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Biofeedback in the Treatment of Headache and Other Childhood Pain

Abstract

Since the first biofeedback (BFB) studies on pediatric pain were published in the early 1980s, most of the studies have focused on the treatment of pediatric migraine. More recently, BFB has also been evaluated in the treatment of tension headache in children. Not surprisingly, most of what we know about the efficacy and mechanisms of BFB in the treatment of children's pain problems concerns the treatment of childhood headache (HA). In this review, we provide a detailed summary of studies that have evaluated BFB in the treatment of childhood HAs with an emphasis on treatment outcome and maintenance of treatment success. Moreover, findings and hypotheses with regard to the mechanisms that may mediate the treatment effects of BFB are addressed. Finally, we discuss specific issues relating to the treatment of pain in children with BFB and outline future directions of research.

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REFERENCES

  • Allen, K. D., & McKeen, L. R. (1991). Home-based multicomponent treatment of pediatric migraine. Headache, 31, 467–472.

    Google Scholar 

  • Allen, K. D., & Shriver, M. D. (1997). Enhanced performance feedback to strengthen biofeedback treatment outcome with childhood migraine. Headache, 37, 169–173.

    Google Scholar 

  • Allen, K. D., & Shriver, M. D. (1998). Role of parent-mediated pain behavior management strategies in biofeedback treatment of childhood migraines. Behavior Therapy, 29, 477–490.

    Google Scholar 

  • Andrasik, F., Attanasio, V., Blanchard, E. B., Burke, E., Kabela, E., McCarran, M., et al. (1984). Behavioral treatment of pediatric migraine headache. In F. Andrasik (Chair), Recent developments in the assessment and treatment of headache. Symposium held at the annual meeting of the Association for the Advancement of Behavior Therapy, Philadelphia.

  • Andrasik, F., Blanchard, E. B., Edlund, S. R., & Attanasio, V. (1983). EMG biofeedback treatment of a child with muscle contraction headache. American Journal of Clinical Biofeedback, 6, 96–102.

    Google Scholar 

  • Apley, J. (1975). The child with abdominal pains. London: Blackwell.

    Google Scholar 

  • Attanasio, V., Andrasik, F., Burke, E., Blake, D., Kabela, E., & McCarran, M. (1985). Clinical issues in utilizing biofeedback with children. Clinical Biofeedback and Health, 8, 134–141.

    Google Scholar 

  • Banks, S. M., & Kerns, R. D. (1996). Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychological Bulletin, 119, 95–110.

    Google Scholar 

  • Barowsky, E. (1990). The use of biofeedback in the treatment of disorders of childhood. Annals of New York Academy of Sciences, 602, 221–233.

    Google Scholar 

  • Bille, B. (1989). Migraine in childhood: A 30 years follow-up. In G. Lanzi, U. Balottin, & A. Cernibori (Eds.), Headache in children and adolescents (pp. 12–26). New York: Elsevier.

    Google Scholar 

  • Birbaumer, N., Elbert, T., Canavan, A. G., & Rockstroh, B. (1990). Slow potentials of the cerebral cortex and behavior. Physiological Reviews, 70, 1–41.

    Google Scholar 

  • Blanchard, E. B. (1992). Psychological treatment of benign headache disorders. Journal of Consulting and Clinical Psychology, 60, 537–551.

    Google Scholar 

  • Blanchard, E. B., Kim, M., Hermann, C., Steffek, B. D., Nicholson, N. I., & Taylor, A. E. (1994). The role of perception of success in the thermal biofeedback treatment of vascular headache. Headache Quarterly, 5, 231–236.

    Google Scholar 

  • Blanchard, E. B., & Schwarz, S. P. (1988). Clinically significant changes in behavioral medicine. Behavioral Assessment, 10, 171–188.

    Google Scholar 

  • Burke, E. J., & Andrasik, F. (1989). Home-vs. clinic-based biofeedback treatment for pediatric migraine: Results of treatment through one-year follow-up. Headache, 29, 434–440.

    Google Scholar 

  • Bussone, G., Grazzi, L., D'Amico, D., Leone, M., & Andrasik, F. (1998). Biofeedback-assisted relaxation training for young adolescents with tension-type headache: A controlled study. Cephalalgia, 18, 463–467.

    Google Scholar 

  • Cohen, J. (1987). Statistical power analysis for the behavioral sciences (2nd Rev. ed.). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Compas, B. E., Davis, G. E., & Forsythe, C. J. (1985). Characteristics of life events during adolescence. American Journal of Community Psychology, 13, 677–691.

