An alternative perspective on biofeedback efficacy studies: A reply to Steiner and Dince

Clinical applications of biofeedback have proliferated and considerable lore surrounding the application of these techniques has evolved. Many assertions about the effectiveness of biofeedback training are based on findings of the least well-controlled studies, while many of the better controlled studies have failed to show that biofeedback directly mediates target symptoms or is superior to other treatments. Steiner and Dince (1981) suggest that the failure of these controlled studies is primarily attributable to methodological deficiencies. We believe that the question of whether or not there is a specific effect of biofeedback training is still frequently confused with the question of whether or not the treatment package as a whole has therapeutic value. Biofeedback is often therapeutic; however, evidence is often lacking that its effectiveness is due to biofeedback-trained changes in a target physiological process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44088/1/10484_2005_Article_BF00998755.pd

Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions) were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients