Tai chi as good as or better than aerobic exercise for managing chronic pain

A graphic abstract to accompany The BMJ research paper: Tai chi as good as or better than aerobic exercise for managing chronic pain Credit: The BMJ

The ancient martial art of tai chi has similar or greater benefits than aerobic exercise for people with the chronic pain condition fibromyalgia, finds a trial published by The BMJ today.
The findings suggest it may be time to rethink what type of exercise is most effective for patients with chronic pain conditions.

22 mar 2018--Fibromyalgia is a long-term condition that causes widespread body pain. It may also lead to extreme tiredness, muscle stiffness, difficulty sleeping and depression. It affects around 2-4% of the adult population worldwide.
Aerobic exercise is currently recommended as a standard treatment, but many patients find it difficult to exercise due to fluctuations in symptoms.
Some trials have suggested that tai chi alleviates pain and improves physical and mental health in patients with fibromyalgia but concluded that larger and more rigorous trials are needed to confirm the results.
So to investigate further, a team of US researchers set out to compare the effectiveness of tai chi with aerobic exercise and to test whether this depends on its frequency or duration.
They identified 226 adults with fibromyalgia who had not participated in tai chi or other similar types of complementary and alternative medicine within the past six months. The average age of participants was 52 years, 92% were women, 61% were white, and average duration of body pain was nine years.
At the start of the trial, participants completed the fibromyalgia impact questionnaire (FIQR), which scores physical and psychological symptoms such as pain intensity, physical function, fatigue, depression, anxiety, and overall wellbeing.
Participants were then randomly assigned to either supervised aerobic exercise twice weekly for 24 weeks or to one of four tai chi interventions: 12 or 24 weeks of supervised tai chi completed once or twice weekly.
Changes in symptom scores were assessed at 12, 24 and 52 weeks and participants were able to continue routine drugs and usual visits to their physicians throughout the trial.
FIQR scores improved in all five treatment groups at each assessment, but the combined tai chi groups improved significantly more than the aerobic exercise group at 24 weeks. Tai chi also showed greater benefit when compared with aerobic exercise of the same intensity and duration (twice weekly for 24 weeks).
Those who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks, but there was no significant increase in benefit for those who received tai chi twice weekly compared with once weekly.
The effects of tai chi were consistent across all instructors and no serious adverse events related to the interventions were reported. The findings also remained largely unchanged after further analyses to test the strength of the results.
The researchers point to several study limitations. For example, participants were aware of their treatment group assignment, and attendance differed between the two treatment groups, both of which could have influenced the results. However, key strengths include the large and diverse sample and longer follow-up than previous studies.
"Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia," write the authors. "This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia," they conclude.
In a linked opinion article, lead researcher Dr Chenchen Wang, says the public health problem of chronic pain calls for an "all hands on deck" approach to give patients feasible therapeutic options for the management of fibromyalgia. "It is time, therefore, for physicians to explore new approaches and rethink their strategies in order to provide the best care for patients with chronic pain conditions."
In a second opinion article, Amy Price, a trauma survivor with chronic pain, describes how tai chi has helped improve her balance, reduce anxiety, and manage pain.
She acknowledges that tai chi does not work for everyone with fibromyalgia, but says the advantage is that "it is low risk and minimally invasive, unlike surgery, and it will not harm your organs, like long term drug use." And there is also the chance that it might complement other interventions to help your body work better, she concludes.

More information: Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial, www.bmj.com/content/360/bmj.k851
Opinion: Time to rethink exercise for fibromyalgia care, blogs.bmj.com/bmj/2018/03/21/c … r-fibromyalgia-care/
Opinion: The unintended consequences of tai chi for fibromyalgia, blogs.bmj.com/bmj/2018/03/21/a … hi-for-fibromyalgia/


Provided by British Medical Journal

ACR: Pregabalin Soothes Fibromyalgia Pain in Randomized Trial

BOSTON, Nov. 11 -- Pain associated with fibromyalgia can be effectively relieved by pregabalin (Lyrica), reported investigators here.
In a placebo-controlled trial, patients randomly assigned to receive one of three doses of pregabalin reported pain relief at one week and continuing at nearly all time points at all dose levels through 14 weeks, Erdal Diri, M.D., of the Trinity Health Center-Medical Arts in Minot, North Dakota, told attendees at the American College of Rheumatology meeting.
"Pregabalin monotherapy demonstrated clinically meaningful symptomatic relief of fibromyalgia," said Dr. Diri.
Pregabalin was approved by the FDA for the treatment of fibromyalgia earlier this year, and is currently the only drug with an approved indication for the complex disorder.
Dr. Diri and colleagues conducted a randomized, double-blind, placebo-controlled trial in 745 patients with fibromyalgia meeting American College of Rheumatology criteria, which include a pain visual analog scale score of 40 mm or greater on a 0 to 100 mm scale, and a less than 30% reduction in pain VAS score during a one-week single-blind placebo run-in phase.
After the run-in, patients were randomly assigned to received placebo or pregabalin in doses of 300, 450, or 600 mg/d, delivered twice a day in divided doses, for 14 weeks, including a two-week dosage escalation phase and a 12-week fixed-dosage phase.
The primary efficacy measure was the last observation carried forward endpoint mean pain score. Secondary measures included pain relief assessed with the Duration Adjusted Average Change to determine the effect over the entire treatment period, and a Mixed Model Repeated Measurements analysis to address time-course and durability of response.
A total of 745 patients were enrolled, 95% female, with a mean age of 50. The median duration of fibromyalgia was 10 years, and the mean pain score at baseline was 6.7.
The researchers found that there were significant differences from placebo in the mean change from baseline to study endpoint for the mean pain score, at -0.71 in the 300-mg group (P=0.0009), -0.98 in the 450-mg group (P0.0001), and -1.00 in the 600-mg group (P0.0001).
Over the entire treatment period, the mean differences from placebo at endpoint over the entire treatment period (Duration Adjusted Average Change) were -0.38 in the 300-mg group (P=0.0200), -0.62 in the 450-mg group (P=0.0001), and -0.57 in the 600-mg group.
In the Mixed Model Repeated Measurements analysis there was pain relief among patients in all three pregabalin treatment groups by week one, and at all other weekly measurements, with the exception of one treatment group at the 11-week interval only. Dr. Diri did not specify which dosage had the anomalous measurement.
For all pregabalin groups, the Mixed Model Repeated Measurements mean scores (week 14) were significantly improved compared with placebo, Dr. Diri said.
The difference from baseline was -0.63 for the 300-mg pregabalin group (P=0.0051), -0.90 for the 450-mg group (P0.0001), and -0.96 for patients taking the 600-mg dose (P0.0001).
The most common adverse event was dizziness, occurring in 35.8% of patients on pregabalin compared with 7.6% of those on placebo, and somnolence in 18% versus 3.8%, respectively. The incidence of adverse events seen with pregabalin appeared to be dose related, Dr. Diri said.
The study was supported by Pfizer, maker of Lyrica.
Dr. Diri has received research support from the company and is a member of its speakers bureau. His co-authors are all current or former Pfizer employees.Primary source: American College of RheumatologySource reference: Duan R, et al "Efficacy of Pregabalin Monotherapy for Relief of Pain Associated with Fibromyalgia: Time Course and Durability of Pain Results of a 14-Week, Double-Blind, Placebo-Controlled Trial" ACR Meeting 2007; Abstract 715 presented Nov. 8.