Mini Review

Unlocking the Healing Power of Integrative Tele-Yoga Therapy: A Mini Review

Jacob Hascalovici MD, PhD*^1,2,4-7, Cyan James PhD¹, MFA, Joanne Wu MD^2,8, MBA, E-RYT, Amaresh Vydyanathan MBBS^1-3,5-7

¹Clearing.com (Relief Labs Inc.)

²Relief Medical Group P.A

³Multidisciplinary Pain Program, Montefiore Medical Center

⁴Saul R. Korey Department of Neurology

⁵The Arthur S. Abramson Department of Physical Medicine and Rehabilitation

⁶Department of Anesthesiology

⁷Albert Einstein College of Medicine, Bronx, NY

⁸Department of Health Humanities and Bioethics, University of Rochester Medical Center

Corresponding Author

Jacob Hascalovici MD, PhD, Jacob R. Hascalovici MD, PhD, 50 West 72nd Street, Suite 1002 NY, New York, 10025.

Received Date: January 31, 2023;  Published Date:February 14, 2023

Introduction

Affecting 50 to 100 million adults across the US, chronic pain is an extremely common condition that is often profoundly debilitating. Defined as pain that persists longer than three months, chronic pain can deeply and negatively impact a patient’s quality of life, affecting their mood, sleep, relationships, and ability to work. It is linked with anxiety, depression, loss of mobility, loss of function and reduced productivity. Furthermore, chronic pain and stress can lead to various forms of dependence, including opioid dependence and use disorder [1]. This chronic disease can require costly, complex, and lengthy treatment, which is complicated by the fact that there are fewer than 7,000 pain specialists, most of whom cluster in large cities or along the coasts. Annually, chronic pain costs the country up to $635 billion [2].

A traditional biomedical approach to treating chronic pain involves topicals and prescription oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, anticonvulsants, antidepressants, and in some cases, opioids. An integrative biopsychosocial model has recently been gaining clinical popularity, since it combines medication with modalities such as physical therapy, chiropractic, massage, acupuncture, psychological support, and other tenets of lifestyle medicine that work together while avoiding many of the side-effects of medication or interventional-only approaches. Yoga and yoga therapy belong squarely within the biopsychosocial model of care, particularly since they combine exercise with scientifically grounded complementary approaches such as mindfulness.

Originating some 2000 years ago in India, the foundation of yoga consists of physical postures (asanas), breathing exercises (pranayama), meditation, and other mindfulness and movement techniques. The worldwide study and practice of yoga also often includes learning about yoga philosophy such as yamas (restraints) and niyamas (observances) [3]. In the U.S., people frequently practice yoga for fitness, stress management, and overall well-being. However, a more targeted, goal-directed modality of yoga, yoga therapy, focuses on how to utilize yoga for healing and rehabilitation. According to the educational standards of the International Association of Yoga Therapists (IAYT), yoga therapy is the process of empowering individuals to progress toward improved health and wellbeing through the application of the teachings and practices of yoga [3]. This tailored approach usually involves focusing on specific poses that promote recovery or address stiffness or muscle loss; props and pose modifications are also commonly used. Moreover, by encouraging more understanding and practice of yoga philosophies to maximize the therapeutic power of the mind/body connection, outcomes, including outcomes for pain management, can be transformative.

Both yoga and yoga therapy can give patients powerful tools to better manage their pain. The literature to date shows that yoga can effectively address multiple forms of chronic pain, improve concentration, enhance mindfulness, and instill a heightened sense of calm. With the recent sweeping advances in digital healthcare technologies, yoga therapy advances could offer people living with chronic pain even more powerful, targeted benefits conveyed to them directly in their living spaces for greater convenience, compliance, and feasibility.

The intersection of chronic pain, yoga therapy, and telehealth, could in fact, be a “sweet spot” for pioneering clinical practitioners who wish to expand their patient offerings and provide better, more holistic care. To enhance our understanding of this promising nexus, we performed a mini literature review of research work focusing on chronic pain, yoga therapy, and telehealth.

