External Qigong for Chronic Pain
Ann Vincent,*Jamia Hill,xKelly M. Kruk,y
Stephen S. Chazand Brent A. Bauer*
*Division of General Internal Medicine
yCollege of Medicine
zThe Division of Biomedical Informatics and Biostatistics
Mayo Clinic, Rochester, Minnesota
xThe Department of Epidemiology
University of Minnesota, Minneapolis, Minnesota
Abstract: External qigong as a pharmacotherapy adjunct was investigated in 50 subjects with
chronic pain (pain lasting > 3 months with pain score of ? 3 on 0–10 numeric analog scale)
who presented to a qigong healing center. Participants were randomized to receive either
external qigong treatment (EQT) or equivalent attention time (EAT) in weekly 30-min
sessions for four consecutive weeks. Outcomes were assessed before and after sessions. The
primary outcome measure was intensity of pain by a 10-cm visual analog scale used to rate
all pain severity measurements. At 8-week follow-up, participants were contacted by tele-
phone and mailed a questionnaire. Most had experienced pain for > 5 years (66%); the rest,
for > 3 to 5 years (8%), 1 to 3 years (10%), or < 1 year but > 3 months (10%). The most
frequent concomitant diagnoses were multifactorial (26%), osteoarthritis (18%), and low
back pain (12%). Most patients were also receiving other treatments (74%); none previously
had EQT. Participants were randomly assigned to EQT (n = 26) or EAT (n = 24). These
groups had no significant differences at baseline except for prior awareness of qigong (EQT
31% vs. EAT 63%; p ¼ 0:025). Compared to the EAT group, EQT participants had a
significant decrease in pain intensity in the 2nd (p ¼ 0:003), 3rd (p < 0:001), and 4th weeks
of treatment (p ¼ 0:003). At week 8, these differences in overall decreased pain intensity
persisted but were not statistically significant.
Keywords: Osteoarthritis; Pain; Pain Clinics; Pain, Intractable; Pain Measurement.
In contrast to acute pain, which is a protective mechanism, chronic pain can endure for
months or even years past the typical time needed to heal from an injury or illness
Correspondence to: Dr. Ann Vincent, Division of General Internal Medicine, Mayo Clinic, 200 First St SW,
Rochester, MN 55905, USA. E-mail: email@example.com
The American Journal of Chinese Medicine, Vol. 38, No. 4, 695–703
© 2010 World Scientific Publishing Company
Institute for Advanced Research in Asian Science and Medicine
(American Chronic Pain Association, 2009). The extent and impact of chronic pain on both
quality of life and the health care economy are significant. Chronic pain is estimated to be
the most common condition impairing quality of life (Bonica, 1990). The socioeconomic
impact of chronic pain in 1994 was estimated to be $15,000 to $24,000 per patient per year
(Latham and Davis, 1994).
Despite the availability of multiple modalities to address chronic pain, many patients
with chronic pain are still inadequately treated and turn to complementary and alternative
medicine therapies for management of symptoms (Rosenberg et al., 2008).
Qigong refers to several modalities from traditional Chinese medicine that deals with
energy exercises and treatments to regulate the flow of vital energy [qi (also known as
“chi”)] in the body. Qigong can be subdivided into internal and external qigong. Internal
qigong refers to individual practices and exercises to achieve optimal dynamic mind-body
integration. External qigong refers to practices in which a qigong practitioner directs energy
toward an individual to improve the flow of qi or to treat a condition. A recent systematic
reviewof external qigong for pain conditions reported preliminary positive observations and
highlighted the need for controlled clinical trials (Lee et al., 2007). The purpose of our study
was to evaluate the effectiveness of external qigong treatment (EQT) compared with
equivalent attention time (EAT) as an adjunct in the management of chronic pain.
