Content uploaded by Oystein Torleiv Førre
Author content
All content in this area was uploaded by Oystein Torleiv Førre on Jul 03, 2014
Content may be subject to copyright.
ORIGINAL ARTICLE
Treatment of fibromyalgia at the Maharishi Ayurveda Health
Centre in Norway II—a 24-month follow-up pilot study
Lars Bjørn Rasmussen &Knut Mikkelsen &
Margaretha Haugen &Are H. Pripp &Jeremy Z. Fields &
Øystein T. Førre
Received: 24 November 2010 /Revised: 26 September 2011 /Accepted: 5 December 2011
#Clinical Rheumatology 2012
Abstract Treatments offered at the Maharishi Ayurveda
Health Centre in Norway are based on Maharishi Vedic
Medicine (MVM). MVM is a consciousness-based revival
by Maharishi Mahesh Yogi, the founder of the Transcen-
dental Meditation (TM) program of the ancient Ayurvedic
medicine tradition in India. To extend from 6 to 24 months,
a pilot study of the effects of the treatment program at the
Health Centre on fibromyalgia. Retesting 2 years after a
clinical trial. In this intention to treat study, 31 women with
a diagnosis of fibromyalgia received an individually
tailored program of (1) physiological purification therapy
(Maharishi Panchakarma) and (2) Ayurvedic recommenda-
tions regarding daily routine and diet including a novel ap-
proach to food intolerance. Five subjects chose to learn TM
for stress reduction, pain management and personal develop-
ment. All were recommended Ayurvedic herbal products for
follow-up treatment. A modified Fibromyalgia Impact Ques-
tionnaire (FIQ) that included seven dimensions. Scores at
24 months follow-up were compared with pre-treatment
scores. At 24-months follow-up, there were significant reduc-
tions (26% to 44%) in six of the seven fibromyalgia dimen-
sions: impairment of working ability, pain, tiredness, morning
tiredness,stiffness and anxiety. The 7th, depression, decreased
32% (borderline significant). At 24 months, the four subjects
who continued practising TM, had almost no symptoms and
significantly lower FIQ change scores (−92% to 97%) than the
non-meditators on all outcomes. This pilot study suggests that
the treatments and health promotion programs offered at the
Maharishi Ayurveda Health Centre in Norway lead to long-
term reductions in symptoms of fibromyalgia, which is
considered a treatment-resistant condition, and further studies
are warranted.
Keywords Alternative treatment .Ayurveda .
Complementary treatment .Fibromyalgia .Transcendental
Meditation
Introduction
Treatments offered at the Maharishi Ayurveda Health Centre
in Norway are based on Maharishi Vedic Medicine (MVM;
also known as Maharishi Ayurveda). MVM is a
consciousness-based revival of the ancient Ayurvedic med-
icine tradition in India. MVM was established over the last
L. B. Rasmussen (*)
Maharishi Ayurveda Health Centre,
Sjusjøvegen 1332,
2610 Mesnali, Norway
e-mail: lars.rasmussen@ayurveda.no
K. Mikkelsen
Head of Department,
Lillehammer Hospital for Rheumatic Diseases,
Lillehammer, Norway
M. Haugen
The Norwegian Institute of Public Health,
Oslo, Norway
A. H. Pripp
Biostatistics Unit, Research Services Department,
University Hospital of Oslo,
Oslo, Norway
J. Z. Fields
Adjunct Research Professor,
Maharishi University of Management,
Fairfield, IA, USA
Ø. T. Førre
Department of rheumatology, University Hospital of Oslo,
Oslo, Norway
Clin Rheumatol
DOI 10.1007/s10067-011-1907-y
50 years by Maharishi Mahesh Yogi, a Vedic scholar and the
founder of the Transcendental Meditation (TM) program.
MVM offers a range of treatment and life-supporting
modalities based on the 40 branches of the Vedic literature,
including Ayurveda. Two of these strategies are the TM
technique and the Maharishi Vedic physiological purifica-
tion program (Panchakarma) [1]. MVM extends the frame
of Ayurveda by recognising that the mind and body have
their basis in a level of consciousness said to transcend time
and space, a level known as pure consciousness. This level
of consciousness is considered to be primary for all exis-
tence and thus it is primary for the structure and functioning
of the individual mind–body [2]. The TM technique is a
strategy for the development of consciousness. It is easy to
learn and involves neither concentration nor contemplation.
