Article

Randomized-controlled Trial Comparing Yoga and Home-based Exercise for Chronic Neck Pain

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Abstract

Objectives: Chronic neck pain is a significant public health problem with only very few evidence-based treatment options. There is growing evidence for the effectiveness of yoga for relieving musculoskeletal disorders. The aim of this study was to evaluate the effect of Iyengar yoga compared with exercise on chronic nonspecific neck pain. Methods: Patients were randomly assigned to either yoga or exercise. The yoga group attended a 9-week yoga course and the exercise group received a self-care manual on home-based exercises for neck pain relief. The main outcome measure was the present neck pain intensity (100 mm visual analog scale). Secondary outcome measures included functional disability (Neck Disability Index), pain at motion (visual analog scale), health-related quality of life (Short Form-36 questionnaire), cervical range of motion, proprioceptive acuity, and pressure pain threshold. Results: Fifty-one patients (mean age 47.8 y ; 82.4% female) were randomized to yoga (n=25) and exercise (n=26) intervention. After the study period, patients in the yoga group reported significantly less neck pain intensity compared with the exercise group [mean difference: -13.9 mm (95% CI, -26.4 to -1.4), P=0.03]. The yoga group reported less disability and better mental quality of life. Range of motion and proprioceptive acuity were improved and the pressure pain threshold was elevated in the yoga group. Discussion: Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.

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... A total of 3,562 participants were included. Of these, 26 studies (1,649 participants) examined exercises for patients with fibromyalgia (Assis et al., 2006;Assumpção et al., 2018;Bircan et al., 2008;Bjersing et al., 2012;Calandre et al., 2009;Demir-Göçmen et al., 2013;Duruturk et al., 2015;Evcik et al., 2008;Fernandes et al., 2016;Gavi et al., 2014;Genc et al., 2015;Jentoft et al., 2001;Jones et al., 2002;Kayo et al., 2012;Mannerkorpi et al., 2010;McCain et al., 1988;Nørregaard et Rooks et al., 2007;van Santen et al., 2002;Sañudo et al., 2010;Schachter et al., 2003;Sevimli et al., 2015;Valim et al., 2003;Wang et al., 2018), two studies (326 participants) examined exercises for patients with CWAD (Seferiadis et al., 2016;Vikne et al., 2007) and 22 studies (1,587 participants) examined exercises for patients with CINP (Andersen et al., 2008;Bobos et al., 2016;Borisut et al., 2013;Cramer et al., 2013;Falla et al., 2006;Häkkinen et al., 2008;Izquierdo et al., 2016;Javanshir et al., 2015;Karlsson et al., 2014;Khan et al., 2014;Kietrys et al., 2007;Kim & Kwag, 2016;Lansinger et al., 2007Lansinger et al., , 2013Lauche et al., 2016;O'Leary et al., 2012;Rendant et al., 2011;Salo et al., 2010Salo et al., , 2012Senthil et al., 2016;von Trott et al., 2009;Ylinen et al., 2003). The results are presented by clinical condition. ...
... Muscle strengthening (strength exercise, endurance, or both) was tested in 12 treatment groups (Bobos et al., 2016;Borisut et al., 2013;Javanshir et al., 2015;Karlsson et al., 2014;Khan et al., 2014;Kietrys et al., 2007;Kim & Kwag, 2016;O'Leary et al., 2012;Salo et al., 2010;Ylinen et al., 2003). Motor control exercises were examined in nine treatment groups (Andersen et al., 2008;Bobos et al., 2016;Borisut et al., 2013;Falla et al., 2006;Izquierdo et al., 2016;Javanshir et al., 2015;Kim & Kwag, 2016;O'Leary et al., 2012;Senthil et al., 2016), stretching in four (Häkkinen et al., 2008;Karlsson et al., 2014;Kietrys et al., 2007;Salo et al., 2012), a combination of different types of exercises in nine (Cramer et al., 2013;Häkkinen et al., 2008;Lansinger et al., 2007Lansinger et al., , 2013Lauche et al., 2016;Rendant et al., 2011;Salo et al., 2012;Senthil et al., 2016;von Trott et al., 2009), specific techniques (Qigong, Tai Chi and Yoga) in six (Cramer et al., 2013;Lansinger et al., 2007Lansinger et al., , 2013Lauche et al., 2016;Rendant et al., 2011;von Trott et al., 2009), and aerobic exercise (Andersen et al., 2008), active range of motion exercises (Khan et al., 2014) and proprioceptive exercises (Izquierdo et al., 2016) in one treatment group each. ...
... Muscle strengthening (strength exercise, endurance, or both) was tested in 12 treatment groups (Bobos et al., 2016;Borisut et al., 2013;Javanshir et al., 2015;Karlsson et al., 2014;Khan et al., 2014;Kietrys et al., 2007;Kim & Kwag, 2016;O'Leary et al., 2012;Salo et al., 2010;Ylinen et al., 2003). Motor control exercises were examined in nine treatment groups (Andersen et al., 2008;Bobos et al., 2016;Borisut et al., 2013;Falla et al., 2006;Izquierdo et al., 2016;Javanshir et al., 2015;Kim & Kwag, 2016;O'Leary et al., 2012;Senthil et al., 2016), stretching in four (Häkkinen et al., 2008;Karlsson et al., 2014;Kietrys et al., 2007;Salo et al., 2012), a combination of different types of exercises in nine (Cramer et al., 2013;Häkkinen et al., 2008;Lansinger et al., 2007Lansinger et al., , 2013Lauche et al., 2016;Rendant et al., 2011;Salo et al., 2012;Senthil et al., 2016;von Trott et al., 2009), specific techniques (Qigong, Tai Chi and Yoga) in six (Cramer et al., 2013;Lansinger et al., 2007Lansinger et al., , 2013Lauche et al., 2016;Rendant et al., 2011;von Trott et al., 2009), and aerobic exercise (Andersen et al., 2008), active range of motion exercises (Khan et al., 2014) and proprioceptive exercises (Izquierdo et al., 2016) in one treatment group each. ...
Article
Background and objective: To compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash-associated disorders (CWAD), and chronic idiopathic neck pain (CINP). Databases and data treatment: Randomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis. Results: Fifty studies with 3,562 participants were included. For fibromyalgia, both aerobic or strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50- to 60-minute supervised sessions, 2 to 3 times a week, for 13 weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90-minute supervised sessions, twice a week, for 10 to 16 weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30- to 60-minute supervised sessions, 2 to 3 times a week, for 7 to 12 weeks. Conclusions: The choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non-nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills.
... Attrition and reporting bias were mainly low. Two of the 13 articles accounted for co-interventions by recording medications and other treatments received in a diary [30] and by registering medication type and frequency [27]; the other articles did not account for co-interventions. Five articles conducted a sample size calculation [23,26,27,30,31]. ...
... Two of the 13 articles accounted for co-interventions by recording medications and other treatments received in a diary [30] and by registering medication type and frequency [27]; the other articles did not account for co-interventions. Five articles conducted a sample size calculation [23,26,27,30,31]. Two of the 13 articles [32,33] included more than 50 subjects per group. ...
... Most of the patients were office workers [22,[24][25][26][31][32][33] and assembly line workers [24,26]. Six out of the 13 articles did not specify the patients jobs [21,23,[27][28][29][30]. ...
Article
Full-text available
The current systematic review aimed to compare the effect of injury-focused (specific) exercises versus more general (non-specific) exercises on pain in patients with chronic neck or shoulder pain. We searched PubMed, EMBASE, and Web of Science. Two reviewers screened and selected studies, extracted outcomes, assessed risk of bias, and rated the quality of evidence. A total of nine eligible studies, represented in 13 articles, were identified, with a considerable risk of bias. One article investigated the acute effect of single bouts of exercise on pain and reported an immediate pain reduction after non-specific exercise. Regarding short-term effects, seven out of the nine studies found no differences in pain between interventions, with inconsistent results among two other studies. Concerning the long-term effects, while pain reduction seems to be favored by specific exercises (two out of four articles), the best format is still unclear. Based on the acute effects, a single bout of non-specific exercise seems to be a better option for pain-relief for patients with chronic neck or shoulder pain. For short-term effects, there are no differences in pain between specific and non-specific exercises. Regarding long-term effects, specific exercises seem to be the best option. Nevertheless, more studies are warranted.
... Yoga has been practiced in India since ancient times and is increasingly being accepted by the Western world. The beneficial effects of medical yoga have been documented in various chronic musculoskeletal diseases [11,12]. However, there is only one study in reference to yoga and the FS. ...
... Recent research has shown that yogic practices positively impact the body in many ways. Unlike the exercises which yield physical benefit, yoga seems to be able to improve body awareness, pain acceptance, and coping [11]. Healthy persons practicing yoga have been found to have better body and mind coordination, anxiety control, breath control, and improved body flexibility [17]. ...
... In multiple studies, yoga has been found to decrease inflammatory markers [18,19]. The beneficial effect has been documented when yoga is practiced as an additional therapy for people suffering from for back and neck pain [11,12]. Specific asanas (yoga practices) help in correcting the vertebral curvature, strengthening the thoracic and abdominal cavities, along with supporting respiratory muscles, thus overall improving the posture [20]. ...
Article
Full-text available
Background The available treatments for frozen shoulder yield variable results. Physical therapy and analgesics are considered as the first-line treatment for this disorder, but the effects are not uniform. There is some evidence to support that alternative medicine may have a role in its management. This study was designed to examine the short-term effects of yoga therapy in patients with frozen shoulder of mild to moderate severity. Materials and methods A prospective randomized controlled trial was conducted on patients with frozen shoulder between 30 and 60 years of age. They were divided into two groups: yoga (Y) and control (NY). A set of Asana exercises called “Standing Group of Asana” was practiced by the yoga group in addition to the conventional therapy as received by the control group. The patients were reviewed at 1, 2 and 4 weeks. The pain and functional assessment were done at baseline and at each review using the Shoulder Pain and Disability Index (SPADI). Results There were 16 male and 20 female participants in the Y group, and 15 males and 21 females in the NY group. There was no statistically significant difference in age, sex, and pre-treatment SPADI score between the groups. At the end of the four weeks, the SPADI pain scores in the Y and NY group were 20.47 and 20.14, respectively (p = 0.666). The SPADI disability scores in the Y and NY group were 20.4 and 19.7, respectively (p = 0.599). Overall SPADI scores were 40.67 and 40.03 in the Y and NY group, respectively (p = 0.736). Both groups had a significant reduction in SPADI pain and disability scores. However, there was no significant difference between the groups in terms of SPADI scores. Conclusion The effect of the Standing Group of Asana has no added advantage relative to standard frozen shoulder treatment when practiced for one month.
... Some high-quality evidence was presented for four of the five proposed physical exercise interventions for chronic neck pain. Several studies that analysed the effects of general physical exercise, yoga, Pilates and Tai Chi demonstrated to have a low risk of bias [37][38][39][40][41]. A high risk of bias was determined for both studies that investigated the effectiveness of Qigong as intervention [41,42]. ...
... Of the nine included studies that investigated the effectiveness of general whole-body physical exercise as intervention for individuals with chronic neck pain, two studies utilised individualised physical exercise [40,44], four studies utilised yoga or Pilates [37,38,43,45] and three studies utilised Tai Chi or Qigong [39,41,42]. The study samples consisted of 51 to 216 participants, and the physical exercise interventions took 6, 9 or 12 weeks. ...
... The study samples consisted of 51 to 216 participants, and the physical exercise interventions took 6, 9 or 12 weeks. Five studies [37,39,42,43,45] included only individuals with chronic idiopathic neck pain, whereas two [40,44] included only individuals with chronic WAD. Von Trott et al. [41] included both individuals with chronic idiopathic and chronic WAD. ...
Article
Purpose: To investigate the effectiveness of general, whole-body, physical exercise interventions compared to usual care for individuals with chronic neck pain. Materials and methods: Systematic review of randomised controlled trials. Electronic databases MEDLINE, EMBASE, CINAHL and PEDro were searched. Data were extracted using a standardised data extraction table. Methodological quality was determined using the Cochrane Handbook risk of bias assessment tool. Results: A total of 1601 unique records were identified and screened independently for eligibility by two reviewers. Nine randomised controlled trials were included in the review, reporting three types of physical exercise: individualised physical exercise, yoga and Pilates, and Tai Chi and Qigong. Overall, interventions utilising these modes of exercise delivery demonstrated significant improvements in neck pain intensity and neck disability. Conclusions: Despite currently limited evidence being available on the effectiveness of general physical exercise in individuals with chronic neck pain, this systematic review identified nine studies that support the use of physical exercise. All studies found improvements in pain outcomes, and six studies found physical exercise to be more successful than usual care interventions. Further evidence is needed to confirm the effectiveness of physical exercise interventions with long-term follow-up periods.
