A small study completed in the US suggests that yoga may help alleviate the symptoms of fibromyalgia, a disorder that causes widespread pain; the participants also showed improvements in coping and other functions. The researchers urged that further studies now be done to evaluate yoga as a suitable treatment to accompany medication, for which robust evidence already exists.

You can read about the pilot study, by researchers at Oregon Health & Science University (OHSU) in Portland, Oregon, in the November print issue of Pain, which was made available online on 12 October.

The first and corresponding author was Dr James Carson, a clinical health psychologist and an assistant professor of anesthesiology and perioperative medicine in the School of Medicine at OHSU.

He told the press that:

"Although yoga has been practised for millennia, only recently have researchers begun to demonstrate yoga's effects on persons suffering from persistent pain."

"The findings of this pilot study provide promising preliminary support for the beneficial effects of yoga in patients with FM [fibromyalgia]," he added.

Fibromyalgia is a syndrome where the predominant symptoms are muscle pain and fatigue. The cause is unknown, but is thought to involve genes and physical or emotional stress.

As well as feeling pain and discomfort all over, people with the disorder often don't sleep well, feel tired a lot and get stressed easily. They may also feel stiffness in the mornings, tingling or numbness in fingers and toes, get frequent headaches and have problems remembering things.

The disorder affects between 11 and 15 million Americans, and the associated cost is estimated to be around 20 billion US dollars.

Carson and colleagues wrote in their background information that there is mounting evidence that fibromyalgia can effectively be treated with a combination of drugs, physical exercise and learning coping skills, but there is a "significant gap" between what we know about the effectiveness of medications compared to therapies that incorporate both exercise and coping.

So they chose to do a small study to look specifically at how effective yoga might be as a prescribed treatment, both in terms of alleviating symptoms and improving coping.

The researchers enrolled 53 women of minimum age 21 who had been diagnosed with fibromyalgia and randomly assigned them to one of two groups. One group attended an 8-week yoga program and the other group (the controls) received the standard medication treatments ("wait-listed standard care").

To be eligible for the study, the women had to be diagnosed with fibromyalgia in line with American College of Rheumatology (ACR) criteria and be having the symptoms for at least 1 year, and be on a stable treatment for at least 3 months (either medication based or non-medication based).

The researchers decided to enroll just women because the condition affects mostly females (80 to 90 per cent of people with the disorder are women).

The 8-week yoga program (called Yoga of Awareness) incuded doing 40 minutes of gentle stretching poses, 10 minutes of breathing exercises, 25 minutes of mindfulness meditation, 20 minutes of being taught how to apply yogic principles to achieve best coping, and 25 minutes of group discussion (for instance to go over experience of home practice).

Before and after the study, all participants filled in questionnaires and underwent physical assessment. The yoga group participants also kept a daily diary where they noted comments about their symptoms and how they felt.

The researchers then compared the before and after data for the two groups.

They found that: The yoga group appeared to show improvements in a number of serious fibromyalgia symptoms, including: "pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies".
All the improvements were statistically and clinically significant: that is they were big enough to impact daily functioning.
For example: in the yoga group, depression went down by an average of 42%, fatigue by 30% and pain by 24%. The researchers also wrote that the yoga intervention appeared to have:

"... led to a beneficial shift in how patients cope with pain, including greater use of adaptive pain coping strategies (ie problem solving, positive reappraisal, use of religion, activity engagement despite pain, acceptance, relaxation) and less use of maladaptive strategies (ie catastrophizing, self-isolation, disengagement, confrontation)."

They concluded that:

"This pilot study provides promising support for the potential benefits of a yoga program for women with FM."

Carson said one of the reasons for the study's apparent success was the "strong commitment shown by the study subjects".

He said attendance was high, as was participants' commitment to practice at home between classes.

"Based on the results of this research, we strongly believe that further study of this potential therapy is warranted," he urged.

As a result of these findings, and other research they have done, Carson and his team at the Department of Anesthesiology and Perioperative Medicine at OHSU are sponsoring a traning program for yoga teachers from the US and Canada.

The course will be offered in June 2011 and will suit yoga teachers who want to develop skills for working with students in chronic pain.

Funds from the Oregon Health & Science University Medical Research Foundation and resources from the Fibromyalgia Information Foundation sponsored the study.

"A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia."
James W. Carson, Kimberly M. Carson, Kim D. Jones, Robert M. Bennett, Cheryl L. Wright and Scott D. Mist.
Pain, Volume 151, Issue 2, November 2010, Pages 530-539
DOI:10.1016/j.pain.2010.08.020

Additional sources: OHSU, Elsevier.

: Catharine Paddock, PhD