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REVIEW ARTICLE
ABSTRACT
ARTICLE HISTORY
The definition of functional pain syndromes is varied across literature. No effort has been made
to see all functional pain disorder groups under broad nomenclature which would exclude conditions for which pathophysiology is strongly known. Since these disorders are commonly treated
with alternative treatment modalities and impose significant burden on health utilization, an
effort to look into studies on yoga-based interventions on functional pain syndromes (FPS) was
made. This study defined FPS as Chronic relapsing remitting pain conditions, the origin of which
is difficult to trace with no definite physical pathology on clinical suspicion or available laboratory
measures and are valid based on subjective pain reporting, associated distress and socio-occupational dysfunction. Chronic headache, neck pain, back pain, fibromyalgia, pelvic pain, Irritable
Bowel Syndrome, Chronic Fatigue Syndrome, and somatoform pain disorders were included for
this review. The review found four meta-analyses on the selected topic both indicating modest
efficacy and benefit of yoga in these disorders. Future efforts should be directed to do a large
meta-analysis of functional pain syndromes.
Introduction
In ancient times yoga was considered as a medium to
connect the body with the mind, as described in
Upanishads and Patanjali yoga sutra. Today we know
that any disharmony between body and mind has the
potential to cause an adverse health effect. This imbalance can lead to multiple symptoms, which either take
a form of syndromal diagnosis of a disease or group of
symptoms that have no definite aetiological basis
according to modern science. The curiosity is about
learning to make a balance between mind and body so
as to prevent rather than curing these illnesses (Telles,
Kozasa, Bernard, & Cohen, 2013). This article focuses
on revisiting the role of yoga from ancient texts to
modern times, defining functional pain syndrome
(FPS) category and review of various yoga-based interventions in FPS.
There are various types of yoga described from the
Vedic times, and it reflects the art of life. However, this
art seemed to have worked effectively in gaining control
over ones psyche and contributing to the preventive
strategy for multiple psychological illnesses. Yoga has
been defined as the mechanism to gain control over
fluctuations of the mind (Yogahchittavrttinirodhah,
Patanjalis Yoga Sutras, Chapter 1, Verse 2; Patanjali
circa 900 BC). It has also been described as a synonym
for equilibrium or balance towards calmness of mind
CONTACT Geetha Desai
2016 Institute of Psychiatry
desaigeetha@gmail.com
KEYWORDS
Backache; fibromyalgia;
functional pain; yoga;
review
Methodology
We defined functional pain syndrome for the article
as:
Chronic relapsing remitting pain conditions, the
origin of which is difficult to trace with no definite
physical pathology on clinical suspicion or available
laboratory measures and are valid based on
subjective pain reporting, associated distress and
socio-occupational dysfunction.
317
Results
The majority of studies on yoga intervention were for
chronic low back pain following fibromyalgia, chronic
headache, and chronic neck pain. The details of the
studies for fibromyalgia are presented in Table 1
(Carson, Carson, Jones, Bennett, Wright, & Mist, 2010;
Carson, Carson, Jones, Mist, & Bennett, 2012; Curtis,
Osadchuk, & Katz, 2011; da Silva, Lorenzi-Filho, &
Lage, 2007; Hennard 2011; Langhorst, Klose, Dobos,
Bernardy, & Hauser, 2013; Mist, Wright, Jones, &
Carson, 2011; Rudrud 2012). There were two meta
analyses which not only included RCT but also open
label trials with control groups. The number of participants across the studies varied and studies including
only women as participants were higher. The control
group had a variety of treatments provided which
include education, waitlist, and other CAM therapies.
The duration of intervention varied between 8 weeks
to 12 month follow-up with varying frequency and
type of yoga practice. Details about medication use
were missing. Yoga was found to be effective in reducing the pain intensity and also improving functioning.
Most studies did not mention the sampling methods.
