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Biofeedback for anismus: has placebo effect been overlooked?

Meagher1, Sun, Kennedy

  • 1Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, Australia, Department of Nuclear Medicine, St George Hospital, Sydney, Australia Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia.

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|April 13, 2013
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Summary

Biofeedback and placebo treatments showed similar symptom improvement in anismus patients. Physiological changes with biofeedback were minimal and not correlated with symptom relief, suggesting a significant placebo effect.

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Area of Science:

  • Gastroenterology
  • Physiology
  • Clinical Medicine

Background:

  • Anismus is a condition often treated with biofeedback, with prior studies suggesting its efficacy.
  • However, the physiological underpinnings and the extent of placebo effect in anismus treatment remain unclear.

Purpose of the Study:

  • To evaluate the physiological effects of biofeedback versus placebo in patients diagnosed with anismus.
  • To correlate observed physiological changes with clinical symptom improvement.

Main Methods:

  • Twelve anismus patients underwent assessment including symptom scales, anorectal manometry, and scintigraphy.
  • They received 5 days of placebo treatment, followed by reassessment, then 5 days of biofeedback, followed by a final reassessment.

Main Results:

  • Seven patients reported symptom improvement with placebo, and seven with biofeedback; three improved with both.
  • Biofeedback uniquely improved anal pressure and electromyographic activity during defecation attempts.
  • No correlation was found between symptom changes and physiological test results; rectal ejection fraction remained unchanged.

Conclusions:

  • Clinical improvements in anismus may be partly attributed to placebo effects and observer bias.
  • Observed physiological changes with biofeedback might not be captured by standard anorectal tests.