Therapeutic Yoga Interventions for Chronic Pain (Extracts)

Ting Qi Huang, Faculty of Health Sciences, McMaster University, April 12 2021, Supervisor: Dr Eleni Hapidou

In 2020, the International Association for the Study of Pain redefined chronic pain as ‘persistent or recurrent pain lasting longer than three months’. The impact of yoga on chronic pain has been extensively researched. In Alberta, Tul and colleagues observed seven chronic pain patients in an eight-week hatha yoga program consisting of group classes and at-home practice. Group sessions included a question-and-answer period, beginning and ending breathing exercises, 5 to 12 postures, and guided deep relaxation exercises. A main characteristic of the yoga program was to teach participants to be aware of their bodies and minds during the sessions, without concern for any desired outcomes.

By the end of the eight weeks, through qualitative analysis the researchers identified three themes of improvement in the participants:

  • renewed awareness of their body,
  • transformed relationship with their body in pain, and
  • a sense of acceptance of their situation.

Increased awareness of their bodies led to participants noticing pain patterns, uncovering certain tensions and feelings that incite painful responses. By remedying the initial trigger to pain, for example, conducting yoga stretches when triggering tensions are noticed, the final pain sensation is cancelled. In this study, the practice of acceptance relies on the letting go of expectations and goals, and coming to accept that even with chronic pain, one is ‘still okay’. This mindset is analogous to the letting go mindset of MM (Mindfulness Meditation). The letting go mindset of MM echoes the same ideology of relinquishing one’s expectations for the treatment, while placing focus on the present.

Fibromyalgia

Fibromyalgia is a disease characterized by widespread continuous pain, negative affect, and poor sleep. Lazaridou and colleagues studied the impact of a six-week Satyananda Yoga program on fibromyalgia patients with chronic pain. The Satyananda Yoga program consisted of weekly in-person 1.5 hour sessions and included asanas, meditation, and mindfulness-based practices. Participants were also encouraged to follow a daily 30-minute yoga video as homework in between the in-person classes.

Thirty-six participants completed the study to a meaningful extent (attended 4-6 classes and reported home practice), all female, with an average age of 48.5 years. Results revealed that pain intensity, as measured by the Brief Pain Index (BPI), significantly decreased from baseline to post-treatment. The greatest benefit was observed in participants who practiced 25 min/day or more compared to those who did less than 25 min/day. This study was limited by the lack of a control group, making the generalizability of the beneficial findings difficult.

Veterans

Recent explorations of yoga in medicine have highlighted the practice of yoga as a promising, novel non-drug therapy for post-traumatic stress disorder (PTSD) and chronic pain in veterans. In 2016, 8891 US military veterans were surveyed regarding their use of non-drug therapies for chronic pain, with 6.4% indicating practice of yoga, and 19.8% using mindfulness or meditation.

In a pilot study, the impact of a hatha yoga intervention was observed in veterans with comorbid chronic pain and PTSD, at an urban Veterans Affairs Medical Center in Virginia, United States. The study was designed as a cross-sectional, open-trial with pre- and post-test measures.

In total, 87 participants were enrolled, with 49 completing the sessions, presenting an attrition rate of 44%. The majority of the participants were African American (69%) and male (61%), with an average age of 51.41 years. The primary study analyses were conducted on those who completed the full program (n=49).

The intervention, Yoga for Warriors, initially consisted of 12 weekly, 90-minute classes. Over the course of the study, with the addition of time and access constraints, the program format was changed to eight weekly, 60-minute classes. All symptom measures decreased from baseline to post-treatment, with the physical functional measures increasing. Of note, significant differences between pre- and post- measures existed for an increase in social functioning, decrease in PTSD symptoms, kinesiophobia, depression, and anxiety.

Veterans and lower back pain

Donaldson and associates examined differences in yoga practice between veterans with and without chronic pain through survey. Out of the 174 participants contacted, 110 were actively practicing yoga and among these participants, 41 had chronic pain. Yoga practitioners with chronic pain were slightly older and less likely to report excellent or very good health in comparison to those without chronic pain. They were also more likely to practice yoga independently at home, and use gentler exercises.

In the qualitative results, the authors found that chronic pain participants commented on feelings of self-consciousness in group yoga practice, with participants feeling self-conscious when seeing others perform agile postures. While other participants reported ease of concern when practicing yoga in group settings, as they enjoy the social aspect of practicing together. Overall, the participants enjoyed the convenience of yoga. Participants feel that they are able to practice yoga on their own terms and when needed. A limitation of the study is the possible impact of recall bias, as the qualitative results were based on participant recollection of past yoga practice.

Attitudes, perspectives and preferences of military personnel and veterans towards yoga as a therapy were collected via qualitative interviews by Hurst and colleagues. 36 participants were enrolled in the study, with 24 yoga students, and 12 yoga instructors, each participating in 45-50 minute interviews with a researcher to discuss their yoga experiences.

Results found that all participants highlighted the clinical relevance of yoga for managing symptoms and conditions, regardless of the participant’s health status. Improvements in managing pain and related symptoms were noted by several students and instructors. Many participants included examples of how yoga reduced pain for conditions such as arthritis, lower back pain, migraines, and headaches.

Participants touched on the importance of integrating yoga into the military, as it is a cost-effective therapy and beneficial to all ranks. Yoga stigma was also explored in the interviews, with participants touching on misconceptions of yoga that are often shared in military culture. Yoga can be type-casted as not macho or manly, and not comparable to endurance and physically taxing workouts.

This study shed light on the interpretation of yoga in the military, and shared personal anecdotes of veteran yoga participants with the clinical field. It is limited by the structure of the interviews, as the researchers may have introduced interviewer bias to the conversations.

Conclusion

The impacts of yoga on chronic pain were explored through qualitative and quantitative research studies. Results highlight the improvement of various pain outcomes in both the general population and veterans. Participants comment that yoga has transformed the relationship with their bodies in regard to pain and uncovered the possibility of remedying painful sensations using self-awareness and yoga.

Future studies should focus on employing larger sample sizes, as well as further in-depth quantitative analysis of the effect of yoga on various populations. The use of yoga in treating chronic pain prompts healthcare practitioners to re-evaluate treatment programs and represents a transition towards exploring non-drug therapies in medicine.