A Pilot Study of the Efficacy of Heart Rate Variability (HRV) Biofeedback in Patients with Fibromyalgia

Journal: Applied Psychophysiology and Biofeedback. 2007 Jan 12; [E-publication ahead of print]

Authors and affiliation: Hassett AL, Radvanski DC, Vaschillo EG, Vaschillo B, Sigal LH, Karavidas MK, Buyske S, Lehrer PM. Department of Medicine, Division of Rheumatology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. [E-mail: a.hassett@umdnj.edu ]

PMID: 17219062

Fibromyalgia (FM) is a non-inflammatory rheumatologic disorder characterized by musculoskeletal pain, fatigue, depression, cognitive dysfunction, and sleep disturbance. Research suggests that autonomic dysfunction may account for some of the symptomatology of FM. An open label trial of biofeedback training was conducted to manipulate suboptimal heart rate variability (HRV), a key marker of autonomic dysfunction.

[Note: Autonomic dysfunction, or dysfunction of the autonomic nervous system (ANS) is known as dysautonomia. The autonomic nervous system regulates unconscious body functions, including heart rate, blood pressure, temperature regulation, gastrointestinal secretion, and metabolic and endocrine responses to stress such as the "fight or flight" syndrome. As regulating these functions involves various and multiple organ systems, dysfunctions of the autonomic nervous systems encompass various and multiple disorders.]

Methods: Twelve women ages 18-60 with FM completed 10 weekly sessions of heart rate variability biofeedback. They were taught to breathe at their resonant frequency (RF) and asked to practice twice daily. At sessions 1, 10, and 3-month follow-up, physiological and questionnaire data were collected.
[Note: resonant frequency means breathing at a frequency that matches or resonates with the heart rate.]

n There were clinically significant decreases in depression and pain and improvement in functioning from Session 1 to a 3-month follow-up.
n For depression, the improvement occurred by Session 10.
n Heart rate variability and blood pressure variability (BPV) increased during biofeedback tasks.
n Heart rate variability increased from Sessions 1-10
n While blood pressure variability decreased from Session 1 to the 3 month follow-up.

n These data suggest that heart rate variability biofeedback may be a useful treatment for FM, perhaps mediated by autonomic changes.
n While heart rate variability effects were immediate, blood pressure, baroreflex, and therapeutic effects were delayed. This is consistent with data on the relationship among stress, HPA axis activity, and brain function.
[Note: The baroreflex is a bodily mechanism for maintaining blood pressure. Normally, it provides a feedback loop so that an elevated blood pressure “reflexively” causes blood pressure to decrease, and vice-versa.]

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