During the practice, the mind experiences a thought at more
and more subtle levels until the subtlest level of the thought
is experienced and transcended. The mind thereby gains the
direct experience of pure consciousness. Since the teaching
and the verification of the practice of the TM technique is
standardised at TM Centres world-wide, the technique has
been subjected to extensive research covering a wide range
of health issues [3].
Maharishi Ayurveda Health Centres have been estab-
lished in many countries around the world, and at the health
centre in Mesnali, Norway, much experience has been
gained in the treatment of fibromyalgia (FM) patients [4,5].
The pathogenesis of FM is far from being understood and
there has not yet been any breakthrough in the treatment of
the condition, in spite of it being a rapidly growing area of
research on a wide range of treatment modalities [6]. We
recently reported the results of a 6-month follow-up study
that showed statistically significant improvements in most
outcome measures included in the Fibromyalgia Impact
Questionnaire [5]. The aim of the present study was to
evaluate the longer-term effects of the treatment program—
after 24 months.
Materials and methods
Subjects participated in a purification program, the Mahari-
shi Panchakarma program, that included a range of full body
herbalised oil massages (abhyanga, vishesh, pizzichili),
“swedana”(herbalised steam bath), “shirodhara”(the
streaming of oil on the forehead) and the administration of
“bastis”(Ayurvedic enemas).
An integral part of the program was the daily assessment
of each participant’s condition using Ayurvedic pulse diag-
nosis. According to MVM, a holistic understanding of the
functioning of the mind–body is gained through the pulse
reading technique known as “Maharishi Nadivigyan”. The
treatment program was adjusted daily, in accord with the
pulse analysis (performed by LBR). During their stay, the
participants were offered an MVM-based health education
program along with instruction in the TM technique (to be
practised twice a day for 20 min/session) for stress reduction,
pain management and personal development.
Prior to the treatment program at the health centre, all
the participants underwent an individually-tailored pre-
treatment program for 7–9 days at home that included the
intake of clarified butter in the morning for some days
followed by a laxative treatment. They also received guide-
lines for establishing a diet of easily digested food and a
stress reducing-lifestyle. These guidelines were to be fol-
lowed for 2 weeks post-treatment. At the end of the treat-
ment period, participants received personalised advice on
(1) diet based on Ayurvedic principles, (2) daily routines
and (3) Ayurvedic herbal products (including Triphala Plus,
Livogard and Fibrozan (Table 1)) that was intended to be
easily integrated into their daily lives on returning home.
At the health centre, a novel approach to food intolerance
is used. This approach, which is also a consciousness-based
strategy, is believed to identify food items that have a
negative effect on the health of a specific individual and
thus are incompatible with the mind–body. Incompatible
items identified by this approach include foods processed
in a particular way or foods that contain synthetic additives,
as well as pharmaceutical products, toothpastes (including
Ayurvedic ones) and herbal products. However, some of
these foods have been found to become compatible either
due to the treatment offered by the health centre or by
adding specific spices in the cooking or baking process.
The adding of specific spices is believed to transform the
food items during the cooking process, due to the influence
of chemical substances in the spices.
Patients were advised to avoid ingestion of specific foods
or other products that were determined to be incompatible
for them.
Thirty-three consecutive subjects seeking treatment at the
Maharishi Ayurveda Health Centre for widespread, chronic
pain volunteered to participate in a 24-month follow-up
study. Participants were enrolled in the study between No-
vember 2005 and March 2006. A clinical examination was
performed just prior to the start of the treatment by a rheu-
matologist (KM in most cases). Two did not meet the
requirements for a FM diagnosis based on the Boston
criteria [7] and were excluded. The remaining 31 subjects
were women aged 33 to 74 years (mean, 46 years). Disease
duration was 3–42 years (mean, 16 years). One subject
underwent treatment for 3 days, 11 for 5 days and 19
for 7 days. One subject had previously learned the TM tech-
nique but had not practised it for 7 years prior to the onset of
her FM symptoms. She resumed the practice during her stayat
the clinic, and four other subjects received instruction in the
technique.