Design and Setting
We conducted an 8-week randomized controlled clinical trial at a single site, after approval
by the institutional review board of the University of Minnesota. Participants were ran-
domized to receive four weekly 30-min sessions of EQT or EAT for four consecutive
weeks as an adjunct treatment for chronic pain.
All 50 participants were recruited from those who called the Spring Forest Qigong (SFQ)
Center, in Minneapolis, Minnesota, to make an initial appointment for external qigong. The
SFQ receptionist asked callers if they suffered from chronic pain. Those who responded
positively to the question were offered the opportunity to participate in the study and, with
the subject’s permission; their information was provided to one of the study personnel.
Study personnel contacted participants within 24 hours to explain the study, answer
questions, and assess whether they met the inclusion criteria.
Eligibility criteria included (1) age 18 years or older; (2) pain experienced for at least
3 months; (3) reported severity of ? 3 on a numeric analog scale for pain ranging from
0 to 10; (4) no active plans to change the pain management strategy over the next 2 to
3 months; (5) ability to read and understand English; and (6) agreement to participate in the
four weekly visits. All participants signed an informed consent form. Recruitment statistics
are summarized in Fig. 1.
696 A. VINCENT et al.
The study used a stratified randomization technique. Prior to randomization, participants
were classified by pain intensity and sex. Pain intensity was measured using a visual analog
scale (VAS), with the subject asked to rate the severity of pain by drawing a mark across a
Figure 1. Recruitment statistics.aOne patient had emergency surgery before week 2 visit, and one failed to keep
appointments at weeks 2 and 3.bOne patient withdrew after randomization, and one was hospitalized for infection
before week 3 visit.
EXTERNAL QIGONG FOR CHRONIC PAIN 697
10-cm line; this self-reported pain was categorized as less severe (< 6cm) or more severe
pain (? 6cm), based on the length of the subject’s mark along the VAS line (from left to
right). Members of each stratum were then randomly assigned to one of two groups. The
EQT, or intervention group, was monitored before and after four weekly qigong therapies.
The EAT, or control group, was monitored before and after four weekly conversational
After participants were assigned to EQT or EAT, they completed baseline questionnaires
that elicited demographic information and information regarding their current illnesses,
medications, and treatment modalities. Blood pressure and pulse rate were also measured at
that time. The participants reported their current level of pain with the VAS, and they were
also asked to rate the average pain intensity they experienced during the past week. A
short-form McGill Pain Questionnaire (SF-MPQ) and a Profile of Chronic Pain Screening
Questionnaire (PCPS) were also administered. Four weekly visits were then set up for each
participant to come to the SFQ center for EQT or EAT. At each visit, the participant met
with a researcher for 15 min before and after the session during which data were collected;
these included medication changes, VAS score for current pain, blood pressure, and pulse
rate. Regardless of which group patients were randomized to, all participants received
a follow-up phone call and a mailed questionnaire approximately four weeks after their last
in-person assessment visit.
External Qigong Treatment
The intervention being evaluated was EQT. The qigong therapists were both certified
international qigong masters, one of whom is the founder and creator of SFQ. There are no
specific methods for EQT, in which the master uses his or her ability and knowledge to
improve the flow of qi for the client seeking help. Typically, the practitioner will lightly
touch the patient’s body, or simply pass his or her hands over the patient, using a technique
such as Bellows Palm to help guide the qi (International Institute of Medical Qigong,
Equivalent Attention Time
For the control group, an investigator engaged each participant in conversation and pro-
vided full attention to the participant for 25 to 30min. After completion of the four weeks
of assessment visits, the control group (which was both a matched time of attention group
and a delayed treatment group) received four weekly qigong sessions at SFQ. These visits
did not include any monitoring from the researcher.
698 A. VINCENT et al.
In compensation for their time, each participant received a 50% discount off the usual fee
for EQT for each of their four qigong visits. This represented a discount of approximately
$200 for each participant.
