There are currently no large outcome studies which demonstrate the effectiveness of biofeedback for the treatment of pain disorders. The purpose of this study is to determine the effectiveness of biofeedback techniques as they are actually practiced for control of several pain problems. The effectiveness of the interventions for chronic musculo- skeletal low back pain and muscle related orofacial pain will be evaluated during the first year. This is intended to be an initial study to test the proposed design, data gathering techniques, and scientist - practitioner interactions as well as to provide sound data on the short term effectiveness of techniques at the borderline between clinical acceptance and research. The effectiveness of the techniques as they are actually practiced at this time with the types of patients normally treated by biofeedback practitioners will be established by performing a multipractitioner outcome study. This is intended to assure the rapid and inexpensive acquisition of a large number of subjects while permitting the independent follow-up of patients required for credibility. The Association for Applied Psychophysiology and Biofeedback (AAPB) is the primary group concerned with clinical application of biofeedback. Licensed clinicians who are members of the AAPB and meet its practice criteria will sequentially enter all patients who meet the diagnostic and other entrance requirements. The providers will fill out one form which details their usual treatment for the disorder. Very careful diagnostic categorization for each patient according to specified, standard criteria will be required. After treatment, each practitioner will send a form with a code number for each patient indicating deviations of the individual subject's treatment from their usual practice, number of sessions, objective outcome measures, and details of how the diagnosis was made. Each patient will keep a home log of pain and other factors for two weeks during the pre-treatment evaluation period, at the end of treatment, three months after treatment, and six months after treatment. Part of the six month follow-up will be after the initial funding has been completed. The patients will send their logs directly to the investigators with their code numbers on them. One thousand subjects with each disorder will be enrolled as a power analysis shows that about 700 will be required to be 95% certain of the results and a 30% failure rate for sending all logs is anticipated. If the techniques proposed for this study work well, the study can be extended to biofeedback interventions for other techniques in future years.