Clin Rheumatol
We used the intention to treat method to handle drop outs;
the least registered value was used. Five subjects dropped out
of the study—all without giving any explicit reason. Two of
the five subjects completed the 1 month follow-up—the first
reporting a moderate improvement and the second (after only
3 days of treatment) a moderate worsening. The latter dropped
out after experiencing mouth ulcers along with both mouth
dryness and at times excessive salivation. These symptoms
ceased upon withdrawal of the herbal product that she was
using and were experienced again when the product later was
taken. The third drop out, was one of the five participants who
started practising the TM technique, but declined any further
follow-up after treatment. The 4th and the 5th drop-outs left
the study after completing 6 months of follow-up (see Fig. 1).
The Fibromyalgia Impact Questionnaire (FIQ) is not
validated in the Norwegian language. This American ques-
tionnaire includes a set of seven Visual Analogue Scales
(VAS)—each scale represented by a line that is 9.3 cm long.
Five scales relate to the body: limitations caused by FM on
working ability, pain, tiredness, stiffness and tiredness on
rising in the morning. Two scales relate to the mind: anxiety
and depression. A modified questionnaire was designed
with scales 10 cm in length. The VAS for pain was replaced
with a new scale in order to differentiate between local and
generalised pain—the latter being used as the outcome mea-
sure. The participants were asked to evaluate their condition as
a whole for the last 7 days and indicate their score for each
measure with a mark on the line. A mark to the extreme left of
the scale indicated no problems at all and a mark to the
extreme right indicated the worst imaginable condition. In
addition, participants evaluated the performance of their daily
activities by answering questions similar to those in the FIQ.
The participants filled out the questionnaires in private
just prior to the start of the treatment at the health centre.
Questionnaires were also filled out at home at one, 3 and
6 months post-treatment [5] and again at 24 months post-
treatment. Scores were calculated by the distance, in centi-
metres (to an accuracy of one decimal place), from 0 to the
participant’s mark on the VAS. For four of the five drop-outs,
the least score from each of the seven scales from at least one
follow-up was taken as the outcome measure.
The first three participants to enrol completed a question-
naire at entry that was a copy of the American questionnaire.
Their scores were later transformed to corresponding scores
on the 10-cm scale.
A paired sample ttest was used to compare outcome meas-
ures at study entry and at 24-month follow-up. A Mann–
Whitney Utestwasusedtoanalysedifferencesinoutcome
measures between the TM + Panchakarma group (n04) and
the Panchakarma-only group (n026). Cluster analysis using
the Square Euclidian Distance was used to identify a group of
good responders. SPSS 15.0 was used for all analyses.
Results
1. Decreases in symptoms between baseline and 24 months
ranged from −44% for pain to −26% for anxiety. Across
Table 1 Content of some Maharishi Ayurveda herbal products
Name of ingredients contained in Livogard Composition in %
Terminalia chebula 12
Andographis paniculata 9
Curcuma longa 8
Zingiber officinale 8
Trigonella foenum-graecum 8
Swertia chirata 8
Carum copticum 8
Piper longum 4
Myristica fragans 4
Lotus arabicus 4
Ferri oxidum 4
Boswellia serrata 4
Cypraea moneta 4
Terminalia belerica 4
Emblica officinalis 4
Excipients 7
Name of ingredients contained in Triphala Plus
E. officinalis 35
T. chebula 35
T. belerica 19
Rosa centifolia 8
Excipients 3
Name of ingredients contained in Fibrozan
B. serrata 11
Commiphora mukul 11
Asphaltum 9
Z. officinale 9
C. copticum 9
P. longum 9
Piper nigrum 9
Allium sativum 5
Hemidesmus indicus 5
Cinnamomum tamala 5
Carum carvi 5
F. oxidum 3
Mytilus margaritiferus 3
Piper chava 1
P. longum 1
Excipients 7
Clin Rheumatol
the seven domains of the FIQ, the average decrease
in scores was 33% (it had been 37% at the 6-month
follow-up). All decreases were statistically significant
compared with baseline (Table 2) except for depression.
Depression had an effect size in the same range (−32%)
but only borderline significance (p00.062).
2. Changes in symptoms at the 24-month follow-up com-
pared with scores at the 1-month follow-up showed
non-significant increases on all subscales but one, rang-
ing from 0% (depression) to +25% (morning tiredness)
with an average increase of +11%. Changes in symp-
toms at the 24-month follow-up compared with scores at
the 6-month follow-up showed both decreases and
increases on the various FIQ subscales. The changes,
which were non-significant, ranged from −8% (pain)
to +14% (working ability) with an average increase
of 5%.
