Applied Psychophysiology and Biofeedback

, Volume 35, Issue 4, pp 293–302 | Cite as

Neurofeedback Intervention in Fibromyalgia Syndrome; a Randomized, Controlled, Rater Blind Clinical Trial

  • Sadi Kayıran
  • Erbil Dursun
  • Nigar Dursun
  • Numan Ermutlu
  • Sacit Karamürsel
Article

Abstract

We designed a randomized, rater blind study to assess the efficacy of EEG Biofeedback (Neurofeedback-NFB) in patients with fibromyalgia syndrome (FMS). Eighteen patients received twenty sessions of NFB-sensory motor rhythm (SMR) treatment (NFB group) during 4 weeks, and eighteen patients were given 10 mg per day escitalopram treatment (control group) for 8 weeks. Visual Analog Scales for pain and fatigue, Hamilton and Beck Depression and Anxiety Inventory Scales, Fibromyalgia Impact Questionnaire and Short Form 36 were used as outcome measures which were applied at baseline and 2nd, 4th, 8th, 16th, 24th weeks. Mean amplitudes of EEG rhythms (delta, theta, alpha, SMR, beta1 and beta2) and theta/SMR ratio were also measured in NFB group. All post-treatment measurements showed significant improvements in both of the groups (for all parameters p < 0.05). NFB group displayed greater benefits than controls (for all parameters p < 0.05). Therapeutic efficacy of NFB was found to begin at 2nd week and reached to a maximum effect at 4th week. On the other hand, the improvements in SSRI treatment were also detected to begin at 2nd week but reached to a maximum effect at 8th week. No statistically significant changes were noted regarding mean amplitudes of EEG rhythms (p > 0.05 for all). However, theta/SMR ratio showed a significant decrease at 4th week compared to baseline in the NFB group (p < 0.05). These data support the efficacy of NFB as a treatment for pain, psychological symptoms and impaired quality of life associated with fibromyalgia.

