Effects of yoga on chronic neck pain: a systematic review of randomized controlled trials

Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews

BACKGROUND

To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence.

METHODS

We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible.

RESULTS

Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available.

CONCLUSION

Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality.

TRIAL REGISTRATION

Prospero CRD42022336014.

Ergonomics in Spine Surgery

As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.

Additive effect of "Brahma Mudra" on pain, proprioception and functional abilities in non-specific mechanical neck pain

OBJECTIVE

Being the second highest musculoskeletal problem irrespective of age, gender and occupation, the etiology of neck pain is predominantly mechanical in nature. This can lead to dysfunction with time and recurrence. Altered joint position sense (JPS) from soft tissues can alter the cervical biomechanics by compromising the cephalo spatial orientation, which depends on the visual, vestibular and proprioceptive cues. This study was done to observe the additive effect of "Brahma mudra" (BM) a yogic tool on non-specific mechanical neck pain and its clinical implication on pain, proprioception and functional abilities.

METHODS

It was a quasi-experimental pre -post study design involving 30 individuals from a software firm between the age group of 18-45 years. The conventional treatment group received standard physiotherapy regime and in the BM group BM was incorporated in addition to standard physiotherapy regime. Independent sample student t-test/Mann Whitney test were used to compare continuous variables between two groups. Paired sample test/Wilcoxon signed rank test were used for within groups.

RESULTS

There was a significant reduction in pain, improved functional abilities and proprioception in BM group when compared to conventional treatment group with 0.01 level of statistical significance.

CONCLUSION

It may be concluded that practice of BM had an added effect to conventional standard physiotherapy regime in reduction of pain, improvement of proprioception and functional abilities among individuals with chronic non-specific mechanical neck pain.

Effects of body-oriented yoga: a RCT study for patients with major depressive disorder

The major depressive disorder is one of the most common mental illnesses worldwide. Current treatment standards recommend a combined therapy with medication and psychotherapy. As an additive component and to further improvements in treatment, physical activity such as yoga may be integrated into conventional treatment. This study investigates the impact of a 3-month body-oriented yoga in patients with major depressive disorder (MDD). In total, n = 83 patients were included. An intervention group received a vigorous Ashtanga-Yoga three times a week. The waiting-list control group obtained a treatment as usual (TAU). As a primary outcome depression scores (Beck Depression Inventory-II (BDI-II), Montgomery Asberg Depression Rating Scale (MADRS)) were tested at three time points. Secondary outcome was the positive and negative affect [Positive and Negative Affect Scale (PANAS)] and remission rates. To analyze the data, multilevel models and effect sizes were conducted. The results showed an improvement in BDI-II scores for both groups over time [γ =  -  3.46, t(165) =  - 7.99, p < 0.001] but not between groups [γ = 0.98, t(164) = 1.12, p = 0.263]. An interaction effect (time x group) occurred for MADRS [γ = 2.10, t(164) = 2.10, p < 0.038]. Positive affects improved over time for both groups [γ = 1.65, t(165) = 4.03, p < 0.001]. Negative affects decreased for all over time [γ =  -  1.00, t(165) = - 2.51, p = 0.013]. There were no significant group differences in PANAS. Post hoc tests revealed a greater symptom reduction within the first 6 weeks for all measurements. The effect sizes for depression scores showed a positive trend. Remission rates indicated a significant improvement in the yoga group (BDI-II: 46.81%, MADRS: 17.02%) compared to the control group (BDI: 33.33%, MADRS: 8.33%). The findings suggest that there is a trendsetting additive effect of Ashtanga-Yoga after 3 months on psychopathology and mood with a greater improvement at the beginning of the intervention. Further research in this field can help to achieve more differentiated results.

Immediate Effects and Acceptability of an Application-Based Stretching Exercise Incorporating Deep Slow Breathing for Neck Pain Self-management

Objectives

This study evaluated the immediate effects and acceptability of a smartphone application named NeckProtector to promote neck pain self-management through stretching incorporating deep slow breathing, among smartphone users with neck pain.