The primary outcome measure was the VAS score for pain intensity. Additional outcome
measures included pain quality measurements (SF-MPQ and PCPS), blood pressure, and
pulse rate. These were measured at baseline, week 4, and week 8. Blood pressure and pulse
rate were also measured at baseline, as well as at the start and the end of each of the four
VAS pain severity, blood pressure, and pulse rate before and after intervention (EQT or
EAT) were compared between the treatment and the control groups, as was weekly average
pain over time. Changes in pain severity (VAS scores) were compared using the t-test.
Additionally, alterations in medication, dose, or frequency, any changes in reported treat-
ment modalities, and the Patient’s Global Impression of Change (PGIC) were noted and
compared between the two groups. Finally, changes in the SF-MPQ and PCPS were
the two groups in terms of pain quality, emotional burden, and pain-caused functional
limitations, as well as by treatment or medication changes during the course of the study.
The sample size (n ¼ 50) was selected to provide sufficient power to demonstrate statistical
significance for differences (in mean change of pain intensity scores) of ? 33% when the
two study groups (EQT and EAT) were compared. Changes in pain intensity scores of this
magnitude were deemed to be clinically significant.
The median age of the 50 participants, of whom 37 (74%) were women, was 56.5 years
(range, 27–86 years). Forty-nine were white; one was Hispanic. Most had pain for > 5
years (66%); 8%, for 3 to 5 years; and 10%, respectively for 1 to 3 years and < 1 year but
> 3 months. The most frequent diagnoses associated with chronic pain were: (1) multi-
factorial (26%), (2) osteoarthritis (18%), and (3) low back pain (12%). Most of the patients
were receiving other pain treatments (74%), and none had ever experienced EQT.
EXTERNAL QIGONG FOR CHRONIC PAIN699
Of the 50 participants, 26 were randomly assigned to EQT and 24 to EAT. There were no
qigong(EQT,31%vs.EAT63%;p ¼ 0:025).Table 1showsacomparisonofthemean ? SD
changes in VAS pain intensity after the weekly sessions of EQT or EAT, which were,
respectively, ?1:35 ? 1:88 vs. ?0:63 ? 1:13 at week 1 (p ¼ 0:12); ?1:90 ? 1:55 vs. ?0:6
3 ? 1:25 at week 2 (p ¼ 0:003);?1:75 ? 1:32 vs. ?0:30 ? 0:91 at week 3 (p < 0:001);and
?1:13 ? 1:47 vs. ?0:04 ? 0:72 at week 4 (p ¼ 0:003). At week 8, differences in overall
and Fig. 2, there was a statistically significant decrease in the mean VAS score of the EQT
group after each treatment.
The baseline mean ? SD VAS score for the EQT group was 3:72 ? 2:54, and the VAS
score at the start of the weekly visits was 4:6 ? 2:75 for week 1,4:14 ? 2:51 for week 2,
3:73 ? 2:81 for week 3, and 3:63 ? 3:19 for week 4. At week 8 the mean ? SD VAS score
for the EQT group was 3:17 ? 2:92. During the four consecutive weeks of treatment, the
EQT group demonstrated a statistically significant decrease in pain intensity compared to
that of the EAT group at weeks 2, 3, and 4 (Table 1, Fig. 1). Although there was a
progressive overall decrease in pain intensity during the study, the difference was not
Blood pressure and pulse rate measurements were taken at baseline, and before and after
each weekly session for both the EQT and EAT groups. In the EQT group, systolic blood
pressure ranged from an increase of 2:56 ? 8:06mmHg to 3:83 ? 11:79mmHg, the dias-
tolic blood pressure ranged from an increase of 2:67 ? 3:55mmHg to 2:8 ? 4:14mmHg,
andthedecreaseinpulserangedfrom2:46 ? 5:57beats/minto4:8 ? 5:43beats/minoverthe
course of the treatments. In the EAT group, the systolic blood pressure ranged from an
increaseof0:17 ? 10:82mmHgto1:86 ? 10:29mmHg,thediastolicbloodpressureranged
from an increase of 1:43 ? 6:76mmHg to 1:73 ? 5:15mmHg, and the pulse decrease
ranged from 2:74 ? 5:88 beats/min to 2:55 ? 6:22 beats/min over the same period. These
results were not statistically significant.
