The Use of E.M.G. Biofeedback to Promote Relaxation and Relief of Chronic Low Back Pain
The purpose of this exploratory study was to determine if relaxation instruction and electromyographic (E.M.G.) feedback would reduce chronic low back pain. A secondary aim was to determine if the locus of control variable as defined by Rotter would influence the results obtained. Fourteen non-hospitalized subjects with chronic low back pain, meeting the criteria of this study became the sample group. The training program consisted of six 30-minute sessions during which the subjects were taught relaxation with the use of a feedback electromyograph and relaxation instructions. After an interval of two weeks, a seventh session was conducted to evaluate if the relaxation learned could be maintained without frequent training sessions. The subjects also practiced relaxation twice daily at home between training sessions. A daily record of analgesics, sedatives and muscle relaxants taken three days before, during and two weeks after the training sessions was kept by the subjects. In a preliminary orientation session, demographic data was collected. principles of relaxation and biofeedback were discussed and the subjects completed Rotter's Internal-External Scale questionnaire. According to their scores they were ranked and dichotomized into two groups, those having greater internal locus of control and those having greater external locus of control. Seven subjects fell into each category. Data was analyzed and conclusions drawn on the basis of changes in the average pain scores, the changes in the amount of medication required and the decreases in the E.M.G. microvolt levels. A t-test showed a significant difference between baseline pain recordings and those of the week before the sixth session. There was also a significant difference between the baseline record and the average of the week before the seventh session. A decrease in the amount of medication required was noted. No attempt was made to analyze this variable statistically because of the limited number of subjects who took medication with any degree of consistency. The difference in the E.M.G. microvolt levels between the beginning of the first relaxation session and the mean of the sixth session was significant at the .02 level. The difference was less when the first session was compared with the seventh session, P = .13). T-tests indicated no significant difference between the two locus of control groups in their ability to relax, reduce the intensity of their pain and pain medications required, and to retain what they have learned for two weeks after the end of the training period. Subjective responses indicated that eight subjects felt that the program improved their ability to sleep. Ten subjects reported that they were able to increase their activity levels, and/or maintain a sitting or standing position with less discomfort. Results from responses to the questionnaire at the end of the sixth session indicated that thirteen of the fourteen subjects felt that they had experienced some decline in the intensity of their low back pain. Seven noted that they felt a marked improvement. There are limitations on the interpretation of the findings of this exploratory study which should be emphasized. Some of these limitations are as follows: The instructions for relaxation and the autogenic phrases read by the researchers were rated by the subjects as more helpful than the E.M.G. visual and audiofeedback. It is possible that the recumbent position of the subjects during the training sessions might have reduced their ability to see the E.M.G. microvolt dial, thereby reducing the effectiveness of the visual feedback signal. The researchers related to all subjects in a supportive way. Since no control group was used in the exploratory study, the Hawthorne effect cannot be excluded as an explanation for relief of pain, reduction in medication used, or increases in relaxation. Two researchers administered the training program, each used the same protocol and followed specific subjects throughout the entire session. However, because of small subgroup numbers no attempt was made to evaluate the effect of the differences in the individuality of the researchers on respective subjects. Other intervening variables that were apparent but impossible to control were: pain from other sources; interfering emotional concerns; concomitant therapy and the possibility that the presenting low back pain problem was due to an acute episode of the existing chronic back pain.
Nursing, Pain Management, Backache; Biofeedback (Psychology)
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