By Jeffrey H. Baker, MD, FAAFP, DABMA, DABIHM
Assistant Professor, Department of Family and Community Medicine, Penn State College of Medicine, State College PA
Dr. Baker reports no financial relationships relevant to this field of study.
Remote video yoga instruction service has the potential to bring chronic pain improvement to those who have difficulty in accessing medical care.
Mathersul D, Mahoney L, Bayley P. Tele-yoga for chronic pain: Current status and future directions. Glob Adv Health Med 2018; Apr. 2. doi.org/10.1177/2164956118766011.
- Researchers reviewed the use of yoga instruction, transmitted remotely for access-challenged patients in treating chronic pain. The study suggests that tele-yoga can be an effective treatment, but it is unknown if it is as effective as in-person yoga instruction.
Chronic pain continues to trouble people in the United States in terms of healthcare costs and lost work productivity. Mathersul et al reviewed the military’s early research results in telehealth, using an innovative approach to reaching those patients who have difficulty in accessing their care. “Most days” pain is encountered more frequently in the veteran population than the general population (9.1% vs. 6.4%), whereas 65.5% of veterans reported pain in the past three months compared to 56.4% of the general population.1 There is direct correlation of pain to the number of years of post-deployment.2 Current pharmaceutical interventions have brought limited success with significant unwanted side effects. Even cognitive behavioral therapy, the standard for psychological intervention in pain therapy, has limited effectiveness. Because of the effect of chronic pain on veterans, the National Institutes of Health and the Department of Veterans Affairs have prioritized research in this field looking for other interventions that might produce results and be acceptable to patients.
As a prelude to their discussion concerning yoga and tele-yoga activities for chronic pain, the authors described “telehealth” as an inclusive term for real-time video or telephone conferencing for individuals living in remote areas or who have reduced mobility. This is in contrast to “telemedicine” that refers to direct clinical services.
Yoga is one of many mind-body or energy therapies that have been used to treat chronic pain, both as first-line and as adjunctive therapy. The authors were careful to elucidate the scenarios where in-person yoga has been studied and is helpful: cancer pain, headache, musculoskeletal pain of the lower back and neck, rheumatoid arthritis, osteoarthritis, irritable bowel syndrome, and fibromyalgia. Although in-person yoga is an effective method for treating pain, the authors suggested that telehealth sessions are feasible and may be helpful on many levels, in addition to pain management, including exercise, peer mentoring, and psychological treatments.
Suggestive evidence for support of telehealth programs comes from studies performed at the War Related Illness and Injury Study Center in Palo Alto, CA. The first study involved telehealth intervention for heart and respiratory issues in individuals with congestive heart failure and chronic obstructive pulmonary disease;3 a second study involved treating chronic pain.4 In these studies, participants rated their satisfaction and improved self-reported pain, energy level, depression, and anxiety to be comparable to in-person yoga classes. To date for safety reasons, the Palo Alto group has not used poses that require the participant to lay prone or supine on the floor. They suggested further research will provide answers for poses that can be used safely in the telehealth mode.
The authors discussed issues that need to be addressed to further study the implementation of yoga telehealth activities. There are many differing styles of yoga that, if studied or reviewed together, would impede the identification of positive/negative effects. The addition or subtraction of mindfulness in yoga research also interferes with outcome analyses. It still is not proven that telehealth interventions are as successful as in-person interactions. Consistent study design has yet to be formulated, while the feasibility of performing large studies hinders both in-person and telehealth mind-body medicine. This article represents innovative thinking using a relatively inexpensive and accessible technology to help members of a mobile, and at times, isolated, societal group. Translation to the general population would be easy and worthwhile. We can look forward to further research from the military and integrative medical communities to aid in chronic pain management.
REFERENCES
- Nahin RL. Severe pain in veterans: The effect of age and ex, and comparisons with the general population. J Pain 2017;18:247-254.
- Haskell SG, Ning Y, Krebs E, et al. The prevalence of painful musculoskeletal conditions in female and male veterans in 7 years after return from deployment in Operation Enduring Freedom/Operation Iraqi Freedom. Clin J Pain 2012;28:163-167.
- Selman L, McDermott K, Donesky D, et al. Appropriateness and acceptability of a tele-yoga intervention for people with heart failure and chronic obstructive pulmonary disease: Qualitative findings from a controlled pilot study. BMC Complement Altern Medicine 2015;2015:15-21.
- Schulz-Heik RJ, Meyer H, Mahoney L, et al. Results from a clinical yoga program for veterans: Yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga. BMC Complement Altern Med 2016;2016:1-9.