During the four weeks of the clinical trial, 15 participants (8 EQT; 7 EAT) reported
3 EAT) and six dose decreases (4 EQT; 2 EAT). One medication was discontinued (EAT),
Table 1. Mean Changes in Weekly Pain Intensity
by the Visual Analog Scale
EQT ? SD
?1:35 ? 1:88
?1:90 ? 1:55
?1:75 ? 1:32
?1:13 ? 1:47
EAT ? SD
?0:63 ? 1:13
?0:63 ? 1:25
?0:30 ? 0:91
?0:04 ? 0:72
Abbreviations: EAT, equivalent attention time; EQT,
external qigong treatment.
700 A. VINCENT et al.
and one new medication was prescribed (EQT). At the 8-week follow-up (of all participants
who received four EQT sessions), there were reports two of dose increases (1 EQT; 1 EAT),
eight dose decreases (3 EQT; 5 EAT), and two new prescription medications (1 EQT; 1
All results for qualitative measures including the SF-MPQ, PCPS, and PGIC will be
reported in a separate future publication.
Prior clinical studies on qigong included either small sample sizes or were pilot studies,
most of which were not adequately powered to demonstrate the statistical significance of
their findings, and many lacked sufficient control or comparison groups (Creamer et al.,
Figure 2. Comparison of pain intensity scores over time. For baseline and week 8, the p values relate to the t-test
comparing the mean pain intensity in the treatment (external qigong treatment) and control (equivalent attention
time) groups. For weeks 1 to 4, the p values relate to the 2-sample t-test comparing the change in pain intensity in
the treatment group (before and after treatment) to the change in pain intensity in the control group (before and
after matched time of attention). VAS indicates visual analog scale.
EXTERNAL QIGONG FOR CHRONIC PAIN701
2000; Chen et al., 2003; 2006). Additionally, no previous study has attempted to quantify
the benefits of EQT, specifically for the management of chronic pain. In contrast, our study
was a randomly controlled clinical trial that demonstrated statistically significant results of
immediate reductions in pain intensity in persons with chronic pain after the 2nd, 3rd, and
4th EQT sessions. This finding is especially impressive given the long duration of pain
(> 5 years), in most of the participants.
Our study investigated the effect of external qigong on general chronic pain. Chronic
pain is highly prevalent in the general population. Adequate clinical management of
chronic pain is an ongoing challenge, and a purely pharmaceutical approach has proven
inadequate. With chronic pain as a key feature of so many conditions, we decided to study
the effect of external qigong on chronic pain so that results could be generalized on a
A key aspect of our research was the attempt to investigate qigong while trying to
preserve its philosophies and practices. Therefore, all EQT and EAT sessions took place at
SFQ. Also, in keeping with qigong philosophy and at the request of the qigong master,
sham treatments were avoided and replaced with EAT and delayed treatments. Thus,
deception was avoided and control subjects also had the opportunity to benefit from their
experience. Our goal was to provide the actual qigong experience for the research subjects
as much as possible without imposing Western biomedical concepts on the practice.
Although there was a trend toward an overall decrease in pain over the 8 weeks, a
sustained reduction in pain intensity did not meet standards for statistical significance. This
may reflect the study’s relatively small sample size, and statistical significance in this
regard might be achieved by evaluating a larger sample. Further studies investigating
frequency and duration of treatment for optimization and prolongation of effect might also
prove beneficial. Additionally, the pain reduction demonstrated by the use of EQT suggests
that future investigations into the mechanism behind this improvement would be useful.
Portions of this manuscript have been published in abstract form at the North American
Research Conference on Complementary and Integrative Medicine, Minneapolis,
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