Keywords

Fibromyalgia syndrome Neurofeedback Escitalopram 

References

  1. Ahles, T. A., Khan, S. A., Yunus, M. B., Spiegel, D. A., & Masi, A. T. (1991). Psychiatric status of patients with primary fibromyalgia, patients with rheumatoid arthritis, and subjects without pain: A blind comparison of DSM-III diagnoses. The American Journal of Psychiatry, 148, 1721–1726.PubMedGoogle Scholar
  2. Akdemir, A., Türkçapar, M. H., Orsel, S. D., Demirergi, N., Dag, I., & Ozbay, M. H. (2001). Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Comprehensive Psychiatry, 42(2), 161–165.CrossRefPubMedGoogle Scholar
  3. Alanoglu, E., Ulas, U. H., Ozdag, F., Odabaşi, Z., Cakçi, A., & Vural, O. (2005). Auditory event-related brain potentials in fibromyalgia syndrome. Rheumatology International, 25(5), 345–349.CrossRefPubMedGoogle Scholar
  4. Anderberg, U. M., Marteinsdottir, I., & von Knorring, L. (2000). Citalopram in patients with fibromyalgia—a randomized, double-blind, placebo-controlled study. European Journal of Pain, 4(1), 27–35.CrossRefPubMedGoogle Scholar
  5. Babu, A. S., Mathew, E., Danda, D., & Prakash, H. (2007). Management of patients with fibromyalgia using biofeedback: A randomized control trial. Indian Journal of Medical Sciences, 61(8), 455–461.CrossRefPubMedGoogle Scholar
  6. Basmajian, J. V. (1982). Clinical use of biofeedback in rehabilitation. Psychosomatics, 23, 67–73.PubMedGoogle Scholar
  7. Bennett, R. M. (1999). Emerging concepts in the neurobiology of chronic pain: Evidence of abnormal sensory processing in fibromyalgia (review). Mayo Clinic Proceedings, 74, 385–398.CrossRefPubMedGoogle Scholar
  8. Caruso, I., Sarzi Puttini, P., Cazzola, M., & Azzolini, V. (1990). Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. The Journal of International Medical Research, 18(3), 201–209.PubMedGoogle Scholar
  9. Carville, S. F., Arendt-Nielsen, S., Bliddal, H., Blotman, F., Branco, J. C., Buskila, D., et al. (2008). EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases, 67, 536–541.CrossRefPubMedGoogle Scholar
  10. Chiarioni, G., Salandini, L., & Whitehead, W. E. (2005). Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation. Gastroenterology, 129(1), 86–97.CrossRefPubMedGoogle Scholar
  11. Çorapçıoğlu, A., Aydemir, Ö., Yıldız, M., Esen, A., & Köroğlu, E. (1999). DSM-IV Eksen-I Bozuklukları İçin Yapılandırılmış Klinik Görüşme. Ankara, Turkey: Hekimler Yayın Birliği.Google Scholar
  12. Crider, A., Glaros, A. G., & Gevirtz, R. N. (2005). Efficacy of biofeedback-based treatments for temporomandibular disorders. Applied Psychophysiology and Biofeedback, 30(4), 333–345.CrossRefPubMedGoogle Scholar
  13. Da Costa, D., Dobkin, P. L., Fitzcharles, M. A., Fortin, P. R., Beaulieu, A., Zummer, M., et al. (2000). Determinants of health status in fibromyalgia: A comparative study with systemic lupus erythematosus. The Journal of Rheumatology, 27(2), 365–372.PubMedGoogle Scholar
  14. Denk, D. M., & Kaider, A. (1997). Videoendoscopic biofeedback: a simple method to improve the efficacy of swallowing rehabilitation of patients after head and neck surgery. Journal for Oto-Rhino-Laryngology and Its Related Specialties, 59(2), 100–105.PubMedGoogle Scholar
  15. Draizar, A. (1984). Clinical EMG feedback in motor speech disorders. Archives of Physical Medicine and Rehabilitation, 65(8), 481–484.PubMedGoogle Scholar
  16. Dursun, E. (2009). Biofeedback. In J. H. Stone, M. Blouin (Eds.), International encyclopedia of rehabilitation. http://cirrie.buffalo.edu/encyclopedia/article.php?id=23&language=en.
  17. Dursun, E., Dursun, N., & Alican, D. (2004). Effects of biofeedback treatment on gait in children with cerebral palsy. Disability and Rehabilitation, 26(2), 116–120.CrossRefPubMedGoogle Scholar
  18. Dursun, N., Dursun, E., & Kiliç, Z. (2001). Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome. Archives of Physical Medicine and Rehabilitation, 82(12), 1692–1695.CrossRefPubMedGoogle Scholar
  19. Egner, T., & Gruzelier, J. H. (2001). Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans. Neuroreport, 12, 4155–4160.CrossRefPubMedGoogle Scholar
  20. Egner, T., & Gruzelier, J. H. (2004). EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials. Clinical Neurophysiology, 115(1), 131–139.CrossRefPubMedGoogle Scholar
