Efficacy of Biofeedback in Chronic back Pain: a Meta-Analysis



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.


A literature search using PubMed, PsycINFO, and the Cochrane Library identified 21 eligible studies including 23 treatment conditions and 1062 patients.


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.


It is concluded that biofeedback treatment can lead to improvements on various pain-related outcomes in the short and long terms, both as a standalone and as an adjunctive intervention.

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  1. 1.

    The full version of the validity scale is available upon request from one of the authors (JAG).

  2. 2.

    Our rationale for excluding studies on other pain syndromes such as fibromyalgia or headache was that these disorders show different symptom patterns, e.g., higher muscle tension in CLBP patients compared to fibromyalgia patients [59], and usually show different treatment effect sizes [60].


*References marked with an asterisk indicate studies included in the meta-analysis

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Correspondence to Robert Sielski.

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The study was supported by a doctoral thesis scholarship from the University of Marburg.

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Sielski, R., Rief, W. & Glombiewski, J.A. Efficacy of Biofeedback in Chronic back Pain: a Meta-Analysis. Int.J. Behav. Med. 24, 25–41 (2017). https://doi.org/10.1007/s12529-016-9572-9

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  • Chronic back pain
  • Biofeedback
  • Psychological treatment
  • Meta-analysis