Thermal Biofeedback for Primary Raynaud’s Phenomenon: A Review of the Literature

Abstract

The clinical presentation of primary Raynaud's phenomenon (RP) derives from various pathogenic triggers. The use of thermal biofeedback (TBF) may be of benefit in reducing the severity and frequency of attacks. This article summarizes the relevant research regarding the pathophysiology of primary RP and mechanism of TBF for RP. Systematic reviews of the efficacy of TBF for RP and treatment guidelines for clinicians are provided. The panel concludes that the level of evidence for TBF efficacy is categorized as Level IV: efficacious. The rationale, based on three randomized controlled trials conducted in independent laboratories, demonstrated "superiority or equivalence" of treatments that include TBF. However, randomly controlled trials (RCT) with positive clinical outcomes tended to be small. A large RCT with negative results did not effectively teach handwarming skills. Procedures for reviewing and rating of the levels of evidence of efficacy of studies was based on the Template for Developing Guidelines for the Evaluation of the Clinical Efficacy of Psychophysiological Interventions developed by the joint task force of the AAPB and the Society for Neuronal Regulation (SNR).

Efficacy of Biofeedback for Medical Conditions: an Evidence Map

“…20 In patients with fibromyalgia, electromyograph (EMG), but not electroencephalograph (EEG) biofeedback has the potential to improve short-and long-term pain (but not quality of life or 19 Wearable plantar pressure sensors, IMU -Labor pain 24 EMG, skin conductance biofeedback Varied-relaxation, PMR, Lamaze Bell's palsy 16 EMG, biofeedback rehabilitation With mime therapy. Other therapies varied-facial expression exercises, lip movement without eye closure Raynaud's 26 Thermal biofeedback, thermal feedback + EMG Varied-autogenic training, relaxation Intradialytic hypotension 20 Biofeedback hemodialysis: BVM with dialysate conductivity control, BVM with plasma conductivity control -BFB biofeedback, BVM blood volume monitoring, BVP blood volume pulse, EEG electroencephalograph, EMG electromyograph, IMU inertial measurement units, GSR galvanic skin response, LENS low-intensity neurofeedback system, PMR progressive muscle relaxation, sEMG surface electromyography, SMR sensorimotor rhythm, TEMP peripheral temperature feedback 26 10 (531) 10 (531) ---Stroke 25 18 (429) 18 (429) ---Urinary incontinence after prostatectomy 21 13 (1108) 13 (1108) -5 (354) -Urinary incontinence in women 13 24 (1583) 5 (520) 24 (1583) 12 (698) -secondary outcomes). 23 Finally, wearable plantar pressure sensors (which measure the distribution of plantar pressure, usually when standing or moving) may provide better static steady-state balance and health-related quality-of-life outcomes for patients undergoing balance or gait training ( Fig.…”

“…2 and Table 3). 19 It is unclear whether biofeedback is effective for the treatment of Bell's palsy, 16 chronic idiopathic constipation, 18 dysphagia, 14 osteoarthritis of the knee, 10 labor pain, 24 Raynaud's, 26 and sleep bruxism. 17 Limited (low-confidence) evidence suggests that biofeedback provides no benefit for urinary incontinence in women once differences in PFMT programs were controlled for, 13 nor was it effective for blood pressure control.…”

Integrated use of biofeedback and neurofeedback techniques in treating pathological conditions and improving performance: a narrative review

“…Peripheral skin temperature biofeedback: measures the temperature of the fingers and/or toes and is used to treat repetitive strain injury, arthritis, diabetes, migraines, anxiety, chronic pain, hypertension, and Raynaud’s disease ( Fiero et al, 2003 ; Karavidas et al, 2006 ; Fritsche et al, 2013 ).…”

“…-Skin conductance biofeedback: evaluates the activity of eccrine sweat glands and is used in the treatment of anxiety, hypertension, and car/seasickness (Elavally et al, 2020). -Peripheral skin temperature biofeedback: measures the temperature of the fingers and/or toes and is used to treat repetitive strain injury, arthritis, diabetes, migraines, anxiety, chronic pain, hypertension, and Raynaud's disease (Fiero et al, 2003;Karavidas et al, 2006;Fritsche et al, 2013). -Biofeedback of the Central Nervous System (or neurofeedback) which will be described in the next paragraph.…”

Temperature biofeedback and sleep: limited findings and methodological challenges

“…[23][24][25][26][27][28][29] By contrast, less is known about the effectiveness of thermal biofeedback as a treatment for insomnia. Two case studies report that hand temperature biofeedback was successful in normalizing sleep onset in a middle-aged patient with sleep-onset insomnia, 25 and that foot warming improved sleep quality in a 21-year-old good sleeper.…”