The COVID-19 outbreak is a rapidly evolving situation. CDC health information   NIH research information

Nccih Logo

NCCIH Clinical Digest

for health professionals

Yoga for Pain: What the Science Says

September 2020

Clinical Guidelines, Scientific Literature, Info for Patients: 
Yoga for Pain

Image of a woman doing yoga at home

Fibromyalgia

Recent systematic reviews and randomized clinical trials provide encouraging evidence that some mind and body practices such as yoga may help relieve some fibromyalgia symptoms. Current diagnostic criteria are available from the American College of Rheumatology. Treatment often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive-behavioral therapy, movement/body awareness practices, massage, acupuncture, and balneotherapy.

What Does the Research Show?

  • In 2017, the European League Against Rheumatism (EULAR) evaluated non-pharmacologic therapies, including complementary health approaches, and issued revised recommendations for the management of fibromyalgia. The strength of these recommendation is “based on the balance between desirable and undesirable effects (considering values and preferences), confidence in the magnitude of effects, and resource use. A strong recommendation implies that, if presented with the evidence, all or almost all informed persons would make the recommendation for or against the therapy, while a weak recommendation would imply that most people would, although a substantial minority would not.”
    • Based on the evaluation of acupuncture, meditative movement practices (e.g., tai chi, qi gong, and yoga), and mindfulness-based stress reduction, the recommendation for each was weak for use of the therapy.
  • A 2015 Cochrane review of 61 trials involving 4,234 predominantly female participants with fibromyalgia concluded that the effectiveness of biofeedback, mindfulness, movement therapies (e.g., yoga), and relaxation techniques remains unclear as the quality of evidence was low or very low.

Low-Back Pain

For patients with chronic low-back pain, recent evidence-based clinical practice guidelines from the American College of Physicians gave a strong recommendation based on moderate-quality evidence that clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, or mindfulness-based stress reduction. The guidelines also strongly recommend, based on low-quality evidence, several mind and body approaches, including yoga.

What Does the Research Show?

  • A 2020 review of 25 randomized controlled trials examined the effects of yoga for back pain and found that 20 studies reported positive outcomes in variables such as pain or psychological distress (e.g.,, depression and anxiety), or energy. However, no significant difference in treatment effect on pain and disability was seen between yoga and physical therapy at 6 weeks.
  • A 2018 report from the Institute for Clinical and Economic Review analyzed data from 28 randomized clinical trials of mind and body therapies (including yoga) for chronic low-back pain. The analysis showed that participants in the yoga group had a moderate level of certainty of having small health benefits (both decreased pain and improved function) when added to usual care compared with usual care alone.
  • A 2018 report by the Agency for Healthcare Research and Quality evaluated 8 trials of yoga for low-back pain (involving 1,466 total participants) and found that yoga improved pain and function both in the short term (1 to 6 months) and intermediate term (6 to 12 months). The effects of yoga were similar to those of exercise.
  • 2017 clinical practice guidelines issued by ACP strongly recommended yoga, based on low-quality evidence, as initial treatment for patients with chronic low-back pain. A systematic review supporting the 2017 clinical practice guidelines evaluated 14 randomized controlled trials and found that yoga was associated with lower pain scores, although the effects were small and were not always statistically significant.
  • A 2017 Cochrane review of 12 trials involving 1,080 participants found low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at 3 and 6 months. Yoga may also be slightly more effective for pain at 3 and 6 months, however the effect size did not meet predefined levels of minimum clinical importance.
  • A 2017 randomized controlled trial involving 320 predominantly low-income, racially diverse adults showed that yoga and physical therapy offer similar pain-relief and functional benefits to people with low socioeconomic status who had chronic low-back pain. These improvements were greater than self-education; however, they were not considered significant.

Neck Pain

There is some limited evidence that yoga may provide short-term improvements for neck pain.

What Does the Research Show?

  • A 2019 meta-analysis of 10 randomized controlled trials involving 686 participants concluded that yoga may relieve neck pain intensity, improve pain-related function disability, increase cervical range of motion, improve quality of life, and boost mood. The review authors noted that it was difficult to make a comprehensive summary of all the evidence due to the different session and duration of the yoga interventions, and the different outcome measurement tools in the study.
  • A 2017 review of 3 studies (involving 188 total participants) found that yoga had short-term benefits for both the intensity of neck pain and disability related to neck pain.

Headaches

Only a few studies have been conducted on yoga for headaches, so there aren’t enough data to determine if yoga has beneficial effects for this pain condition.

What Does the Research Show?

