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.
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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.
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.
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.
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.
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.
Basmajian, J. V. (1982). Clinical use of biofeedback in rehabilitation. Psychosomatics, 23, 67–73.
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.
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.
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.
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.
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.
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.
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.
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.
Draizar, A. (1984). Clinical EMG feedback in motor speech disorders. Archives of Physical Medicine and Rehabilitation, 65(8), 481–484.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hisli, N. (1989). Beck Depresyon Envanterinin üniversite öğrencileri için geçerliliği, güvenilirliği. Psikoloji Dergisi, 7, 3–13.
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.
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.
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.
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.
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.
Kayıran, S., Dursun, E., Ermutlu, N., Dursun, N., & Karamürsel, S. (2007). Neurofeedback in fibromyalgia syndrome. Ağrı, 19(3), 47–53.
Koçyiğit, H., Aydemir, Ö., Ölmez, N., & Memiş, A. (1999). SF-36’nın Türkçe için güvenilirliği ve geçerliliği. Ege Fizik Tedavi ve Rehabilitasyon Dergisi.
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.
Lautenbacher, S., & Rollman, G. B. (1997). Possible deficiencies of pain modulation in fibromyalgia. The Clinical Journal of Pain, 13, 189–196.
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.
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.
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.
Moldofsky, H., & Warsh, J. J. (1978). Plasma tryptophan and musculoskeletal pain in non-articular rheumatism (“fibrositis syndrome”). Pain, 5(1), 65–71.
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.
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.
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.
Mur, E., Drexler, A., Gruber, J., Hartig, F., & Günther, V. (1999). Electromyography biofeedback therapy in fibromyalgia. Wiener Medizinische Wochenschrift, 149, 561–563.
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.
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.
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.
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.
Park, D. C., Glass, J. M., Minear, M., & Crofford, L. J. (2001). Cognitive function in fibromyalgia patients. Arthritis and Rheumatism, 44, 2125–2133.
Petrofsky, J. S. (2001). The use of electromyogram biofeedback to reduce Trendelenburg gait. European Journal of Applied Physiology, 85(5), 491–495.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Suhr, J. A. (1999). Neuropsychological impairment in fibromyalgia. Relation to depression, fatigue, and pain. Journal of Psychosomatic Research, 47, 403–410.
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.
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.
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.
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.
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.
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.
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.
Wolf, S. L. (1983). Electromyographic biofeedback applications to stroke patients. A critical review. Physical Therapy, 63, 1448–1459.
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.
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.
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.
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.
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.
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Kayıran, S., Dursun, E., Dursun, N. et al. Neurofeedback Intervention in Fibromyalgia Syndrome; a Randomized, Controlled, Rater Blind Clinical Trial. Appl Psychophysiol Biofeedback 35, 293–302 (2010). https://doi.org/10.1007/s10484-010-9135-9
- Fibromyalgia syndrome