Heart rate variability biofeedback therapy for children and adolescents with chronic pain

      Biofeedback is a noninvasive, cost-effective, and technology-driven therapy that has been found to be a promising clinical intervention for children and adolescents with chronic pain. Recently, investigators have started exploring the efficacy of Heart Rate Variability (HRV) biofeedback for chronic pain because it targets a specific aspect of autonomic regulation. The aim of this pilot study was to explore the application of a brief HRV biofeedback intervention supplemented by at-home breathing practice as a tool for reducing symptomatology associated with chronic pain in a pediatric urban hospital setting. Twenty-one participants between the ages of 10-17 years (M = 14.05, SD = 1.91; 76% female) and their caregivers were recruited from a pain management clinic and the division of rheumatology. Participants were randomized to receive either 1) immediate biofeedback treatment including at-home breathing practice or 2) to be placed on a 4-week waitlist and then enrolled in the biofeedback treatment. Study outcomes included HRV data from biofeedback sessions and self-reported pain intensity, health-related quality of life, sleep, depression, and anxiety sensitivity. Following biofeedback treatment, children in this study achieved significant reductions in self-reported pain intensity, higher levels of self-reported school functioning, and increased HRV, as measured by blood volume pulse amplitude. Pain intensity scores decreased for both treatment groups following treatment, with results indicating a significant time effect for the Faces Pain Scale - Revised (Wilk's Λ = .531, F(1, 17) = 15.037, p = .001) and the Varni-Thompson Pediatric Pain Questionnaire (Wilk's Λ = .574, F(1, 17) = 12.607, p = .002). The control group reported increased pain intensity over the waitlist period while the treatment group reported pain reductions at the conclusion of biofeedback therapy. Further research is needed to explore the mechanisms underlying HRV biofeedback and its treatment of pediatric chronic pain, including long-term health outcomes.