Abstract
Objectives
Fibromyalgia (FM) is associated with debilitating pain and a reduced heart rate variability
(HRV), reflecting decreased emotional adaptability and resistance to stress. Common
pharmacological treatments are ineffective, and opioids are highly addictive and cause
an estimated 15,000 overdose deaths per year. Effective recommendations include patient-centered
interventions like physical activity, cognitive behavioral therapy, and biofeedback.
Heart rate variability biofeedback (HRVB) may be effective in improving HRV, thus
increasing stress resistance and emotional adaptability and reducing pain.
Design
This integrative literature review was conducted to examine the relationship between
HRVB and FM-related chronic pain using the Theory of Symptom Self-Management and to
identify available HRVB technology.
Data Sources
We searched PubMed, EBSCOhost, and Google Scholar electronic databases for relevant
publications. Manuscripts were selected using the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses strategy, and study quality was assessed using the Critical
Appraisal Skills Programme guidelines. The relationship between HRVB and FM was analyzed
and evaluated based on the methodological framework proposed by Whittemore and Knafl.
Review/Analysis Methods
We reviewed 22 articles and included six in this review. Five reported HRVB as a treatment
for chronic pain, and one for FM pain.
Results
Overall, the articles in this review support the claim that HRVB is related to decreased
pain. The researchers evaluated five HRVB programs, three on handheld devices and
two on desktop computers.
Conclusions
The reviewed studies had methodological flaws. However, HRVB is a promising treatment
for chronic pain. Larger, randomized controlled studies are needed to thoroughly evaluate
the relationship between HRVB and FM pain.
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References
- Management of patients with fibromyalgia using biofeedback: A randomized control trial.Indian Journal of Medical Sciences. 2007; 61: 455-461
- Self-efficacy.in: Encyclopedia of human behavior. 4. Academic Press, New York1994: 71-81
- Non-pharmacological intervention for chronic pain in veterans: A pilot study of heart rate variability biofeedback.Global Advances In Health And Medicine. 2014; 3: 28-33
- Fibromyalgia: Novel therapeutic aspects...International MYOPAIN Society's (IMS) Sixth World Congress, MYOPAIN 2004, Munich, Germany, July 18-22, 2004.Journal of Musculoskeletal Pain. 2004; 12: 65-72
- Fibromyalgia.(Retrieved from)
- The comparative economic burden of mild, moderate, and severe fibromyalgia: Results from a retrospective chart review and cross-sectional survey of working-age U.S. adults.Journal of Managed Care Pharmacy. 2012; 18: 415-426
- Heart rate variability in assessment of autonomic dysfunction in patients with chronic prostatitis/chronic pelvic pain syndrome.Urology. 2011; 78: 1369-1372
- Fibromyalgia: A clinical review.JAMA. 2014; 311: 1547-1555
- Controversies and challenges in fibromyalgia: A review and a proposal.Therapeutic Advances in Musculoskeletal Disease. 2017; 9: 115-127
- Autonomic dysfunction in patients with fibromyalgia: Application of power spectral analysis of heart rate variability.Seminars in Arthritis and Rheumatism. 2000; 29: 217-227
Critical Appraisal Skills Programme. Retrieved from https://casp-uk.net. (Accessed 2 May 2018).
- A smartphone-based cardiac coherence biofeedback system.Annual International Conference of the IEEE Engineering in Medicine and Biology Society. 2014; : 4791-4794
- Fibromyalgia from the perspective of neuropathic pain.The Journal of Rheumatology. 2005; 75: 1-5
- Evaluation of heart rhythm coherence feedback training on physiological and psychological variables.South African Journal of Psychology. 2014; 44: 73-82
- An integrated approach to an analysis of symptom management in patients with cancer.Oncology Nursing Forum. 2004; 31: 65-70
- The promise of heart rate variability biofeedback: Evidence-based applications.Biofeedback. 2013; 41: 110-120
- The iceberg nature of fibromyalgia burden: The clinical and economic aspects.The Korean Journal of Pain. 2015; 28: 169
- Effects of heart rate variability biofeedback in subjects with stress-related chronic neck pain: A pilot study.Applied Psychophysiology and Biofeedback. 2011; 36: 71-80
- A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fibromyalgia.Applied Psychophysiology and Biofeedback. 2007; 32: 1-10
- emWave stress relief system. J&J Engineering (n.d.). J&J I-330 neurofeedback.2004
- Enhancing self-efficacy for optimized patient outcomes through the theory of symptom self-management.Cancer Nursing. 2013; 36: E16-E26
- Fibromyalgia: The fibromyalgia Impact questionnaire (FIQ).Arthritis Care & Research. 2003; 49: S210-S213
- Disability in patients with chronic neck pain: Heart rate variability analysis and cluster analysis.Clinical Journal of Pain. 2012; 28: 797-803
- First non-contingent respiratory biofeedback placebo versus contingent biofeedback in patients with chronic low back pain: A randomized, controlled, double-blind trial.Applied Psychophysiology and Biofeedback. 2010; 35: 207-217
- Protocol for heart rate variability biofeedback training.Biofeedback. 2013; 41: 98-109
- Heart rate variability biofeedback: How and why does it work?.Frontiers in Psychology. 2014; 5: 756
- Self-management education: History, definition, outcomes, and mechanisms.Annals of Behavioral Medicine. 2003; 26: 1-7
- EULAR revised recommendations for the management of fibromyalgia.Annals of the Rheumatic Diseases. 2017; 76: 318-328
- Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia.Seminars in Arthritis and Rheumatism. 2000; 29: 197-199
- Heart rate variability: New perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk.Global Advances in Health and Medicine. 2015; 4: 46-61
- Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: A systematic review.Seminars in Arthritis & Rheumatism. 2013; 43: 279-287
- The application of heart rate variability biofeedback to medical and mental health disorders.Biofeedback. 2017; 45: 2-8
- Health and distress predictors of heart rate variability in fibromyalgia and other forms of chronic pain.Journal of Psychosomatic Research. 2012; 72: 39-44
- Mind body therapies in rehabilitation of patients with rheumatic diseases.Complimentary Therapies in Clinical Practice. 2016; 22: 6
- The comparative burden of chronic widespread pain and fibromyalgia in the United States.Pain Practice. 2015; 16: 565-579
- Heart coherence training combined with Back School in patients with chronic non-specific low back pain: First pragmatic clinical results.Applied Psychophysiology and Biofeedback. 2014; 39: 259-267
- The influence of perceived control and self-efficacy on the sensory evaluation of experimentally induced pain.Journal of Behavior Therapy and Experimental Psychiatry. 2011; 42: 511-517
- Pilot randomized trial comparing intersession scheduling of biofeedback results to individuals with chronic pain: Influence on psychologic function and pain intensity.American Journal of Physical Medicine & Rehabilitation. 2015; 94: 869-878
- Biofeedback of heart rate variability and related physiology: A critical review.Applied Psychophysiology and Biofeedback. 2010; 35: 229-242
- Effectiveness of emWave biofeedback in improving heart rate variability reactivity to and recovery from stress.Applied Psychophysiology and Biofeedback. 2014; 39: 75-88
- The integrative review: Updated methodology.Journal of Advanced Nursing. 2005; 52: 546-553
- Heart rate variability biofeedback training as an intervention for chronic pain.(Dissertation) Marquette University, 2017 ([email protected], Marquette, Michigan. Retrieved from)http://epublications.marquette.edu/cgi/viewcontent.cgi?article=1750&context=dissertations_mu Google Scholar databaseDate accessed: September 14, 2017
- The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care and Research. 2010; 62: 600-610
- The prevelance and characteristics of fibromyalgia in the general population.Arthritis & Rheumatology. 1995; 38: 19-28
Article info
Publication history
Published online: September 06, 2019
Accepted:
August 1,
2019
Received in revised form:
June 14,
2019
Received:
July 7,
2018
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Society for Pain Management Nursing
