The Effectiveness of Electromyographic Biofeedback in Reducing Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Background: Despite the ongoing debate surrounding its analgesic efficacy, EMG-BF(Electromyographic Biofeedback) is commonly used for neuromuscular re-education. This study aimed to quantify its pain-reducing effects. Methods: Two researchers followed PRISMA 2020 guidelines to synthesize randomized controlled trials comparing EMG-BF to control interventions. By using a random-effects model, they calculated standardized mean differences (Hedges’ g). A total of 9 studies were included in the systematic review, and 8 of these were subjected to meta-analysis. The assessment of risk of bias and certainty of evidence was done using Cochrane RoB 2 and the GRADE approach, respectively. Results: Eight trial comparisons (N = 298 participants; 149 experimental, 149 control) evaluating continuous clinical pain intensity met all inclusion criteria. EMG biofeedback demonstrated a statistically significant reduction in pain intensity compared to control interventions (random-effects SMD = −0.6046, 95% CI: [−0.8707; −0.3384], z = −4.45, p < 0.0001; common-effect SMD = −0.6193, 95% CI: [−0.8541; −0.3844], p < 0.0001). Between-study heterogeneity was low and non-significant (I2 = 17.7%, τ2 = 0.0259, Q = 8.50, df = 7, p = 0.2905). The 95% prediction interval remained entirely below zero [−1.1026; −0.1065]. Subgroup analysis by pain tool (7 VAS comparisons, 1 NPRS comparison) showed no significant interaction (Q = 1.66, p = 0.1973). Egger’s linear regression test indicated no significant small-study effect (t = 1.17, p = 0.2874). Conclusion: These findings indicate that EMG-BF provides clinically meaningful pain reduction in musculoskeletal disorders, especially when used alongside conventional physical therapy.