Overview & Efficacy: Several small studies have shown that temperature biofeedback is capable of helping people with Raynaud's syndrome control their hand temperatures. One controlled study and a moderate number of clinical studies showed that temperature biofeedback can result in significantly reduced symptoms.

This therapy is rated as between possibly and probably efficacious (levels 2 to 3 on a scale of 1 - 5 with 5 being the best).

For more information on how efficacy is rated click here.

Why biofeedback would help this problem: The symptoms of Raynaud's syndrome (blanching and pain eventually followed by cyanosis) are caused by spasms in the vascular system in at least the fingers and toes with possible involvement of the ears and nose. The reason some people experience these spasm while others don't is really not understood. The spasms are usually set off by sudden cooling of the extremities and / or psychological stress responses. The inability to maintain the fingers at a minimal temperature leads to onset of the spasms which then cause the pain and other symptoms associated with Raynaud's disease.

Anyone will go into vasospasm if the hands are cold enough and then are suddenly cooled even more because the individual's own "catastrophic break point" is reached below which spasms occur. The difference between normal people and those having Raynaud's phenomenon are that Raynaud's sufferers (1) have cooler hands and feet than most people all of the time and (2) they are more reactive to cooling stressors such as sudden exposure to a cool breeze or a freezer than are most people. This combination means that they are always closer to their "break point" than the rest of us and that they will have severe spasms with much cooling less stress than we would.

Vasoconstriction due to psychological stress would be just as effective a way to initiate a spasm as any physical stress. Thus, temperature biofeedback is used to train patients to keep their hand temperatures elevated to as close to normal as possible all the time and to keep them warm even when cooling stresses take pace.

Brief summary of evidence supporting the efficacy of biofeedback for Raynaud's Syndrome:

Freedman and his co-workers (Freedman et al 1970, 1981, 1985) did a series of studies showing that people with Raynaud's syndrome could learn to warm their hands, keep them at nearly normal temperatures for years, and keep them warm against cooling stresses. Their long term follow-up studies showed that people could help themselves avoid vasospastic attacks (and thus the symptoms of Raynaud's) for years.

Much of the information which follows is from Carolyn Yucha and Christopher Gilbert's 2004 book "Evidence Based Practice in Biofeedback Neurofeedback" AAPB, Wheat Ridge, CO.

Several brief, relatively uncontrolled studies seem to confirm the rationale underlying biofeedback treatment of Raynaud's disease. Peterson and Vorhies (1983) studied thermal biofeedback-trained Raynaud's patients, observing the speed of hand temperature return to baseline after hand immersion in ice water, which was six to seven times as fast after biofeedback training (6 minutes average after training vs. 40 minutes before). Jobe, Sampson, Roberts, and Kelly (1986) compared hand temperature responses to whole-body chilling before and after either classical or standard biofeedback ("operant") biofeedback training, and found that both approaches were effective. When Guglielmi, Roberts, and Patterson (1982) compared thermal biofeedback with EMG biofeedback and controls, with a double-blind procedure, all three groups had comparable improvements, suggesting a role of non-specific factors. Keefe, Surwit, and Pilon (1980) found similar results, in which other behavioral control methods performed as well as thermal biofeedback. However, Freedman et al (1988) compared simple thermal biofeedback with autogenic training and found the former more effective.

The largest study to date of Raynaud's involving biofeedback compared use of a calcium-channel blocker (nifedipine) with thermal biofeedback, EMG feedback, and a placebo (Raynaud's Treatment Study Investigators, 2000). In this study of 313 subjects with primary Raynaud's disease, nifedipine seemed to be the superior agent for reducing symptoms. Problems with training the thermal biofeedback subjects to an adequate level of skill, however, (Middaugh et al., 2001) mitigated the final results.

Detailed information on biofeedback augmented treatment of Raynauds Syndrome

A. Citations to the papers summarized in the "brief summary":

Freedman R: Physiological mechanisms of temperature biofeedback. Biofeedback and Self-Regulation 16: 95 - 115, 1991.

Freedman R, Ianni P: Role of cold and emotional stress in Raynaud's disease and scleroderma. British Medical Journal, 287: 1499 1502, 1983.

Freedman R, lanni P, Hale P, Lynn S: Treatment of Raynaud's phenomenon with biofeedback and cold desensitization. Psychophysiology, 16: 182, 1970.

Freedman R, Ianni P, Wenig P: Behavioral treatment of Raynaud's disease. Journal of Consulting and Clinical Psychology, 51: 539 549, 1983.

Freedman R, Ianni P, Wenig P: Behavioral treatment of Raynaud's disease: Long term follow up. Journal of Consulting and Clinical Psychology, 5: 136, 1985.

Freedman R, Lynn S, Ianni P, Hale P: Biofeedback treatment of Raynaud's disease and phenomenon. Biofeedback and Self Regulation, 6: 355 365, 1981.

Freedman R, Mayes M, Sabharwal S: Induction of vasospastic attacks despite digital nerve block in Raynaud's disease and phenomenon. Circulation, 80: 859 862, 1989.

Freedman R, Morris R, Norton M, Masselink D, Sabharwal D, Mayes M: Physiological mechanism of digital vasoconstriction training. Biofeedback and Self Regulation, 13: 299 305, 1988.

Freedman, R.R., Sabharwal, S.C., Ianni, P., Desai, N., Wenig, P., & Mayes, M. (1988). Nonneural beta-adrenergic vasodilating mechanism in temperature biofeedback. Psychosomatic Medicine, 50(4), 394-401.

Guglielmi, R.S., Roberts, A.H., & Patterson, R. (1982). Skin temperature biofeedback for Raynaud's disease: a double-blind study. Biofeedback & Self-Regulation, 7(1), 99-120.

Jobe, J.B., Sampson, J.B., Roberts, D.E., & Kelly, J.A. (1986). Comparison of behavioral treatments for Raynaud's disease. Journal of Behavioral Medicine, 9(1), 89-96.

Keefe, F.J., Surwit, R.S., & Pilon, R.N. (1980). Biofeedback, autogenic training, and progressive relaxation in the treatment of Raynaud's disease: A comparative study. Journal of Applied Behavior Analysis, 13(1), 3-11.

Middaugh, S.J., Haythornthwaite, J.A., Thompson, B., Hill, R., Brown, K.M., Freedman, R.R., et al. (2001). The Raynaud's Treatment Study: Biofeedback protocols and acquisition of temperature biofeedback skills. Applied Psychophysiology and Biofeedback, 26(4), 251-278.

Peterson, L.L., & Vorhies, C. (1983). Raynaud's syndrome. Treatment with sublingual administration of nitroglycerin, swinging arm maneuver, and biofeedback training. Archives of Dermatology, 119(5), 396-9.

Raynaud's Treatment Study Investigators. (2000). Comparison of sustained-release nifedipine and temperature biofeedback for treatment of primary Raynaud's phenomenon. Results from a randomized clinical trial with 1-year follow-up. Archives of Internal Medicine, 160(8), 1101-8.