... Whereas the results of most studies are inconsistent. [17][18][19][20][21][22][23][24][25][26] So conducting a meta-analysis to explore the synthetical effects seems to be necessary. Only one metaanalysis [15] was found in databases up to now, which concluded that yoga has short-term effects on chronic neck pain, which only searched English-language databases and included 3 eligible studies, resulting in a relatively limited overall sample size. ...
... Of these 297 were excluded because of duplication, or because they did not meet our inclusion criteria after going through the titles and abstracts. After reading the full text of the remaining 50 studies, 10 studies [17][18][19][20][21][22][23][24][25][26] including 686 cases were included in the quantitative synthesis and meta-analysis (Fig. 1). ...
... The basic characteristics of these 10 studies were represented in Table 1, including 2 q-RCT [19,21] and 8 RCT. [17][18]20,[22][23][24][25][26] These articles were from Turkey, [17] India, [18,26] Korea, [19] Sweden, [20] United States, [21] Germany, [22,24,25] and China, [20] were published between 2010 and 2018, cover 686 patients, and sample sizes ranging from 38 to 159. All the studies involved yoga intervention, including both exercise-based and meditationbased, and the program length ranging from 10 days to 12 weeks. ...
Article
Full-text available
Background: Chronic nonspecific neck pain (CNNP) has a high prevalence and is more common among younger people. Clinical practice suggests that yoga is effective in relieving chronic pain. Objectives: This meta-analysis aimed to quantitatively summarize the efficacy of yoga for treating CNNP. Data sources: We searched for trials in the electronic databases from their inception to January 2019. English databases including PubMed, MEDLINE, Cochrane Library, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Ind Med; Chinese databases including China National Knowledge Infrastructure (CNKI), WanFang Database, and VIP Information. We also conducted a manual search of key journals and the reference lists of eligible papers to identify any potentially relevant studies we may have missed. We placed no limitations on language or date of publication. Study eligibility criteria: We included only randomized controlled trials (RCTs) and q-RCTs evaluating the effects of yoga on patients with CNNP. The primary outcomes for this review were pain and disability, and the secondary outcomes were cervical range of motion (CROM), quality of life (QoL), and mood. Participants and interventions: Trails that examined the clinical outcomes of yoga intervention in adults with CNNP compared with those of other therapies except yoga (e.g., exercise, pilates, usual care, et al) were included. Study appraisal and synthesis methods: Cochrane risk-of-bias criteria were used to assess the methodological quality, and RevMan 5.3 software was used to conduct the meta-analysis. Results: A total of 10 trials (n = 686) comparing yoga and interventions other than yoga were included in the meta-analysis. The results show that yoga had a positive effects on neck pain intensity (total effect: SMD = -1.13, 95% CI [-1.60, -0.66], Z = 4.75, P < .00001), neck pain-related functional disability (total effect: SMD = -0.92, 95% CI [-1.38, -0.47], Z = 3.95, P < .0001), CROM (total effect: SMD = 1.22, 95% CI [0.87, 1.57], Z = 6.83, P < .00001), QoL (total effect: MD = 3.46, 95% CI [0.75, 6.16], Z = 2.51, P = .01), and mood (total effect: SMD = -0.61, 95% CI [-0.95, -0.27], Z = 3.53, P = .0004). Conclusions and implications of key findings: It was difficult to make a comprehensive summary of all the evidence due to the different session and duration of the yoga interventions, and the different outcome measurement tools in the study, we draw a very cautious conclusion that yoga can relieve neck pain intensity, improve pain-related function disability, increase CROM, improve QoL, and boost mood. This suggests that yoga might be an important alternative in the treatment of CNNP. Systematic review registration number: Details of the protocol for this systematic review and meta-analysis were registered on PROSPERO and can be accessed at www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42018108992.
... For functional disability, we also found that app-based neck exercise showed greater improvement than did active exercise, such as yoga. Cramer H et al. (2013) reported that 9 weeks of yoga exercise showed an approximately 33% improvement while app-based neck exercise in the present study showed approximately 36% improvement in function disability, despite the shorter intervention duration [36]. In addition, Chao ma et al. (2011) reported, in patients with work-related neck pain, greater improvement in functional disability following workplacebiofeedback training than with other interventions such as those involving active thera-band exercise and interferential therapy [37]. ...
... For functional disability, we also found that app-based neck exercise showed greater improvement than did active exercise, such as yoga. Cramer H et al. (2013) reported that 9 weeks of yoga exercise showed an approximately 33% improvement while app-based neck exercise in the present study showed approximately 36% improvement in function disability, despite the shorter intervention duration [36]. In addition, Chao ma et al. (2011) reported, in patients with work-related neck pain, greater improvement in functional disability following workplacebiofeedback training than with other interventions such as those involving active thera-band exercise and interferential therapy [37]. ...
Article
Introduction Chronic neck pain in office workers is a prevalent occupational disorder. Recently, smartphone applications (apps) have increased rapidly, and provide the benefits in terms of accessibility to health information. The objective of this study was to examine the effectiveness of an app-based exercise in office workers on pain intensity, functional disability, exercise adherence, muscle strength, quality of life and fear-avoidance. Methods 20 office workers participated in the study excluding one drop-out. The app-based exercise group (n = 11) conducted neck exercise through the mobile app in the workplace environment for at least 10–15 min/day, 2 days/week for 8 weeks while the control group (n = 9) received a brochure showing how to correct their posture themselves during the same period. Evaluations using the following were performed at baseline and after 8 weeks: the Visual Analog Scale (VAS), for pain intensity; Neck Disability Index (NDI), for functional disability; level of exercise adherence; maximal voluntary flexion/extension strength (MVFS/MVES); 36-Item Short-Form Healthy Survey (SF-36), for quality of life; and Fear-Avoidance Belief Questionnaire (FABQ). Results Within the app-based exercise group, the VAS (P = 0.003) and NDI (P = 0.005) improved significantly after the app-based neck exercise. MVES (P = 0.013), physical component summary (P = 0.02) of the SF-36, and the work-related subscale (P = 0.011) in the FABQ improved significantly. The level of exercise adherence was high. In VAS and NDI, there were statistically significant differences in the amounts of improvement between the groups. Conclusion An app-based neck exercise positively effects pain intensity, functional disability and partially improves muscle strength, SF-36 score, and FABQ score.
... Previous studies have reported the effects of therapeutic exercise, including neck stabilization exercise, with or without thermotherapy on nonspecific musculoskeletal pain and disability [8][9][10][11][12]34,[37][38][39]. ...
... This study showed significant time and group interactions of PPT, and both intervention and control groups showed significant improvements in PPT. Prior studies have also reported that thermotherapy has a greater influence on PPT in comparison with other treatments for chronic neck pain [38,42]. However, a previous study [12] reported no significant change in PPT after thermotherapy application. ...
Article
Full-text available
Neck pain is a serious problem for public health. This study aimed to compare the effects of thermotherapy plus neck stabilization exercise versus neck stabilization exercise alone on pain, neck disability, muscle properties, and alignment of the neck and shoulder in the elderly with chronic nonspecific neck pain. This study is a single-blinded randomized controlled trial. Thirty-five individuals with chronic nonspecific neck pain were randomly allocated to intervention (n = 18) or control (n = 17) groups. The intervention group received thermotherapy with a salt-pack for 30 min and performed a neck stabilization exercise for 40 min twice a day for 5 days (10 sessions). The control group performed a neck stabilization exercise at the same time points. Pain intensity, pain pressure threshold (PPT), neck disability index, muscle properties, and alignment of the neck and shoulder were evaluated before and after the intervention. Significant time and group interactions were observed for pain at rest (p < 0.001) and during movement (p < 0.001), and for PPT at the upper-trapezius (p < 0.001), levator-scapula (p = 0.003), and splenius-capitis (p = 0.001). The disability caused by neck pain also significantly changed between groups over time (p = 0.005). In comparison with the control group, the intervention group showed significant improvements in muscle properties for the upper-trapezius (tone, p = 0.021; stiffness, p = 0.017), levator-scapula (stiffness, p = 0.025; elasticity, p = 0.035), and splenius-capitis (stiffness, p = 0.012), and alignment of the neck (p = 0.016) and shoulder (p < 0.001) over time. These results recommend the clinical use of salt pack thermotherapy in addition to neck stabilization exercise as a complementary intervention for chronic nonspecific neck pain control.
... Vijayaraghava A et al. and Nagarathna R et al. have reported that yoga reduces the inflammatory markers [23,24]. These have been instrumental in translating benefits in persons who have arthritis, LBP, and neck pain [13,14]. The American Pain Society also brace yoga as an evidence-based treatment for LBP with at least moderate benefit [15]. ...
... Crammer et al. compared the yoga group (n ¼ 25) with a nonyoga group (n ¼ 26) in a study and found significant improvement in the 9-week yoga intervention group in term of improved neck pain and neck-related disability [14]. The results were sustained even 12 months after the completion of yoga. ...
Article
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Background “Cervical spondylosis” (CS) is a collective term used for non-specific neck pain post 30 age group. Management of CS is mainly non-surgical, particularly in mild to moderate severity that includes the oral anti-inflammatory drugs, exercises, manipulation, mobilization, or combination of these. Objective The objective of the study is to assess the possible benefit of a selected group of asana in a group of patients over a short time frame and assess their functional outcome. Materials & methods An observational study of cohort of patients having mild to moderate CS, who visited the AYUSH department between May 2016 and November 2016 were included. “Selected group of Asana (SGOA)” was practiced for 30 min supervised and then home-based for a period of 8 weeks with usual standard treatment. Patients followed up fortnightly, and their degree of severity & disability assessed. Results Thirty patients with 19 males and 11 females having ages mean ± SD 45.61 ± 8.3 and 44.18 ± 9.78 having NDI score of mean ± SD 17.83 ± 4.749 at baseline (0 weeks) were included. Patients showed an improvement in NDI score to finally 7.40 ± 3.180, p-value = 0.0001. This improvement was also noted at various time intervals (p-value = 0.0001 each time), as seen in the post hoc analysis. Conclusion Yogic practices “Specific Group of Asana” done for eight weeks on a home-based program could be useful in reducing pain and disability in people suffering from CS of mild to a moderate degree. However, more extensive, comparative, and multi-centric trials are required for establishing this as a treatment modality.
... These checks all preceded actual follow-up periods. Three of the 27 studies did not involve follow-up periods [41,42,46]. Of the remaining 24 studies, the maximum duration of follow-up � Various terminology as used to specify pain type across all studies (e.g. ...
... included studies. The minimum reported age of participants was 18 years[42] and the maximum reported age was 88 years[43]. One study did not specify participant age range of adult participants[55]. ...
Article
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Background There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored. Objectives 1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management. Methods Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model. Results Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported. Conclusions Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended.
... 30 Yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program. 31 Yoga reduced neck pain intensity and disability and improved health-related quality of life. Yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain. ...
... 42 In two RCTs on fibromyalgia syndrome, there was very low evidence for effects on pain and low evidence for effects on disability. 31 There is no definitive cure for fibromyalgia, and treatment primarily focuses on symptom management and improving patient quality of life. This treatment strategy involves a comprehensive multidisciplinary approach consisting of lifestyle modifications, pharmacologic measures, and other complementary approaches including but not limited to acupuncture, yoga, tai chi, and meditation. ...
Article
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This paper examines the role of yoga therapy in comprehensive integrative pain management (CIPM). The pain crisis is described, and how yoga therapists can contribute to its solution is explained. Yoga therapy can be an essential component of the multidisciplinary undertaking that will be required to improve patient outcomes and alter the trajectory of the global public health crisis constituted by an epidemic of poorly understood and inadequately addressed pain. Additional context and evidence are presented to document the effectiveness of yoga therapy interventions to support people living with pain. The white paper concludes by listing recommendations to providers, consumers, payers, and legislators, who together can address systemic and structural barriers to CIPM, as well as suggestions for enabling the yoga therapy profession to more fully participate in these solutions.
