Skip to main content

Advertisement

SpringerLink
Log in

Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study

  • Published:
Applied Psychophysiology and Biofeedback Aims and scope Submit manuscript

Abstract

Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Berntson, G. G., Bigger, T., Jr., Eckberg, D. L., Grossman, P., Kaufmann, P. G., Malik, M., et al. (1997). Heart rate variability: Origin, methods, and interpretive caveats. Psychophysiology, 34, 623–648.

    Article  PubMed  Google Scholar 

  • Bongers, P. M., Kremer, A. M., & ter Laak, J. (2002). Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature. American Journal of Industrial Medicine, 41, 315–342.

    Article  PubMed  Google Scholar 

  • Borg, G. (1998). Borg’s perceived exertion and pain scales. Champaign, IL: Human Kinetics.

    Google Scholar 

  • Davies, L. C., Colhoun, H., Coats, A. J. S., Piepoli, M., & Francis, D. P. (2002). A noninvasive measure of baroreflex sensitivity without blood pressure measurement. American Heart Journal, 143, 441–447.

    Article  PubMed  Google Scholar 

  • Del Pozo, J., Gevirtz, R., Scher, B., & Guarneri, E. (2004). Biofeedback treatment increases heart rate variability in patients with known coronary artery disease. American Heart Journal, 147, G1–G6.

    Article  Google Scholar 

  • Fagius, J., Karhuvaara, S., & Sundlof, G. (1989). The cold pressor test: Effects on sympathetic nerve activity in human muscle and skin nerve fascicles. Acta Physiologica Scandinavia, 137(3), 325–334.

    Article  Google Scholar 

  • Gevirtz, R. (2006). The muscle spindle trigger point model of chronic pain. Biofeedback, 34, 53–56.

    Google Scholar 

  • Gockel, M., Lindholm, H., Alaranta, H., Viljanen, A., Lindquist, A., & Lindholm, T. (1995). Cardiovascular functional disorder and stress among patients having neck-shoulder symptoms. Annals of the Rheumatic Diseases, 54(6), 494–497.

    Article  PubMed  Google Scholar 

  • Hassett, A. L., Radvanski, D. C., Vaschillo, E. G., Vaschillo, B., Sigal, L. H., et al. (2007). A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fibromyalgia. Applied Psychophysiology and Biofeedback, 32(1), 1–10.

    Article  PubMed  Google Scholar 

  • Hubbard, D., & Berkhoff, G. (1993). Myofascial trigger points show spontaneous needle EMG activity. Spine, 18, 1803–1807.

    Article  PubMed  Google Scholar 

  • Johansson, H., Windhorst, U., Djupsjöbacka, M., & Passatore, M. (Eds.). (2003). Chronic work-related myalgia. Neuromuscular mechanisms behind work-related chronic muscle pain syndromes. Gävle: Gävle University press.

    Google Scholar 

  • Kalezic, N., Åsell, M., Kerschbaumer, H., & Lyskov, E. (2007). Physiological reactivity to functional tests in patients with chronic low back pain. Journal of Musculoskeletal Pain, 15(1), 29–40.

    Article  Google Scholar 

  • Kalezic, N., Noborisaka, Y., Nakata, M., Crenshaw, A., Karlsson, S., Lyskov, E., et al. (2010). Cardiovascular and muscle activity during chewing in whiplash-associated disorders (WAD). Archives of Oral Biology, 55, 447–453.

    Article  PubMed  Google Scholar 

  • Kapitza, K. P., Passie, T., Bernateck, M., & Karst, M. (2010). First non-contingent respiratory biofeedback placebo versus contingent biofeedback in patients with chronic low back pain: A randomized controlled, double-blind trial. Applied Psychophysiology & Biofeedback, 35, 207–217.

    Article  Google Scholar 

  • Khurana, R. K., & Setty, A. (1996). The value of isometric hand-grip test—studies in various autonomic disorders. Clinical Autonomic Research, 6, 211–218.

    Article  PubMed  Google Scholar 

  • Larsman, P., Thorn, S., Søgaard, K., Sandsjö, L., Sjøgaard, G., & Kadefors, R. (2009). Work related perceived stress and muscle activity during standardized computer work among female computer users. Work: A Journal of Prevention, Assessment and Rehabilitation, 32(2), 189–199.

    Google Scholar 

  • Larsson, S. E., Larsson, R., Zhang, Q., Cai, H., & Öberg, P. Å. (1995). Effects of psychophysiological stress on trapezius muscles blood flow and electromyography during static load. European Journal of Applied Physiology and Occupational Physiology, 71, 493–498.

    Article  PubMed  Google Scholar 

  • Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Applied Psychophysiology and Biofeedback, 25(3), 177–191.

    Article  PubMed  Google Scholar 

  • Lehrer, P. M., Vaschillo, E., Vaschillo, B., Lu, S. E., Eckberg, D. L., Edelberg, R., et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5), 796–805.

    Article  PubMed  Google Scholar 

  • Leistad, R., Nilsen, K., Stovner, L., Westgaard, R., Rø, M., & Sand, T. (2008). Similarities in stress physiology among patients with chronic pain and headache disorders: Evidence for a common pathophysiological mechanism? The Journal of Headache and Pain, 9, 165–175.

    Article  PubMed  Google Scholar 

  • Linton, S. J. (2000). A review of psychological risk factors in back and neck pain. Spine, 25, 1148–1156.

    Article  PubMed  Google Scholar 

  • Lisspers, J., Nygren, A., & Soderman, E. (1997). Hospital Anxiety and Depression Scale (HAD): Some psychometric data for a Swedish sample. Acta Psychiatrica Scandinavica, 96(4), 281–286.