    Google Scholar 

  • Cozzi, L., Tryon, W.W., & Sedlacek, K. (1987). The effectiveness of biofeedback-assisted relaxation in modifying sickle cell crisis. Biofeedback and Self-Regulation, 12, 51–61.

    Google Scholar 

  • Culbert, T. P., Kajander, R. L., & Reaney, J. B. (1996). Biofeedback with children and adolescents: Clinical observations and patient perspectives. Developmental and Behavioral Pediatrics, 17, 342–350.

    Google Scholar 

  • Faull, C., & Nicol, A. R. (1986). Abdominal pain in six-year-olds: An epidemiological study in a new town. Journal of Child Psychology and Psychiatry, 27, 251–260.

    Google Scholar 

  • Fentress, D.W., Masek, B. J., Mehegan, J. E., & Benson, H. (1986). Biofeedback and relaxation—response training in the treatment of pediatric migraine. Developmental Medicine and Child Neurology, 28, 139–146.

    Google Scholar 

  • Flor, H., & Turk, D. C. (1989). Psychophysiology of chronic pain: Do chronic pain patients exhibit symptom specific psychophysiological responses? Psychological Bulletin, 105, 215–259.

    Google Scholar 

  • Fordyce, W. E. (1976). Behavioral methods in chronic pain. St. Louis, MO: Mosby.

    Google Scholar 

  • Goodman, J. E., & McGrath, P. J. (1991). The epidemiology of pain in children and adolescents: A review. Pain, 46, 247–264.

    Google Scholar 

  • Grazzi, L., Andrasik, F., D'Amico, D., Leone, M., Moschiano, F., & Bussone, G. (2001). Electromygraphic biofeedback-assisted relaxation training in juvenile episodic tension-type headache: Clinical outcome at three year follow-up. Cephalalgia, 21, 798–803.

    Google Scholar 

  • Grazzi, L., Leone, M., Frediani, F., & Bussone, G. (1990). A therapeutic alternative for tension headache in children: Treatment and 1-year follow-up results. Biofeedback and Self-Regulation, 15, 1–7.

    Google Scholar 

  • Guarnieri, P., & Blanchard, E. B. (1990). Evaluation of home-based thermal biofeedback treatment of pediatric migraine headache. Biofeedback and Self-Regulation, 15, 179–184.

    Google Scholar 

  • Hartmann, A., & Herzog, T. (1995). Varianten der Effektstärkenberechnung in Meta-Analysen: Kommt es zu variablen Ergebnissen? [Variants in effect size calculation: How much do the results differ?] Zeitschrift f¨ur Klinische Psychologie, 24, 337–443.

    Google Scholar 

  • Hermann, C., Blanchard, E. B., & Flor, H. (1997). Biofeedback treatment for pediatric migraine: Prediction of treatment outcome. Journal of Consulting and Clinical Psychology, 85, 611–616.

    Google Scholar 

  • Hermann, C., Kim, M., & Blanchard, E. B. (1995). Behavioral and prophylactic pharmacological intervention studies of pediatric migraine: An exploratory meta-analysis. Pain, 60, 239–256.

    Google Scholar 

  • Hernandez-Latorre, M. A., & Roig, M. (2000). Natural history of migraine in childhood. Cephalalgia, 20, 573–579.

    Google Scholar 

  • Holden, E.W., Deichmann, M. M., & Levy, J. D. (1999). Empirically supported treatments in pediatric psychology: Recurrent pediatric headache. Journal of Pediatric Psychology, 24, 91–109.

    Google Scholar 

  • Holroyd, K. A., Penzien, D. B., Hursey, K. G., Tobin, D. L., Rogers, L., Holm, J. E., et al. (1984). Change mechanisms in EMG biofeedback training: Cognitive changes underlying improvements in tension headache. Journal of Consulting and Clinical Psychology, 52, 1039–1053.

    Google Scholar 

  • Holroyd, K. A., Stensland, M., Lipchik, G. L., Hill, K. R., O'Donnell, F. S., & Cordingley, G. (2000). Psychosocial correlates and impact of chronic tension-type headaches. Headache, 40, 3–16.

    Google Scholar 

  • Hyams, J. S., Burke, G., Davis, P. M., Rzepski, B., & Andrulonis, P. A. (1996). Abdominal pain and irritable bowel syndrome in adolescents: A community-based study. Journal of Pediatrics, 129, 220–226.

    Google Scholar 

  • Kotchoubey, B., Blankenhorn, V., Froscher, W., Strehl, U., & Birbaumer, N. (1997). Stability of cortical self regulation in epilepsy patients. NeuroReport, 8, 1867–1870.

    Google Scholar 

  • Kraemer, H., & Andrew, G. (1982). A non-parametric technique for meta-analysis effect size calculation. Psychological Bulletin, 91, 404–412.

    Google Scholar 

  • Kröner-Herwig, B., Mohn, U., & Pothmann, R. (1998). Comparison of biofeedback and relaxation in the treatment of pediatric headache and the influence of parent involvement on outcome. Applied Psychophysiology and Biofeedback, 23, 143–157.

    Google Scholar 

  • Kröner-Herwig, B., Plump, U., & Pothmann, R. (1992). Progressive relaxation und EMG-Biofeedback in der Therapie von chronischem Kopfschmerz bei Kindern. Der Schmerz, 6, 121–127.

    Google Scholar 

  • Kropp, P., & Gerber, W. D. (1993). Contingent negative variation―findings and perspectives in migraine. Cephalalgia, 13, 33–36.

    Google Scholar 

  • Kuhn, B. R., & Allen, K. D. (1993). Long-term follow-up of a home-based multicomponent treatment for pediatric migraine. Poster presented at the 27th annual meeting of the Association for Advancement of Behavior Therapy, Atlanta, GA.

  • Labbé, E. E. (1988). Childhood muscle contraction headache: Current issues in assessment and treatment. Headache, 28, 430–434.

    Google Scholar 

  • Labbé, E. E. (1995). Treatment of childhood migraine with autogenic training and skin temperature biofeedback: A component analysis. Headache, 35, 10–13.

    Google Scholar 

  • Labbé, E. E., & Ward, C. H. (1990). Electromyographic biofeedback with mental imagery and home practice in the treatment of children with muscle-contraction headache. Developmental and Behavioral Pediatrics, 11, 65–68.

    Google Scholar 

  • Labbé, E. E., & Williamson, D. A. (1984). Treatment of childhood migraine using autogenic feedback training. Journal of Consulting and Clinical Psychology, 52, 968–976.

    Google Scholar 

  • Larsson, B., Melin, L., & Döberl, A. (1990). Recurrent tension headache in adolescents treated with self-help relaxation training and a muscle relaxant drug. Headache, 30, 665–671.

    Google Scholar 

  • Lavigne, J. V., Ross, C. K., Berry, S. L., Hayford, J. R., & Pachman, L. M. (1992). Evaluation of a psychological treatment package for treating pain in juvenile rheumatoid arthritis. Arthritis Care and Research, 5, 101–110.

    Google Scholar 

  • Linet, M. S., & Stewart, W. F. (1984). Migraine headache: Epidemiologic perspectives. Epidemiological Review, 6, 107–139.

    Google Scholar 

  • Linet, M. S., Stewart, W. F., Celentano, D. D., Ziegler, D., & Sprecher, M. (1989). An epidemiologic study of headache among adolescents and young adults. JAMA, 261, 2211–2216.

    Google Scholar 

  • Marcus, D. A. (2000). Identification of patients with headache at risk of psychological distress. Headache, 40, 373–376.

    Google Scholar 

  • McGrath, P. J., Humphreys, P., Keene, D., Goodman, J. T., Lascelles, M. A., Cunningham, S. J., et al. (1992). The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain, 49, 321–324.

    Google Scholar 

  • McQuaid, E. L., & Nassau, J. H. (1999). Empirically supported treatments of disease-related symptoms in pediatric psychology: Asthma, diabetes, and cancer. Journal of Pediatric Psychology, 24, 305–328.

    Google Scholar 

  • Mehegan, J. E., Masek, B. J., Harrison, R. H., Russo, D. C., & Leviton, A. (1987). A multicomponent behavioral treatment for pediatric migraine. Clinical Journal of Pain, 2, 191–196.

    Google Scholar 

  • Mikkelsson, M., Salminen, J. J., & Kautiainen, H. (1997). Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain, 73, 29–35.

    Google Scholar 

  • Mikkelsson, M., Salminen, J. J., Sourander, A., & Kautiainen, H. (1997). Contributing factors to the persistence of musculoskeletal pain in preadolescents: A prospective 1-year follow-up study. Pain, 77, 67–72.

    Google Scholar 

  • Miller, N. E., & Dworkin, B. R. (1977). Effects of learning on visceral functions: Biofeedback. New England Journal of Medicine, 296, 1274–1278.

    Google Scholar 

  • Murphy, E., & Carr, A. (2000). Pediatric pain problems. In A. Carr (Ed.), What works with children and adolescents? A critical review of psychological interventions with children, adolescents and their families (pp. 258–279). Florence, KY: Taylor & Francis/Routledge.

