Talk:Biofeedback headband

Neutral POV?

I felt this article did not present this treatment alongside the alternative options, which are far more commonly used. I have started a new section to attempt to address this. This article may be better merged to biofeedback anyway. Lesion (talk) 12:24, 29 May 2013 (UTC)

In 2010, a 92-person clinical trial was conducted which showed that over 50% of users are able to obtain more than an 80% reduction in nighttime clenching activity using the biofeedback headband. <ref>{{cite journal|last=Weinstein|first=L.|title=Nighttime Biofeedback as a Tool for the Reduction of Habitual Bruxism Activity and Related TMD Symptoms|journal=3rd Annual Sacro Occipital Technique Research Conference Proceedings: Nashville, TN. 2011|pages=114-24}}</ref>

This is a primary source. Do not delete secondary sources and try to contradict what they say by using a primary source. Please read WP:MEDRS (and WP:COI btw). Lesion (talk) 19:37, 30 May 2013 (UTC)

Again, I point out that this is a primary source (some presentation at a scientific meeting-- not even a real medical publication) and we can't use it. Lesion (talk) 20:36, 30 May 2013 (UTC)

I have not seen a prohibition against primary sources on Wikipedia, just a caution. When few studies have been done with a treatment modality and there is much more interesting information in the primary sources than in the brief mentions in secondary sources, it seems to serve people interested in the topic to include information form primary sources. RagingDog (talk)

Here is the prohibition against primary sources for wikipedia generally WP:RS, and the medical content version here WP:MEDRS. Lesion (talk) 13:12, 13 June 2013 (UTC)

However, a growing number of MDs, dentists, psychologists, and naturopaths are using nighttime biofeedback in the management of bruxism. There are currently about 2000 people who have been using the biofeedback headband nightly for in excess of one year.

One key factor for beneficial nighttime use of the biofeedback headband is the the ability for people to learn to respond to the audio biofeedback without waking. About 75% of people are able to learn to respond in sleep within one week.

The biofeedback headband is cleared by the FDA as a 510k-exempt class-2 medical device efficacious at "muscle reeducation". The the biofeedback headband can be set up to "reeducate" three different muscle groups: temporalis, frontalis, and masseter.

You need a source to support these statements please. Legislation is no substitute for scientific evidence. We were talking about this recently on wikiproject medicine, e.g. "dietary supplement" means nothing more than "this bottle of pills probably wont kill lots of people" according to the FDA. It has no implications for the efficacy for anything. Lesion (talk) 20:36, 30 May 2013 (UTC)

FDA is not a legislative body. FDA is charged with certifying efficacy and safety. When FDA clears a medicine or device for a certain use, that typically carries more weight in the medical community than any article. FDA does not clear nutritional supplements. They do clear medical devices. RagingDog (talk)

You need a source for that content. Lesion (talk) 20:30, 6 June 2013 (UTC)

There is already a good article on the FDA on Wikipedia. For the above matter see the "FDA-Cleared vs FDA-Approved" section of that article. RagingDog (talk) —Preceding undated comment added 16:19, 7 June 2013 (UTC)

We would need a real source, can't use other Wikipedia articles as sources. "Thus Wikipedia articles (or Wikipedia mirrors) are not reliable sources for any purpose." (from WP:WPNOTRS) Lesion (talk) 16:42, 7 June 2013 (UTC)

It would be really good to get a source for that "2000 people have been using biofeedback" comment, because that would definitely support the fact that it is an uncommon treatment. Consider the general population prevalences of the conditions we are dealing with here... Lesion (talk) 21:22, 30 May 2013 (UTC)

I got the number 2000 from the serial number on the back of my friend's unit (1925, if I remember correctly). A friend of hers recently bought a unit and the number on that one is in the 5000's. I understand that such a number is a small number compared to the millions of splints out there, but so what? A treatment can be superior, and if it is vastly less profitable to dentists, it is less likely to be adopted quickly. Do you think the financial conflict of interest for dentists should be documented and discussed in this article? RagingDog (talk)

That's very ingenious, but do you think that looking at a bar code on the back is reliable? Even if you are correct in your assumption, this makes it WP:OR. If you can find a source that discusses the financial aspects of headband vs occlusal splints then please feel free, but no original research and unreferenced content please. Lesion (talk) 13:12, 13 June 2013 (UTC)