... A large body of interventions aims to improve posture and postural control in patients with chronic musculoskeletal pain [6][7][8][9][10][11][12] based on the long-held notion that 'bad' posture and 'poor' postural control are major contributors to pain conditions, particularly to back and neck pain [13]. Previous research has indeed shown associations between spinal pain and posture, especially around chronic low back pain. ...
Article
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Background: Habitual postural patterns are associated with musculoskeletal pain, and improving a maladaptive posture requires postural awareness in order to lead to clinical improvements. This study aimed to develop and evaluate the psychometric properties of an innovative postural awareness scale. Methods: A 12-item Postural Awareness Scale (PAS) was developed and administered to 512 chronic pain patients (50.3 ± 11.4 years, 91.6% female, 37.1% spinal/shoulder pain) to assess its factor structure and reliability. To determine convergent validity, measures of body awareness, body responsiveness, body image, and mindfulness were correlated with the PAS, as were clinical measures of pain intensity, disability, and mental health. Sensitivity to change was assessed in 202 outpatients participating in a 10-week multimodal mind-body program. Results: Factor analysis revealed two factors (Ease/Familiarity with Postural Awareness and Need for Attention Regulation with Postural Awareness) that explained 50.8% of the variance. Cronbach’s alpha for the complete scale was 0.80; Spearman-Brown coefficient of split-half reliability was 0.67; and intra-class correlation was ICC2,1 = 0.75 (95% confidence interval = 0.71, 0.78). Significant positive correlations were found for body awareness (r = 0.23), body responsiveness (r = 0.41), body image (r = 0.22–0.32), and mindfulness (r = 0.38); negative correlations for pain intensity (r = − 0.14), disability (r = − 0.12), depression (r = − 0.23), and stress (r = − 0.29). Postural awareness scores increased with a mind-body program (p < 0.001); changes in the PAS were negatively correlated with changes in pain intensity (r = − 0.35) in patients with spinal/shoulder pain. Conclusion: Self-reported postural awareness is associated with clinical symptoms in chronic pain patients; improvements in postural awareness are longitudinally associated with reduced pain in patients with spinal/shoulder pain.
... 12 Yoga has been shown to reduce stress and psychological distress, in varied patient populations. [13][14][15][16][17][18] It may prove equally effective in improving the symptoms of IBS. 19 The primary purpose of this study was to analyse the effectiveness of a yoga-based intervention compared to the use of a low-FOD-MAP diet in treating the gastrointestinal symptoms of patients with IBS. ...
Article
Background: Irritable bowel syndrome is the most frequent gastrointestinal disorder. It is assumed that lifestyle interventions might be a rational treatment approach. Aim: To examine the effect of a yoga-based intervention vs a low-FODMAP diet on patients with irritable bowel syndrome. Methods: Fifty-nine patients with irritable bowel syndrome undertook a single-blind, randomised controlled trial involving yoga or a low-FODMAP diet for 12 weeks. Patients in the yoga group received two sessions weekly, while patients in the low-FODMAP group received a total of three sessions of nutritional counselling. The primary outcome was a change in gastrointestinal symptoms (IBS-SSS). Secondary outcomes explored changes in quality of life (IBS-QOL), health (SF-36), perceived stress (CPSS, PSQ), body awareness (BAQ), body responsiveness (BRS) and safety of the interventions. Outcomes were examined in weeks 12 and 24 by assessors "blinded" to patients' group allocation. Results: No statistically significant difference was found between the intervention groups, with regard to IBS-SSS score, at either 12 (Δ = 31.80; 95%CI = -11.90, 75.50; P = .151) or 24 weeks (Δ = 33.41; 95%CI = -4.21, 71.04; P = .081). Within-group comparisons showed statistically significant effects for yoga and low-FODMAP diet at both 12 and 24 weeks (all P < .001). Comparable within-group effects occurred for the other outcomes. One patient in each intervention group experienced serious adverse events (P = 1.00) and another, also in each group, experienced nonserious adverse events (P = 1.00). Conclusions: Patients with irritable bowel syndrome might benefit from yoga and a low-FODMAP diet, as both groups showed a reduction in gastrointestinal symptoms. More research on the underlying mechanisms of both interventions is warranted, as well as exploration of potential benefits from their combined use.
... In a number of hospitals, yoga is already part of a multimodal tre a t m e n t approach and delivered by physical therapists or members of other health professions within inpatient integrative medicine treatment, 18 integrative oncology, 19 or multimodal pain treatment. An increasing number of yoga therapy clinical trials are conducted in Germany (for example, by the author and others [20][21][22][23][24][25], and the BDY recently started funding yoga trials with a therapeutic focus. 26 Given the strong demand by the general public and the growing evidence base for yoga as a therapeutic intervention, 27,28 yoga therapy might eventually be reconsidered by German healthcare decision makers. ...
Article
An estimated 15.7 million Germans are currently practicing yoga or are at least interested in starting to practice, and they often perceive yoga as a therapeutic approach. From a healthcare system perspective, the situation is less clear. Here, yoga is only recognized as a recreational or preventive activity. When yoga teachers fulfill specific qualifications, their preventive yoga classes are covered by the statutory health insurances. Only those with additional qualifications in medicine or psychotherapy, however, can independently use and promote "yoga therapy." The general perception of yoga in Germany as a preventive practice is reflected in the professional organization of yoga providers. Most providers are considered to be yoga teachers rather than yoga therapists and are organized mainly in yoga teacher associations. Despite the uncertain legal framework, yoga is now considered in a number of medical guidelines; in a number of hospitals, yoga is part of multimodal inpatient treatment programs and is delivered by physical therapists or members of other health professions. An increasing number of yoga therapy clinical trials are conducted in Germany, and efforts are underway to establish yoga therapy as an accepted adjunct treatment approach for selected medical conditions within the German healthcare system.
... Physical activity can not only abate many somatic symptoms, 24,25 but also alleviate the stress and pain associated with various diseases. 25,26 However, the effects of exercise on IBS are unclear. Therefore, we performed this systematic review to comprehensively assess the effects of exercise on IBS in patients with this disease. ...
... These coping behaviors can be maladaptive and result in disability and disuse, leading to chronic pain(Leeuw et al. 2007;Turk and Wilson 2010). Some studies indicated individuals with chronic musculoskeletal disorders and high kinesiophobia reported greater activity-associated pain and low levels of physical activity(Damsgard et al. 2010;Elfving et al. 2007). Conversely, Cheung et al.(2013) showed that individuals with mild neck pain and healthy controls do not differ in physical activity. ...
Thesis
Among occupational settings an unusual, but nonetheless important job at high prevalence area of occupational neck injury (reports of up to 90% incidence during flying careers in the aviation medicine literature) that of High Performance Combat Pilots (HPCP) has received relatively less studies. In the last years, the military helmet systems have increased the amount of head-supported mass (HSM) to serve also as mounting platforms for numerous combat-essential devices. It has been hypothesized that there could be an increase of risk for neck injuries as a function of the weight of the aviator's helmet. In this thesis, a prevalence study was carried out to verify the extent of the problem among Italian Air Force (ITAF) aircrews and, afterwards it was performed a study to identify the risk factors that characterize neck pain (NP) in Eurofighter pilots. It wanted to also identify simple tools, as well as the most common tests using in clinical setting, useful to simplify the epidemiological studies on cervical injuries among ITAF. Finally, a specific Physical Exercise Training (PET) was proposed to reduce incidence or to improve neck pain condition in pilots who suffer. The subjects were 44 volunteer male pilots (age: 34.6 ± 5.5) employed on Eurofighter Typhoon aircraft. Design of the study included three main area of investigation: first, a wide survey about individual and flight related factors, lifestyle, prevention strategies, medical treatments and pain experience; second, a functional assessment through Muscular Endurance Performance and Active Cervical Range of Motion (ACROM) evaluations; third, effect of an eight-weeks of specific PET on cervical functionality. For the first two areas of investigation, the pilots were grouped together as one cohort, later 24 pilots (35.6 + 4.4 yrs.) were selected and randomly divided into 2 groups: exercise group (EG) and control group (CG). In this study, smartphone application was used in physical assessment of cervical muscles. The iPhone 5c® used showed good intra- and inter-rater reliability and good validity for movements in all planes of movement compared to a gold standard (fluid inclinometer). More than 43% of pilots reported NP in the previous year. Among them, functional assessment was worse than the healthy pilots, but only Cranio-Cervical Flexion Test (CCFT) produced significant difference between the groups (p<.05). Pilots with previous F-16 experience were selected and they seemed more correlated with NP and cervical dysfunction. They showed no significant difference in NP compared to other pilots, but reported significant limitation in some ACROM. Age of pilots showed no correlation with NP, but was negatively correlated with ACROM, with significant limitation over 34 years old. Pilots suffering NP reported heavier physical activity during occupational duties and it may suggest to investigate more thoroughly some psychological or different stress factors in NP survey. The amount of physical exercise during leisure time seemed negatively correlated with neck injuries, especially for subjects who practiced ball games and core stability training. The data about PET were inconsistent. In conclusion, associate factors to NP investigated in this dissertation did not seem to affect the incidence of neck disorders among Typhoon pilots. Only previous experience on F-16 may suggest to deserve more attention about neck disorder in this population, although the transition to Typhoon does not seem to have exacerbate their condition. A programmed functional assessment and survey in pilots with and without NP may help to prevent acceleration-induced neck injuries, especially with increasing age and flight hours.
... Yoga is primarily used for health maintenance and preventive purposes, but is also increasingly being used for the treatment of specific physical and mental health conditions. Such conditions include chronic back [7][8][9] and neck pain [10,11], cancer related conditions [12][13][14], stress [15], and depression [16]. In Germany, yoga is used for increasing physical and mental well-being by 62.9 and 56.9%, respectively [4], with spiritual reasons for practice reported by 29.4% [4]. ...
Article
Full-text available
Background: While yoga is increasingly used for health purposes, its safety has been questioned. The aim of this cross-sectional survey was to analyze yoga-associated adverse effects and their correlates. Methods: A cross-sectional anonymous national online survey among German yoga practitioners (n = 1702; 88.9% female; 47.2 ± 10.8 years) was conducted from January to June 2016. Participants were queried regarding their yoga practice, i.e. yoga styles used, length and intensity of yoga practice, practice patterns, and whether they had experienced acute or chronic adverse effects of their yoga practice. Independent predictors of acute or chronic adverse effects were identified using multiple logistic regression analyses. Results: Ashtanga yoga (15.7%), traditional Hatha yoga (14.2%), and Sivananda yoga (22.4%) were the most commonly used yoga styles. 364 (21.4%) yoga users reported 702 acute adverse effects, occurring after a mean of 7.6 ± 8.0 years of yoga practice. The most commonly reported yoga practices that were associated with acute adverse effects were hand-, shoulder- and head stands (29.4%). Using Viniyoga was associated with a decreased risk of acute adverse effects; practicing only by self-study without supervision was associated with higher risk. One hundred seventy-three participants (10.2%) reported 239 chronic adverse effects. The risk of chronic adverse effects was higher in participants with chronic illnesses and those practicing only by self-study without supervision. Most reported adverse effects concerned the musculoskeletal system. 76.9% of acute cases, and 51.6% of chronic cases reached full recovery. On average 0.60 injuries (95% confidence interval = 0.51-0.71) per 1000 h of practice were reported, with Power yoga users reporting the highest rate (1.50 injuries per 1000 h; 95% confidence interval = 0.98-3.15). Conclusions: One in five adult yoga users reported at least one acute adverse effect in their yoga practice, and one in ten reported at least one chronic adverse effect, mainly musculoskeletal effects. Adverse effects were associated with hand-, shoulder- and head stands; and with yoga self-study without supervision. More than three quarters of of cases reached full recovery. Based on the overall injury rate per 1000 practice hours, yoga appears to be as safe or safer when compared to other exercise types.
... The neck pain group in this study could have differed from a treatment-seeking patient sample. However, the majority of previous studies testing cervical sensorimotor control have also recruited through advertising, 4,5,10,18,24,32,37,40,[47][48][49][50][51]53 so our sample is likely to be similar to those of the studies used for comparison. ...
