Biofeedback: A Mainstay of Integrative and Holistic Pain Management

Seth L. Enos, ND, BCB; Ria Abelon, MS, BCB; Ivan Quintero, ND, BCB; Robyn Evans, ARNP; Cora Collette Breuner, MD, MPH, FAAP

Biofeedback Team, Adolescent Medicine
Seattle Children’s Hospital

Biofeedback therapy is a non-invasive therapy that shows a patient their own physiological changes that occur in the body in real time via sensors, software, and screens.  The patient works with a biofeedback therapist to recognize and adjust their physical, mental, and emotional responses to stimuli.  With time and practice, patients learn to recognize their own responses to stressors and other stimuli, such as pain, while adjusting their own physiological response to manage the accompanying symptoms.

Most children over 8 years of age and adolescents can grasp and develop a proficiency with biofeedback skills in six one-hour sessions when they apply themselves to routine, consistent practice.  While symptoms may fully or partially resolve before the end of the series of trainings for biofeedback, we do not expect to see the full effect of therapy until skills have been maintained and applied for about three to six months.  Biofeedback therapy is not an intervention where patients are taught to dissociate or distance themselves from their symptoms, experiences, or stressors. Instead patients are often encouraged to lean into their stressors using biofeedback techniques to stay neutral.  Sometimes this can be summarized by considering how someone wants to “show up” or “be present” with difficult scenarios or challenging situations including episodes of pain.

Studies of clinical outcomes have demonstrated that patients with chronic migraines, tension headaches, chronic abdominal pain without organic cause, and some musculoskeletal complaints can be managed well using biofeedback techniques.  Patients often report improvement with sleep, emotional challenges, and increased resiliency to stressors such as starting classes at a new school, upcoming medical or surgical appointments, living through a global pandemic, and being present in crowds or public spaces.

Seattle Children’s Hospital has been offering biofeedback as a modality to help children and adolescents effectively manage pain for over thirty years.  Our team has helped hundreds of children /adolescents and their families; even now we are providing care to children of past patients who have gone through our program begun by Dr. Mark Smith and Dr. Bill Womack in 1983.

There are several subgroups or specialties of biofeedback therapy including neurofeedback, pelvic floor biofeedback, and Heart Rate Variability (HRV) biofeedback.  The Biofeedback Certification International Alliance website ( has more material on these subgroups, as well as information on  how to become a certified  biofeedback therapist and how to find a biofeedback therapist in your community. For published, up to date research on biofeedback therapy see the website for The Association for Applied Psychophysiology and Biofeedback (

Further biofeedback therapy resources are available on the Seattle Children’s Hospital website.

Patient and Family Resources – Biofeedback (