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Papers of the Week

Papers: 2 Nov 2019 - 8 Nov 2019


Human Studies

2020 May - Jun

J Pain



Modified biofeedback (Conditioned Biofeedback) promotes anti-nociception by increasing the nociceptive flexion reflex threshold and reducing temporal summation of pain: A controlled trial.


This study examined whether a modified version of biofeedback (ie, Conditioned Biofeedback) that incorporated placebo analgesia-like manipulations could promote anti-nociception in healthy, pain-free participants. During Conditioned Biofeedback (n=28), sympathetic arousal level was displayed visually and participants were asked to reduce it while they received painful electric stimulations that were surreptitiously controlled by their arousal level. Thus, electric pain decreased as arousal decreased to associate successful arousal-reduction/relaxation with pain relief, and to promote expectations for future pain relief. A Biofeedback Only group (n=24) controlled for the general effects of biofeedback/relaxation. A Biofeedback+Shock group (n=21) controlled for the effects of practicing biofeedback during painful shocks. Nociceptive flexion reflex (NFR) threshold and temporal summation of pain (TS-pain) were used to assess changes in spinal nociception and pain facilitation, respectively. Results indicated all groups showed pre- to post-biofeedback increases in NFR threshold, but only the Conditioned Biofeedback group showed pre- to post-biofeedback reductions in TS-pain. Moreover, Conditioned Biofeedback resulted in a persistent (pre-biofeedback) increase in NFR threshold across sessions, whereas Biofeedback Only resulted in a persistent (pre-biofeedback) decrease in TS-pain. In sum, Conditioned Biofeedback may promote anti-nociception in healthy participants thus reducing risk for chronic pain. The study was registered prospectively on ClinicalTrials.gov (TU1560). PERSPECTIVE: A modified version of biofeedback that employs placebo analgesia manipulations was successful in increasing descending inhibition and reducing pain facilitation in healthy volunteers. As a result, it may be an effective means of reducing risk of future chronic pain onset by promoting an anti-nociceptive pain profile.