Article
Study design: Case-control study. Background: Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. Objectives: To compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability. Methods: Fifty participants with chronic idiopathic neck pain and 50 age and sex-matched asymptomatic controls completed seven cervical sensorimotor control tests: joint position error, joint position error torsion, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with Mann-Whitney U tests. Correlations between tests and levels of neck pain and disability were investigated using Spearman's rho. Results: There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (p-values ranged from p=0.203 to p=0.981). For each test, 'poor performers' consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r values ranged from 0.010 to 0.294) and neck disability (0.007 to 0.316). Discussion: These findings suggest sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2019.8846.
... Egzersizleri ağrının akut, subakut ve kronik tüm evrelerinde yapılması önerilmektedir. Servikal ortezler, egzersiz, yoga, manipülasyon, mobilizasyon, masaj, akupunktur, kupa-hacamat, fizik tedavi modaliteleri, balneoterapi ve termal kaplıca bu başlık altında sayılan yöntemlerdir (11,13,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). ...
... Previous studies have reported that various exercise programs are effective in correcting shoulder imbalances [18,19]. In particular, the beneficial effects of medical yoga have been documented for various chronic musculoskeletal diseases [20][21][22] These results suggest that regular physical activity can correct long-term postural imbalances at the shoulder in middle-aged women. ...
Article
BACKGROUND Long-term postural imbalances can promote the development of diseases such as scoliosis or pain in the neck, shoulders, arms, and lumbar spine. Yoga combines exercises that target muscular strength and flexibility, suggesting that it can aid in attenuating structural and postural imbalances without the need for invasive procedures. The present study aimed to investigate the effect of a 16-week yoga program on Cobb’s angle and other postural indicators in patients with scoliosis.METHODS Ten middle-aged women living in South Korea who were judged to have scoliosis based on the results of posture tests participated in a 16-week yoga program.It consisted of two 70-min sessions per week during weeks 1–4, two 80-min sessions per week during weeks 5–9, and two 90-min sessions per week during weeks 10–16. The heights of the ilium and ischium were measured to check for pelvic imbalances. Shoulder height and Cobb’s angle in the spine were also assessed on radiography both before and after the intervention.RESULTS Following the 16-week program, Cobb’s angle had significantly decreased from 10.50±4.26 to 7.05±3.37 (p<0.001). However, there were no statistically significant differences between pre- and postintervention shoulder height (pre: 2.85±1.76 mm; post: 1.58±0.99 mm;p=0.124). In contrast, iliac height had decreased from 2.62±1.33 mm to 1.78±0.80 mm (p=0.048), and ischial height had decreased from 1.72±0.92 mm to 1.17±0.80 mm (p=0.043), and both differences were significant.CONCLUSIONS These results suggest that regular participation in yoga is effective for maintaining or improving postural indicatorsand attenuating imbalances in middle-aged women with scoliosis.
... 1,5,[14][15][16] Few intervention studies report SMC outcomes over time in individuals with chronic idiopathic neck pain. 13,17,18 As these studies each employed only 1 CSMC outcome, used relatively short follow-up times (ranging between 9 and 13 weeks), and did not report consistent changes across studies, little is known about changes in CSMC outcomes over time. If clinicians use CSMC outcomes to select an intervention, it is important to know whether improved symptoms of neck pain are associated with changes in CSMC. ...
Article
Background: Cervical sensorimotor control (CSMC) outcomes have been suggested to be important in the assessment of individuals with neck pain, despite the lack of consistent supporting evidence that CSMC skills are related to neck pain. Objective: The aim of this study was to investigate whether CSMC changes over time in individuals with chronic idiopathic neck pain and whether neck pain characteristics are associated with CSMC. Design: A longitudinal observational study was performed. Methods: A total 50 participants with chronic idiopathic neck pain and 50 matched participants who were healthy (controls) completed 7 CSMC tests (including 14 test conditions): joint position error, postural balance, subjective visual vertical, head tilt response, The Fly, smooth pursuit neck torsion, and head steadiness. Neck pain characteristics included pain intensity (visual analog scale), pain duration, and neck disability (Neck Disability Index). Linear mixed models were used to investigate whether any factors were associated with changes in CSMC. Results: Neck pain intensity was associated with 1 of 14 CSMC test conditions (balance with torsion and eyes open), and neck disability was associated with balance with eyes open and high-load head steadiness. Other factors, including sex, age, body mass index, physical activity levels, and neck pain duration, showed no association with CSMC. Limitations: Although all other tests involved computerized data collection, the joint position error test was administered manually, introducing the risk of researcher bias. Conclusions: The few associations between test conditions and neck pain characteristics were at best weak; hence, these are likely to be chance findings. These results suggest that CSMC may not be associated with improvement/worsening of chronic idiopathic neck pain, spawning debate on the clinical usefulness of CSMC tests.
... 36,37 There is evidence from randomized controlled trials (RCTs) that yoga is effective in the treatment of a variety of chronic conditions as either a stand-alone treatment or as an adjuvant therapy. Yoga has been shown to be effective in reducing pain and disability for individuals with low-back pain, 38 neck pain, 39,40 knee and hand osteoarthritis, 41,42 and rheumatic disease and fibromyalgia. 43,44 RCTs have also demonstrated that yoga practice results in improvements in mental health (depression, anxiety, self-efficacy, psychological flexibility in relation to posttraumatic stress disorder, and sleep), [45][46][47] and fatigue-and mood-related impacts in multiple sclerosis. ...
Article
Full-text available
Objectives The purpose of this randomized controlled trial was to evaluate the effects of a specialized yoga program for individuals with a spinal cord injury (SCI) on pain, psychological, and mindfulness variables. Materials and methods Participants with SCI (n=23) were outpatients or community members affiliated with a rehabilitation hospital. Participants were randomized to an Iyengar yoga (IY; n=11) group or to a 6-week wait-list control (WLC; n=12) group. The IY group participated in a twice-weekly 6-week seated IY program; the WLC group participated in the same yoga program, after the IY group’s yoga program had ended. Pain, psychological, and mindfulness measures were collected at two time points for both groups (within 1–2 weeks before and after program 1 and at a third time point for the WLC group (within 1 week after program 2). Results Linear mixed-effect growth models were conducted to evaluate the main effects of group at T2 (postintervention), controlling for T1 (preintervention) scores. T2 depression scores were lower (F1,18=6.1, P<0.05) and T2 self-compassion scores higher (F1,18=6.57, P< 0.05) in the IY group compared to the WLC group. To increase sample size and power, the two groups were combined and analyzed across time by comparing pre- and postintervention scores. Main effects of time were found for depression scores, (F1,14.83=6.62, P<0.05), self-compassion, (F1,16.6=4.49, P<0.05), mindfulness (F1,16.79=5.42, P<0.05), mindful observing (F1,19.82=5.06, P<0.05), and mindful nonreactivity, (F1,16.53=4.92, P<0.05), all showing improvement after the intervention. Discussion The results indicated that a specialized 6-week yoga intervention reduced depressive symptoms and increased self-compassion in individuals with SCI, and may also have fostered greater mindfulness.
... The neck pain group in this study could have differed from a treatment-seeking patient sample. However, the majority of previous studies testing cervical sensorimotor control have also recruited through advertising, 4,5,10,18,24,32,37,40,[47][48][49][50][51]53 so our sample is likely to be similar to those of the studies used for comparison. ...
Article
Objective: Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. We aimed to compare cervical sensorimotor control outcomes between individuals with chronic idiopathic neck pain and asymptomatic individuals using a battery of recommended tests, and to investigate the correlation between cervical sensorimotor control outcomes and pain intensity and neck disability. Design: Case-control study. Methods: Fifty participants with chronic idiopathic neck pain and 50 age- and sex-matched asymptomatic controls completed 7 cervical sensorimotor control tests: joint position error (including joint position error torsion), postural balance, subjective visual vertical, head-tilt response, "the Fly," smooth pursuit neck torsion, and head steadiness. Between-group differences were investigated with the Mann-Whitney U test. Correlations between tests and levels of neck pain and disability were investigated using the Spearman rho. Results: There were no differences in cervical sensorimotor outcomes between participants with chronic idiopathic neck pain and asymptomatic controls for any test (P = .203-.981). For each test, "poor performers" consisted of both individuals with and without neck pain. Correlations were weak between tests and levels of neck pain (r = 0.010-0.294) and neck disability (r = 0.007-0.316). Conclusion: These findings suggest that sensorimotor control disturbances in individuals with chronic idiopathic neck pain may not be present, spawning debate on the clinical usefulness of these tests. J Orthop Sports Phys Ther 2020;50(1):33-43. Epub 23 Aug 2019. doi:10.2519/jospt.2020.8846.
... A trial on neck pain, for example, identified age and compliance as crucial factors for a positive treatment response. 11 A methodological study also concluded that perprotocol and on-treatment analyses may produce unreliable estimates when the effect of treatment is small. 63 Other sociodemographic or disease-related factors might also contribute to the treatment response and should be included in future analyses on RCT and systematic review levels. ...
Article
Full-text available
Yoga is frequently used for back pain relief. However, evidence was judged to be of only low- or moderate. To assess the efficacy and safety of yoga in patients with low back pain a meta-analysis was performed. Therefore Medline/PubMed, Scopus, and the Cochrane Library was searched to May 26 2020. Only randomized controlled trials (RCTs) comparing Yoga with passive control (usual care or waitlist), or an active comparator, for patients with low back pain, that assessed pain intensity or pain-related disability as a primary outcome were considered to be eligible. Two reviewers independently extracted data on study characteristics, outcome measures, and results at short-term and long-term follow-up. Risk of bias was assessed using the Cochrane Risk of Bias Tool. 30 articles on 27 individual studies (2702 participants in total) proved eligible for review. Compared to passive control, yoga was associated with short-term improvements in pain intensity (15 RCTs; Mean Difference (MD)=-0.74 points on a numeric rating scale; 95%CI=-1.04,-0.44; Standardized Mean Difference (SMD)=-0.37 95%CI=-0.52,-0.22), pain-related disability (15 RCTs; MD=-2.28; 95%CI=-3.30,-1.26; SMD=-0.38 95%CI=-0.55,-0.21), mental health (7 RCTs; MD=1.70; 95%CI=0.20,3.20; SMD=0.17 95%CI=0.02,0.32) and physical functioning (9 RCTs; MD=2.80; 95%CI=1.00,4.70; SMD=0.28 95%CI=0.10,0.47). Except for mental health all effects sustained long-term. Compared to an active comparator, yoga was not associated with any significant differences in short- or long-term outcomes.In conclusion, yoga revealed robust short- and long-term effects for pain, disability, physical function and mental health, when compared to non-exercise controls. However these effects were mainly not clinically significant.
... The etiology may be complex and may involve er-gonomic (such as the use of strong physical activity, force, and vibration, inadequate posture, and repetitive movement), personal (such as age, body mass index, genome, and history of musculoskeletal pain), behavioral (such as smoking and level of physical activity), and psychosomatic (such as job satisfaction, level of stress, anxiety, and depression) factors. 1 Previous studies have suggested that many patients with chronic neck pain use alternative or complementary methods to relieve their pain. [2][3][4] Yoga comprises breathing postures (pr an ay ama), meditation (dhyana), physical postures ( asana), and relaxation, which are used to enhance physical, emotional, and mental wellbeing. 5,6 The ultimate goal of yoga is to achieve the union of mind, body, and spirit. ...
... 23,30 A growing body of research evidence also supports the use of yoga for treating cNP. 31,32 Although almost all previous studies of yoga for chronic pain focus on a single type of pain condition (osteoarthritis, cLBP, or cNP) a goal of this study was to create and test yoga interventions that can treat more than a single type of chronic pain. This pragmatic approach is warranted because it is unlikely that health organizations can offer separate yoga interventions for each specific pain condition. ...
