A single case study of biofeedback training in an adolescent with cancer-related pain

Daily challenges faced by adolescents diagnosed with cancer are many, and they become even more difficult when the patients are in pain. Both acute (from procedures) and chronic (from cancer itself or treatments) pain has been recognized as one of the most frequent and distressing symptoms in cancer which adversely affects the quality of life and the ability to control one’s own body.1,2 Cancer related pain (in a broader sense) can elicit or is associated to a variety of somatic symptoms such breathlessness, muscle tension, dizziness, palpitation and anxiety.3 It is well known that decreased anxiety in pediatric age is not only associated with decreased distress and pain during invasive medical procedures, but also with less negative attitudes towards future medical procedures and pain episodes.4 It is evident that the main approach in the management of cancer pain in children is surely the pharmacological one, but it could be more efficacious in association with non-pharmacological techniques.5 Among the non-pharmacological approaches, those that include biofeedback (a tool that measures and feeds back information about an individual’s physiological activity) can be very helpful in teaching children through better body control how to manage pain and anxiety, especially when these are related to invasive procedures. In fact, biofeedback affects resonance and oscillations of different feedback loops in the central nervous system6 and when it is delivered together with relaxation therapy or autogenic training seems to be effective in reducing the frequency of pain episodes in the pediatric age.7 Several BiofeedbackAssisted Relaxation Training programs (BART) have been applied in a wide range of pediatric conditions, including Headache,8 Irritable Bowel Syndrome and Functional Abdominal Pain,9 pain in Sickle Cell Disease,10 Burn Jnjury,11 and also for face with anxiety and stress-related medical conditions to learn to relax by the control of physiological reactivity.12 However, to date, little research exists about the use of Biofeedback-based treatments for children with cancer related pain. A good example in this field is the study conducted by Shockey,13 who found that 4-session intervention combining relaxation and biofeedback in a clinical setting may be beneficial to children experiencing procedural distress as a novel coping strategy. Furthermore, over the last decade, new biofeedback tools have been developed with video-game-like technology interfaces. This allows to an immediate experience, in real-time, adapting different kinds of feedback to increase interest and engagement, thus facilitating the learning of deep breathing, heart rate variability (HRV) and muscle relaxation.12