A pilot study of the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease

Nitya Bakshi, Anthony Cooley, Diana Ross, Lauren Hawkins, Marlysa Sullivan, Rachel Astles, Cynthia Sinha, Deeksha Katoch, Manasa Peddineni, Beatrice E Gee, Peter A Lane, Lakshmanan Krishnamurti, Nitya Bakshi, Anthony Cooley, Diana Ross, Lauren Hawkins, Marlysa Sullivan, Rachel Astles, Cynthia Sinha, Deeksha Katoch, Manasa Peddineni, Beatrice E Gee, Peter A Lane, Lakshmanan Krishnamurti

Abstract

Objectives: To determine the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease.

Design and setting: In Part A of this two-part study, adolescents with SCD and chronic pain (Group 1) and their parent (Group 2) completed a survey designed to capture pain characteristics, attitudes and practices related to yoga, and potential acceptability of a yoga program. In Part B, the study assessed the feasibility and safety of an instructor-led group yoga program. The study was registered on clinicaltrials.gov (NCT03694548).

Intervention: Eight instructor-led group yoga sessions.

Main outcome measures: Feasibility and safety outcomes were chosen a priori, as follows: 1) Proportion of adolescent patients with SCD and chronic pain approached that consent to participate in Part A, 2) Proportion of adolescent participants enrolled in Part A that consent to participate in Part B, 3) Proportion of participants enrolled in Part B that attend at least 6 of 8 yoga sessions, 4) Proportion of participants enrolled in Part B with an ED visit or a hospitalization for pain within 24 h of completion of each yoga session, 5) Proportion of participants in Part B who complete all study assessments before, and at the end of the yoga program, 6) Adherence to submission of pain diary.

Results: The median age of 15 patient participants in Part A was 16 (IQR 14-17), and 14 parents was 43.5 (IQR 42-51). Most participants were female. Most participant responses indicated a positive opinion of yoga. Nine adolescents (60 %) from Part A participated in Part B of the study. The median age of 9 participants in Part B was 17 (IQR 15-18), and 5 of the 9 participants were female (53.3 %). Only one participant was able to attend 3 of the 8 yoga sessions offered, and did not experience any ED visits or hospitalizations following the yoga sessions. None of the other feasibility endpoints were met in this study.

Conclusions: Patients with SCD and chronic pain overall have a positive opinion of yoga, but there are challenges with recruitment and retention of participants in a clinical trial of yoga, and barriers to feasibility of an in-person group yoga intervention.

Keywords: Chronic pain; Clinical trial; Feasibility; Sickle cell; Yoga.

Conflict of interest statement

CONFLICT OF INTEREST

The author(s) declare that they have no conflicts of interest.

Copyright © 2021. Published by Elsevier Ltd.

