1. Biofeedback Clinic
for Functional Abdominal Pain
Proposal
Division of Pediatric
Gastroenterology and Nutrition
Children’s Specialists of San Diego
University of California San Diego

2. Recurrent Abdominal Pain (RAP)
 Most common childhood G.I. Disorder
 Affects up to 34% of world’s children
 Three bouts of pain severe enough to
disrupt activities in a three month
period
 No organic cause

3. Recurrent Abdominal Pain (RAP)
• Leading cause of childhood school absences
• Increased medical utilization
• Family disruption
• In nearly 50%, the complaints persist over
many years of their life-span to adolescence
or adulthood.

4. Why Biofeedback
treatment?
 Painless/Non-invasive techniques
 Research shows biofeedback is a
successful treatment for functional
abdominal conditions
 Engaging and fun treatment modality
for children

5. What is Biofeedback?
 Electronic biofeedback instruments
connected to sensors on the body
 Real-time physiological information
(feedback) is displayed to patient on
computer monitor
 A certified biofeedback professional provides
instruction and interpretation

6. How does biofeedback treat
Functional Abdominal Pain?
 Autonomic nervous system (ANS) imbalance
exacerbates abdominal dysfunction.
 ANS feedback (i.e. heart rate, respiration,
skin conductance) educates patients about
effects of stress on their symptoms.
 The therapist guides the patient through
techniques to balance ANS.
 Home practice assignments reinforce
techniques for better results

7. Pre/Post Assessment:
VivoMetrics, Inc. LifeShirt,tm
• 12 hour continuous Ambulatory Monitoring (Heart
rate/Respiration/Personal Diary Entries of Pain/Psychosocial
Stress)

8. J&J Engineering, Inc. Biofeedback Equipment
I-330-C2 Plus Clinical System $3,170.00

9. Example of Currently
Running Biofeedback Program #1
Department of Preventive Medicine
Biofeedback Program
 In continuous service past 7 years.
 Little to no advertising
 Patients self-referred and/or referred by
Kaiser physicians.

10. Example of Currently Running
Biofeedback Program #1:
Cost Considerations
 Billing= $75 dollars in advance for 50 minute
session.
 Average number of sessions per patient= 3
 Approximate number of sessions in 2004 = 300
 300 sessions X $75 = $22,500/annually
 This is with 1 to 2 part time employees.

11. Example of Currently Running
Biofeedback Program #2
Kaiser Permanente
Pediatric Gastroenterology Biofeedback Program
 Program has been in continuous
service for past 4 years
 Biofeedback sessions held in GI clinic

12. Example of Currently Running
Biofeedback Program #2:
Cost Considerations
 Billing through Kaiser Permanente Insurance
 Average number of sessions per patient= 6
 Program Director: Warren L. Shapiro, M.D.
Staff: AIU/CSPP doctoral psychology interns
AIU/CSPP supervisor: Richard Gevirtz, Ph.D.

13. Case Study (Sowder et al., 2004)
From biofeedback program at Kaiser Permanente
 36 kids with RAP/IBS
 Significantly lowered ratings of pain
intensity and frequency post-treatment
 56% pain-free at follow up (3mo, to 2yrs)

14. AIU Case Study Conclusions
 Effective, non-invasive, and timely
treatment option
 Potential to reduce costs/ further distress
(avoiding unnecessary & uncomfortable GI
testing)
 Findings support autonomic dysfunction as a
precipitating factor in RAP
AIU Case Study (Sowder et al., 2004)
Recently presented in Princeton, NJ at the
2004 International Society for the
Advancement of Respiratory and Psychophysiology
(ISARP) Conference

15. Children’s Hospital
Physician Management Group, Inc.
Gastroenterology New Patients (Outpatient only)
in one year: 8-1-03 through 8-31-04
All DX ABD PAIN ABD ABD
DX1 PAIN PAIN
DX2 DX3
PATIENTS 1,813 392 59 18
% 23% 3% 1%

16. Proposal
Biofeedback Treatment Center
CSSD and UCSD
 GI physicians from Children’s and
community will refer patients
 Patients will meet with Biofeedback
therapist in medical setting at
Children’s Hospital
 Patients will be seen for all 6-8
sessions.

17. Proposed CSSD/UCSD
Biofeedback Center Protocol
Prior to 1st session
– Provide instructional DVD with demo
of what to expect in biofeedback
sessions
– Collect payment
($100/session for all 8 sessions)
– Complete paperwork (intake,
demographics, consent)

18. Proposed CSSD/UCSD
Biofeedback Center Protocol
Continued
 1st Session:
– Collect paperwork / Answer questions
– Connect VivoMetrics LifeShirt (wear at
least 8 hours)
 2nd - 7th Sessions:
– Biofeedback Training
– Cognitive Therapy
– Home practice assignments
 8th Session:
– Connect VivoMetrics LifeShirt (8 hours)

19. Typical Home Biofeedback
Practice Regimen
 Daily Homework Assignments
(Reviewed in weekly sessions)
– Takes 20 minutes/day
– Daily pain/stress diary
– Psychophysiological self-monitoring
practice tools:
 Hand temperature biofeedback device ($20)
 Paced breathing compact disc ($15)
 Freeze-framer heart rate/breathing training
device (optional)
www.bio-medical.com &
www.beingart.com

20. Proposed CSSD/UCSD
Biofeedback Center Protocol
Continued
Staff:
 Certified Biofeedback Technician
 Clinical Psychologist Supervisor
-(1 day per week)
 Doctoral Interns
– Alliant International University (AIU)
California School of Professional
Psychology (CSPP)

21. Biofeedback Center
Other:
 Use pre-existing secretarial staff
for reception
 Biofeedback office
Use of underutilized, pre-existing
MOB space under G.I. Dept.

22. Potential Financial
Considerations
 One time costs:
2 Biofeedback clinical systems $6,000
VivoMetrics LifeShirt equipment $25,000
$31,000

23. Potential Financial
Considerations
 Profits
– 10% goes to billing dept.
– 10% goes to taxes
– 50% overhead, equipment, office
– 30% goes to staff
 Psychologist Supervisor
 Certified Biofeedback Technician
 Intern (Stipend)

24. Future Directions
 Expand Biofeedback Clinic to other
locations within San Diego County.
 Open clinics that treat other diagnoses
such as migraines, chronic pain,
fibromyalgia, and other stress related
disorders