3. A good responder was defined as a subject, who
reported a minimum reduction of 50% on all five body
scales. An excellent responder was defined as a subject
who reported that all end point scores were less than
1.0. The two regular TM practitioners were classified as
excellent responders reporting end-point scores that
were all less than 0.3. One reduced her total sum of
scores from 47.0 at baseline to 1.1; the other decreased
from 11.9 to 0.8. The other two TM practitioners (one
was irregular in practise and the other stopped after
3 months of practise) were almost excellent responders,
reporting low end-point scores on all scales except for
stiffness (which slightly exceeded 1.0). They reduced
their total sum of scores from 42.5 to 3.8 and 50.8 to
3.9. These two subgroups experienced, at 24 months, a
92% to 98% decrease in total sum of scores (Table 3).
No other participants improved to such a degree. A
Flow Chart.
33 subjects interviewed 2 excluded 1
31 confirmed to have FM 2
Baseline testing
(0 mos)
Treatment31 drop out
)om1(gnitsetpuwolloF
Follow up testing (3 mo) 2 drop outs
Follow up testing (6 mo) 2 drop outs
)om42(gnitsetpuwolloF
26 completers 4
1 They did not meet clinical criteria for Fibromyalgia (FM). 2 Four subjects learned and practiced TM.
One subject had learned TM previously but had not practiced it for years; she resumed practicing it at the
beginning of the study. 3 Physiological purification treatments (Panchakarma [PK]) + recommendations
re
g
ardin
g
dail
y
routine and herbs. 4 Of the 26 com
p
leters, 4
p
racticed TM and 22 did not.
Fig. 1 Flow chart
Table 2 Pre-post-changes in fibromyalgia-related outcomes
Outcome measures
of the FIQ
Number Mean of outcomes
at entry
Mean of outcomes
at 24 months
Difference
between means
95% confidence interval pvalue
Lower limit Upper limit
Working ability 28 5.9 4.2 1.7 0.5 3.0 0.008
Pain 30 6.6 3.7 2.9 1.8 4.0 0.000
Tiredness 30 6.9 4.9 2.0 0.7 3.2 0.003
Morning tiredness 30 7.2 4.8 2.4 1.2 3.7 0.001
Stiffness 30 6.2 4.0 2.2 1.0 3.5 0.001
Anxiety 30 3.9 2.9 1.0 0.0 2.0 0.043
Depression 30 3.7 2.5 1.2 −0.1 2.5 0.062
Paired samples tests were used to determine the difference in mean values of outcome measures between entry and 24 months follow-up
Clin Rheumatol
Mann–Whitney Utest of the outcomes for this TM-
subgroup of four subjects showed statistically signifi-
cant reductions for all outcome measures compared
with the non-meditating Panchakarma-only group.
4. Cluster analysis had clearly defined a group of 12 good
responders at the 6-month follow-up [5], but the same
analysis could not clearly define a group of good res-
ponders at the 24-months follow-up. Ten subjects, the
four TM subjects and six other subjects, who were all
categorised as good responders at the 6-month follow-up
[5], still met the criteria for being good responders at the
24-month follow-up, except that three of the ten subjects
reported increased tiredness compared to the 6-month
follow-up. One more subject, who reported markedly less
tiredness at 24 months compared to the 6-month follow-
up, met the criteria for being a good responder.
5. The vast majority (26 of 31; 83%) of the participants
showed improvement in terms of a reduced total sum of
scores at the study’s end (24 months). Four subjects
(plus one dropout) had a worsening of their conditions
in terms of an increased total sum of scores (ranging
from +4% to +33%) at the study’s end-point.
6. All participants were found to have intolerance to some
foods. These foods included wheat (in 97% of the
subjects), pork (97%), egg (94%) and spelt (13%). In all
cases except one, the wheat incompatibility was found to
be reversed by the addition of a small quantity of turmeric
during cooking or baking, and the spelt incompatibility
was found to be reversed in all cases by adding a small
quantity of cinnamon.
