Chronic pain is highly prevalent, costly and a leading cause of disability nationally. Nearly 2 million service members have returned to civilian life following deployment in the recent conflicts in Iraq and Afghanistan and approximately half have chronic pain. Although much is still unknown, a number of vulnerability factors have been found to predispose people to pain chronicity and pain-related disability. Even less is known about predictors of resilience in chronic pain. Resilience is a concept that describes how people are able to thrive in the face of a significant stressor. A resilient course for chronic low back pain entails remaining free of back- related disability despite experiencing significant pain. Yoga is a increasingly common strategy used by Americans to manage chronic pain, particularly because of its safety and because of the limited effectiveness of conventional analgesic treatments. The relationship between yoga practice and resilience in chronic pain has not been investigated. Because even the most basic yoga practices possess many of the components thought to be important in fostering resilience, yoga may be a promising means of improving resilience and clinical outcomes for people with chronic pain. A validated conceptual model of how the experience of chronic pain is affected by yoga and other mind-body practices would be useful to guide a future research agenda. We propose two specific aims and one secondary aim to explore yoga as a management technique for chronic pain: 1) examine pain and pain-related vulnerability and resilience factors among Iraq and Afghanistan veterans who regularly practice yoga and those who do not; 2) explore veterans' lived experiences of yoga in managing chronic pain, with special attention to the process of self-selection and the facilitators of developing a regular yoga practice; secondarily, conceptual model of how yoga may influence resilient pain outcomes. First, we propose a convergent parallel mixed methods design in order to build a rich understanding of how yoga shapes the experience of chronic pain. In this first stage, longitudinal data from the RINGS-CAM study will be used to compare those with a yoga practice and those without across a broad range of personality traits and behaviors that may play a role in resilience to chronic pain. Simultaneously, we will collect qualitative data to explore the participant's perspectives on how yoga influences their chronic pain. The reason for collecting both quantitative and qualitative data is to converge the two forms of data and bring greater insight into the problem than would be obtained by either type of data separately. The final stage of the study is to refine a conceptual model of how the effect of yoga practice on resilient chronic pain outcomes may be mediated by pain resilience and vulnerability factors. We will do this with structural equation modeling. The conceptual model guiding this study will only be best understood when exploring the results in the context of the initial mixed method stage.
Recent American combat veterans are especially burdened by chronic pain, yet most follow a resilient course and are not disabled by their pain. Yoga has been shown to be effective in the management of chronic pain and is thought to be a resilience-building practice. Understanding how individual pain resilience and vulnerability factors mediate the effects of yoga on resilience to chronic pain in veterans could aid in the design of an evidence-based yoga program for chronic pain.
| Donaldson, Melvin T; Polusny, Melissa A; MacLehose, Rich F et al. (2018) Patterns of conventional and complementary non-pharmacological health practice use by US military veterans: a cross-sectional latent class analysis. BMC Complement Altern Med 18:246 |
| Matthias, Marianne S; Donaldson, Melvin T; Jensen, Agnes C et al. (2018) ""I Was a Little Surprised"": Qualitative Insights From Patients Enrolled in a 12-Month Trial Comparing Opioids With Nonopioid Medications for Chronic Musculoskeletal Pain. J Pain 19:1082-1090 |