• Reverted your most recent edit. Whilst you are quoting from the articles in question directly, you do so by quoting from somewhere within the text, and deleted the paraphrasing from the conclusion of the references. How is it misquoting to quote from the conclusion of a paper, as you suggest in your edit summary? Surely that is the most important part to quote? Surely therefore, your edit is more misquoting the sources than mine? Lesion (talk) 06:45, 12 June 2013 (UTC)

• More problem edits:

Since the use of biofeedback headbands in treatment of bruxism is far more recent than the use of occlusal splints, there are far fewer research studies to date involving biofeedback headbands. Once a field is mature, literature reviews are usually the most reliable source of evidence, in part because they may weigh studies with conflicting results. However, when a research topic is young enough that only a few studies have been done, primary sources may offer more useful insights, particularly if they are more recent than and not included in literature reviews. One such primary study which used biofeedback headbands as a bruxism treatment on 92 self-selected volunteers found that more than 50% of people had a more than 80% reduction in nightly clenching time. While any single study may be subject to bias and should not be taken as "the truth", it is worth noting that since biofeedback headbands can be tried at no cost, and since they quantitatively measure bruxism, any person wishing to determine whether he or she responds well to a biofeedback headband can find out at no cost.

• Primary source - please avoid using primary sources as much as possible. If only it were a large, well designed RCT, this might not be so bad, but it's a conference presentation, and sounds like an uncontrolled case series. Overall-- this source is unsuitable for Wikipedia, and I think this is the 3rd time I've pointed this out. Please see WP:MEDRS. Even outside of the realms of wikipedia, if I were reading these results, I would consider this source very weak evidence. Systematic reviews please.

Have you read very many bruxism and TMJ papers? Many of them are case studies (single-person), and most are less than 20 people. This one was 92 people, one of the largest TMJ or bruxism trials I have seen. In addition, most trials in the field involve no objective measurement and go only by patient reporting. A trial size should be considered "large" when the statistics it gives are high-certainty statistics. In cases where a result can be measured accurately for a given individual (rare in drug testing but true in the case of measuring nightly clenching reduction) cross-over trial (where each participant serves as their own control and a correlation function is run over time as treatment is turned on and off) produces higher statistical accuracy (way higher) than where one group of people is the controls and a separate group gets the treatment. The validity of a trial should be assessed by the methods and the statistics. The p value on this trial was ten to the minus 16. That is the best p value I have ever seen on any clinical trial of any type, for anything. If you want to have a better understanding of how to evaluate the validity and certainty of clinical trials, I recommend you read the book "Between the Lines: Finding the Truth in Medical Literature" by Marya D Zilberberg, MD. RagingDog (talk)

Yes I have. Large or small, still a primary source. Secondary sources on WIkipedia please WP:MEDRS. The meta analyses and systematic reviews are good because real researchers/medical statisticians (i.e. presumably not you or me) can evaluate the methods and the results. Lesion (talk) 13:12, 13 June 2013 (UTC)

• I feel the wording of this para is not very encyclopedic, and contains tones of advertising towards the end. Why are you trying to write this article to convince readers to try a poorly researched uncommon treatment? Please read WP:COI and WP:NPOV. Please leave your personal opinions and interests behind when you edit content on Wikipedia, and write from a neutral point of view.

Point well taken. Using the biofeedback headband totally got a woman I was dating out of chronic pain she had been in for 18 years (after tens of thousands of dollars spent on splints that made things worse). It took her only two weeks with nighttime biofeedback to be out of pain, and her sleep got way better, not worse. That opened my eyes to what I see an enormous corruption in dentistry because of financial conflicts of interest. Dentists are legally allowed to sell devices they make at a profit. MDs are prohibited form doing that because of all the damage and corruption that historically brought about. When the woman I was dating enthusiastically told her dentist about her biofeedback headband, he was not the least bit interested, and recommended a $3000 mouth guard to her. I later got an opportunity to go to a dental show and found out that mouth guard only costs $75 to make. The manufacturer's booth proclaimed "second most profitable thing in all of dentistry". So yes, I get that some of what I wrote sounded like a commercial and I want it to be objective and evidence-based. That woman has since recommended the headband to four of her friends. Three benefited form it and one returned it because she found it uncomfortable to sleep with. It seems to me an easy determination for anyone to make without any risk of harm. RagingDog (talk)