Article
Full-text available
Background Chronic low back pain (cLBP) and chronic neck pain (cNP) are highly prevalent conditions and common reasons for disability among military personnel. Yoga and other mind-body interventions have been shown to safely decrease pain and disability in persons with cLBP and/or cNP but have not been adequately studied in active duty military personnel. The objective of this study was to examine the feasibility and acceptability of delivering 2 types of yoga (hatha and restorative) to a sample of active-duty military personnel with cLBP/cNP. Methods Military personnel with cLBP and/or cNP (n = 49; 59% men) were randomized to either hatha or restorative yoga interventions. Interventions consisted of in-person yoga 1-2x weekly for 12 weeks. Feasibility and acceptability were measured by rates of recruitment, intervention attendance, attrition, adverse events, and satisfaction ratings. Health outcomes including pain and disability were measured at baseline, 12 weeks, and 6 months. Means and effect sizes are presented. Results Recruitment was completed ahead of projections. Over 90% of participants agreed or strongly agreed that they enjoyed participation, liked the instructor, and would like to continue yoga. Retention rates were 86% and 80% at 12 week and 6 month assessments, respectively. Intervention attendance was adequate but lower than expected. There were small to moderate reductions in back-pain related disability, pain severity and pain interference, and improvements in quality of life, grip strength, and balance. In general, effects were larger for those who attended at least 50% of intervention classes. Participants with cNP tended to have smaller outcome improvements, but conclusions remain tentative given small sample sizes. Conclusions Results demonstrate feasibility for conducting a randomized controlled comparative effectiveness trial of yoga for cLBP and cNP among active duty military personnel. Acceptability was also established. Ongoing work will enhance the intervention for cNP and establish feasibility at another military facility in preparation for a fully-powered comparative effectiveness trial. ClinicalTrials #NCT03504085; registered April 20, 2018.
... A yoga therapy manualization process resulted in a consensus approach for chronic pain in an underserved multimorbid patient population. Yoga positions (asanas) from the low back pain trial 72 will be incorporated along with specific asanas used in trials for upper body/neck pain 73 and for knee OA pain. 74,75 To balance the individualization of yoga practices that yoga therapy provides, along with the structure necessary for research study and replication, a list of practices most relevant to the clinical population were agreed on. ...
Article
Full-text available
Chronic pain is prevalent in the United States, with impact on physical and psychological functioning as well as lost work productivity. Minority and lower socioeconomic populations have increased prevalence of chronic pain with less access to pain care, poorer outcomes, and higher risk of fatal opioid overdose. Acupuncture therapy is effective in treating chronic pain conditions including chronic low back pain, neck pain, shoulder pain, and knee pain from osteoarthritis. Acupuncture therapy, including group acupuncture, is feasible and effective, and specifically so for underserved and diverse populations at risk for health outcome disparities. Acupuncture therapy also encourages patient engagement and activation. As chronic pain improves, there is a natural progression to want and need to increase activity and movement recovery. Diverse movement approaches are important for improving range of motion, maintaining gains, strengthening, and promoting patient engagement and activation. Yoga therapy is an active therapy with proven benefit in musculoskeletal pain disorders and pain associated disability. The aim of this quasi-experimental pilot feasibility trial is to test the bundling of these 2 effective care options for chronic pain, to inform both the design for a larger randomized pragmatic effectiveness trial as well as implementation strategies across underserved settings.
... A trial on neck pain, for example, identified age and compliance as crucial factors for a positive treatment response. 11 A methodological study also concluded that perprotocol and on-treatment analyses may produce unreliable estimates when the effect of treatment is small. 63 Other sociodemographic or disease-related factors might also contribute to the treatment response and should be included in future analyses on RCT and systematic review levels. ...
... These injuries are typically minor and affect mainly muscle groups and the surrounding connective tissue, including fascia [76,78]. Findings from injurious stretching interventions in animal studies may inform strategies for minimizing such adverse events by improving our understanding of the systemic and localized effects of yogic stretching-related injuries in humans [79,80]. Currently, muscle injurious animal studies identified in this review were motivated by stretching issues specific to sports medicine and rheumatology. ...
Article
Full-text available
Objective To conduct a systematic review evaluating the impact of stretching on inflammation and its resolution using in vivo rodent models. Findings are evaluated for their potential to inform the design of clinical yoga studies to assess the impact of yogic stretching on inflammation and health. Methods Studies were identified using four databases. Eligible publications included English original peer-reviewed articles between 1900–May 2020. Studies included those investigating the effect of different stretching techniques administered to a whole rodent model and evaluating at least one inflammatory outcome. Studies stretching the musculoskeletal and integumentary systems were considered. Two reviewers removed duplicates, screened abstracts, conducted full-text reviews, and assessed methodological quality. Results Of 766 studies identified, 25 were included for synthesis. Seven (28%) studies had a high risk of bias in 3 out of 10 criteria. Experimental stretching protocols resulted in a continuum of inflammatory responses with therapeutic and injurious effects, which varied with a combination of three stretching parameters––duration, frequency, and intensity. Relative to injurious stretching, therapeutic stretching featured longer-term stretching protocols. Evidence of pro- and mixed-inflammatory effects of stretching was found in 16 muscle studies. Evidence of pro-, anti-, and mixed-inflammatory effects was found in nine longer-term stretching studies of the integumentary system. Conclusion Despite the overall high quality of these summarized studies, evaluation of stretching protocols paralleling yogic stretching is limited. Both injurious and therapeutic stretching induce aspects of inflammatory responses that varied among the different stretching protocols. Inflammatory markers, such as cytokines, are potential outcomes to consider in clinical yoga studies. Future translational research evaluating therapeutic benefits should consider in vitro studies, active vs. passive stretching, shorter-term vs. longer-term interventions, systemic vs. local effects of stretching, animal models resembling human anatomy, control and estimation of non-specific stresses, development of in vivo self-stretching paradigms targeting myofascial tissues, and in vivo models accounting for gross musculoskeletal posture.
... None of the studies in the current systematic review reported any serious AEs. e most commonly reported AE related to Baduanjin exercise was muscle ache [44,52], which is consistent with previous observations in other exercise studies [61][62][63][64][65]. Notably, some Baduanjin exercises entail a semi-squat position, for example, "Session 2, Open the Arms as an Archer Shooting Both Left-and Right-Handed"; "Session 5, Sway the Head and Shake the Tail"; and "Session 7, Grip the Palms to Improve Strength" [25]. ...
Article
Full-text available
Objectives: Baduanjin exercise is a form of Qigong exercise therapy that has become increasingly popular worldwide. The aims of the current systematic review were to summarize reported adverse events potentially associated with Baduanjin exercise based on currently available literature and to evaluate the quality of the methods used to monitor adverse events in the trials assessed. Methods: The English databases PubMed, Cochrane library, and EMbase were searched from inception to October 2020 using the keywords "Baduanjin" or "eight session brocade." Only studies that included Baduanjin exercise therapy were included. Results: Forty-seven trials with a total of 3877 participants were included in this systematic review. Twenty-two studies reported protocols for monitoring adverse events, and two studies reported the occurrence of adverse events during training. The adverse events reported included palpitation, giddiness, knee pain, backache, fatigue, nervousness, dizziness, shoulder pain, chest tightness, shortness of breath, and muscle ache. Conclusions: Only two studies reported adverse events that were potentially caused by Baduanjin exercise. Adverse events related to Baduanjin exercise in patients with chronic fatigue syndrome may include muscle ache, palpitation, giddiness, knee pain, backache, fatigue, nervousness, dizziness, shoulder pain, chest tightness, and shortness of breath. Further studies conducted in accordance with the Consolidated Standards of Reporting Trials statement guideline incorporating monitoring of adverse events are recommended. Additional clinical trials in which Baduanjin exercise is used as a main intervention are needed, and further meta-analysis may be required to assess its safety and reach more informed conclusions in this regard in the future.
... RCTs demonstrated that yoga improved cervical proprioception, ROM, QOL, and mood and reduces pain and associated disability. 21,27 Evidence also affirmed that yoga decreased headache frequency, duration, and pain intensity in patients suffering from tension or cervicogenic headaches. 23 Iyengar yoga, which emphasizes precise body alignment, may be the most appropriate style for patients with chronic spine pain who need posture training. ...
Article
Movement therapy refers to a broad range of Eastern and Western mindful movement-based practices used to treat the mind, body, and spirit concurrently. Forms of movement practice are universal across human culture and exist in ancient history. Research demonstrates forms of movement therapy, such as dance, existed in the common ancestor shared by humans and chimpanzees, approximately 6 million years ago. Movement-based therapies innately promote health and wellness by encouraging proactive participation in one's own health, creating community support and accountability, and so building a foundation for successful, permanent, positive change.
... The choice of yoga positions (asanas) was based on those used in prior chronic pain yoga research. [47][48][49][50] A detailed description of dyad YT that was developed for this trial, and the yoga manual, are provided in other publications. 41,51 A full course of treatment consisted of 10 GA treatments and 8 YT sessions. ...
Article
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Objective: To identify factors associated with implementing bundled group acupuncture and yoga therapy (YT) to treat underserved patients with chronic pain in community health center (CHC) settings. This is not an implementation science study, but rather an organized approach for identification of barriers and facilitators to implementing these therapies as a precursor to a future implementation science study. Design: This study was part of a single-arm feasibility trial, which aimed to test the feasibility of bundling GA and YT for chronic pain in CHCs. Treatment outcomes were measured before and after the 10-week intervention period. Implementation feasibility was assessed through weekly research team meetings, weekly yoga provider meetings, monthly acupuncture provider meetings, and weekly provider surveys. Settings: The study was conducted in New York City at two Montefiore Medical Group (MMG) sites in the Bronx, and one Institute for Family Health (IFH) site in Harlem. Subjects: Participants in the feasibility trial were recruited from IFH and MMG sites, and needed to have had lower back, neck, or osteoarthritis pain for >3 months. Implementation stakeholders included the research team, providers of acupuncture and YT, referring providers, and CHC staff. Results: Implementation of these therapies was assessed using the Consolidated Framework for Implementation Research. We identified issues associated with scheduling, treatment fidelity, communication, the three-way disciplinary interaction of acupuncture, yoga, and biomedicine, space adaptation, site-specific logistical and operational requirements, and patient-provider language barriers. Issues varied as to their frequency and resolution difficulty. Conclusions: This feasibility trial identified implementation issues and resolution strategies that could be further explored in future implementation studies.
... Wolever and colleagues found that both mindfulnessbased, and therapeutic yoga programs could provide effective interventions in alleviating stress in employees [43]. A review of 56 studies found that workplace stress can also lead to musculoskeletal symptoms especially of back, neck and shoulders [44] and yoga can help deal with stress-induced musculoskeletal symptoms of the neck [45], back [46], and shoulders [47], among other symptoms. ...
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Background: The outbreak of COVID-19 and its associated measures has resulted in a sizeable working population transitioning to working from home (WFH), bringing additional challenges, and increasing work-related stress. Research has indicated that yoga has promising potential in reducing stress in the workplace. However, there are very few studies exploring the impact of online streamed yoga on stress management for people-WFH. Objective: To investigate the feasibility and outcome of an online streamed yoga intervention on stress and wellbeing of people-WFH during COVID-19. Methods: A six-week pilot randomized controlled trial (RCT) yoga intervention was designed with yoga (n = 26) and a wait-list control group (n = 26). A mixed two-way ANOVA was used to assess changes in standardised outcome measures at baseline and post-intervention. Likert and open-ended questions assessed enjoyment, acceptability and perceived benefits of the program, which were analysed thematically. Results: Compared with the control, the yoga group reported significant improvements in perceived stress, mental wellbeing, depression and coping self-efficacy, but not stress and anxiety. Participants experienced physical and mental health benefits and reported high acceptability and enjoyment of the intervention. Conclusions: An online yoga intervention can help people WFH manage stress and enhance wellbeing and coping abilities.
... This study has shown a significant improvement in functional score (NDI) by 58.66% in the BM group compared to the conventional treatment group 24.73%. Similar significant changes in functional disability scores were reported by Cramer (Cramer H et al., 2013) and Michalsen (Michalsen A et al., 2012) in their studies. Therefore, BM can be considered as a useful and a safe additive in the treatment of non-specific mechanical neck pain in improving and reinstating proprioception and to restore functional ability. ...