A recent pilot study by Sharma et al. in which researchers led twice weekly tele-yoga sessions found that patients reported significant improvements in their scores for pain intensity, pain disability, and anxiety and depression [4]. Schulz-Heik et al. demonstrated that yoga delivered via telehealth dropped the pain scores of military veterans while also improving their mental health and energy levels [5]. The same group also compared the outcomes of yoga sessions led in-person to yoga via telehealth and found no significant difference in pain outcomes among participants, suggesting that the benefits conveyed by tele-yoga are not inferior to in-person sessions [5]. Other studies have examined the use of tele-yoga to reach patients who lack ready clinical access – in these cases, tele-yoga has been shown to effectively address chronic pain while also improving access to care [6].

Taken together, these results are meaningful because chronic pain can reach beyond physical impacts to also affect a person’s mind, body, spiritual and social wellbeing, often leading to anxiety and depression, which can in turn exacerbate pain. Consequently, treatments that simultaneously improve multiple pain-related conditions are advisable from the perspective of being both efficient and effective. Telehealth expands the scope of yoga therapy in practice, spreading benefits even farther. We found, in short, that yoga therapy is indeed a promising pain management modality that can be successfully offered via telehealth to achieve better patient outcomes. These findings build on a larger body of literature that demonstrates yoga’s overall effectiveness at helping manage chronic pain. As the field of yoga therapy and telehealth advances, we foresee the development of more integrative, specialized, digitally based programs, interfaces, apps and other offerings to enable patients to reap fuller and more sustained benefits from therapeutic yoga modalities.

While initial results are promising and point to the need for further studies, certain limitations exist. Among these are the heterogeneity of studies researching tele-yoga and yoga therapy – many types of yoga and yoga therapy exist and are used in various studies, making it difficult to compare studies head-to-head. Yoga therapy also does not lend itself as readily as certain other treatments to RCTs, and so RCTs involving yoga therapy are still relatively rare. This results in research on yoga not infrequently being viewed as of lower scientific robustness than studies that incorporate RCTs for chronic pain treatments [7]. Relatively small sample sizes may also limit the generalizability of some findings.

Given telehealth advances that are helping transform complex chronic disease management in areas such as chronic pain, there is a lot of potential for the future growth of integrating yoga therapy. Furthermore, these holistic techniques can help people become more aware and more receptive to their own thoughts, feelings, and emotions, which can be healing for individuals who are suffering, especially when these recommendations are paired with the guidance of expert clinicians. At Clearing.com, we are already starting to lay the groundwork for incorporating treatments such as yoga therapy as part of offering whole-body care customized to each patient’s needs. We see this type of innovative, integrative care as a valuable way to continue revolutionizing pain management by combining the best of traditional therapies with advanced technology to best serve patients in pain.

Acknowledgment

None.

Conflict of Interest

No conflict of interest.

References

1. Volkow ND, McLellan AT (2016) Opioid abuse in chronic pain-misconceptions and mitigation strategies. New England Journal of Medicine 374(13): 1253-1263.
2. Gaskin DJ, Richard P (2012) The economic costs of pain in the United States. J Pain 13(8): 715-724.
3. Horovitz EG, Elgelid S (2015) Yoga therapy: Theory and practice: Routledge.
4. Sharma N, Modi D, Nathwani A, Pandya B, Joshi J (2020) Tele-yoga therapy for patients with chronic pain during COVID-19 lockdown: a prospective nonrandomized single arm clinical trial.
5. Schulz-Heik RJ, Meyer H, Mahoney L, Stanton MV, Cho RH (2017) Results from a clinical yoga program for veterans: yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga. BMC Complementary and Alternative Medicine 17(1): 1-9.
6. Baker JH (2018) Tele-yoga for Chronic Pain: A Management Therapy for the Future? Integrative Medicine Alert v. 21(9).
7. James-Palmer A, Anderson EZ, Daneault J-F (2022) Remote Delivery of Yoga Interventions Through Technology: Scoping Review. Journal of medical Internet research 24(6): e29092.