You need to re-evaluate what you consider as evidence. 3 peoples' personal experience is no evidence at all. An important factor when people start a treatment is the placebo effect, which is why we have randomized control trials. I am not defending the use of occlusal splints, see my edits on other pages like bruxism, temporomandibular joint dysfunction, Nociceptive trigeminal inhibition tension suppression system. Fact is, there is no evidenced based, universally accepted treatment protocol for bruxism and TMD. Why? because we don't fully understand the disorders, and they are probably an umbrella term for a lot of different things. Splints can be harmful at worst, and at best, overall the evidence suggests they only physically protect the teeth from grinding rather than anything else. They are probably totally ineffective for awake bruxism. I don't find it hard to believe that someone would pay so much for a mouth guard ... maybe people with more money than sense in America. The worst part is that the more cleverly designed splints are only supposed to be temporary for a few months. Re dentists making a profit from occlusal guards, is this really news? Go to a health food shop and they will try to sell you some bullshit that doesn't work too. That's just capitalism, which real healthcare (100% in the patient's best interests) cannot operate in. Having said all this, we should not present a treatment that is barely used at all and is largely unproven to be efficacious in a way that does not represent what the sources are saying. Lesion (talk) 12:59, 13 June 2013 (UTC)

The methods of science are not new to me. I have been both a scientist and an engineer for 30 years. Wikipedia's standards are new to me, and I am growing to appreciate why they are what they are. I thank you for your part in that. To a research scientist, the original papers are the most interesting, and good scientists become quite good at sorting out good methods and results without waiting for someone else to publish a literature review. It makes sense that since Wikipedia's authors are anonymous and of unknown background, literature reviews become the arbiters of fact. The possibility for placebo effect varies widely depending on study design. Have you thought about where the placebo effect would be on an instrumentation-measured outcome in a cross-over trial when someone is asleep? The statement that small trials are "no evidence at all" seems to me not to be applicable in any general way. For instance, absolute proof of existence of something (for instance, an atomic bomb) takes only one observation. Many monumental discoveries and widely accepted proofs were made on small trials. People are used to thinking of large trials for pharmaceuticals, but trials for efficacy of equipment (for instance, an X-ray machine) require only a few people. What matters is the derivation of the statistical significance of the evidence. It is possible to have a huge poorly designed trial whose evidence is worthless. It is also possible to have a small trial whose evidence is very statistically significant. Statistical analysis takes most good students a couple of hundred hours to learn. It can't be learned by reading an article. There are lots of aspects to it. The book I referenced is a good start for anyone who wants to grasp the issues of proving efficacy. For the type of trial we are discussing here, statistics start to be pretty good at 20 randomly chosen people, statistics are great at 50, and phenomenally accurate at 90. RagingDog (talk) —Preceding undated comment added 18:49, 13 June 2013 (UTC)

OK, maybe I explain poorly above. The issue is not how well you or I can interpret primary sources, or indeed how well designed they are, or what results they report. Even if a highly competent medical statistician were adding content based on a huge, multicenter, double blind, placebo controlled, etc etc trial, with results that were highly significant, it would still need to go. I resisted the idea that primary sources are not allowed here when I was first starting. Because they are interesting, and often more "cutting edge" and controversial than a source that quotes them. I had edits and even whole articles deleted. Now I understand and strongly support these policies. Wikipedia would be total chaos (or at least, even more so) if we didn't delete primary sources. A section of primary sources can be cherry picked to support any argument, and this might not represent the mainstream view. So, Wikipedia has other concerns outside of the methodological quality of sources, importantly WP:NOTABILITY, which is primarily established by the use of secondary sources. Sure, this primary source said this and this, but it is only notable to be included (as Wikipedia defines notability) if these results are mentioned in a secondary source. Secondary sources like systematic reviews tend to appraise primary studies together, and make a conclusion based upon the overall evidence. This is a much stronger source, and less likely to be biased than a single editor selecting primary sources whose studies support their own personal opinion/agenda. It also prevents fringe theories from being presented with undue weight, e.g. if we take the recent example of the bruxism page, an editor had selected a few primary sources that stated that megadose magnesium was efficacious for bruxism. Could any mention of magnesium be found in secondary sources? No. Why? Because magnesium is not anywhere near mainstream therapy for bruxism, it's some theory from the 80s that never caught on, and then was dug up by quacks/complimentary and alternative medicine. Should the article therefore have discussed magnesium at the length that it did, in the biased language that it did? Of course not. It takes a while to learn the ropes here, and it can get pretty aggressive sometimes. Learning the basics of the main policies will give a gratifying editing experience, in harmony with other editors (usually). Whilst opposing the policies will be a constant, losing battle. Wikipedia's policies have been subject to an evolutionary process since its birth. They are the way they are for a reason, because they are fit for purpose. For building a neutral, reliable, etc. encyclopedia.