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Objective Being the second highest musculoskeletal problem irrespective of age, gender and occupation, the etiology of neck pain is predominantly mechanical in nature. This can lead to dysfunction with time and recurrence. Altered joint position sense (JPS) from soft tissues can alter the cervical biomechanics by compromising the cephalo spatial orientation, which depends on the visual, vestibular and proprioceptive cues. This study was done to observe the additive effect of “Brahma mudra” (BM) a yogic tool on non-specific mechanical neck pain and its clinical implication on pain, proprioception and functional abilities. Methods It was a quasi-experimental pre –post study design involving 30 individuals from a software firm between the age group of 18-45 years. The conventional treatment group received standard physiotherapy regime and in the BM group BM was incorporated in addition to standard physiotherapy regime. Independent sample student t test / Mann Whitney test were used to compare continuous variables between two groups. Paired sample test/ Wilcoxon signed rank test were used for within groups. Results There was a significant reduction in pain, improved functional abilities and proprioception in BM group when compared to conventional treatment group with 0.01 level of statistical significance. Conclusion It may be concluded that practice of BM had an added effect to conventional standard physiotherapy regime in reduction of pain, improvement of proprioception and functional abilities among individuals with chronic non-specific mechanical neck pain.
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Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population. It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.
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Entspannungstechniken und die Schulung der Wahrnehmung sind die wichtigsten Elemente der Mind-Body-Medizin. Sie helfen Schmerzpatienten, Einfluss auf ihre Symptome zu nehmen.
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Objective: Chronic neck pain is a common problem that affects approximately half of the population. Conventional treatments such as medication and exercise have shown limited analgesic effects. This analysis is based on an original study that was conducted to investigate the physical and behavioral effects of a 9-week Iyengar yoga course on chronic non-specific neck pain. This secondary analysis uses linear mixed models to investigate the individual trajectories of pain intensity in participants before, during and after the Iyengar yoga course. Method: Participants with chronic non-specific neck pain were selected for the study. The participants suffered from neck pain for at least 5 days per week for at least the preceding 3 months, with a mean neck pain intensity (NPI) of 40 mm or more on a Visual Analog Scale of 100 mm. The participants were randomized to either a yoga group (23) or to a self-directed exercise group (24). The mean age of the participants in the yoga group was 46, and ranged from 19 to 59. The participants in the yoga group participated in an Iyengar yoga program designed to treat chronic non-specific neck pain. Our current analysis only includes participants who were initially randomized into the yoga group. The average weekly neck pain intensity at baseline, during and post intervention, comprising 11 total time points, was used to construct the growth models. We performed a step-up linear mixed model analysis to investigate change in NPI during the yoga intervention. We fit nested models using restricted maximum-likelihood estimation (REML), tested fixed effects with Wald test p-values and random effects with the likelihood ratio test. We constructed 10 REML models. Results: The model that fit the data best was an unconditional random quadratic growth model, with a first-order auto-regressive structure specified for the residual R matrix. Participants in the yoga group showed significant variation in NPI. They demonstrated variation in their intercepts, in their linear rates of change, and most tellingly, in their quadratic rates of change. Conclusions: While all participants benefitted from the yoga intervention, the degree to which they benefitted varied. Additionally, they did not experience a consistent rate of reduction in NPI - their NPI fluctuated, either increasing and then decreasing, or vice-versa. We comment on the clinical and research implications of our findings.
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Integrative health modalities can provide useful tools in the management of persistent pain in the primary care setting. These modalities, such as acupuncture, mind-body medicine, diet and herbs, and movement strategies can be safely used and may provide patients with hope and empowerment. It is highly recommended that the patient work alongside trained professionals for a given modality and/or an interprofessional team.
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Objective: Active stretching of the body is integral to complementary mind-body therapies such as yoga, as well as physical therapy, yet the biological mechanisms underlying its therapeutic effects remain largely unknown. A previous study showed the impact of active stretching on inflammatory processes in rats. The present study tested the feasibility of using a porcine model, with a closer resemblance to human anatomy, to study the effects of active stretching in the resolution of localized inflammation. Design: 12 pigs were trained to stretch before subcutaneous bilateral Carrageenan injection in the back at the L3 vertebrae, 2 cm from the midline. Animals were randomized to No-Stretch (NS) or Stretch (S); 2X/day for 5 min over 48 hours. 48 hours post-injection, animals were euthanized for tissue collection. Results: The procedure was well tolerated by pigs. On average, lesion area was significantly smaller by 36% in the S group compared to NS (P = 0.03). Conclusion: This porcine model shows promise for studying the impact of active stretching on inflammation-resolution mechanisms. These results are relevant to understanding the stretching-related therapeutic mechanisms of mind-body therapies. Future studies with larger samples are warranted.
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Objectives Yoga is commonly being adopted and prescribed with the intent to increase a participant’s health-related quality of life. In practice, the current gold-standard health-related quality of life measurement tool is the SF-36 and SF-12 assessments. Therefore, it is important for yoga scientists and practitioners to understand yoga’s effects on health-related quality of life when in fact a gold-standard assessment is implemented. The purpose of this study was to employ systematic review and meta-analytic techniques to examine the effect of yoga on measures of health-related quality of life measured using only the SF-36/12 assessments. Methods A current (January 2007 to December 2016) systematic review of the Pubmed database was conducted and included studies that used yoga as an intervention with outcomes measures of health-related quality of life measured by the SF-36/12. Ten different measures were extracted from studies including eight dimension scores (physical functioning, bodily pain, physical role function, general health, mental health, emotional role function, social function, and vitality) and two summary scores (physical component and mental component). Ten different meta-analyses were performed using calculated standardized mean effect sizes and random effects models. Both moderator and sensitivity analyses were conducted. Results A total of 34 studies were included is the analyses with 185 independent effect sizes. Yoga intervention showed a significant positive effect on all ten measures of the SF-36/12. Effects ranged from 0.56 (0.39-0.73) to 0.28 (0.17-0.40). Yoga type (Hatha, Iyengar, Other) moderated the effects of yoga intervention on the mental component (p=.021), with Hatha yielding the greatest effects (ES=1.63, 0.61-2.65). The sensitivity analysis showed little to no bias in mean effect size estimates. Conclusions The meta-analytic evidence clearly supports the small-to-medium positive effects of yoga on health-related quality of life, as measured by the SF-36/12 assessments. Keywords: Health-related quality of life Meta-analysis; SF-12; SF-36; Systematic review
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Resumen Introducción y objetivos El dolor cervical crónico (DCC) confluye con una gran variedad de signos y síntomas, tales como la tensión neural y las alteraciones conductuales. Este estudio pretende evaluar la relación entre la tensión neural y el perfil clínico de los pacientes con DCC. Materiales y métodos Se llevó a cabo un estudio observacional de corte transversal. Se incluyeron 25 pacientes con DCC y 25 personas sin dolor. Se evaluó el perfil clínico incluyendo las variables físicas (dolor, discapacidad), y las variables psicológicas y/o comportamentales (ansiedad, depresión, calidad de vida, miedo al movimiento y conductas de miedo-evitación). La tensión neural se midió a través de pruebas de neurodinamia. Resultados Los sujetos con DCC presentaron una alteración significativa de la tensión neural, en comparación con las personas sin dolor. Se halló una correlación significativa entre los test de neurodinamia y las conductas y creencias sobre el dolor, así como su interferencia en la vida diaria. Adicionalmente se mostró una relación significativa entre las creencias y actitudes sobre el dolor y la intensidad e interferencia del mismo, la discapacidad y el estado de salud percibido. Conclusiones Los pacientes con DCC muestran peores resultados que el grupo sin dolor en los test de neurodinamia del miembro superior. La neurodinamia se relaciona con las variables psicológicas y comportamentales medidas.
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Yoga practice, even in the short term, is supposed to enhance wellbeing and counteract psychopathology through modification of emotion reactivity. Yoga teaches that emotional responses may be less pronounced with longer and more frequent practice, and potentially when people perform yoga for mental rather than physical reasons. We tested 36 yoga practitioners of varying experience (between 6 months and 11 years of practice). We assessed participants’ self-reported emotional experience and peripheral physiological reactions (heart rate, skin conductance, respiration) when seeing positive and negative pictures. Results were analyzed as a function of the years of, frequency of, and reasons for yoga practice. We found a heart rate increase with the degree participants performed yoga for mental reasons. In addition, years of yoga practice were significantly associated with reduced abdominal respiratory rate when facing negative pictures, speaking in favor of reduced arousal with yoga experience. Finally, regarding frequency of practice, a higher frequency in the last month was linked to less negative and positive experiences as well as a reduced abdominal respiratory amplitude when viewing positive pictures. Altogether, these results demonstrate that intense short-term yoga practice might relate to a (i) decrease in the intensity of self-reported emotional experiences and (ii) deepened respiration. Short-term effects might be shaped by what participants expect as practice benefits. However, several years of practice might be needed to decrease respiratory arousal in the face of negative situations, which likely is a manifestation of an evolution in the emotion regulation process.
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Chronic pain is a leading cause of disability among active duty service members in the U.S. armed forces. Standard rehabilitative care and complementary and integrative health therapies are used for chronic pain rehabilitation. However, the optimal sequence and duration of these therapies has yet to be determined. This article describes a sequential multiple assignment randomized trial (SMART) protocol being used to identify the optimal components and sequence of standard rehabilitative care and complementary and integrative health therapies for reducing pain impact and improving other patient outcomes. Active duty service members referred to Madigan Army Medical Center for treatment of chronic pain are being recruited to the Determinants of the Optimal Dose and Sequence of Functional Restoration and Integrative Therapies study. Study participants are randomized to either standard rehabilitative care (physical and occupational therapy and psychoeducation) or complementary and integrative health therapies (chiropractic, acupuncture, yoga and psychoeducation). Those participants who do not respond to the first 3 weeks of treatment are randomized to receive an additional 3 weeks of either (1) the alternative treatment or (2) the first-stage treatment plus the alternative treatment. This study will also determine factors associated with treatment response that can support clinical decision making, such as baseline fitness, pain catastrophizing, kinesiophobia, post-traumatic stress, pain self-efficacy, and biological indicators. The information gained from this research will be applicable to all integrative chronic pain rehabilitation programs throughout the U.S. Department of Defense and the U.S. Department of Veterans Affairs, and the broader rehabilitation community.
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Aim: To compare effects of clinical Pilates and home exercises on postural disorders, strength and endurance of deep cervical flexors (DCF), cervical range of motion (CROM), pain intensity and functional disability in sagittal cervical disorientation. Patients & methods: Fourty six patients were included and divided into two groups. Clinical Pilates group performed stabilization based exercise and home exercise group performed conventional exercises. Results: Craniovertebral, head tilt, cervicothoracic angles and strength and endurance of DCF muscles had improvement in favor of clinical Pilates group (p < 0.05). There was no difference between groups in terms of right–left acromial distance, pain intensity, functional disability and CROM parameters (p > 0.05). Conclusion: Clinical Pilates exercises have been found to provide clinically significant improvements in craniovertebral, head tilt, cervicothoracic angles and strength and endurance of DCF muscles. However, in the increase of CROM, decreasing pain severity and functional impairment parameters there was no superiority of both exercise training. Clinical trial registration number: NCT03352921 (Clinicaltrials.gov).
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Dental profession is very demanding in terms of engrossment and impreciseness required while performing any procedure or operation. Due to inconvenient sitting postures attributableto limited working area and even more restricted access inside the oral cavity, dentists tend to neglect the posture while operating.Due to the long working hours, the dentist tends to brace the body with the support of legs in a sitting position which leads to muscle ischemia. Once the dental procedure is complete and they get back to normal position the muscle ischemia reflects in the form of mild to excruciating pain leaving the neck, shoulder and back regions in utter discomfort. A simple c hange in lifestyle by regular practice of yoga and meditation, helps make a major difference in dentists to escape this health hazard, leading a healthier an d happier life while enjoying professional success.1Yoga is thescience of the mind and soul. Yoga has transformed into a widely used physical, mental and spiritual exercise worldwide for both overall wellness and specific health ailments. Yoga focuses on mindfulness, pranayama (breathing exercises) and meditation by facilitating relaxation of body and mind, intern contributing to decreased perception of pain. Practicing yoga as a daily routinefor dentists offers a way to counteract or avoid many physical conditions that are commonly seen in dental care team members.2
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Objective To compare the effectiveness of different physical exercise interventions for chronic non-specific neck pain. Design Systematic review and network meta-analysis. Data sources Electronic databases: AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus. Eligibility criteria Randomised controlled trials (RCTs) describing the effects of any physical exercise intervention in adults with chronic non-specific neck pain. Results The search returned 6549 records, 40 studies were included. Two networks of pairwise comparisons were constructed, one for pain intensity (n=38 RCTs, n=3151 participants) and one for disability (n=29 RCTs, n=2336 participants), and direct and indirect evidence was obtained. Compared with no treatment, three exercise interventions were found to be effective for pain and disability: motor control (Hedges’ g, pain −1.32, 95% CI: −1.99 to −0.65; disability −0.87, 95% CI: –1.45 o −0.29), yoga/Pilates/Tai Chi/Qigong (pain −1.25, 95% CI: –1.85 to −0.65; disability –1.16, 95% CI: –1.75 to −0.57) and strengthening (pain –1.21, 95% CI: –1.63 to −0.78; disability –0.75, 95% CI: –1.28 to −0.22). Other interventions, including range of motion (pain −0.98 CI: −2.51 to 0.56), balance (pain −0.38, 95% CI: −2.10 to 1.33) and multimodal (three or more exercises types combined) (pain −0.08, 95% CI: −1.70 to 1.53) exercises showed uncertain or negligible effects. The quality of evidence was very low according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Conclusion There is not one superior type of physical exercise for people with chronic non-specific neck pain. Rather, there is very low quality evidence that motor control, yoga/Pilates/Tai Chi/Qigong and strengthening exercises are equally effective. These findings may assist clinicians to select exercises for people with chronic non-specific neck pain. PROSPERO registration number CRD42019126523.