    Article  PubMed  Google Scholar 

  • Lovallo, W. (1975). The cold pressor test and autonomic function. A review and integration. Psychophysiology, 12(3), 268–282.

    Article  PubMed  Google Scholar 

  • Lundberg, U. (2002). Psychophysiology of work: Stress, gender, endocrine responses, and work-related upper extremity disorders. American Journal of Industrial Medicine, 41, 338–392.

    Article  Google Scholar 

  • MacDermid, J. C., Walton, D. M., Avery, S., Blanchard, A., Etruw, E., McAlpine, C., et al. (2009). Measurement properties of the neck disability index: A systematic review. J Journal of Orthopaedic & Sports Physical Therapy, 39(5), 400–417.

    Google Scholar 

  • Maekawa, K., Clark, G. T., & Kuboki, T. (2002). Intramuscular hypoperfusion, adrenergic receptors, and chronic muscle pain. The Journal of Pain, 3, 251–260.

    Article  PubMed  Google Scholar 

  • McCarthy, M. J. H., Grevitt, M. P., Silcocks, P., & Hobbs, G. (2007). The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. European Spine Journal, 16(12), 2111–2117.

    Article  PubMed  Google Scholar 

  • Nolan, R., Kamath, M., Floras, J., Stanley, J., Pang, C., Picton, P., et al. (2005). Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control. American Heart Journal, 149, 1137.e1–1137.e7.

    Article  Google Scholar 

  • Passatore, M., & Roatta, S. (2006). Influence of sympathetic nervous system on sensorimotor function: Whiplash associated disorders (WAD) as a model. European Journal of Applied Physiology, 98, 423–449.

    Article  PubMed  Google Scholar 

  • Roatta, S., Arendt-Nielsen, L., & Farina, D. (2008). Sympathetic-induced changes in discharge rate and spike-triggered average twitch torque of low-threshold motor units in humans. Journal of Physiology, 586, 5561–5571.

    Article  PubMed  Google Scholar 

  • Siepmann, M., Aykac, V., Unterdörfer, J., Petrowski, K., & Mueck-Weymann, M. (2008). A pilot study on the effects of heart rate variability biofeedback in patients with depression and in healthy subjects. Applied Psychophysiology and Biofeedback, 33, 195–201.

    Article  PubMed  Google Scholar 

  • Statistics Sweden. (2008). Arbetsmiljön 2007 (The Work Environment 2007). In Arbetsmiljöstatistisk Rapport 2008:4. Arbetsmiljöverket, Stockholm, Sweden.

  • Swanson, K. S., Gevirtz, R. N., Brown, M., Spira, J., Guarneri, E., & Stoletniy, L. (2009). The effects of biofeedback on function in patients with heart failure. Applied Psychophysiology and Biofeedback, 34, 71–91.

    Article  PubMed  Google Scholar 

  • Task Force of the European Society of cardiology and the North American Society of Pacing and Electrophysiology. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. European Heart Journal, 93, 1043–1065.

    Google Scholar 

  • Vaschillo, E. G., Vaschillo, B., & Lehrer, P. (2006). Characteristics of resonance in heart rate variability stimulated by biofeedback. Applied Psychophysiology and Biofeedback, 31(2), 129–139.

    Article  PubMed  Google Scholar 

  • Vernon, H., & Mior, S. (1991). The Neck Disability Index: A study of reliability and validity. Journal of Manipulative Physiological Therapeutics, 14, 409–415.

    Google Scholar 

  • Victor, R. G., Leimbach, W. N., Jr., Seals, D. R., Wallin, B. G., & Mark, A. L. (1987). Effects of the cold pressor test on muscle sympathetic nerve activity in humans. Hypertension, 9(5), 429–436.

    PubMed  Google Scholar 

  • Ware, J. E., Jr., Gandek, B., Kosinski, M., Aaronson, N. K., Apolone, G., Brazier, J., et al. (1998). The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: Results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1167–1170.

    Article  PubMed  Google Scholar 

  • Wheat, A. L., & Larkin, K. T. (2010). Biofeedback of heart rate variability and related physiology: A critical review. Applied Psychophysiology and Biofeedback, 35, 229–242.

    Article  PubMed  Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.

    Article  PubMed  Google Scholar 

  • Zucker, T., Samuelson, K., Muench, F., Greenberg, M., & Gevirtz, R. (2009). The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: A pilot study. Applied Psychophysiology and Biofeedback, 34, 135–143.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Musculoskeletal Research, University of Gävle, SE-801 76, Gävle, Sweden

    David M. Hallman & Eugene Lyskov

  2. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    David M. Hallman & Erik M. G. Olsson

  3. Biopsychosocial Medicine AB, Uppsala, Sweden

    Bo von Schéele

  4. School of Innovation, Design and Engineering, Mälardalen University, Västerås, Sweden

    Bo von Schéele

  5. Department of Psychology, Uppsala University, Uppsala, Sweden

    Lennart Melin

Authors
  1. David M. Hallman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erik M. G. Olsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bo von Schéele
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lennart Melin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eugene Lyskov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David M. Hallman.

Appendix

Appendix

See Table 5.

Table 5 Means (M) and standard deviations (sd) of HRV measures under rest and reactivity and recovery to HGT and CPT for treatment (T) and control (C) groups, before and after treatment
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hallman, D.M., Olsson, E.M.G., von Schéele, B. et al. Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain: A Pilot Study. Appl Psychophysiol Biofeedback 36, 71–80 (2011). https://doi.org/10.1007/s10484-011-9147-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10484-011-9147-0

Keywords

Search

Navigation