Methods

One-hundred participants were recruited in the study. Participants were divided into two groups by block randomized allocation. The researchers gave the NeckProtector application to all participants for acceptability testing by navigation of the application for 20–30 minutes. Next, the treatment group (n = 50) conducted the exercise program via smartphone application for 15–20 minutes, while the control group (n = 50) rested for 20 minutes. Evaluations were performed at baseline and after intervention for pain intensity, muscle tension, pressure pain threshold (PPT), and cervical range of motion (CROM). Quantitative and qualitative feedback was then obtained by an acceptability survey and open-ended questionnaires.

Results

The immediate effects showed statistically significant improvements in pain intensity, muscle tension, PPT, and CROM in the treatment group in comparison to the control group. Participants reported a high level of acceptability through ratings on a Likert scale. The qualitative questionnaires received positive responses that the application was easy to use and the exercise program was useful to cope with neck pain.

Conclusions

NeckProtector can be an alternative treatment for neck pain self-management via smartphone application among smartphone users with neck pain. Further studies should examine the long-term effectiveness (Clinical trials registry: TCTR20160523001).

Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis

BACKGROUND

Chronic nonspecific neck pain (CNNP) has a high prevalence and is more common among younger people. Clinical practice suggests that yoga is effective in relieving chronic pain.

OBJECTIVES

This meta-analysis aimed to quantitatively summarize the efficacy of yoga for treating CNNP.

DATA SOURCES

We searched for trials in the electronic databases from their inception to January 2019. English databases including PubMed, MEDLINE, Cochrane Library, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Ind Med; Chinese databases including China National Knowledge Infrastructure (CNKI), WanFang Database, and VIP Information. We also conducted a manual search of key journals and the reference lists of eligible papers to identify any potentially relevant studies we may have missed. We placed no limitations on language or date of publication.

STUDY ELIGIBILITY CRITERIA

We included only randomized controlled trials (RCTs) and q-RCTs evaluating the effects of yoga on patients with CNNP. The primary outcomes for this review were pain and disability, and the secondary outcomes were cervical range of motion (CROM), quality of life (QoL), and mood.

PARTICIPANTS AND INTERVENTIONS

Trails that examined the clinical outcomes of yoga intervention in adults with CNNP compared with those of other therapies except yoga (e.g., exercise, pilates, usual care, et al) were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

Cochrane risk-of-bias criteria were used to assess the methodological quality, and RevMan 5.3 software was used to conduct the meta-analysis.

RESULTS

A total of 10 trials (n = 686) comparing yoga and interventions other than yoga were included in the meta-analysis. The results show that yoga had a positive effects on neck pain intensity (total effect: SMD = -1.13, 95% CI [-1.60, -0.66], Z = 4.75, P < .00001), neck pain-related functional disability (total effect: SMD = -0.92, 95% CI [-1.38, -0.47], Z = 3.95, P < .0001), CROM (total effect: SMD = 1.22, 95% CI [0.87, 1.57], Z = 6.83, P < .00001), QoL (total effect: MD = 3.46, 95% CI [0.75, 6.16], Z = 2.51, P = .01), and mood (total effect: SMD = -0.61, 95% CI [-0.95, -0.27], Z = 3.53, P = .0004).

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

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, we draw a very cautious conclusion that yoga can relieve neck pain intensity, improve pain-related function disability, increase CROM, improve QoL, and boost mood. This suggests that yoga might be an important alternative in the treatment of CNNP.

SYSTEMATIC REVIEW REGISTRATION NUMBER

Details of the protocol for this systematic review and meta-analysis were registered on PROSPERO and can be accessed at www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42018108992.

