Author: Siegfried Othmer

We have just returned from the 14th annual meeting of The American Academy of Pain Management. It was held in Denver at the Adam’s Mark Hotel, where the AAPB had its meeting two years ago. The organization is relatively young. It is reminiscent of the biofeedback community in several ways: It has a multi-disciplinary membership and attendance. It favors a multi-disciplinary approach to its subject. It also feels itself on the outside of the mainstream. Pain has not been taken seriously as a discipline within medicine for very long. And many of the conditions treated—such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity—themselves have an equivocal status within medicine. Hence there is a sense of second-class citizenship just as we suffer in biofeedback. There is the wish to be recognized within the larger medical community, of a message not being heard, and of the message being preached to the choir. The exhibit area was flooded with gadgetry from various sources, and here Chinese herbal remedies were to be found shoulder to shoulder with ionic detoxifying baths and infrared healing wands. It was quite the bazaar for the gadgeteer.

The differences between the AAPM and the AAPB were just as pronounced, however. Attendees were mostly MDs, and clearly these were the ones who were willing to think independent thoughts. They were predominantly clinicians from the trenches rather than researchers from academia. In other words, they had all been humbled by the intractability of chronic pain in their own practice, and of the inadequacy of any simple models. Another significant point of difference was that the nametags did not show pedigree, so you could not tell who was an MD and who was not. That meant everyone had to treat everyone else respectfully, both in the lecture halls and in the exhibit area. Continue reading “Report on the AAPM Conference”

In this final installment of the report on the AAPB Conference, I just wanted to catch people up on my impressions of what is happening to the technology. In the exhibit hall it became apparent that we are on the threshold of another generation of software from a number of vendors. I had spent the first day of our attendance at the conference being taught about the new version of Biograph software from Thought Technology. The new software promises to be a lot more versatile than the current generation. This flexibility is exciting to those of us who are thinking up things to do with neurofeedback, but of course it can also be intimidating and bewildering to the end user. The answer is that the new program is really a platform on which user-level programs are constructed. In Thought Tech lingo these are called scripts. I have been talking with Thought Tech people about a number of display options and specific discriminants for training that can be incorporated into a script.

The general thrust will be to incorporate more and more intelligence into the feedback calculation, involving a variety of decision-making that does not have to be under the immediate command of the therapist. We should not burden the practitioner with all of the particulars of a feedback design. Any features that can be automated should be handled in that way. This is particularly true for the inhibits, which can be EEG-responsive in a straight-forward algorithmic fashion. Here we can bring all kinds of sophistication to bear on the question of whether the EEG is moving toward or away from a state of optimal regulation. As new criteria are devised and accepted, they can simply be inserted as additional weighting functions or decision points, all of which function in background as far as the clinician is concerned. What remains for the clinician is to fine-tune choices with respect to the rewards. But as the overall training incorporates more and more measures, the relative impact of the rewards will of necessity decline. The training will therefore become much more manageable and less tippy for the clinician. Continue reading “AAPB Conference Report, Installment #3”

James S. Gordon, MD was an invited speaker at the AAPB to talk about Mind-Body Medicine and the Future of Health Care. Dr. Gordon is the Founder and Director of the Center for Mind-Body Medicine in Washington, DC (www.cmbm.org) and is a Clinical Professor in the Departments of Psychiatry and Family Medicine at the Georgetown University School of Medicine. He made the obvious point that mind-body medicine should be at the heart of what we do, particularly for the increasingly common chronic conditions; and that the drug/surgery mainline medicine approach should be reserved for the more critical, acute medical issues. He referred to this as the “Self-Care” Model, consisting of a combination of complementary and alternative medicine approaches and psychosocial interventions. Of course he was preaching to the choir, and along the way he was very supportive of the role biofeedback could play in this endeavor of changing the medical model. Nevertheless, I felt that his view of biofeedback was the traditional, more limited one (read relaxation training), and he was probably unacquainted with the inroads that we have made through neurofeedback in addressing even classical medical and psychiatric categories.

Gordon referred to the often-quoted study in The New England Journal of Medicine that showed some 42% of Americans were already using complementary and alternative medicine (CAM) in that timeframe (1997). In certain cases, the penetration is much greater. Some 69% of cancer victims resort to CAM, and similar numbers apply to HIV and chronic pain patients. So CAM is not just tending the worried well. Continue reading “Report on AAPB (continued)”