    Google Scholar 

  • Oster, J. (1972). Recurrent abdominal pain, headache and limb pains in children and adolescents. Pediatrics, 50, 429–436.

    Google Scholar 

  • Osterhaus, S. O. L., Passchier, J., van der Helm-Hylkema, H., de Jong, K. T., Orlebeke, J. F., de Grauw, A. J. C., et al. (1993). Effects of behavioral psychophysiological treatment on schoolchildren with migraine in a nonclinical setting: Predictors and process variables. Journal of Pediatric Psychology, 18, 697–715.

    Google Scholar 

  • Passchier, J., & Orlebeke, J. F. (1985). Headaches and stress in schoolchildren: An epidemiological study. Cephalalgia, 5, 167–176.

    Google Scholar 

  • Rachlin, H. (1985). Pain and behavior. Behavioral and Brain Sciences, 8, 43–83.

    Google Scholar 

  • Rhee, H. (2000). Prevalence and predictors of headaches in US adolescents. Headache, 40, 528–538.

    Google Scholar 

  • Sarafino, E. P., & Goehring, P. (2000). Age comparisons in acquiring biofeedback control and success in reducing headache pain. Annals of Behavioral Medicine, 22, 10–16.

    Google Scholar 

  • Sartory, G., Müller, B., Metsch, J., & Pothmann, R. (1998). A comparison of psychological and pharmacological treatment of pediatric migraine. Behaviour Research and Therapy, 36, 1155–1170.

    Google Scholar 

  • Sillanpäa, M. (1983a). Prevalence of headache in prepuberty. Headache, 23, 10–14.

    Google Scholar 

  • Sillanpäa, M. (1983b). Changes in the prevalence of migraine and other headaches during the first seven school years. Headache, 23, 15–19.

    Google Scholar 

  • Sillanpäa, M., & Anttila, P. (1996). Increasing prevalence of headache in 7-year-old schoolchildren. Headache, 36, 466–470.

    Google Scholar 

  • 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, 13–32.

    Google Scholar 

  • Suter, S., Fredericson, M., & Portuesi, L. (1983). Mediation of skin temperature biofeedback effects in children. Biofeedback and Self-Regulation, 8, 567–584.

    Google Scholar 

  • Suter, S., & Loughry-Machado, G. (1981). Skin temperature biofeedback in children and adults. Journal of Experimental Child Psychology, 32, 77–87.

    Google Scholar 

  • Task Force on Promotion and Dissemination of Psychological Procedures. (1995). Training in and dissemination of empricially-validated psychological treatments: Report and recommendation. Clinical Psychologist, 48, 3–23.

    Google Scholar 

  • Waldie, K. (2001). Childhood headache, stress in adolescence, and primary headache in young adulthood: A longitudinal cohort study. Headache, 41, 1–10.

    Google Scholar 

  • Walker, L. S., Garber, J., & Greene, J. W. (1993). Psychosocial correlates of recurrent childhood pain: A comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders. Journal of Abnormal Psychology, 102, 248–258.

    Google Scholar 

  • Walker, L. S., Garber, J., Van Slyke, D. A., & Greene, J. W. (1995). Long-term health outcomes in patients with recurrent abdominal pain. Journal of Pediatric Psychology, 20, 233–245.

    Google Scholar 

  • Walker, L. S., Guite, J. W., Duke, M., Barnard, J. A., & Greene, J. W. (1998). Recurrent abdominal pain: A potential precursor of irritable bowel syndrome in adolescents and young adults. Journal of Pediatrics, 132, 1010–1015.

    Google Scholar 

  • Welch, K. M. (1998). Current opinions in headache pathogenesis: Introduction and synthesis. Current Opinion in Neurology, 11, 193–197.

    Google Scholar 

  • Werder, D. S., & Sargent, J. D. (1984). A study of childhood headache using biofeedback as a treatment alternative. Headache, 24, 122–126.

    Google Scholar 

  • Womack, W. M., Smith, M. S., & Chen, A. C. N. (1988). Behavioral management of childhood headache: A pilot study and case history report. Pain, 32, 279–283.

    Google Scholar 

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Hermann, C., Blanchard, E.B. Biofeedback in the Treatment of Headache and Other Childhood Pain. Appl Psychophysiol Biofeedback 27, 143–162 (2002). https://doi.org/10.1023/A:1016295727345

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  • DOI: https://doi.org/10.1023/A:1016295727345

  • childhood pain
  • pediatric headache
  • biofeedback
  • efficacy
  • treatment mechanisms