Fibromyalgia (FM) is a debilitating condition affecting 11-15 million individuals in the US alone. FM carries an annual direct cost for care of more than $20 billion and drug therapies are generally only 30% effective in relieving symptoms and 20% effective in improving function. Standard care currently includes medications accompanied by exercise and coping skills approaches. In a study published in the November issue of PAIN, researchers report patients participating in a "Yoga of Awareness" program showed significantly greater improvement in FM symptoms and functioning compared to patients on a standard FM care program.

"Although yoga has been practiced for millennia, only recently have researchers begun to demonstrate yoga's effects on persons suffering from persistent pain," commented lead investigator James W. Carson, PhD, Oregon Health & Science University. "The Yoga of Awareness program stands in contrast to previous multimodal interventions with FM patients in that it integrates a wide spectrum of yoga-based techniques - postures, mindfulness meditation, breathing exercises, application of yogic principles to optimal coping, and group discussions....the findings of this pilot study provide promising preliminary support for the beneficial effects of yoga in patients with FM."

Given the much higher prevalence of FM in females (80-90%), researchers chose to include only women in this study. 53 women at least 21 years of age participated. To be eligible, patients had to meet the following criteria: be diagnosed with FM by American College of Rheumatology (ACR) criteria for at least 1 year and be on a stable regimen of pharmacologic and/or non-pharmacologic treatment for FM for at least 3 months. The patients were randomized; 25 participated in the Yoga of Awareness program, while 28 received standard care.

Yoga of Awareness is an innovative, comprehensive yoga program, which for the purposes of this study was tailored to address pain, fatigue, sleep disturbance, and emotional distress in FM. Each Yoga of Awareness class included approximately 40 minutes of gentle stretching poses, 25 minutes of mindfulness meditation (e.g., awareness of breath, awareness of awareness itself), 10 minutes of breathing techniques (e.g., full yogic breath, breathing into sensation), 20 minutes of didactic presentations on the application of yogic principles to optimal coping, and 25 minutes of group discussions (e.g., experiences while practicing yoga at home).

After the yoga program was completed, both groups were assessed for fibromyalgia symptoms and functional deficits, overall improvement in fibromyalgia symptoms, physical tests of fibromyalgia symptoms and functional deficits such as tender points, strength and balance deficits, and a number of pain coping strategies.

Following treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies.

Dr. Carson and colleagues observed, "In addition, the results suggested the yoga intervention led to a beneficial shift in how patients cope with pain, including greater use of adaptive pain coping strategies (i.e., problem solving, positive reappraisal, use of religion, activity engagement despite pain, acceptance, relaxation) and less use of maladaptive strategies (i.e., catastrophizing, self-isolation, disengagement, confrontation)."

To bring these benefits to the patient community, Dr. Carson has planned a training course for yoga teachers who want to build their skills for working with individuals who have chronic pain conditions.

The article is "A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia" by James W. Carson, Kimberly M. Carson, Kim D. Jones, Robert M. Bennett, Cheryl L. Wright, and Scott D. Mist. It appears in PAIN, Volume 151, Issue 2 (October 2010) published by Elsevier.

doi:10.1016/j.pain.2010.08.020

Notes

About The Authors

James W. Carson
Department of Anesthesiology and Peri-operative Medicine, Oregon Health & Science University, Portland, OR, USA

Kimberly M. Carson
School of Nursing, Oregon Health & Science University, Portland, OR, USA

Kim D. Jones
School of Nursing, Oregon Health & Science University, Portland, OR, USA
Department of Medicine, Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA

Robert M. Bennett
School of Nursing, Oregon Health & Science University, Portland, OR, USA
Department of Medicine, Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA

Cheryl L. Wright
School of Nursing, Oregon Health & Science University, Portland, OR, USA

Scott D. Mist
School of Nursing, Oregon Health & Science University, Portland, OR, USA

Source: Elsevier