  21. Egner, T., Zech, T. F., & Gruzelier, J. H. (2004). The effects of neurofeedback training on the spectral topography of the electroencephalogram. Clinical Neurophysiology, 115, 2452–2460.CrossRefPubMedGoogle Scholar
  22. Gentil, M., Aucouturier, J. L., Delong, V., & Sambuis, E. (1994). EMG biofeedback in the treatment of dysarthria. Folia Phoniatrica et Logopaedica, 46(4), 188–192.CrossRefPubMedGoogle Scholar
  23. Grace, G. M., Nielson, W. R., Hopkins, M., & Berg, M. A. (1999). Concentration and memory deficits in patients with fibromyalgia syndrome. Journal of Clinical and Experimental Neuropsychology, 21, 477–487.CrossRefPubMedGoogle Scholar
  24. Gracely, R. H., Petzke, F., Wolf, J. M., & Clauw, D. J. (2002). Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis and Rheumatism, 46, 1333–1343.CrossRefPubMedGoogle Scholar
  25. Guedj, E., Cammilleri, S., Colavolpe, C., De Laforte, C., Niboyet, J., & Mundler, O. (2007). Follow-up of pain processing recover after ketamine in hyperalgesic fibromyalgia patients using brain perfusion ECD-SPECT. European Journal of Nuclear Medicine and Molecular Imaging, 34, 2115–2119.CrossRefPubMedGoogle Scholar
  26. Hidalgo, J., Rico-Villademoros, F., & Calandre, E. P. (2007). An open-label study of quetiapine in the treatment of fibromyalgia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 31(1), 71–77.CrossRefPubMedGoogle Scholar
  27. Hisli, N. (1989). Beck Depresyon Envanterinin üniversite öğrencileri için geçerliliği, güvenilirliği. Psikoloji Dergisi, 7, 3–13.Google Scholar
  28. Ho, Y. H., & Tan, M. (1997). Biofeedback therapy for bowel dysfunction following low anterior resection. Annals of the Academy of Medicine, Singapore, 26(3), 299–302.PubMedGoogle Scholar
  29. Howe, R. C., & Sterman, M. B. (1972). Cortical-subcortical EEG correlates of suppressed motor behavior during sleep and waking in the cat. Electroencephalography and Clinical Neurophysiology, 32(6), 681–695.CrossRefPubMedGoogle Scholar
  30. Intiso, D., Santilli, V., Grasso, M. G., Rossi, R., & Caruso, I. (1994). Rehabilitation of walking with electromyographic biofeedback in foot-drop after stroke. Stroke, 25(6), 1189–1192.PubMedGoogle Scholar
  31. Jensen, M. P., Grierson, C., Tracy-Smith, V., Bacigalupi, S. C., & Othmer, S. (2007). Neurofeedback treatment for pain associated with complex regional pain syndrome type I: A case series. Journal of Neurotherapy, 11, 45–53.CrossRefGoogle Scholar
  32. Jensen, M. P., Hakimian, S., Sherlin, L. H., & Frengi, F. (2008). New insights into neuromodulatory approaches for the treatment of pain. The Journal of Pain: official journal of the American Pain Society, 9(3), 193–199.Google Scholar
  33. Kayıran, S., Dursun, E., Ermutlu, N., Dursun, N., & Karamürsel, S. (2007). Neurofeedback in fibromyalgia syndrome. Ağrı, 19(3), 47–53.PubMedGoogle Scholar
  34. Koçyiğit, H., Aydemir, Ö., Ölmez, N., & Memiş, A. (1999). SF-36’nın Türkçe için güvenilirliği ve geçerliliği. Ege Fizik Tedavi ve Rehabilitasyon Dergisi.Google Scholar
  35. Kop, W. J., Lyden, A., Berlin, A. A., Ambrose, K., Olsen, C., Gracely, R. H., et al. (2005). Ambulatory monitoring of physical activity and symptoms in fibromyalgia and chronic fatigue syndrome. Arthritis and Rheumatism, 52(1), 296–303.CrossRefPubMedGoogle Scholar
  36. Lautenbacher, S., & Rollman, G. B. (1997). Possible deficiencies of pain modulation in fibromyalgia. The Clinical Journal of Pain, 13, 189–196.CrossRefPubMedGoogle Scholar
  37. Lubar, J. F. (1997). Neocortical dynamics: Implications for understanding the role of neurofeedback and related techniques for the enhancement of attention. Applied Psychophysiology and Biofeedback, 22(2), 111–126.CrossRefPubMedGoogle Scholar
  38. Matsutani, L. A., Marques, A. P., Ferreira, E. A., Assumpção, A., Lage, L. V., Casarotto, R. A., et al. (2007). Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia. Clinical and Experimental Rheumatology, 25(3), 410–415.PubMedGoogle Scholar
  39. Middaugh, S. J., Whitehead, W. E., Burgio, K. L., & Engel, B. T. (1989). Biofeedback in treatment of urinary incontinence in stroke patients. Biofeedback and Self-Regulation, 14(1), 3–19.CrossRefPubMedGoogle Scholar
  40. Moldofsky, H., & Warsh, J. J. (1978). Plasma tryptophan and musculoskeletal pain in non-articular rheumatism (“fibrositis syndrome”). Pain, 5(1), 65–71.CrossRefPubMedGoogle Scholar
