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How Yoga Helps With Pain Management

By: Robert Saper, MD • Posted on February 18, 2022

How Yoga Helps With Pain Management

Yoga’s popularity with women has soared over recent years. In 1998, only 4.1% of adult women in the U.S. reported they had practiced yoga in the previous year.¹ In 2017, that proportion shot up to 19.8%.² The same growth has occurred in girls ages 4-17 - from 2007-2017 this age group’s yoga practice went from 2.3% to 11.3%.³ ⁴

Why Yoga is Good for your Mental and Physical Health

Yoga originated in India over 5,000 years ago and came to North America only in the late 19th century. Modern day yoga looks very different compared to its ancient roots. Historically, yoga was a discipline aimed at spiritual growth. Today, women and girls use yoga for many reasons, including aerobic exercise, stretching, reducing stress, improving athletic and cognitive performance, social connection, spirituality, and pregnancy.

Yoga styles

There are many styles or schools of yoga, including Iyengar, Kripalu, Restorative and Silver. Different yoga styles vary in intensity from gentle (restorative yoga) to vigorous (power yoga). Some styles focus on static poses with proper alignment (Iyengar), while others are flowing (Viniyoga). Most yoga styles contain some combination of three elements:

  1. Poses (in Sanskrit called asana)
  2. Breathing exercises (pranayama)
  3. Meditation

Yoga is safe for all women and girls, regardless of age, color, body type, sexual orientation, and fitness level. If you are new to yoga, it’s best to start with a beginner class.

Yoga can help improve pain

The last 20 years has seen a surge in yoga research studies, funded by federal sources such as the National Institutes of Health (NIH), National Center for Complimentary and Integrative Health (NCCIH) and private foundations. One of the largest areas of research to date has been the use of yoga for chronic or recurrent pain. Chronic pain is experienced disproportionately greater by women than men.

In 2016 according to the CDC, 20.8% of adult women in the U.S. experienced chronic pain.⁵ A subset of these women – 8.9% of adult women or 11.3 million – reported high impact chronic pain defined as frequently limiting work or life activities.

Chronic pain conditions

  • Low back pain
  • Neck pain
  • Osteoarthritis
  • Headaches
  • Fibromyalgia

Yoga is being increasingly studied in these conditions and found to have promise for improving pain intensity.⁶ For example, more than one dozen randomized controlled trials suggest a small to moderate effect of yoga to benefit back pain sufferers to function better.⁷

Yoga helps with chronic low back pain

A study conducted in Boston by my colleagues and myself found yoga to be similarly effective as physical therapy to reduce pain intensity, improve function, and lower pain medication use.⁸ Guidelines for treatment of chronic low back pain by the American College of Physicians issued in 2017 now lists yoga as a recommended first-line treatment for chronic low back pain along with other nonpharmacologic approaches such as acupuncture, spinal manipulation, massage, mindfulness-based stress reduction, cognitive behavioral therapy, exercise and tai chi.⁹

It’s important to create with your healthcare team a treatment plan that integrates a safe, evidence-based combination of nonpharmacologic therapies, medications, interventional procedures and surgery when appropriate. You should discuss with your health care professionals all approaches you are using for your pain. It’s also important to share with your health care team your unique preferences, values, and circumstances that may influence your treatment plan. This way you can partner with your health care team to make a shared decision about the right treatment for you.

To learn more information about yoga or other nonpharmacologic therapies for pain, please contact the Department of Wellness and Preventive Medicine at (216) 448-4325 or CILM@ccf.org or visit clevelandclinic.org/integrativemedicine.

Be Strong, Be Healthy, Be in Charge!

-Robert Saper, MD, MPH

References:
  1. Saper RB, Eisenberg DM, Davis RB, Culpepper L, Phillips RS. Prevalence and patterns of adult yoga use in the United States: results of a national survey. Altern Ther Health Med. 2004;10(2):44-49.
  2. Clarke TC, Barnes PM, Black LI, Stussman BJ, Nahin RL. Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Over. NCHS Data Brief. 2018;(325):1-8.
  3. Black LI, Clarke TC, Barnes PM, et al. Use of complementary health approaches among children aged 4-17 years in the United States: National Health Interview Survey, 2007-2012. NCHS Data Brief. 2018;(324):1-8.
  4. Black LI, Barnes PM, Clarke TC, Stussman BJ, Nahin RL. Use of Yoga, Meditation, and Chiropractors Among U.S. Children Aged 4-17 Years. NCHS Data Brief. 2018;(324):1-8.
  5. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006. doi:10.15585/mmwr.mm6736a2
  6. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for rheumatic diseases: a systematic review. Rheumatol. 2013;52(11):2025-2030. doi:10.1093/rheumatology/ket264
  7. Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;1:CD010671. doi:10.1002/14651858.CD010671.pub2
  8. Saper RB, Lemaster C, Delitto A, et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. 2017;167(2):85-94. doi:10.7326/M16-2579
  9. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of P. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
About Robert Saper, MD, MPH

Robert Saper, MD, Department of Wellness and Preventive Medicine, Cleveland Clinic. He graduated from Harvard Medical School in 1988 and completed family medicine residency and chief residency at UCSF in 1992. After being in private practice for eight years in the San Francisco Bay Area, he completed the Harvard NIH-funded research fellowship in integrative medicine research. In 2004 Dr. Saper joined the faculty of Boston University and Boston Medical Center and founded the Program for Integrative Medicine and Health Disparities. Dr. Saper was Professor of Family Medicine at Boston University School of Medicine and held many roles including Director of Integrative Medicine, Chair of Appointments and Promotions, Academic Fellowship Director, and Patient Experience Champion. His research studies the safety and effectiveness of integrative medicine approaches for common primary care problems such as back pain, particularly in underserved populations.

Dr. Saper’s JAMA 2004 and 2008 publications demonstrating the presence of lead, mercury, and arsenic in traditional Indian medicines are highly cited and catalyzed reform in dietary supplement regulation nationally and internationally. His 2017 Annals of Internal Medicine paper demonstrating non-inferiority of yoga to physical therapy for chronic low back pain has contributed to the growing evidence base for nonpharmacologic therapies for chronic pain. He has authored over 65 peer-reviewed publications and received NIH career development, R01, U01 and PCORI grant funding. Dr. Saper is a past chair of the Academic Consortium for Integrative Medicine & Health. He teaches and mentors medical students, residents, fellows, and junior faculty. Dr. Saper also received his 200 hour yoga teacher training certification from Kripalu Center for Yoga and Health in 2018.



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