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
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
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
“…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).”
BackgroundBiofeedback: 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
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
“D Die Wirksamkeit von IMST bei chronischem Rückenschmerz ist durch Metaanalysen belegt.”
BackgroundInfluentialMousavi, S. M., Shabahang, R., & Khodadadi‐Hassankiadeh, N. (2019) · Caspian Journal of Neurological Sciences · doi:10.32598/cjns.5.18.118 · Cited by 2
“This method is used to manage LBP, headache, anxiety disorders, muscular injuries, and urinary incontinence [14].”
BackgroundMethodSeong, J.-H., Kim, C.-B., & Choi, J.-D. (2018) · Physical Therapy Korea · doi:10.12674/ptk.2018.25.1.001 · Cited by 2
Jackson, R. R., Varagnolo, D., & Knorn, S. (2023) · IEEE Control Systems Letters · doi:10.1109/lcsys.2023.3287138 · Cited by 1
“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
Ioannou, C. I., & Avraamides, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-60697-8_1 · Cited by 2
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
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].”
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
Evaluating Player Stress and Motivation Through Biofeedback-Controlled Dynamic Difficulty Adjustment
Oner, A., & Kucukkulahli, E. (2025) · Electronics · doi:10.3390/electronics14193870 · Cited by 1
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
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
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
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].”
BackgroundApplication 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.”
BackgroundEdwards, 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
“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…”
BackgroundResultWomen 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
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
Nonpharmacological Control of Pain
Kitaeff, R., & Dipti, A. C. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-43044-9.00042-x · Cited by 1
Use of Complementary and Integrative Health for Chronic Pain Management
Khusid, M. A., Stern, E. L., & Reed, K. (2019) · Springer eBooks · doi:10.1007/978-3-030-05384-0_13 · Cited by 2
Osipov, V. (2026) · Ukrains'kyi Visnyk Psykhonevrolohii · doi:10.36927/2079-0325-v34-is3-2026-14
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 ].”
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.”
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.
Azer, A., Lally, T., Fried, A., Shah, A., & Radice-Vella, G. (2026) · Hand Clinics · doi:10.1016/j.hcl.2026.03.012
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
Klausing, M. R., Junk, J., & Subialka, J. A. (2026) · Advances in Rehabilitation · doi:10.2478/advrehab-2026-0003
Son, Е. А., & Isaikin, A. I. (2026) · Реабилитология. · doi:10.17749/2949-5873/rehabil.2025.44
Pratscher, S. D., Lalande, L., Davis, A., & Hanley, A. W. (2025) · Journal of Integrative and Complementary Medicine · doi:10.1177/27683605251406218 · Cited by 1
de Aquino, J. D., Costa, G. P. A., Nunes, J. C., Hudak, J., Odette, M. M., & Garland, E. L. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112812
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
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
Metadata
- Authors
- Sielski, R., Rief, W., & Glombiewski, J. A.
- Affiliations
- Philipps University of Marburg (DE)
- Corresponding author
- Sielski, Robert
- Venue
- International Journal of Behavioral Medicine
- Published
- 2016-06-15
- Volume
- 24
- Issue
- 1
- Pages
- 25-41
- ISSN
- 1070-5503 (ISSN-L)
- 1532-7558
- 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
- Locations
- International Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Physiology (medical) › 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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