The details of the studies for chronic low back pain
are given in Table 2 (Cox, Tilbrook, Aplin, Semlyen,
Torgerson, Trewhela, et al., 2010; Evans & Hadler, 2006;
Evans, Carter, Panico, Kimble, Morlock, & Spears, 2010;
Galantino, Bzdewka, Eissler-Russo, Holbrook, Mogck,
Geigle, et al., 2004; Groessl, Weingart, Aschbacher,
Pada, & Baxi, 2008; Haldavnekar et al., 2014; Holtzman
& Beggs, 2013; Lee, Moon, & Kim, 2014; Nambi,
Inbasekaran, Khuman, Devi, & Shanmugananth, 2014;
Saper, Sherman, Cullum-Dugan, Davis, Phillips, &
Culpepper, 2009; Saper et al., 2014; Sherman, Cherkin,
Erro, Miglioretti, & Deyo, 2005; Sherman et al., 2010;
318
R. SUTAR ET AL.
Type of study
No of participants
Type of yoga
Findings
16 studies; 3 studies on
yoga intervention
Hatha Yoga
Yoga of awareness
Yoga with mindfulness
Yoga
Meta-analysis of Qigong,
Tai chi, and Yoga
interventions
Meta-analysis of RCTs
including qigong, Tai
chi, yoga
Rudrud (2012)
Case series
10
Hatha yoga
21
Yoga of Awareness
intervention
22
Hatha yoga
Hennard (2011)
11
RCT
53
RCT
40
Yoga Awareness
programme
Relaxing Yoga (RY) and
Relaxing Yoga plus
Touch (RYT)
319
Type of study
Type of yoga
Findings
No of participants
95
Hatha yoga
14
Hatha Yoga
RCT
40
4
5
Open/Experimental
Meta-analysis of RCT
RCT
95
RCT
228
RCT
313
Descriptive open
53
10
RCT
80
11
Open
20
12
13
RCT
RCT
30
90
14
15
Open
RCT
33
80
Yoga
Hatha Yoga
16
17
18
RCT
101
19
RCT
60
Iyengar Yoga
20
22
Hatha Yoga
60
8 RCTs, 743 patients
6 RCTs
101
320
R. SUTAR ET AL.
Type of study
Prospective study
2
3
Pilot study
Meta analysis
Prospective study
No of participants
Type of Yoga
Findings
50
Rajyoga meditation
8
In 6 studies, yoga was used to treat
patients with back pain; in 2 studies to treat rheumatoid arthritis; in
2 studies to treat patients with
headache/migraine; and 6 studies
enrolled individuals for other
indications
15 patients of Chronic Tension Type
Headache and 7 age-matched
controls
Hatha Yoga
Mixed yoga forms
Significant improvement in
headache
Improved significantly in pain
Moderate effect on pain and
associated disability
Type of study
Systematic review
No of participants
Type of yoga
Findings
570
Iyengar yoga
Quasi-randomized parallel
controlled study
56
Yogic postures
Follow-up
51
Iyengar yoga
RCT
51
Iyengar yoga
Pilot RCT
77
Iyengar yoga
Conclusions
The number of well-designed studies assessing effectiveness of yoga-based interventions in functional pain
disorders was limited. The efficacy has always been
qualitatively verified, but quantitative efficacy is difficult to study. Some studies include certain chronic
organic conditions like migraine, arthritis, etc., which
have been excluded from the current review, as we
defined the functional pain syndrome as Chronic
relapsing remitting pain conditions, the origin of
which is difficult to trace with no definite physical
pathology on clinical suspicion or available laboratory
measures and are valid based on subjective pain
reporting, associated distress and socio-occupational
dysfunction. Hence, most of the organic conditions
whose pathophysiology has been well studied to date
have become exclusion for our study. The purpose of
doing this segregation is
(1) To cover a broad range of disorders under
umbrella whose presentation is similar.
(2) To identify yoga-based interventions in these
disorders.
Disclosure statement
The authors report no conflicts of interest. The authors
alone are responsible for the content and writing of the
paper.
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