  41. Monastra, V. J., Monastra, D. M., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27(4), 231–249.CrossRefPubMedGoogle Scholar
  42. Mountz, J. M., Bradley, L. A., Model, J. G., Alexander, R. W., Triana-Alexander, M., Aaron, L. A., et al. (1995). Fibromyalgia in women. Abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. Arthritis and Rheumatism, 38, 926–938.CrossRefPubMedGoogle Scholar
  43. Mueller, H. H., Donaldson, C. C., Nelson, D. V., & Layman, M. (2001). Treatment of fibromyalgia incorporating EEG-Driven stimulation: A clinical outcomes study. Journal of Clinical Psychology, 57(7), 933–952.CrossRefPubMedGoogle Scholar
  44. Mur, E., Drexler, A., Gruber, J., Hartig, F., & Günther, V. (1999). Electromyography biofeedback therapy in fibromyalgia. Wiener Medizinische Wochenschrift, 149, 561–563.PubMedGoogle Scholar
  45. Nash, J., Neilson, P. D., & O’Dwyer, N. J. (1989). Reducing spasticity to control muscle contracture of children with cerebral palsy. Developmental Medicine and Child Neurology, 31(4), 471–480.CrossRefPubMedGoogle Scholar
  46. Othmer, S., & Othmer, S. F. (2006). Efficacy of neurofeedback for pain management. In M. V. Boswell & B. E. Cole (Eds.), Weiner’s pain management: A practical guide for clinicians (7th ed., pp. 719–739). Boca Raton: CRC Press.Google Scholar
  47. Ozgocmen, S., Cimen, O. B., & Ardıcoglu, O. (2002). Relationship between chest expansion and respiratory muscle strength in patients with primary fibromyalgia. Clinical Rheumatology, 21, 19–22.CrossRefPubMedGoogle Scholar
  48. Ozgocmen, S., Yoldas, T., Kamanlı, A., Yildizhan, H., Yigiter, R., & Ardicoglu, O. (2003). Auditory P300 event related potentials and serotonin reuptake inhibitor treatment in patients with fibromyalgia. Annals of the Rheumatic Diseases, 62, 551–555.CrossRefPubMedGoogle Scholar
  49. Park, D. C., Glass, J. M., Minear, M., & Crofford, L. J. (2001). Cognitive function in fibromyalgia patients. Arthritis and Rheumatism, 44, 2125–2133.CrossRefPubMedGoogle Scholar
  50. Petrofsky, J. S. (2001). The use of electromyogram biofeedback to reduce Trendelenburg gait. European Journal of Applied Physiology, 85(5), 491–495.CrossRefPubMedGoogle Scholar
  51. Pillemer, S. R., Bradley, L. A., Crofford, L. J., Moldofsky, H., & Chrousos, G. P. (1997). The neuroscience and endocrinology of fibromyalgia. Arthritis and Rheumatism, 40, 1928–1939.CrossRefPubMedGoogle Scholar
  52. Reddy, N. P., Simcox, D. L., Gupta, V., Motta, G. E., Coppenger, J., Das, A., et al. (2000). Biofeedback therapy using accelerometry for treating dysphagic patients with poor laryngeal elevation: case studies. Journal of Rehabilitation Research and Development, 37(3), 361–372.PubMedGoogle Scholar
  53. Reiner, R. (2008). Integrating a portable biofeedback device into clinical practice for patients with anxiety disorders: Results of a pilot study. Applied Psychophysiology and Biofeedback, 33(1), 55–61.CrossRefPubMedGoogle Scholar
  54. Rice, K. M., Blanchard, E. B., & Purcell, M. (1993). Biofeedback treatments of generalized anxiety disorder: Preliminary results. Biofeedback and Self-Regulation, 18(2), 93–105.CrossRefPubMedGoogle Scholar
  55. Ros, T., Munneke, M. A. M., Ruge, D., Gruzelier, J. H., & Rothwell, J. C. (2010). Endogenous control of waking brain rhythms induces neuroplasticity in humans. European Journal of Neuroscience, 31, 770–778.CrossRefPubMedGoogle Scholar
  56. Russell, I. J., Michalek, J. E., Vipraio, G. A., Fletcher, E. M., & Wall, K. (1989). Serum amino acids in fibrositis/fibromyalgia syndrome. The Journal of Rheumatology, 19, 158–163.PubMedGoogle Scholar
  57. Sarmer, S., Ergin, S., & Yavuzer, G. (2000). The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatology International, 20(1), 9–12.CrossRefPubMedGoogle Scholar
  58. Sarzi Puttini, P., & Caruso, I. (1992). Primary fibromyalgia syndrome and 5-hydroxy-l-tryptophan: A 90-day open study. The Journal of International Medical Research, 20(2), 182–189.PubMedGoogle Scholar
  59. Siniatchkin, M., Hierundar, A., Kropp, P., Kuhnert, R., Gerber, W. D., & Stephani, U. (2000). Self-regulation of slow cortical potentials in children with migraine: an exploratory study. Applied Psychophysiology and Biofeedback, 25(1), 13–32.CrossRefPubMedGoogle Scholar