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It is well-established that a single bout of exercise can reduce pain sensitivity (i.e., exercise-induced hypoalgesia) in healthy individuals. However, exercise-induced hypoalgesia is often impaired in individuals with chronic pain. This might suggest that repeated bouts of exercise (i.e., exercise training) are needed in order to induce a reduction in pain sensitivity (i.e., training-induced hypoalgesia) among individuals with chronic pain, given that a single bout of exercise seems to be insufficient to alter pain. However, the effect of repeated bouts of exercise on pain sensitivity and its underlying mechanisms remain poorly understood. Therefore, the purpose of this review was to provide an overview of the existing literature on training-induced hypoalgesia, as well as discuss potential mechanisms of training-induced hypoalgesia and offer considerations for future research. Existing literature suggests that training interventions may induce hypoalgesic adaptations potentially driven by central nervous system and immune system factors. However, the limited number of randomized controlled trials available, along with the lack of understanding of underlying mechanisms, provides a rationale for future research.
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Introduction. A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back pain. Methods. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. Developing Recommendations. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required, but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validating the Recommendations. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. Results. Four positive recommendations of clinical benefit were developed. Therapeutic exercises were found to be beneficial for chronic, subacute, and postsurgery low back pain. Continuation of normal activities was the only intervention with beneficial effects for acute low back pain. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 85%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy. Conclusions. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with low back pain where evidence was insufficient to make recommendations.
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Background: Previous studies indicate that yoga may be an effective treatment for chronic or recurrent low back pain. Objective: To compare the effectiveness of yoga and usual care for chronic or recurrent low back pain. Design: Parallel-group, randomized, controlled trial using computer-generated randomization conducted from April 2007 to March 2010. Outcomes were assessed by postal questionnaire. (International Standard Randomised Controlled Trial Number Register: ISRCTN 81079604) Setting: 13 non-National Health Service premises in the United Kingdom. Patients: 313 adults with chronic or recurrent low back pain. Intervention: Yoga (n = 156) or usual care (n = 157). All participants received a back pain education booklet. The intervention group was offered a 12-class, gradually progressing yoga program delivered by 12 teachers over 3 months. Measurements: Scores on the Roland-Morris Disability Questionnaire (RMDQ) at 3 (primary outcome), 6, and 12 (secondary outcomes) months; pain, pain self-efficacy, and general health measures at 3, 6, and 12 months (secondary outcomes). Results: 93 (60%) patients offered yoga attended at least 3 of the first 6 sessions and at least 3 other sessions. The yoga group had better back function at 3, 6, and 12 months than the usual care group. The adjusted mean RMDQ score was 2.17 points (95% CI, 1.03 to 3.31 points) lower in the yoga group at 3 months, 1.48 points (CI, 0.33 to 2.62 points) lower at 6 months, and 1.57 points (CI, 0.42 to 2.71 points) lower at 12 months. The yoga and usual care groups had similar back pain and general health scores at 3, 6, and 12 months, and the yoga group had higher pain self-efficacy scores at 3 and 6 months but not at 12 months. Two of the 157 usual care participants and 12 of the 156 yoga participants reported adverse events, mostly increased pain. Limitation: There were missing data for the primary outcome (yoga group, n = 21; usual care group, n = 18) and differential missing data (more in the yoga group) for secondary outcomes. Conclusion: Offering a 12-week yoga program to adults with chronic or recurrent low back pain led to greater improvements in back function than did usual care. Primary funding source: Arthritis Research UK.
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A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
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Objectives: This study investigated the perceived influence of yoga on body perception and psychosocial aspects of life for patients with chronic neck pain. Design: This qualitative study was conducted using semistandardized interviews. Setting: The interventions and interviews took place in a referral center's research department. Subjects: Eighteen (18) patients with chronic nonspecific neck pain were recruited from a larger randomized controlled trial of yoga for chronic neck pain. Interventions: Participants attended 90 minutes of Iyengar yoga once a week for 9 weeks.
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The main objectives of this study were 1) to examine changes in self-reported moods and emotional states from before to after lyengar Yoga classes and how they are affected by the practice of different types of Yoga poses and (2) to determine whether observed changes in mood depend on one's personality traits. The partici-pants were 11 healthy Yoga students in a nine-session Yoga course in which three different types of Yoga poses were compared: back bends, forward bends, and stand-ing poses. Each 90-minute class focused on one of the three types of poses with three repetitions of each type of class. Self-ratings of 15 moods dealing with positive, negative, and energy-related emotional states were obtained before and after each class. Personality traits of depression, anxiety, and hostility were assessed at an initial orientation. Independently of the specific pose, positive moods increased, negative moods decreased, and energy-related moods increased from before to after classes with most changes lasting for two hours. Specific poses resulted in differences in how moods were affected, with back bends associated with greater increases in positive moods. Some mood changes were dependent on one's characteristic personality traits. The positive mood effects of back bends were greater for participants who were relatively hostile or depressed. The specific and nonspecific effects of different bodily postures and move-ments on psychological processes in Yoga and other forms of physical activity deserve further study. Yoga practices should be investigated for their potential clinical application in mood disorders and depression.
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Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. A total of 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (92 patients) or conventional stretching exercises (91 patients) or a self-care book (45 patients). Back-related functional status (modified Roland Disability Questionnaire, a 23-point scale) and bothersomeness of pain (an 11-point numerical scale) at 12 weeks were the primary outcomes. Outcomes were assessed at baseline, 6, 12, and 26 weeks by interviewers unaware of treatment group. After adjustment for baseline values, 12-week outcomes for the yoga group were superior to those for the self-care group (mean difference for function, -2.5 [95% CI, -3.7 to -1.3]; P < .001; mean difference for symptoms, -1.1 [95% CI, -1.7 to -0.4]; P < .001). At 26 weeks, function for the yoga group remained superior (mean difference, -1.8 [95% CI, -3.1 to -0.5]; P < .001). Yoga was not superior to conventional stretching exercises at any time point. Yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms due to chronic low back pain, with benefits lasting at least several months. clinicaltrials.gov Identifier: NCT00447668.
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Enhancing body awareness has been described as a key element or a mechanism of action for therapeutic approaches often categorized as mind-body approaches, such as yoga, TaiChi, Body-Oriented Psychotherapy, Body Awareness Therapy, mindfulness based therapies/meditation, Feldenkrais, Alexander Method, Breath Therapy and others with reported benefits for a variety of health conditions. To better understand the conceptualization of body awareness in mind-body therapies, leading practitioners and teaching faculty of these approaches were invited as well as their patients to participate in focus groups. The qualitative analysis of these focus groups with representative practitioners of body awareness practices, and the perspectives of their patients, elucidated the common ground of their understanding of body awareness. For them body awareness is an inseparable aspect of embodied self awareness realized in action and interaction with the environment and world. It is the awareness of embodiment as an innate tendency of our organism for emergent self-organization and wholeness. The process that patients undergo in these therapies was seen as a progression towards greater unity between body and self, very similar to the conceptualization of embodiment as dialectic of body and self described by some philosophers as being experienced in distinct developmental levels.
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Several mind body medicine interventions require an active participation of the practitioners. We intended to develop a questionnaire to operationalize and measure the "inner correspondence" of individuals practicing Yoga or Eurythmy Therapy. In an anonymous cross-sectional study we enrolled 501 individuals (61% yoga). Exploratory factor analysis (study 1) of the 12-item instrument (Cronbach's alpha = .84) pointed to a 3-factor solution, with one major scale and good internal consistency (alpha = .83) and two minor scales with weak internal consistency. To improve the quality of the main scale, we added 8 new items which were tested in a sample of 135 individuals (study 2: 71% Yoga). Factor analysis confirmed a 12-item single factor (alpha = .95), that is, Inner Correspondence/Peaceful Harmony with Practices (ICPH). The scale correlated strongly with mindfulness (FMI; r > .50), moderately with life and patient satisfaction (BMLSS; r between .32 and .43), and weakly negative with symptom score (VAS; r = -.23). In conclusion, the scale ICPH was confirmed as a relevant tool to measure the inner correspondence and feelings of peacefulness with practices. It can be used in clinical studies to assess the efficacy of mind-body practices involving physical movements.
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We examined which adaptive coping strategies, referring to the concept of 'locus of disease control', were of relevance for patients with chronic pain conditions, and how they were interconnected with patients' life satisfaction and interpretation of disease. In a multicenter cross-sectional anonymous survey with the AKU questionnaire, we enrolled 579 patients (mean age 54 ± 14 years) with various chronic pain conditions. Disease as an adverse interruption of life was the prevalent interpretation of chronic pain conditions. As a consequence, patients relied on external powerful sources to control their disease (i.e., Trust in Medical Help; Search for Information and Alternative Help), but also on internal powers and virtues (i.e., Conscious Way of Living; Positive Attitudes). In contrast, Trust in Divine Help as an external transcendent source and Reappraisal: Illness as Chance as an internal (cognitive) strategy were valued moderately. Regression analyses indicated that Positive Attitudes and higher age were significant predictors of patients' life satisfaction, but none of the other adaptive coping strategies. While the adaptive coping strategies were not associated with negative interpretations of disease, the cognitive reappraisal attitude was of significant relevance for positive interpretations such as value and challenge. The experience of illness may enhance intensity and depth of life, and thus one may explain the association between internal adaptive coping strategies (particularly Reappraisal) and positive interpretations of disease. To restore a sense of self-control over pain (and thus congruence with the situation), and the conviction that one is not necessarily disabled by disease, is a major task in patient care. In the context of health services research, apart from effective pain management, a comprehensive approach is needed which enhances the psycho-spiritual well-being of patients.
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Unlabelled: The aim of this study was to investigate bilateral pressure-pain sensitivity over the trigeminal region, the cervical spine, and the tibialis anterior muscle in patients with mechanical chronic neck pain. Twenty-three patients with neck pain (56% women), aged 20 to 37 years old, and 23 matched controls (aged 20 to 38 years) were included. Pressure pain thresholds (PPTs) were bilaterally assessed over masseter, temporalis, and upper trapezius muscles, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in a blinded design. The results showed that PPT levels were significantly decreased bilaterally over the masseter, temporalis, and upper trapezius muscles, and also the C5-C6 zygapophyseal joint (P < .001), but not over the tibialis anterior muscle (P = .4) in patients with mechanical chronic neck pain when compared to controls. The magnitude of PPT decreases was greater in the cervical region as compared to the trigeminal region (P < .01). PPTs over the masseter muscles were negatively correlated to both duration of pain symptoms and neck-pain intensity (P < .001). Our findings revealed pressure-pain hyperalgesia in the trigeminal region in patients with mechanical chronic neck pain, suggesting spreading of sensitization to the trigeminal region in this patient population. Perspective: This article reveals the presence of bilateral pressure-pain hypersensitivity in the trigeminal region in patients with idiopathic neck pain, suggesting a sensitization process of the trigemino-cervical nucleus caudalis in this population. This finding has implications for development of management strategies.
