Yoga for warriors: An intervention for veterans with comorbid chronic pain and PTSD.

Abstract

Objective: Comorbid chronic pain and posttraumatic stress disorder (PTSD) is common in veterans; this comorbidity is associated with increased severity and poorer prognosis when compared to each outcome alone. Yoga has been shown to be effective for chronic pain and promising for PTSD, but yoga for comorbid pain and PTSD has not been examined. This article offers empirical support for a yoga intervention for comorbid chronic pain and PTSD in a veteran population. Method: Results are presented from a 4-year pilot yoga intervention for comorbid chronic pain and PTSD at a large, urban Veterans Affairs Medical Center. Based on the fear avoidance model of pain, the intervention used a cross-sectional, open-trial design with pre-and postmeasures. T test analyses were conducted on program completers (N ϭ 49; out of 87 initially enrolled, 44% attrition rate), who were primarily African American (69%) and male (61%) and had a mean age of 51.41 years (SD ϭ 11.32). Results: Results indicated trend-level reductions in overall PTSD symptoms, as measured by the PTSD Checklist for DSM-5 (p ϭ .02, d ϭ 0.38) and in symptom cluster scores of negative alterations of cognitions and mood (p ϭ .03, d ϭ 0.36) and arousal and reactivity (p ϭ .03, d ϭ 0.35). Veterans reported significant improvement in ability to participate in social activities (p Ͻ .001, d ϭ 0.44) and significant reductions in kinesiophobia (fear of movement or physical activity; p Ͻ .001, d ϭ 0.85). On a satisfaction measure with a range of 1 (quite dissatisfied) to 4 (extremely satisfied), the mean rating was 3.74 (SD ϭ 0.33). Conclusion:Yoga is a feasible and effective intervention for veterans with comorbid chronic pain and PTSD. Clinical Impact StatementThis study offers support for the benefits of yoga for veterans who have both chronic pain and posttraumatic stress disorder (PTSD). Although prior studies have demonstrated improvements in chronic pain or PTSD, this is the first to consider the effects of yoga when both conditions are present. After the intervention, veterans reported reductions in PTSD symptoms, less fear of physical activity, and improved ability to participate in activities with family and friends. Veterans also reported high levels of satisfaction with the program, suggesting it may be possible to use yoga more widely with veterans who have both chronic pain and PTSD.

Exercise to Reduce Posttraumatic Stress Disorder Symptoms in Veterans

“…25 In a study with 34 veterans, Chopin and colleagues found that a trauma-informed yoga intervention was associated with a statistically significant reduction in PTSD symptoms, as did a study by Zaccari and colleagues with 17 veterans. 26,29 Justice and Brems also found some evidence that trauma-informed yoga interventions helped PTSD symptoms in a small sample of 4 veterans, although these results were not quantitatively analyzed. 27 In contrast, a small pilot study (n = 12) by Staples and colleagues testing a biweekly, 6-week yoga program did not show a significant effect on PTSD symptoms.…”

“…18,[25][26][27][28][29] Participants consisted of veterans with chronic pain, post-9/11 veterans, female veterans of childbearing age, veterans with a history of trauma therapy, and other veterans. Types of exercise included moderate aerobic exercise and yoga.…”

Enhancing Access to Yoga for Older Male Veterans After Cancer: Examining Beliefs About Yoga

“…18 It may also be useful to offer yoga interventions taught by older veterans, such as in Veteranto-Veteran programs, and veteran-specific resources available through VHA Whole Health program. 24,26,27 Researchers should consider interventions that address investigator reluctance to include older adults in clinical trials, including comorbidities, ageism, and practical barriers. 39 These considerations may be especially applicable now that research on the efficacy of yoga has matured and effectiveness studies are now needed.…”

“…[21][22][23] Yoga has been increasingly studied within the Veterans Health Administration (VHA) for treatment of posttraumatic stress disorder (PTSD) and has been found effective in reducing symptoms through the use of traumainformed and military-relevant instruction as well as a military veteran yoga teacher. [24][25][26] This work has not targeted older veterans or cancer survivors who may be more difficult to recruit into such programs, but who would nevertheless benefit.…”

Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery.

“…This study's preliminary results add to the growing empirical evidence on TIWT as a complementary treatment for youth with trauma histories. Chopin et al (2020) present the results of a 4-year pilot study, examining the use of yoga for comorbid chronic pain and PTSD symptoms in veterans. Their study is the first research study to consider the effects of yoga on individuals presenting both chronic pain and PTSD simultaneously.…”