Supervised yogic intervention improves pain, cortical excitability and flexibility in fibromyalgia patients: Objective evidence based of journey from case control study to randomized controlled trial

Background and AimFibromyalgia is an idiopathic chronic widespread pain syndrome affecting 2-4% of the general population globally. Besides widespread fibromyalgia pain, morning stiffness, associated neurologic as well as sleep problems are also reported. Disease is more prevalent in females of middle-age group with low socioeconomic status, thus deteriorating overall productivity and psychosocial health. There is no permanent cure of the disease. This study aimed to explore, validate and assess the effect of four weeks of supervised yogic intervention on pain status, quality of life, sleep, cortical excitability, flexibility and range of motion in fibromyalgia patients, as compared to standard therapy. MethodCase-control study, interventional study and assessor-blined randomized controlled trial, conducted in 120 fibromyalgia patients (60 yoga group: 60 waitlisted controls) and 60 age-matched healthy controls. Pain was assessed subjectively, using questionnaires and objectively, using quantitative sensory testing and ELISA. Sleep and quality of life were assessed using common and disease specific decsiptors. Flexibility and range of motion was assessed using sit and reach box, lateral goniometry and modified Schobers test. Transcranial magnetic stimulation on M1 was used to assess corticomotor excitability of participants. Study parameters were assessed at baseline and after four weeks of the intervention. ResultsA significantly poor sleep, flexibility and quality of life was reported in the fibromyalgia patients due to excruciating pain (VAS = 6.92{+/-}0.12); corticomotor function was also abnormal in the patients, which were restored after four weeks of yogic intervention. On subjective and objective assessment of pain, we found significant relief and improvement in pain status in the yoga group as compared to the waitlisted controls. Fibromyalgia impact, sleep, quality of life and flexibility were also found solely better in fibromyalgia patients undergoing yogic interventions. Cortical parameters, specifically RMT, MEPs and MEP recruitment curves showed a significant improvement in yoga group as compared to waitlisted controls. ConclusionFour weeks of regular and supervised yogic intervention may ameliorate pain, improve flexibility and range of motion and changes cortical plasticity in the Indian cohort of fibromyalgia patients, as compared to standard therapy. Yoga-based interventions can also improve overall quality of life and sleep impairmentsby reducing catastrophization and fibromyalgia impact.