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Several studies suggest yoga may be effective for chronic low back pain; however, trials targeting minorities have not been conducted. PRIMARY STUDY OBJECTIVES: Assess the feasibility of studying yoga in a predominantly minority population with chronic low back pain. Collect preliminary data to plan a larger powered study. Pilot randomized controlled trial. Two community health centers in a racially diverse neighborhood of Boston, Massachusetts. Thirty English-speaking adults (mean age 44 years, 83% female, 83% racial/ethnic minorities; 48% with incomes < or = $30,000) with moderate-to-severe chronic low back pain. Standardized series of weekly hatha yoga classes for 12 weeks compared to a waitlist usual care control. Feasibility measured by time to complete enrollment, proportion of racial/ethnic minorities enrolled, retention rates, and adverse events. Primary efficacy outcomes were changes from baseline to 12 weeks in pain score (0=no pain to 10=worst possible pain) and back-related function using the modified Roland-Morris Disability Questionnaire (0-23 point scale, higher scores reflect poorer function). Secondary efficacy outcomes were analgesic use, global improvement, and quality of life (SF-36). Recruitment took 2 months. Retention rates were 97% at 12 weeks and 77% at 26 weeks. Mean pain scores for yoga decreased from baseline to 12 weeks (6.7 to 4.4) compared to usual care, which decreased from 7.5 to 7.1 (P=.02). Mean Roland scores for yoga decreased from 14.5 to 8.2 compared to usual care, which decreased from 16.1 to 12.5 (P=.28). At 12 weeks, yoga compared to usual care participants reported less analgesic use (13% vs 73%, P=.003), less opiate use (0% vs 33%, P=.04), and greater overall improvement (73% vs 27%, P=.03). There were no differences in SF-36 scores and no serious adverse events. A yoga study intervention in a predominantly minority population with chronic low back pain was moderately feasible and may be more effective than usual care for reducing pain and pain medication use.
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The effectiveness and efficacy of Iyengar yoga for chronic low back pain (CLBP) were assessed with intention-to-treat and per-protocol analysis. Ninety subjects were randomized to a yoga (n = 43) or control group (n = 47) receiving standard medical care. Participants were followed 6 months after completion of the intervention. This study aimed to evaluate Iyengar yoga therapy on chronic low back pain. Yoga subjects were hypothesized to report greater reductions in functional disability, pain intensity, depression, and pain medication usage than controls. CLBP is a musculoskeletal disorder with public health and economic impact. Pilot studies of yoga and back pain have reported significant changes in clinically important outcomes. Subjects were recruited through self-referral and health professional referrals according to explicit inclusion/exclusion criteria. Yoga subjects participated in 24 weeks of biweekly yoga classes designed for CLBP. Outcomes were assessed at 12 (midway), 24 (immediately after), and 48 weeks (6-month follow-up) after the start of the intervention using the Oswestry Disability Questionnaire, a Visual Analog Scale, the Beck Depression Inventory, and a pain medication-usage questionnaire. Using intention-to-treat analysis with repeated measures ANOVA (group x time), significantly greater reductions in functional disability and pain intensity were observed in the yoga group when compared to the control group at 24 weeks. A significantly greater proportion of yoga subjects also reported clinical improvements at both 12 and 24 weeks. In addition, depression was significantly lower in yoga subjects. Furthermore, while a reduction in pain medication occurred, this was comparable in both groups. When results were analyzed using per-protocol analysis, improvements were observed for all outcomes in the yoga group, including agreater trend for reduced pain medication usage. Although slightly less than at 24 weeks, the yoga group had statistically significant reductions in functional disability, pain intensity, and depression compared to standard medical care 6-months postintervention. Yoga improves functional disability, pain intensity, and depression in adults with CLBP. There was also a clinically important trend for the yoga group to reduce their pain medication usage compared to the control group.
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Chronic back pain affects a large proportion of both the general population and of military veterans. Although numerous therapies exist for treating chronic back pain, they can be costly and tend to have limited effectiveness. Thus, demonstrating the efficacy and cost-effectiveness of additional treatment alternatives is important. The purpose of our study was to examine the benefits of a yoga intervention for Veterans Administration (VA) patients. SUBJECTS/INTERVENTION: VA patients with chronic back pain were referred by their primary care providers to a yoga program as part of clinical care. Before starting yoga, a VA physician trained in yoga evaluated each patient to ensure that they could participate safely. The research study consisted of completing a short battery of questionnaires at baseline and again 10 weeks later. Questionnaires included measures of pain, depression, energy/fatigue, health-related quality of life, and program satisfaction. Paired t-tests were used to compare baseline scores to those at the 10-week follow-up for the single group, pre-post design. Correlations were used to examine whether yoga attendance and home practice were associated with better outcomes. Baseline and follow-up data were available for 33 participants. Participants were VA patients with a mean age of 55 years. They were 21% female, 70% white, 52% married, 68% college graduates, and 44% were retired. Significant improvements were found for pain, depression, energy/fatigue, and the Short Form-12 Mental Health Scale. The number of yoga sessions attended and the frequency of home practice were associated with improved outcomes. Participants appeared highly satisfied with the yoga instructor and moderately satisfied with the ease of participation and health benefits of the yoga program. Preliminary data suggest that a yoga intervention for VA patients with chronic back pain may improve the health of veterans. However, the limitations of a pre-post study design make conclusions tentative. A larger randomized, controlled trial of the yoga program is planned.
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The prevalence of neck pain in the general population ranges from 10 to 15%. The complaints can result in substantial medical consumption, absenteeism from work and disability. In this study we investigated the costs of neck pain in the Netherlands in 1996 to assess the financial burden to society. The study was based on prevalence data. Data sources included national registries, reports of research institutes and health care authorities. Direct health care costs were estimated for hospital care, general practice care and paramedical care. These costs were calculated using fees. Calculation of indirect costs (absenteeism and disability) was based on the Human Capital Method (HCM). As an alternative approach the Friction Cost Method (FCM) was used. The total cost of neck pain in The Netherlands in 1996 was estimated to be US $686 million. The share of these costs was about 1% of total health care expenditures and 0.1 % of the Gross Domestic Product (GDP) in 1996. Direct costs were $160 million (23%). Paramedical care accounted for largest proportion of direct costs (84%). When applying the HCM for calculating indirect costs, these costs amounted to $527 million (77%). The total number of sick days related to neck pain were estimated to be 1.4 million with a total cost of $185.4 million in 1996. Disability for neck pain accounted for the largest proportion (50%) of the total costs related to neck pain in 1996 ($341). When applying the FCM for calculating the indirect costs, these costs were reduced to $96 million. The costs related to neck pain in 1996 in The Netherlands were substantial. Some caution should be taken in interpretation, as a number of assumptions had to be made in order to estimate the total costs. The cost structure shown in this study, with high indirect costs, has also been found in other studies. From an economical point of view it seems to be important to prevent patients from having to take sick leave and disability. One way in achieving this goal is to develop and investigate more effective treatments for acute neck pain, in order to prevent patients developing chronic pain and disability. Another option is to protect chronic patients from sick leave and disability by careful management. Thus, also in the area of direct medical costs, there may be room for cost savings by stimulating and improving cost-efficiency and cost-effectiveness of the (para)medical care. In order to deal with the lack of specific disease information, more detailed information of medical consumption, sick leave and disability is required for future cost analysis.
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Pain interrupts and demands attention. The authors review evidence for how and why this interruption of attention is achieved. The interruptive function of pain depends on the relationship between pain-related characteristics (e.g., the threat value of pain) and the characteristics of the environmental demands (e.g., emotional arousal). A model of the interruptive function of pain is developed that holds that pain is selected for action from within complex affective and motivational environments to urge escape. The implications of this model for research and therapy are outlined with an emphasis on the redefinition of chronic pain as chronic interruption.
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To investigate cervicocephalic kinesthetic sensibility (head repositioning accuracy to subjective straight ahead) in patients with chronic, nontraumatic cervical spine pain. A prospective, 2-group, observational design. An outpatient chiropractic clinic in the United Kingdom. Eleven patients (6 men, 5 women; mean age +/- standard deviation, 41.1 +/- 13.3 yr; range, 18-55 yr) with chronic, nontraumatic cervical spine pain (mean duration, 24 +/- 18 mo), with no evidence of cervical radiculopathy and/or myelopathy or any other neurologic disorder. Eleven asymptomatic, unimpaired volunteers (5 men, 6 women; mean age, 39.3 +/- 10.3 yr; range, 28-54 yr) with no history of whiplash or other cervical spine injury or pain served as controls. Cervicocephalic kinesthetic sensibility was investigated by testing the ability of blindfolded participants to relocate accurately the head on the trunk, to a subjective straight-ahead position, after a near-maximal active movement of the head in the horizontal or vertical plane. The active cervical range of motion and the duration and intensity of neck pain were also recorded. Mann-Whitney U testing indicated that the patient (P) group was no less accurate in head repositioning than the control (C) group for all movement directions except flexion (median global positioning error [95% confidence interval], P = 5.7 degrees [5.03-9.10], C = 4.2 degrees [3.17-5.32]; p <.05). Nontraumatic neck pain patients show little evidence of impaired cervicocephalic kinesthetic sensibility. These results contrast with studies of chronic cervical pain patients in which the origin was not controlled or involved a cervical whiplash injury.
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Study Design. Best evidence synthesis. Objective. To identify, critically appraise, and synthesize literature from 1880 through 2006 on noninvasive interventions fer neck pain and its associated disorders. of Background Data. No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade. Methods. We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of non-invasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis. Results. Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to non-invasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus. Conclusion, Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.
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Background: Chronic low back pain is a common problem that has only modestly effective treatment options. Objective: To determine whether yoga is more effective than conventional therapeutic exercise or a self-care book for patients with chronic low back pain. Design: Randomized, controlled trial. Setting: A nonprofit, integrated health care system. Patients: 101 adults with chronic low back pain. Intervention: 12-week sessions of yoga or conventional therapeutic exercise classes or a self-care book. Measurements: Primary outcomes were back-related functional status (modified 24-point Roland Disability Scale) and bothersomeness of pain (11-point numerical scale). The primary time point was 12 weeks. Clinically significant change was considered to be 2.5 points on the functional status scale and 1.5 points on the bothersomeness scale. Secondary outcomes were days of restricted activity, general health status, and medication use. Results: After adjustment for baseline values, back-related function in the yoga group was superior to the book and exercise groups at 12 weeks (yoga vs. book: mean difference, -3.4 [95% Cl, -5.1 to-1.6] [P< 0.001]; yoga vs. exercise: mean difference, -1.8 [Cl, -3.5 to - 0.1] [P= 0.034]). No significant differences in symptom bothersomeness were found between any 2 groups at 12 weeks; at 26 weeks, the yoga group was superior to the book group with respect to this measure (mean difference, -2.2 [Cl, -3.2 to - 1.2]; P < 0.001). At 26 weeks, back-related function in the yoga group was superior to the book group (mean difference, -3.6 [Cl, -5.4 to - 1.8]; P< 0.001). Limitations: Participants in this study were followed for only 26 weeks after randomization. Only 1 instructor delivered each intervention. Conclusions: Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.
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Introduction Assumptions EM and Inference by Data Augmentation Methods for Normal Data More on the Normal Model Methods for Categorical Data Loglinear Models Methods for Mixed Data Further Topics Appendices References Index
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Scand J Caring Sci; 2011; 25; 435–443 Yoga for chronic pain management: a qualitative exploration Objective: To explore patients’ perceptions of their pain while participating in a weekly yoga program. Methods: A consecutive convenience sample was recruited from a Multidisciplinary Pain Centre. Seven adult patients (six women), agreed to participate in an 8-week Hatha yoga program, including weekly group sessions and at-home practice. Data were gathered from participant observation and in-depth interviews. Interviews explored the experience of practicing yoga and its relationship to the participant’s pain experience. An inductive analysis of the interviews explored emergent themes from participants’ descriptions of their experience. Results: Analyses identified three themes: renewed awareness of the body; transformed relationship with the body in pain; and acceptance. Discussion: Participants’ data suggested that they reframed what it meant to live with chronic pain. Some participants reported that the sensory aspects of pain did not change but that pain became less bothersome. They were better able to control the degree to which pain interfered with their daily life. Other participants reported less frequent or less intense pain episodes because they could recognize body signals and adjust themselves to alleviate painful sensations. The findings suggest that patients who benefit from yoga may do so in part because yoga enables changes in cognitions and behaviours towards pain.