Heart Rate Variability biofeedback therapy for children and adolescents with chronic pain: A pilot study

  • Alexis K. Yetwin
    Corresponding author at: 4650 Sunset Blvd. MS #53, Los Angeles, CA 90027, United States of America.
    Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, University Center for Excellence in Developmental Disabilities, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States of America
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  • Nicole E. Mahrer
    Psychology Department, University of La Verne, La Verne, CA, United States of America
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  • Terece S. Bell
    Alliant International University, Los Angeles, CA, United States of America
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  • Jeffrey I. Gold
    Department of Anesthesiology Critical Care Medicine, Division of Pain Medicine, University Center for Excellence in Developmental Disabilities, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States of America

    Keck School of Medicine, University of Southern California, Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, United States of America
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      As a brief, noninvasive, cost-effective, and technology-driven therapy, biofeedback is a promising and welcomed clinical intervention for children and adolescents with pediatric chronic pain conditions. The aim of this pilot study was to explore the application of a brief Heart Rate Variability (HRV) biofeedback intervention supplemented by at-home breathing practice as a tool for reducing symptomatology associated with chronic pain in a pediatric urban hospital setting.

      Design and methods

      Twenty-one participants aged 10–17 years (M = 14.05, SD = 1.91; 76% female) and their caregivers completed the study. Participants were randomized to either 1) receive immediate biofeedback treatment including at-home breathing practice or 2) to be placed on a 4-week waitlist and then enrolled in the biofeedback treatment. Study outcomes included self-reported pain intensity, health-related quality of life (HRQOL), and anxiety sensitivity. HRV data were obtained from biofeedback sessions. Results: Following biofeedback treatment, participants achieved significant reductions in self-reported pain intensity, higher levels of self-reported school functioning, and increased HRV, as measured by Blood Volume Pulse (BVP) amplitude. Participants in the waitlist group experienced an increase in pain intensity during the waitlist period.


      Further research is needed to understand the mechanisms underlying HRV biofeedback and its treatment of pediatric chronic pain.

      Practice implications

      Nurses are ideal practitioners for biofeedback given their training in physiology and background in healthcare and should be encouraged to explore training in this area. Suggested biofeedback-related apps and mobile devices to share with patients at bedside are provided.


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