When I came to this article, it was not up to these standards. When I start to work with the article, I see an editor persistently perusing an apparent non neutral agenda, and yet now you do not seem to have any commercial interest in a company that manufactures biofeedback headbands, or as I often suspect, a scientist involved in researching the area and who has non mainstream opinions. Classic example of why we should WP:assume good faith, although you do seem to admit to a view that dentists are deliberately not using this therapy in favor of bite guards so as to make a larger profit. This is hardly neutral point of view, even if the arguments you make are compelling, but if you can find a source then it ceases to be just your own opinion (not suitable for wikipedia) and becomes potentially notable for inclusion. I have opinions too, as does any editor, but ideally we put a neutral point of view, like a second skin, when logged in, and cease to have any opinions at all. However, I still believe that there are insufficient reliable secondary sources to warrant a stand alone article here. We are resorting to using refs about biofeedback generally, and it is duplication. Merge does not necessarily equal deletion of all, or any, content. Subsection called biofeedback headband on the main biofeedback page would be preferable, especially since biofeedback in TMD and bruxism can mean different things. Would be good to discuss the different types there in detail. Lesion (talk) 21:19, 13 June 2013 (UTC)

• The statement you put before was from the summary not the body of the text, apologies. I've added another quote from Shetty et al. to expand on what they said about biofeedback in the conclusion.
• Orlando et al. is titled "biobehavioral" not behavioral- I changed this back.

Biofeedback as a treatment option is relatively new, and currently only a small percentage of people undergoing treatment for TMD and bruxism use biofeedback as a treatment modality.

• need a source for the above, but since it is replacing another unsourced statement, may as well leave it in since it seems not so biased. Small percentage- I would imagine that it is less than 1% using this modality considering how common these disorders are. This is why I originally said "mostly of relevance to research rather than routine management" because there seems to be a disproportionate amount of scientific interest compared to how much it is actually used. Need a source at some point for this please. Lesion (talk) 15:15, 12 June 2013 (UTC)
  • I think you're making a couple of assumptions there. This method of treating bruxism has been investigated at least as early as 1982. It has gained some popularity recently because wireless headbands are now available, compared to the ones where you had to be tethered to a machine. http://www.is.wayne.edu/MNISSANI/BRUXNET/nocures.htm should provide virtually all of the sources you need, assuming wikipedia accepts sources that date back 15+ years. It's worth noting that in your conversation with the other (admittedly biased) user above, you come off as having the opposite bias and not understanding the wealth of limitations of traditional splint-based treatment - mainly that it does nothing to solve the problem, which means you will still ruin your teeth with a splint, just slower. In patients with severe bruxism, this is a serious issue. I have a traditional nightguard of the 'hard' type that is extremely thick, but I grind so badly and so frequently that I -obliterate- this appliance within 3-6 months. I have gone through 4 of them in 2 years. Last week, I broke a tooth (an actual tooth, not a filling) while wearing this massively thick nightguard - it is something that should never happen. My dentist kind of shrugged and said 'maybe try biofeedback'. Just my two cents; I know a lot of what I said cannot be stated directly in the article because it's a personal anecdote, etc. 76.123.93.232 (talk) 13:19, 16 November 2013 (UTC)

Merge to biofeedback

Most of the references discuss biofeedback generally, and I am not sure if this was with a headband or some other type of biofeedback. I honestly think that this whole content could be better presented as a subsection of the main biofeedback page. Lesion (talk) 20:54, 30 May 2013 (UTC)

If by your statement "Most of the references discuss biofeedback generally", you are meaning to assert that most of the references *only* discuss biofeedback generally, I don't believe that to be correct. It is standard practice to list the equipment used in a study. If you are reading a literature review, you may have to go back to the original article being referenced. That is easy to do. There have been only two brands of biofeedback headbands produced(The BruxCare/GrindAlert (the original American rand which was later renamed SleepGuard) and GrindCare (manufactured in the Netherlands)). Both devices were designed to provide biofeedback signals that could be responded to in sleep, rather than a signal that would wake a person up. As far as I know, the American biofeedback headband was the first biofeedback device specifically designed to e responded to without waking up. The other unit followed suit about five years later. RagingDog (talk) —Preceding undated comment added 02:59, 12 June 2013 (UTC)

(Moved above comment and replied on talk:Biofeedback, where earlier parts of this discussion are) Lesion (talk) 06:33, 12 June 2013 (UTC)