Figures

Figure 1:
Figure 1:
Screening and Enrollment Schema

References

    1. Sil S, Cohen LL, Dampier C. Psychosocial and Functional Outcomes in Youth With Chronic Sickle Cell Pain. Clin J Pain 2016;32:527–533.
    1. Taylor LE, Stotts NA, Humphreys J, Treadwell MJ, Miaskowski C. A review of the literature on the multiple dimensions of chronic pain in adults with sickle cell disease. J Pain Symptom Manage 2010;40:416–435.
    1. Bakshi N, Ross D, Krishnamurti L. Presence of pain on three or more days of the week is associated with worse patient reported outcomes in adults with sickle cell disease. J Pain Res 2018;11:313–318.
    1. Carroll CP. Opioid treatment for acute and chronic pain in patients with sickle cell disease. Neurosci Lett 2020;714:134534.
    1. Carroll CP, Lanzkron S, Haywood C Jr., et al. Chronic Opioid Therapy and Central Sensitization in Sickle Cell Disease. Am J Prev Med 2016;51:S69–77.
    1. Baldini A, Von Korff M, Lin EH. A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide. Prim Care Companion CNS Disord 2012;14.
    1. Yi P, Pryzbylkowski P. Opioid Induced Hyperalgesia. Pain Med 2015;16 Suppl 1:S32–36.
    1. Section On Integrative Medicine. Mind-Body Therapies in Children and Youth. Pediatrics 2016;138.
    1. Black LI, Clarke TC, Barnes PM, Stussman BJ, Nahin RL. Use of complementary health approaches among children aged 4–17 years in the United States: National Health Interview Survey, 2007–2012. Natl Health Stat Report 2015:1–19.
    1. Tsao JC, Meldrum M, Kim SC, Jacob MC, Zeltzer LK. Treatment Preferences for CAM in children with chronic pain. Evid Based Complement Alternat Med 2007;4:367–374.
    1. 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;166:493–505.
    1. Chang DG, Holt JA, Sklar M, Groessl EJ. Yoga as a treatment for chronic low back pain: A systematic review of the literature. J Orthop Rheumatol 2016;3:1–8.
    1. Williams K, Abildso C, Steinberg L, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976) 2009;34:2066–2076.
    1. Curtis K, Osadchuk A, Katz J. An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia. J Pain Res 2011;4:189–201.
    1. Cheung C, Wyman JF, Bronas U, McCarthy T, Rudser K, Mathiason MA. Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int 2017;37:389–398.
    1. Cramer H, Lauche R, Hohmann C, Langhorst J, Dobos G. Yoga for chronic neck pain: a 12-month follow-up. Pain Med 2013;14:541–548.
    1. Cramer H, Lauche R, Haller H, Langhorst J, Dobos G, Berger B. “I’m more in balance”: a qualitative study of yoga for patients with chronic neck pain. J Altern Complement Med 2013;19:536–542.
    1. Zeidan F, Gordon NS, Merchant J, Goolkasian P. The effects of brief mindfulness meditation training on experimentally induced pain. J Pain 2010;11:199–209.
    1. Bushnell MC, Case LK, Ceko M, et al. Effect of environment on the long-term consequences of chronic pain. Pain 2015;156 Suppl 1:S42–49.
    1. Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis. Psychoneuroendocrinology 2017;86:152–168.
    1. Cotton VA, Low LA, Villemure C, Bushnell MC. Unique Autonomic Responses to Pain in Yoga Practitioners. Psychosom Med 2018;80:791–798.
    1. Hofmann SG, Andreoli G, Carpenter JK, Curtiss J. Effect of Hatha Yoga on Anxiety: A Meta-Analysis. J Evid Based Med 2016;9:116–124.
    1. Danhauer SC, Addington EL, Sohl SJ, Chaoul A, Cohen L. Review of yoga therapy during cancer treatment. Support Care Cancer 2017;25:1357–1372.
    1. Moody K, Abrahams B, Baker R, et al. A Randomized Trial of Yoga for Children Hospitalized With Sickle Cell Vaso-Occlusive Crisis. J Pain Symptom Manage 2017.
    1. Sinha CB, Bakshi N, Ross D, Krishnamurti L. Management of Chronic Pain in Adults Living With Sickle Cell Disease in the Era of the Opioid Epidemic: A Qualitative Study. JAMA Netw Open 2019;2:e194410.
    1. Levenson JL, McClish DK, Dahman BA, et al. Depression and anxiety in adults with sickle cell disease: the PiSCES project. Psychosom Med 2008;70:192–196.
    1. Ameringer S, Elswick RK Jr., Smith W. Fatigue in adolescents and young adults with sickle cell disease: biological and behavioral correlates and health-related quality of life. J Pediatr Oncol Nurs 2014;31:6–17.
    1. Dampier C, Palermo TM, Darbari DS, Hassell K, Smith W, Zempsky W. AAPT Diagnostic Criteria for Chronic Sickle Cell Disease Pain. J Pain 2017;18:490–498.
    1. McCracken LM, Gauntlett-Gilbert J, Eccleston C. Acceptance of pain in adolescents with chronic pain: validation of an adapted assessment instrument and preliminary correlation analyses. Eur J Pain 2010;14:316–320.
    1. Amtmann D, Cook KF, Jensen MP, et al. Development of a PROMIS item bank to measure pain interference. Pain 2010;150:173–182.
    1. PROMIS Pain Intensity [online]. Available at: . Accessed 11 November 2020.
    1. Reeve BB, Edwards LJ, Jaeger BC, et al. Assessing responsiveness over time of the PROMIS((R)) pediatric symptom and function measures in cancer, nephrotic syndrome, and sickle cell disease. Qual Life Res 2018;27:249–257.
    1. Dampier C, Barry V, Gross HE, et al. Initial Evaluation of the Pediatric PROMIS(R) Health Domains in Children and Adolescents With Sickle Cell Disease. Pediatr Blood Cancer 2016;63:1031–1037.
    1. Woby SR, Roach NK, Urmston M, Watson PJ. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 2005;117:137–144.
    1. Crombez G, Bijttebier P, Eccleston C, et al. The child version of the pain catastrophizing scale (PCS-C): a preliminary validation. Pain 2003;104:639–646.
    1. Jones SM, Lange J, Turner J, et al. Development and Validation of the EXPECT Questionnaire: Assessing Patient Expectations of Outcomes of Complementary and Alternative Medicine Treatments for Chronic Pain. J Altern Complement Med 2016;22:936–946.
    1. Wilkie DJ, Molokie R, Boyd-Seal D, et al. Patient-reported outcomes: descriptors of nociceptive and neuropathic pain and barriers to effective pain management in adult outpatients with sickle cell disease. J Natl Med Assoc 2010;102:18–27.
    1. Tran ST, Guite JW, Pantaleao A, et al. Preliminary Outcomes of a Cross-Site Cognitive-Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia. Arthritis Care Res (Hoboken) 2017;69:413–420.
    1. Selhorst M, Fernandez-Fernandez A, Schmitt L, Hoehn J. Adolescent psychological beliefs, but not parent beliefs, associated with pain and function in adolescents with patellofemoral pain. Phys Ther Sport 2020;45:155–160.
    1. Pells J, Edwards CL, McDougald CS, et al. Fear of movement (kinesiophobia), pain, and psychopathology in patients with sickle cell disease. Clin J Pain 2007;23:707–713.
    1. Wallace DP, Harbeck-Weber C, Whiteside SP, Harrison TE. Adolescent acceptance of pain: confirmatory factor analysis and further validation of the chronic pain acceptance questionnaire, adolescent version. J Pain 2011;12:591–599.
    1. Matthie N, Jenerette C, Gibson A, Paul S, Higgins M, Krishnamurti L. Prevalence and predictors of chronic pain intensity and disability among adults with sickle cell disease. Health Psychol Open 2020;7:2055102920917250.
    1. Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol 2014;69:119–130.
    1. Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv 2020;4:2656–2701.
    1. Burke A, Nahin RL, Stussman BJ. Limited Health Knowledge as a Reason for Non-Use of Four Common Complementary Health Practices. PLoS One 2015;10:e0129336.
    1. Middleton KR, Ward MM, Haaz S, et al. A pilot study of yoga as self-care for arthritis in minority communities. Health Qual Life Outcomes 2013;11:55.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する