7. Compliance with the home treatment, including the
intake of herbal preparations and the practice of TM,
was retrospectively assessed by telephone interviews at
the study’s end-point. Subjects evaluated their compli-
ance in terms of very good (A), good (B) and bad (C)
(Table 4). Most subjects (81%) were compliant (A + B)
with dietary recommendations. Almost half of the
subjects (42%) were compliant (A + B) with herbal
recommendations.
Discussion
In this 24-month follow-up study, we found that the treat-
ment program offered at the Maharishi Ayurveda Health
Centre in Norway significantly reduced most FM symptoms
that it did so in most FM patients and that these reductions
were maintained for 24 months. These reductions were not
significantly different than outcomes at 1- and 5-month
follow-up.
At the end-point of the study at 24 months, the four
subjects (13 %) who started to practise TM (one stopped
after 3 months) had a substantially and significantly better
response than the Panchakarma-only group. Indeed, the
Panchakarma + TM group had almost no symptoms. Al-
though this number of subjects is too small to draw any firm
conclusions on the effect of TM on FM, the substantially
larger outcomes experienced by the TM-participants
(around sevenfold greater) are consistent with previous ex-
perience at the health centre (11 cases of individuals with
FM who learned TM and had Panchakarma with a maxi-
mum follow-up time of 10 years) [4]. They are also sup-
ported by research on the effects of TM that are relevant to
FM. One study showed decreased pain perception amongst
practitioners of the TM technique [8]. Other studies of large
groups of TM practitioners suggest decreased usage of
medical services [9,10]. Randomised, controlled studies
on TM have shown statistically significant reductions in
depression compared with control groups [11–16]. One
meta-analysis showed a reduction in trait anxiety and another
showed an increase in self-actualisation with effects signifi-
cantly larger for TM than that for other relaxation and
Table 3 Outcome measures be-
fore 3–6 days of treatment at
the Maharishi Ayurveda Health
Centre, Norway, and after
24 months follow-up in a group
learning and practicing TM
and in a control group not
learning or practicing TM
*p<0.05; **p< 0.01; ***p<
0.005 (Mann–Whitney Utest,
TM group compared with the
non-TM control group)
Outcome measures
of FIQ
TM group (n04) Non-TM group (n026)
At entry
median (range)
At 24 months
median (range)
At entry
median (range)
At 24 months
median (range)
Working ability 6.1 (0.4–7.6) 0.2 (0.1–0.3)*** 7.0 (0.1–9.7) 4.6 (0.2–10)
Pain 6.5 (4.5–8.4) 0.5 (0.1–0.7)*** 6.7 (2.9–10) 3.6 (0.7–10)
Tiredness 7.7 (2.3–8.2) 0.3 (0.2–0.7)*** 7.4 (1.2–10) 6.2 (0.2–9.9)
Morning tiredness 4.5 (0.1–8.8) 0.2 (0.1–0.5)*** 7.5 (1.1–10) 6.3 (0.5–9.0)
Stiffness 8.4 (3.7–9.4) 0.6 (0.1–1.5)*** 5.3 (2.9–9.3) 4.3 (0.5–10)
Anxiety 3.8 (0.1–5.9) 0.1 (0.0–1.0)* 4.1 (0–9.5) 3.9 (0.0–8.3)
Depression 3.1 (0.1–6.7) 0.1 (0.0–0.1)** 3.0 (0.0–8.4) 2.6 (0.0–9.0)
Table 4 Compliance at 24 months follow-up assessed for months 18–24
ABC
Herbs 27% 15% 58%
Diet 46% 35% 19%
Avery good, Bgood, Cbad
Clin Rheumatol
meditation programs [17,18]. Self-actualisation, as measured
by the Shostrom Personal Orientation Inventory, is a measure
of overall mental health. One of the two major subscales of
this inventory is a subscale of inner-directedness. This sub-
scale corresponds to “locus of inner control”or self-efficacy,
which has been shown to be higher in FM subjects reporting
less pain and less physical impairment [19] and to be a
predictor of positive outcomes for FM subjects undergoing
rehabilitation [20]. Some subjects, who underwent treatment
at the health centre, felt that the practice of TM made it easier
to adopt the MVM recommendations for a healthy lifestyle.
A previous study on Maharishi Panchakarma (142 con-
secutive subjects) showed statistically significant improve-
ments over a range of health scales including stamina,
energy, mind/emotions and previous complaints 1 month
post-treatment, compared with a control group (n060) that
only participated in an MVM-based health education
program [21]. A case series of four subjects suffering
from chronic diseases suggested substantial improvement
after patients underwent a 3-week in-residence Maharishi
Panchakarma treatment program and a home follow-up
program [22].