Add-on Effect Of Hot Sand Fomentation To Yoga On Pain, Disability, And Quality Of Life In Chronic Neck Pain Patients

BACKGROUND

Neck pain is one of the commonest complaints and an important public health problem across the globe. Yoga has reported to be useful for neck pain and hot sand has reported to be useful for chronic rheumatism. The present study was conducted to evaluate the add-on effect of hot sand fomentation (HSF) to yoga on pain, disability, quality of sleep (QOS) and quality of life (QOL) of the patients with non-specific neck pain.

MATERIALS AND METHODS

A total of 60 subjects with non-specific or common neck pain were recruited and randomly divided into either study group or control group. Both the groups have received yoga and sesame seed oil (Sesamum Indicum L.) application. In addition to yoga and sesame seed oil, study group received HSF for 15 min per day for 5-days. Assessments were taken prior to and after the intervention.

RESULTS

Results of the study showed a significant reduction in the scores of visual analogue scale for pain, neck disability index (NDI), The Pittsburgh Sleep Quality Index (PSQI), and a significant increase in physical function, physical health, emotional problem, pain, and general health both in study and control groups. However, reductions in pain and NDI along with improvement in social functions were better in the study group as compared with control group.

CONCLUSION

Results of this study suggest that addition of HSF to yoga provides a better reduction in pain and disability along with improvement in the social functioning of the patients with non-specific neck pain than yoga alone.

Integrative Medicine for the Treatment of Persistent Pain

Integrative health modalities can provide useful tools in the management of persistent pain in the primary care setting. These modalities, such as acupuncture, mind-body medicine, diet and herbs, and movement strategies can be safely used and may provide patients with hope and empowerment. It is highly recommended that the patient work alongside trained professionals for a given modality and/or an interprofessional team.

Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper

Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.

Effects of yogic exercise on nonspecific neck pain in university students

OBJECTIVE

To assess the effects of yogic exercise on nonspecific neck pain in university students.

METHODS

This study is a pretest-posttest design with a non-equivalent control group. Thirty-eight university students were selected by convenience sampling, with 18 assigned to an exercise group and 20 assigned to a control group. The yoga group participated in one-hour sessions of yogic exercise two days a week for eight weeks. The exercise comprised eight stages: relaxation, flexion of neck, extension of neck, right lateral flexion of neck, left lateral flexion of neck, right rotation of neck, left rotation of neck, and relaxation. Neck pain intensity was measured using a 100 mm visual analogue scale.

RESULTS

The yoga group showed significantly decreased neck pain scores compared with those of the control group.

CONCLUSIONS

These findings indicate that yogic exercises could reduce neck pain in university students.

A systematic review of yoga for major depressive disorder

BACKGROUND

The purpose of this review was to investigate the efficacy and safety of yoga interventions in treating patients with major depressive disorder.

METHODS

MEDLINE, Scopus, and the Cochrane Library were screened through December 2016. Randomized controlled trials (RCTs) comparing yoga to inactive or active comparators in patients with major depressive disorder were eligible. Primary outcomes included remission rates and severity of depression. Anxiety and adverse events were secondary outcomes. Risk of bias was assessed using the Cochrane tool.

RESULTS

Seven RCTs with 240 participants were included. Risk of bias was unclear for most RCTs. Compared to aerobic exercise, no short- or medium-term group differences in depression severity was found. Higher short-term depression severity was found for yoga compared to electro-convulsive therapy; remission rates did not differ between groups. No short-term group differences occurred when yoga was compared to antidepressant medication. Conflicting evidence was found when yoga was compared to attention-control interventions, or when yoga as an add-on to antidepressant medication was compared to medication alone. Only two RCTs assessed adverse events and reported that no treatment-related adverse events were reported.

LIMITATIONS

Few RCTs with low sample size.

CONCLUSIONS

This review found some evidence for positive effects beyond placebo and comparable effects compared to evidence-based interventions. However, methodological problems and the unclear risk-benefit ratio preclude definitive recommendations for or against yoga as an adjunct treatment for major depressive disorder. Larger and adequately powered RCTs using non-inferiority designs are needed.