  60. Staud, R., Vierck, C. J., Cannon, R. L., Mauderli, A. P., & Price, D. D. (2001). Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain, 91, 165–175.CrossRefPubMedGoogle Scholar
  61. Sterman, M. B. (1996). Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation. Biofeedback and Self-Regulation, 21(1), 3–33.CrossRefPubMedGoogle Scholar
  62. Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical EEG (Electroencephalography), 31, 45–55.Google Scholar
  63. Strombeck, B., Ekdahl, C., Manthorpe, R., Wikström, I., & Jacobsson, L. (2000). Health-related quality of life in primary Sjogren’s syndrome, rheumatoid arthritis and fibromyalgia compared to normal population data using SF-36. Scandinavian Journal of Rheumatology, 29, 20–28.CrossRefPubMedGoogle Scholar
  64. Suhr, J. A. (1999). Neuropsychological impairment in fibromyalgia. Relation to depression, fatigue, and pain. Journal of Psychosomatic Research, 47, 403–410.CrossRefGoogle Scholar
  65. Tomberg, C., & Desmedt, J. E. (1998). Human perceptual processing: inhibition of transient prefrontal-parietal 40 Hz binding at P300 onset documented in non-averaged cognitive brain potentials. Neuroscience Letters, 255(3), 163–166.CrossRefPubMedGoogle Scholar
  66. Ulusoy, M., Sahin, N. H., & Erkmen, H. (1998). Turkish version of the beck anxiety inventory psychometric properties. Journal of Cognitive Psychotherapy: An International Quarterly, 12, 163–172.Google Scholar
  67. Uveges, J. M., Parker, J. C., Smarr, K. L., McGowan, J. F., Lyon, M. G., Irvin, W. S., et al. (1990). Psychological symptoms in primary fibromyalgia syndrome relationship to pain, life stress and sleep disturbance. Arthritis and Rheumatism, 33(8), 1278–1283.Google Scholar
  68. Vernon, D., Egner, T., Cooper, N., Compton, T., Neilands, C., Sheri, A., et al. (2003). The effect of training distinct neurofeedback protocols on aspects of cognitive performance. International Journal of Psychophysiology, 47(1), 75–85.CrossRefPubMedGoogle Scholar
  69. Wenck, L. S., Leu, P. W., & D’Amato, R. C. (1996). Evaluating the efficacy of a biofeedback intervention to reduce children’s anxiety. Journal of Clinical Psychology, 52(4), 469–473.CrossRefPubMedGoogle Scholar
  70. Williams, D. A., & Clauw, D. J. (2009). Understanding fibromyalgia: Lessons from the broader pain research community. The Journal of Pain: Official Journal of the American Pain Society, 10(8), 777–791.Google Scholar
  71. Wissel, J., Ebersbach, G., Gutjahr, L., & Dahlke, F. (1989). Treating chronic hemiparesis with modified biofeedback. Archives of Physical Medicine and Rehabilitation, 70(8), 612–617.PubMedGoogle Scholar
  72. Wolf, S. L. (1983). Electromyographic biofeedback applications to stroke patients. A critical review. Physical Therapy, 63, 1448–1459.PubMedGoogle Scholar
  73. Yazıcı, M. K., Demir, B., Tanrıverdi, N., Karaağaoğlu, E., & Yolaç, P. (1998). Hamilton Anksiyete Değerlendirme Ölçeği, değerlendiriciler arası güvenirlik ve geçerlik çalışması. Türk Psikiyatri Dergisi, 9, 114–117.Google Scholar
  74. Yip, S. L., & Ng, G. Y. (2006). Biofeedback supplementation to physiotherapy exercise programme for rehabilitation of patellofemoral pain syndrome: A randomized controlled pilot study. Clinical Rehabilitation, 20(12), 1050–1057.CrossRefPubMedGoogle Scholar
  75. Yunus, M. B. (2007). Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Practice and Research. Clinical Rheumatology, 21(3), 481–497.CrossRefPubMedGoogle Scholar
  76. Yunus, M. B., Ahles, T. A., Aldag, J. C., & Masi, A. T. (1991). Relationship of clinical features with psychological status in primary fibromyalgia. Arthritis and Rheumatism, 34(1), 15–25.CrossRefPubMedGoogle Scholar
  77. Yunus, M. B., Dailey, J. W., Aldag, J. C., Masi, A. T., & Jobe, P. C. (1992). Plasma tryptophan and other amino acids in primary fibromyalgia: A controlled study. The Journal of Rheumatology, 19(1), 90–94.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sadi Kayıran
    • 1
  • Erbil Dursun
    • 1
  • Nigar Dursun
    • 1
  • Numan Ermutlu
    • 2
  • Sacit Karamürsel
    • 3
  1. 1.Department of Physical Medicine and RehabilitationFaculty of Medicine, Kocaeli UniversityKocaeliTurkey
  2. 2.Department of PhysiologyFaculty of Medicine, Istanbul Science UniversityIstanbulTurkey
  3. 3.Department of PhysiologyIstanbul Faculty of Medicine, Istanbul UniversityIstanbulTurkey

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