Entry scores may have affected our findings for two
outcomes, anxiety and depression. The entry scores for the
two mental subscales were considerably lower compared
with the other five outcome measures (seven subjects
(23%) had entry scores for anxiety lower than 0.4, and four
subjects (13%) had entry scores less than 0.2). The decrease
in anxiety (−26%) was significant (p00.043) at 24 months,
but the decrease in depression, although a bigger absolute
effect (−32%) was only borderline significant (p00.062).
This was the reverse of the 6-month data where the decrease
in depressive symptoms (−46%) was significant (p< 0.001)
and the decrease in anxiety (−25%) was not (p00.136) [5].
It is possible that the lack of significance in each instance
was due to the already low baseline scores (floor effect) and
a small sample size, causing the study to be underpowered
for these variables.
Based on a retrospective interview at 24-months, com-
pliance with using the herbal products seemed to be poor
(Table 4). This could be mostly due to self-selection due to
(i) the costs of the products, (ii) differing individual effects
of the products.
Side effects
No participant reported a major complaint as a result of the
Panchakarma treatment. Treatments were in general enjoyed
and experienced as soothing and relaxing, even by the
six participants who reported allodynia (experience of
pain from normally non-noxious stimuli). Short periods
of increased pain were experienced by some of the
participants.
Other comments
Two of the four TM practitioners reported that they had been
meditating twice a day fairly regularly during the 2-year
post-treatment period. The third discontinued after almost
3 months of practice, and the fourth was irregular in her
practise, both despite good experiences. The two regular
TM practitioners maintained an excellent response at the
study’s end-point, and the other two slightly increased their
responder scores.
In the group of 11 good responders, three subjects in-
cluding one TM practitioner were taking regular analgesic
medication at the start of the study. By 24 months, all three
had stopped all analgesics. Data were missing for one of the
11 good responders. Two subjects started to exercise after
they had experienced improvements following the treat-
ment. Of these two, the first was the subject that stopped
practising TM after 3 months, and the other was subject
number two, who reported a worsening of symptoms (16%)
at the 24-month end-point.
Limitations
Our study has limitations. First, the sample was small.
Second, the study was not randomised—the participants in
this study were all self-selected and thus very motivated.
Third, the study was not controlled. Having said that, we felt
that it was reasonable to allow each subject’s baseline data
to serve as the control. We felt that way because FM is
considered a treatment-resistant condition, and most of our
subjects had, according to their reports, severe symptoms for
many years. This was confirmed by the fact that the total
sum of their baseline scores for the five body scales aver-
aged 32.4 (range, 11.8–48.4); only three subjects had a sum
less than 20. It was also confirmed by the fact that they
entered a rather costly treatment programme without any
insurance compensation. The price for a 9-day residence
treatment programme is, today, including instruction in the
TM-technique US $5,780. The price for the TM course
alone is US $1,830 (students US $915). The price for a
residential treatment programme in Norway based on con-
ventional medicine (Jeløy kurbad) is US $5,590. (US $1 0
5.90 NOK) Fourth, the instrument we used to measure FM
was not a very sharp one—especially on the anxiety and
depression dimensions. Fifth, all data were self-reported.
Conclusions
The treatment offered at the Maharishi Ayurveda Health
Centre in Mesnali can provide substantial and significant
long-term benefits to FM patients. The results of this pilot
study are encouraging and warrant further research using a
Clin Rheumatol
stronger experimental design (randomised and controlled),
one with sufficient power for all variables (larger sample
size) and one in which all participants receive 9 days of
Panchakarma treatment plus TM. The concept of food in-
tolerance that was used in our study also warrants further
investigation.
Acknowledgements The study was financially supported by EXTRA
funds from The Norwegian Foundation for Health and Rehabilitation. We
thank Helge Marthinussen, Maharishi Ayurveda Health Centre, Mesnali
for assistance in the collection of data.
Conflicts of interests The first author is the administrative and
medical director of the Maharishi Ayurveda Health Centre, Mesnali,
Norway. Jeremy Z. Fields is Adjunct Research Professor at Maharishi
University of Management, Fairfield, Iowa, USA. The rest of the
authors declare no conflict of interest.
