The Role of Heart Rate Variability Biofeedback in Pediatric Chronic Pain Rehabilitation: A Case Series Design

Biofeedback is 1 form of complementary therapy commonly used to treat pediatric chronic pain. Given the limited research in biofeedback treatment outcomes with youth experiencing chronic pain, the present study sought to initially examine the potential for heart rate variability (HRV) biofeedback to support self-regulation training for adolescents participating in a chronic pain rehabilitation program. Using a case series design, this study examined changes in HRV and respiration rate for 4 adolescents with chronic pain. Adolescents completed an initial assessment followed by 3-4 biofeedback training sessions. The Nexus 10 biofeedback system (BioTrace+ software) was used to obtain respiration rate and HRV low-frequency percentage. Visual inspection of plotted graphs from adolescents' HRV biofeedback training demonstrated (a) improved cardiopulmonary functioning across sessions during active training, (b) changed cardiopulmonary functioning across sessions during baseline assessment, and (c) improved functioning without active feedback, suggesting self-regulation of cardiopulmonary functioning. Adolescents using a brief protocol of HRV biofeedback training demonstrated expected changes in cardiopulmonary functioning and self-regulation. Similar to findings in adults, HRV biofeedback yields promise as an intervention to treat children with chronic pain and comorbid symptoms. However, because this is an initial study, additional research with more rigorous methodology is needed to further support the benefit of HRV biofeedback in modifying physiological awareness and self-regulation and the connection of this self-regulation with clinical outcomes. Future clinical research should build on these initial findings to develop and test biofeedback protocols to treat chronic pain in children.