Biofeedback training in patients with multiple sclerosis

Patients with multiple sclerosis (MS) have chronic symptoms, including unremitting fatigue, spasticity, bowel and bladder dysfunction, pain syndromes, cognitive impairment, mood disorders and gait disturbances. Underlying pathophysiology of this disease is complex, but includes dysfunction of the autonomic nervous system (ANS) and activation of inflammatory cascades. In a small pilot study, we tested the hypothesis that biofeedback‐mediated stress management (BFSM) training in patients with MS would improve autonomic balance, decrease the inflammatory state, reduce symptoms, and enhance quality of life. Patients between the ages of 18 and 90, with a complaint of fatigue interfering with daily activities, but with no recent disease exacerbation, were enrolled in a randomized, controlled pilot study. All patients received an initial evaluation including psychophysiologic reactivity to mental stress (Stroop color words and serial sevens, in random order), manual muscle testing, numeric pain rating, the multiple sclerosis functional composite test, measurement of plasma norepinephrine, tumor necrosis factor alpha and C‐reactive protein, and four questionnaires asking about overall health status, life engagement, anxiety and depression (SF‐36, LET, GAD‐7 and PHQ‐8). After the initial evaluation, patients were randomized to BFSM or usual care (UC). Patients in the BFSM group returned for eight weekly sessions of training, including finger temperature, skin conductance, respiration and heart rate variability (HRV) biofeedback training. They were also asked to practice the techniques at home daily and to rate their stress levels before and after practice. Patients in the UC group continued as they normally would, with no additional sessions. After ten weeks, all patients returned for a final evaluation, which duplicated the initial evaluation. Data from the pilot study show that patients with chronic MS are able to learn to selfregulate and that that they enjoy the training. HRV was improved in the BFSM group, as was quality of life. Anxiety and depression were decreased. We further subdivided the BFSM group into those who were more successful with BFSM and those who were less successful. Patients who demonstrated better skill at selfregulation had greater improvement in every domain. These data suggest that BFSM may be a viable adjunctive therapy for patients with MS. A large scale trial is warranted, to confirm these observations.