References
1. Schneider RH, Fields JZ (2006) Total heart health. How to prevent
and reverse heart disease with the Maharishi Vedic Approach to
Health. Basic Health Publications, Laguna Beach
2. Nader T (2000) Human physiology. Expression of Veda and the
Vedic Literature. Maharishi Vedic University, 6063 NP Vlodrop,
The Netherlands
3. www.tm.org/research. Accessed 12 January 2011
4. www.ayurveda.no Accessed 12 January 2011.
5. Rasmussen LB, Mikkelsen K, Haugen M, Pripp AH, Førre ØT
(2009) Treatment of fibromyalgia at the Maharishi Ayurveda
Health Centre in Norway. A six month follow-up study. Clin Exp
Rheumatol 27(suppl 56):S46–S50
6. Anonymous (2009) Fibromyalgia: poorly understood; treatments
are disappointing. Prescrire Int 18:169–173.
7. Wolfe F, Smythe HA, Yunus MB et al (1990) The American
College of Rheumatology 1990 criteria for the classification of
fibromyalgia. Arthritis Rheum 33:160–172
8. Orme-Johnson DW, Schneider RH, Son YD, Nidich S, Cho ZH
(2006) Neuroimaging of meditation's effect on brain reactivity to
pain. Neuroreport 17(12):1359–1363
9. Orme-Johnson D (1987) Medical care utilization and the transcen-
dental meditation program. Psychosom Med 49:493–507
10. Herron RE, Hillis SL (2000) The impact of the transcendental
meditation program on government payments to physicians in
Quebec: an update. Am J Health Promot 14(5):284–291
11. Brooks JS, Scarano T (1985) Transcendental Meditation in the
treatment of post-traumatic-adjustment. J Counsel Develop
65:212–215
12. Haratani T, Hemmi T (1990) Effects of Transcendental Meditation
(TM) on the mental health of industrial workers. Jpn J Ind Health
32(7):656
13. Jayadevappa R, Johnson JC, Bloom BS, Nidich S, Desai S,
Chhatre S et al (2007) Effectiveness of transcendental meditation
on functional capacity and quality of life of African Americans
with congestive heart failure: a randomized control study. Ethnicity
Dis 17(1):72–77
14. Kondwani KA, Schneider RH, Alexander CN, Sledge C, Staggers
F, Clayborne M et al (2005) Left ventricular mass regression with
the Transcendental Meditation technique and a health education
program in hypertensive African Americans. J Soc Behav Personal
17(1):181–200
15. Sheppard DH, Staggers F, John L (1997) The effects of a stress
management program in a high security government agency. Anxiety
Stress Coping 10:341–350
16. Nidich SI, Rainforth MV, Haaga DA, Hagelin J, Salerno JW,
Travis F, Tanner M, Gaylord-King C, Grosswald S, Schneider
RH (2009) A randomized controlled trial on effects of the Transcen-
dental Meditation program on blood pressure, psychological distress,
and coping in young adults. Am J Hypertens 22:1326–1331
17. Eppley KR, Abrams AI, Shear J (1989) Differential effects of
relaxation techniques on trait anxiety: a meta-analysis. J Clin
Psychol 45(6):957–974
18. Alexander CN, Rainforth MV, Gelderloos P (1991) Transcendental
meditation, self-actualization and psychological health: a concep-
tual overview and statistical meta-analysis. J Soc Behav Pers
6:189–247
19. Buckelew SP, Murray SE, Hewett JE, Johnson J, Huyser B (1995)
Self-efficacy, pain, and physical activity among fibromyalgia sub-
jects. Arthritis Care Res 8(1):43–50
20. Buckelew SP, Huyser B, Hewett JE et al (1996) Self-efficacy
predicting outcome among fibromyalgia subjects. Arthritis Care
Res 9(2):97–104
21. Schneider RH, Cavanaugh KL, Kasture HS et al (1990) Health
promotion with a traditional system of natural health care, Maharishi
Ayurveda. J Soc Behav Person 5:21–27
22. Nader T, Rothenberg S, Averbach R, Charles B, Fields JZ,
Schneider RH (2000) Improvements in chronic diseases with a
comprehensive natural medicine approach: a review and case
series. Behav Med 26:34–46
Clin Rheumatol
