Tai chi complements holistic pain management

With Professor Wei-Zen Sun  |  8 Oct 2014  |  Print

Tai chi complements holistic pain management

The practice of tai chi eases the physical, mental and emotional symptoms of chronic pain, says a pain expert.

Professor Wei-Zen Sun of the Department of Anesthesiology, National Taiwan University Hospital, Taiwan said that tai chi has been documented as providing additional relief to patients with fibromyalgia and other chronic pain disorders. He explained that prescription pain medications are important, but may not comprehensively relieve pain-related co-morbidities like functional impairment, sleep disturbances and mood disorders.

“Alternative pain modalities are required to fill the missing gaps in pain management,” he said in a recent interview.

Tai chi is an ancient Chinese martial art known for its graceful, low impact movements. It provides aerobic, moderate-intensity activity, regardless of age or gender.[1] During practice, researchers found that heart rates of 15 male practitioners were 58% of the heart rate reserve and oxygen uptake  VO2 was 55% of peak oxygen uptake.[2]

Why tai chi?

Traditionally, pain was managed with a combination of physiotherapy and bed rest. Bed rest is no longer promoted in chronic pain because prolonged immobility is associated with declining health and worsening of symptoms, noted Professor Sun.

“Now, you need to work on strengthening your muscles as well,” he said. Nonetheless, undertaking physical exercise requires strong personal will, he explained. Pain can be a strong deterrent. Tai chi is easier to promote because patients are more receptive to its additional spiritual and psychological benefits.

Tai chi for fibromyalgia management

A single-blind, randomized trial of 66 patients with fibromyalgia compared the impact of tai chi on Fibromyalgia Impact Questionnaire (FIQ) scores with that of wellness education and stretching. Patients who were enrolled in the tai chi group underwent 60-minute sessions twice a week.[3]

After 12 weeks, FIQ scores declined:

  • 62.9±15.5 (at baseline) to 35.1±18.8 in the tai chi group
  • 68.0±11 (at baseline) to 58.6±17.6 in the control group

Baseline change in the tai chi group versus change in the control group was -18.4 points (p<0.001).[3]

“[Tai chi-inspired] lifestyle changes can complement pharmacological interventions and other modalities in the management of fibromyalgia,” said Professor Sun.

Another 12-week trial of 101 patients reported that when compared with educational control, a 90-minute, biweekly tai chi program improved:[4]

  • FIQ scores (16.5 vs 3.1, p=0.0002)
  • Brief Pain Inventory (BPI) pain severity (1.2 vs 0.4, p=0.0008)
  • BPI pain interference (2.1 vs 0.6, p=0.0000)
  • Sleep (2.0 vs -0.03, p=0.0003)
  • Self-efficacy for pain control (9.2 vs -1.5, p=0.0001)

In a review of fibromyalgia guidelines from Canada, Germany and Israel, authors noted a common theme of individualized treatment and self-management strategies encompassing exercise and psychological techniques. The German and Israeli guidelines in particular, highlighted the benefits of tai chi for patients. [5]

Tai chi for other chronic pain conditions

Tai chi is being investigated in other chronic pain conditions. A randomized control trial in patients with persistent nonspecific low back pain showed that a 10-week tai chi program reduced bothersome back symptoms, pain intensity and improved self-reported disability.[6]

In knee osteoarthritis, there are suggestions that tai chi may help relieve disease-related pain,[7] even in older patients with cognitive impairment.[8]

Cancer is another area of investigation. One publication suggested that tai chi relieves treatment side effects, improves cognitive and physical function along with quality-of-life in cancer survivors.[9]

Supporting patients in tai chi programs

Some doctors may not be enthused with tai chi, as they fear that it may affect the treatment objectives. However, Professor Sun stressed that the practice of tai chi should always comply with the standard of care in pain management at healthcare institutions.

As part of a program with his hospital’s Department of Complementary Medicine, patients are offered tai chi classes that are structured to accommodate limitations of their age and disease. The pace of these small group classes is tailored to patients’ capabilities.

Besides creating a shared experience, these classes provide members with the support and motivation to maintain tai chi principles in their daily lives. These patient groups are also enrolled in trials to monitor outcomes following prolonged tai chi practice.

“Even after 12 weeks, you see dramatic differences in these patients,” he commented. “My approach as a clinician is that you need to measure improvements to convince [other] clinicians and patients of tai chi’s benefits.”

In conclusion, Professor Sun believes that tai chi can complement standard of care in pain management. As part of a healthy lifestyle and adjunct to standard medical treatment, tai chi can be beneficial to people with chronic pain, helping them lead healthier and more active lives.

References:

1. Lan C, Chen SY, Lai JS. The exercise intensity of Tai Chi Chuan. Med Sport Sci 2008;52:12-19.
2. Lan C, et al. Heart rate responses and oxygen consumption during Tai Chi Chuan practice. Am J Chin Med 2001;29:403-410.
3. Wang C, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med 2010;363:743-754.
4. Jones KD, et al. A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clin Rheumatol 2012;31:1205-1214.
5. Ablin J, et al. Treatment of fibromyalgia syndrome: Recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evid Based Complement Alternat Med 2013;2013:485-272.
6. Hall AM, et al. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res (Hoboken) 2011;63:1576-1583.
7. Ye J, et al. Effects of tai chi for patients with knee osteoarthritis: a systemic review. J Phys Ther Sci 2014;26:1133-1137.
8. Tsai PF, et al. A pilot cluster randomized trial of a 20-week tai chi program in elders with cognitive impairment and osteoarthritic knee: effects on pain and other health outcomes. J Pain Symptom Manage 2013;45:660-669.
9. Mustian KM, et al. Exercise recommendations for cancer-related fatigue, cognitive impairment, sleep problems, depression, pain, anxiety, and physical dysfunction: a review. Oncol Hematol Rev 2012;8:81-88.

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