Yoga for Fibromyalgia

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Yoga is a mind-body activity that falls under the classification of complementary and alternative medicine, or CAM. It originates from ancient Indian philosophy and is the sixth most commonly practiced CAM modality in the United States. Yoga typically combines various physical postures and breathing techniques, along with meditation or relaxation. The most common form of yoga practiced in the United States is hatha yoga, which combines postures and breathing exercises. Popular styles of hatha yoga include Iyengar, Asthanga, Vini, Kundalini, and Bikram. Yoga is used both as a symptom management tool for various conditions and for physical fitness and relaxation. While the way in which yoga influences health and the body are not well-understood, it has been suggested that yoga helps to improve stress-coping and mind-body awareness. There is a lack of research regarding the use of yoga to manage the symptoms of Fibromyalgia, however several studies have recently been conducted.

A 2011 study by Curtis et al. recruited 22 women with Fibromyalgia to participate in yoga twice a week for eight weeks. Yoga sessions were 75 minutes in length, consisted of hatha yoga, and were taught by a certified yoga instructor. In addition, each participant completed a series of questionnaires designed to assess pain, anxiety, depression, and mindfulness. The first series of questionnaires was completed prior to the first yoga session, the second series was completed before the ninth yoga class, and the third and final series was completed at the follow-up session (three days after the final yoga class). Finally, each subject provided a total of 12 saliva samples (six pre-intervention and six post-intervention) so that researchers could evaluate their cortisol levels. Cortisol is a hormone produced by the adrenal gland that is released as part of the body’s natural response to stress or low blood sugar. Citing research that indicates Fibromyalgia patients have low cortisol levels, Curtis et al. sought to determine if the yoga intervention could increase cortisol levels among the subjects.

After the intervention, the researchers found that the following measures had improved significantly from their pre-intervention measurements: continuous pain, pain catastrophizing (exaggerated characterizations of pain as unbearable, horrible, awful, etc.), pain acceptance, and mindfulness. In addition, the study also found that cortisol levels increased in the women following the yoga intervention. The authors concluded that yoga may help to reduce pain and pain catastrophizing, but cite the need for additional, randomized-controlled trials to investigate the role of yoga in Fibromyalgia (Curtis et al. 2011).

Along those lines, a randomized-controlled trial was recently conducted to evaluate the usefulness of using mindfulness-based stress reduction (MBSR) to treat Fibromyalgia symptoms. This study by Schmidt et al. randomly assigned 177 female Fibromyalgia patients to one of three groups: 1) a structured, eight week group program consisting of mindfulness meditation and mindful yoga exercises (one 2.5 hour session per week, plus one seven-hour session each weekend); 2) an active control group consisting of relaxation and exercise; or 3) a wait list (patients randomized to this group were given their choice of either the MBSR or the exercise intervention at the conclusion of the study). The major purpose of the study was to investigate the effects of MBSR on the health-related quality of life for the patients; however, additional research was done to determine Fibromyalgia-specific quality of life, depression, anxiety, pain, and mindfulness. While the authors did not find any benefit to the MBSR group when compared to the active control group or the wait list group, patients in the MBSR group showed significant improvements in health-related quality of life at the short-term follow-up. Furthermore, those in the MBSR group showed significant improvements in six of eight secondary outcome measures, including disease-specific impact on quality of life, depression, anxiety, sleep quality, pain perception, and physical symptoms (Schmidt et al. 2011).

An earlier study by da Silva and colleagues (2007) compared the use of two separate yoga interventions in 40 Fibromyalgia patients. The women were randomly assigned to receive either relaxing yoga or relaxing yoga plus touch, which incorporated a touch technique known as Tui Na. Tui na involves sliding and pressuring the trunk, arms, and legs while an individual lies on their back. There were eight weekly sessions, all administered individually, with an average length of 50 minutes each. One week prior to the first session and four to six weeks after completing the last session, each subject completed the Fibromyalgia Impact Questionnaire (FIQ), which is designed to  assess pain, physical functioning, employment, fatigue, morning tiredness and stiffness, overall well-being, depression, and anxiety. A manual tender point examination was also conducted. At the time of analysis, the researchers found that both the relaxing yoga and the relaxing yoga plus touch interventions resulted in significant decreases in pain intensity as well as improvements in the scores on the FIQ. There were no significant differences between the two groups, other than the relaxing yoga group reporting less pain over time than the relaxing yoga plus touch group. The authors concluded that yoga may be an effective therapeutic method for Fibromyalgia symptoms (da Silva et al., 2007).

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References

1.        Curtis K, Osadchuk A, Katz J. An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with Fibromyalgia. J Pain Res. 2011;4:189-201.

2.        Schmidt S. Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating Fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain. 2011;152:361-369.

Da Silva GD, Lorenzi-Filho G, Lage LV. Effects of yoga and the addition of Tui Na in patients with Fibromyalgia. J Altern Complement Med. 2007;13(10):1107-1113.

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