Thursday, September 4, 2014


EEG Biofeedback for PAIN AND HEADACHE meets all of the criteria for Level 4: Efficacious 


Explanation of Efficacy Levels

Biofeedback and neurofeedback therapies have continued to develop over the last 40 years. Today there are myriad disorders for which is used. Large research grants have funded studies on neurofeedback therapy for a variety of disorders. These studies consistently report positive results.

In 2001, a Task Force of the Association for Applied Psychophysiology and Biofeedback and the Society for Neuronal Regulation developed guidelines for the evaluation of the clinical efficacy of psychophysiological interventions. The board of directors of both organizations subsequently approved these guidelines.

A low efficacy rating does not mindicate that neurofeedback is not effective for the disorder, only that an insufficient number of studies have been completed for conclusive results. 

Level 1: Not Empirically Supported
Supported only by anecdotal reports and/or case studies in nonpeer-reviewed venues. Not empirically supported.

Level 2: Possibly Efficacious
At least one study of sufficient statistical power with well-identified outcome measures but lacking randomized assignment to a control condition internal to the study.

Level 3: Probably Efficacious
 Multiple observational studies, clinical studies, wait-list controlled studies, and within-subject and intrasubject replication studies that demonstrate efficacy.

Level 4: Efficacious
a. In a comparison with a no-treatment control group, alternative treatment group, or sham (placebo) control utilizing randomized assignment, the investigational treatment is shown to be statistically significantly superior to the control condition, or the investigational treatment is equivalent to a treatment of established efficacy in a study with sufficient power to detect moderate differences, and
b. The studies have been conducted with a population treated for a specific problem, for whom inclusion criteria are delineated in a reliable, operationally defined manner, and
c. The study used valid and clearly specified outcome measures related to the problem being treated, and
d. The data are subjected to appropriate data analysis, and
e. The diagnostic and treatment variables and procedures are clearly defined in a manner that
permits replication of the study by independent researchers, and
f. The superiority or equivalence of the investigational treatment has been shown in at least two independent research settings.

Level 5: Efficacious and Specific
Evidence for Level 5 efficacy meets all of the criteria for Level 4. In addition, the investigational treatment has been shown to be statistically superior to credible sham therapy, pill, or alternative bonafide treatment in at least two independent research settings.

Disclaimer: All the articles, documents or publications mentioned by or linked on this site have been provided as a public service. There is absolutely no endorsement of any statement made in any of these documents, articles, or publications.

Research studies:
Bazanova, O.M., Aftanas, L.I. (2010).Individual EEG alpha activity analysis for enhancement neurofeedback efficiency: Two case studies.  Journal of Neurotherapy14(3), 244 – 253.
Coger, R., & Werbach, M. (1975). Attention, anxiety, and the effects of learned enhancement of EEG alpha in chronic pain: A pilot study in biofeedback. Chapter in B. L. Drue, Jr. (Ed.), Pain Research and Treatment. New York: Academic Press.
Gannon, L., & Sternbach, R. A. (1971). Alpha enhancement as a treatment for pain: A case study. Behavior Therapy & Experimental Psychiatry, 2, 209-213.
Ham, L. P., & Packard, R. C. (1996). A retrospective, follow-up study of biofeedback-assisted relaxation therapy in patients with posttraumatic headache. Biofeedback & Self-Regulation, 21(2), 93-104.
Jensen, M.P., Sherlin, L.H., Hakimian, S., Fregni, F. (2009). Neuromodulatory approaches for chronic pain management: Research findings and clinical implications.Journal of Neurotherapy 13(4), 196 – 213.
Jensen, M. P., Grierson, C., Tracy-Smith, V., Bacigalupi, S. C., Othmer, S. (2007).  Neurofeedback treatment for pain associated with complex regional pain syndrome. Journal of Neurotherapy, 11(1), 45-53. 
Lehmann, D., Lang, W., & Debruyne, P. (1976). Controlled EEG alpha feedback training in normals and headache patients. Archives of Psychiatry, 221, 331-343.
Matthew, A., Mishm, H., & Kumamiah, V. (1987). Alpha feedback in the treatment of tension headache. Journal of Personality & Clinical Studies, 3(1), 17-22.
McKenzie, R., Ehrisman, W., Montgomery, P. S., & Barnes, R. H. (1974). The treatment of headache by means of electroencephalographic biofeedback. Headache, 13, 164-172.
Pelletier, K. R., & Pepper, E. (1977). Developing a biofeedback model: Alpha EEG feedback as a means for pain control. International Journal of Clinical & Experimental Hypnosis, 25, 361-371.
Rosenfeld, J. P., Dowman, R., Heinricher, N., & Silvia, R. (1984). Operantly controlled somatosensory evoked potentials: Specific effects on pain processes. Chapter in B. Rockstroh, T. Elbert, W. Lutzenberger, & N. Birbaumer (Eds.), Self-Regulation of the Brain and Behavior. Berlin: Springer-Verlag, pp. 164-179.
Rosenfeld, J. P., Silvia, R.,Weitkunat, R., & Dowman, R. (1985). Operant control of human somatosensory evoked potentials alters experimental pain perception. Chapter in H. L. Fields, R. Dubner, & F. Cervero (Eds.), Advances in Pain Research and Therapy, Volume 9: Proceedings of the Fourth World Congress on Pain. New York: Raven Press, 343-349.
Sime, A. (2004). Case study of trigeminal neuralgia using neurofeedback and peripheral biofeedback. Journal of Neurotherapy, 8(1), 59-71.
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 & Biofeedback, 25(1), 13-32.
Tansey, M. A. (1991). A neurobiological treatment for migraine: The response of four cases of migraine to EEG biofeedback training. Headache Quarterly: Current Treatment & Research, 90-96.


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