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Tai Chi Improves Fibromyalgia Pain
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Tai chi mind-body interventions resulted in comparable or greater improvements in pain symptoms than traditional aerobic exercise, the most commonly prescribed nonpharmacological treatment, among patients with fibromyalgia, according to findings published in the BMJ.
“We are in the middle of a crisis — the opioid epidemic,” Chenchen Wang, MD, MSc, of the Tufts University School of Medicine and the Tufts Medical Center, told Healio Rheumatology. “Patients with chronic widespread pain often try many different types of pain medications, antidepressants, physical therapy and other approaches, and commonly find that none of these therapies work for them. Clinicians currently lack sufficient treatment options for managing pain safely and effectively. Finding safe, effective approaches for pain management is an urgent priority.”
To analyze the effectiveness of tai chi compared with aerobic exercise, and to determine whether dosage and duration influence its effects among patients with fibromyalgia, the researchers conducted a prospective, randomized, single-blind study at Tufts Medical Center. The 52-week trial included 226 adult patients with fibromyalgia.
Among the participants, 75 were randomly assigned to receive supervised aerobic exercise, conducted twice weekly for 24 weeks. The remaining 151 patients were randomly placed into one of four tai chi groups, which practiced the intervention either once or twice weekly, for either 12 or 24 weeks. The primary endpoint was a change in the revised fibromyalgia impact questionnaire scores at 24 weeks, compared with baseline. Secondary outcomes included changes in scores related to global assessment, anxiety, depression, self-efficacy, coping strategies, physical function, functional limitation, sleep and quality of life.
According to Wang and colleagues, the patients’ questionnaire scores improved in all five treatment groups. However, the improvements demonstrated in the combined tai chi groups were significantly greater than those reported among those who practiced traditional aerobic exercise, with a 5.5-point difference in fibromyalgia impact questionnaire scores between the groups (95% CI, 0.6-10.4; P = .03). In addition, tai chi produced greater benefits at 24 weeks than aerobic workout when practiced with the same intensity and duration (16.2-point difference; 95% CI, 8.7-23.6; P < .001). Patients who practiced tai chi for 24 weeks showed greater improvements than those who practiced it for 12 weeks (9.6-point difference; 95% CI, 2.6-16.6; P = .007). However, there was no significant increase in benefit for patients who received tai chi twice weekly compared with once weekly.
“Previous evidence suggested that tai chi, a multidimensional mind-body practice that integrates physical, psychosocial and behavioral elements, may be especially suited to address both chronic pain and associated psychological and somatic symptoms,” Wang said. “We also found these therapeutic benefits were consistent across a diverse group of patients regardless of who the tai chi instructor was. This suggests that the intervention can be delivered in a wide variety of settings by appropriately trained instructors.” – by Jason Laday
Disclosure: The researchers report funding from the NIH.
Perspective
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Eileen J. Lydon, MA, RN, ANP-BC
Although aerobic exercise is recommended as part of treatment guidelines, it can be difficult for some patients with fibromyalgia to adhere to or even participate in due to pain and/or other physical or psychological limitations; therefore, it is important to study other exercise options.
Wang and colleagues explored the effectiveness of tai chi interventions compared with aerobic exercise, and found greater improvement of fibromyalgia symptoms in the tai chi groups — benefits which increased the longer one participated. This study’s main strengths were that it was a large cohort comprised of patients with a variety of disease manifestations, and yet no adverse events were reported.
Tai chi is a low impact activity that puts minimal stress on joints and therefore safe for many patients, especially those with injuries, which may increase adherence. Another exciting observation was the reduction in the use of analgesics among all groups; future investigations of this intervention may lead to further improved outcomes by decreasing opioid use.
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