The benefits of yoga for chronic pain conditions

 


 Yoga is a mind-body practice that should be adapted to each person's medical situation. People who are not ambulatory, for example, can do chair yoga. It is important to know and understand that yoga is a mindfulness discipline that can be offered within the scope of each person's limitations. The benefits in mental and physical health can be attained when a qualified instructor has the intention and knowledge to address safety issues.

Yoga is often used as a complementary therapy for chronic pain, and the field of research that focuses on the use of yoga to help relieve various chronic pain conditions is evolving (1, 2, 3).

 Chronic pain affects quality of life and costs 635 billion dollars a year (5). The opioid epidemic in America leads to more than 24,000 deaths per year, and the COVID pandemic has worsened the opioid crisis (4). Chronic pain is often the cause of overuse of opioids, which leads to increased cost of care and mortality (4). The use of opioids for chronic pain management can impair function and affect quality of life (9).

In August 2019 the Journal of Evidence Based Integrative Medicine published a pilot study to assess the benefits of yoga in people with chronic pain (5). Even though 83 patients were enrolled, sixty-seven participants completed the study.

Sixty-five percent of the participants (n:43) had chronic pain for over ten years. All participants, except one, were using opioid medications for pain management. The study was done in a community-based pain clinic for individuals with any type of pain. All participants received usual care, which integrates a multifaceted intervention to improve pain, and it is important to highlight that the clinic provided care for underserved and underinsured patients.

Participants were randomized to yoga or just usual care (control group) . Yoga was offered for one hour twice a week for eight weeks. The Brief Pain Inventory was the primary outcome; pain severity and interference on daily activities were measured by using the Brief Pain Inventory, and the patients' quality of life was also evaluated in response to the intervention.

Most patients reported that pain was located in more than one area or joint. Twenty-four patients reported headaches or migraines. Thirty-four patients (57%) indicated that their pain was related to trauma (automobile accident, work injury, fall). The other participants (n:9) reported that the pain was a result of medical conditions such as arthritis, fibromyalgia, cancer and stroke.

The yoga instructors were also physical therapists or occupational therapists, and they offered props and modifications of the poses as needed to make the classes safe and accessible. The adverse events reported were not related to yoga itself but to other underlying conditions, and these events happened in cases in which the patients refused to follow the recommendations offered by the instructor. For example, a patient refused to use a walker despite the fact that balance issues were a limiting factor, and the use of a walker had been recommended.

Both the yoga group and the control group had improvements in their quality of life, but the yoga group also improved in all outcome measures of BPI, except BPI severity. In other studies in which a specific type of pain was the focus, yoga was shown to be effective to reduce the severity of the pain. This was a small study, and it was not powered to detect differences when the various kinds of pain were compared (5).

A study published by Pain Medicine in July 2020 explored the response of 290 patients with low back pain, comparing three different interventions by assessing their responses to yoga, physical therapy and a self-care book during 12 weeks (6). The patients were divided in three groups depending on the intervention they received. The design was a secondary analysis of a randomized controlled trial. The results showed that there were more responders in the yoga group and physical therapy group (42%) compared to the self-care one (23%). Both yoga and physical therapy helped to improve the outcome.

Another pilot study in which participants were randomized and controlled showed that yoga helped to decrease the severity of the pain and also improved occupational performance and depression (7). This pilot study researched a group of 83 women and even though it was not considered inclusive, it concluded that occupational therapists may consider adding yoga to help with pain management (7) . In 2017 the Annals of Internal Medicine published a study that included 320 low income, racially diverse patients with non-specific chronic low back pain (8). The objective was to compare the yoga intervention with physical therapy intervention in a more inclusive study. The participants were divided into three groups and randomized to receive 12 weekly yoga classes, 15 physical therapy visits or an educational book and newsletters (8). Yoga was not found to be inferior to physical therapy. Adverse events were mild and self-limited. Both physical therapy and yoga groups were less likely to use pain medication compared to the education group after the 12 weeks of intervention. The low frequency of adverse events consisted of self-limited mild joint and back pain that were present in both the PT and Yoga group. Improvements at one year were maintained in both the Yoga and the PT group.

More research is needed to address the role of yoga as a complementary strategy to relieve different chronic pain conditions.

 

References:

 

1) https://www.frontiersin.org/articles/10.3389/fmed.2018.00145/full

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936076/

3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689911/

4) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01653-6/fulltext

5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689911/

6) https://academic.oup.com/painmedicine/article-abstract/22/1/165/5869175?redirectedFrom=fulltext

7) https://pubmed.ncbi.nlm.nih.gov/31156199/

8) https://pubmed.ncbi.nlm.nih.gov/28631003/

9) https://www.acpjournals.org/doi/10.7326/m14-2559#:~:text=Good%2D%20and%20fair%2Dquality%20observational,some%20harms%2C%20higher%20doses%20are



 

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