  • A 2015 attempt to review the research on this topic found only one study with 72 participants that could be evaluated. That study had favorable results, with decreases in headache intensity and frequency.

Arthritis

Results from clinical trials suggest that some mind and body practices, including yoga, may be beneficial additions to conventional treatment plans for patients with arthritis, but some studies indicate that these practices may do more to improve other aspects of patients’ health than to relieve pain.

What Does the Research Show?

  • A 2018 meta-analysis of 13 clinical trials involving 1557 patients with knee osteoarthritis and rheumatoid arthritis found that regular yoga training may be useful in reducing knee arthritic symptoms, promoting physical function, and general wellbeing in arthritic patients.
  • A 2017 review of two studies found some beneficial effect on pain, but due to the high risk of bias in both studies, the reviewers gave a weak recommendation for yoga in rheumatoid arthritis. Yoga incorporates several elements of exercise that may be beneficial for arthritis, including activities that may help improve strength and flexibility.
  • A 2019 randomized controlled trial involving 72 participants with RA found that after 8 weeks of yoga, there was significant decrease in the severity of RA as seen by reduction in levels of various systemic inflammatory markers. Also, the yoga group experienced a statistically significant time dependent step-wise decline in depression symptoms over the period of 8 weeks as compared to control group.

Safety

  • Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other types of physical activity, injuries can occur. The most common injuries are sprains and strains. Serious injuries are rare.
  • People with health conditions, older adults, and pregnant women may need to avoid or modify some yoga poses and practices.

References

  • Chen L, Michalsen A. Management of chronic pain using complementary and integrative medicine. BMJ. 2017;357:j1284.
  • Chen L, Michalsen A. Management of chronic pain using complementary and integrative medicine. BMJ. 2017;357:j1284.
  • Cherkin DC, Herman PM. Cognitive and mind-body therapies for chronic low back pain and neck pain: effectiveness and value. JAMA Intern Med. 2018;178(4):556-557.
  • Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017; 166(7):493-505.
  • Cramer H, Klose P, Brinkhaus B, et al. Effects of yoga on chronic neck pain: a systematic review and meta-analysis. Clinical Rehabilitation. 2017;31(11):1457-1465.
  • De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology. 2010;49(6):1063–1068.
  • Evans S, Moieni M, Taub R, et al. Iyengar yoga for young adults with rheumatoid arthritis: results from a mixed–methods pilot study. Journal of Pain and Symptom Management. 2010;39(5):904–913.
  • Furlan AD, Yazdi F, Tsertsvadze A, et al. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evidence-Based Complementary and Alternative Medicine. 2012;2012:953139.
  • Furlan AD, Yazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. AHRQ Publication No. 10(11)–E007, October 2010.
  • Gautam S, Tolahunase M, Kumar U, et al. Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active rheumatoid arthritis patients: A randomized controlled trial. Restor Neurol Neurosci. 2019;37(1):41-59.
  • Kim S-D. Effects of yoga exercises for headaches: a systematic review of randomized controlled trials. Journal of Physical Therapy Science. 2015;27(7):2377-2380.
  • Li Y, Li S, Jiang J, et al. Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine (Baltimore). 2019;98(8):e14649.
  • Macfarlane GJ, Kronish C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328.
  • Nahin RL, Boineau R, Khalsa PS, et al. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings. September 2016;91(9):1292-1306.
  • Nahin RL, Boineau R, Khalsa PS, et al. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings. September 2016;91(9):1292-1306.
  • Park J, Krause-Parello CA, Barnes CM. A narrative review of movement-based mind-body interventions: effects of yoga, tai chi, and qigong for back pain patients. Holist Nurs Pract. 2020;34(1):3-23.
  • Qaseem A, Wilt TJ, McLean RM, et al. 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.
  • Skelly AC, Chou R, Dettori JR, et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Copmparative Effectiveness Review no. 209. Rockville, MD: Agency for Healthcare Research and Quality; 2018. AHRQ publication no. 18-EHC013-EF.
  • Theadom A, Cropley M, Smith HE, et al. Mind and body therapy for fibromyalgia. Cochrane Database Syst Rev. 2015;4:CD001980.
  • Wang Y, Lu S, Wang R, et al. Integrative effect of yoga practice in patients with knee arthritis: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 2018; 97(31):e11742.
  • 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 Jan 12; 1(1):CD010671.

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH Web site at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

Copyright

Content is in the public domain and may be reprinted, except if marked as copyrighted (©). Please credit the National Center for Complementary and Integrative Health as the source. All copyrighted material is the property of its respective owners and may not be reprinted without their permission.