Heart Rate Variability Biofeedback to Treat Fibromyalgia: An Integrative Literature Review

Pain Manag Nurs. 2020 Jun;21(3):225-232. doi: 10.1016/j.pmn.2019.08.001. Epub 2019 Sep 26.


Objectives: Fibromyalgia (FM) is associated with debilitating pain and a reduced heart rate variability (HRV), reflecting decreased emotional adaptability and resistance to stress. Common pharmacological treatments are ineffective, and opioids are highly addictive and cause an estimated 15,000 overdose deaths per year. Effective recommendations include patient-centered interventions like physical activity, cognitive behavioral therapy, and biofeedback. Heart rate variability biofeedback (HRVB) may be effective in improving HRV, thus increasing stress resistance and emotional adaptability and reducing pain.

Design: This integrative literature review was conducted to examine the relationship between HRVB and FM-related chronic pain using the Theory of Symptom Self-Management and to identify available HRVB technology.

Data sources: We searched PubMed, EBSCOhost, and Google Scholar electronic databases for relevant publications. Manuscripts were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses strategy, and study quality was assessed using the Critical Appraisal Skills Programme guidelines. The relationship between HRVB and FM was analyzed and evaluated based on the methodological framework proposed by Whittemore and Knafl.

Review/analysis methods: We reviewed 22 articles and included six in this review. Five reported HRVB as a treatment for chronic pain, and one for FM pain.

Results: Overall, the articles in this review support the claim that HRVB is related to decreased pain. The researchers evaluated five HRVB programs, three on handheld devices and two on desktop computers.

Conclusions: The reviewed studies had methodological flaws. However, HRVB is a promising treatment for chronic pain. Larger, randomized controlled studies are needed to thoroughly evaluate the relationship between HRVB and FM pain.

Publication types

  • Review

MeSH terms

  • Biofeedback, Psychology / instrumentation*
  • Biofeedback, Psychology / methods
  • Exercise / physiology
  • Fibromyalgia / complications*
  • Fibromyalgia / physiopathology
  • Heart Rate / drug effects
  • Heart Rate / physiology*
  • Humans
  • Quality of Life / psychology
  • Self-Management / methods
  • Self-Management / psychology