Between 50-75% of veterans in primary care report experiencing chronic pain (1, 2). Chronic pain is treatment-resistant, and medications often include the risk of addiction or overdose. In recognition of the scope of this problem, the VA has promoted complementary and integrative health (CIH) for use in conjunction with conventional pain treatments. Yoga is a popular CIH approach and is effective in treating many types of chronic pain. A recent literature review (3) concluded that evidence is particularly strong for yoga as a treatment for chronic musculoskeletal-type pain, which is the most common type of chronic pain. Accordingly, this proposal focuses on yoga treatment for chronic musculoskeletal pain. The VA Palo Alto Health Care System runs a clinical yoga program for veterans using two modalities; traditional in-person yoga, and clinic- based teleyoga in which a yoga instructor communicates with veterans at VA clinics using real-time interactive video conferencing. Our pilot data suggest that clinic-based teleyoga is as safe and effective as in-person yoga for treating chronic musculoskeletal pain. However, this telehealth model does not overcome barriers such as the time, cost and difficulty of travel to a clinic. Very recently, the VA launched a new web-based telehealth system called VA Video Connect (VVC), which allows veterans to communicate with their health care providers from home via a tablet computer. VVC can be used for group or individual sessions and has immense potential for delivering treatments at home. Earlier attempts by other research groups to develop at-home teleyoga have been met with technical problems. VVC offers an exciting opportunity to overcome these problems using a well-resourced, scalable, and technically advanced system. Ideally, a randomized controlled trial would be performed to rigorously compare at-home teleyoga to in-person yoga for treating chronic musculoskeletal pain. Before such a trial can be considered, we need to evaluate and overcome the technical barriers of delivering at-home teleyoga using VVC. Phase 1 of this proposal focuses on refining an existing yoga protocol to make it suitable for treating musculoskeletal pain using at-home teleyoga delivered via VVC (n=20). Each veteran will be given a tablet computer and we will use an iterative process to identify and overcome the technical limitations imposed by the technology. The product of this phase will be a 12-week yoga intervention. Phase 2 will demonstrate the feasibility of conducting a randomized controlled trial involving at-home teleyoga using the yoga protocol developed in Phase 1. We will enroll and randomize veterans with chronic musculoskeletal pain to one of two treatment groups: in-person yoga and at-home teleyoga (n=15 per group). Primary feasibility outcomes will include rates of recruitment, retention, protocol adherence, participant satisfaction, fidelity of treatment delivery, and adverse events. We will also assess the feasibility of measuring heart rate variability as an experimental outcome that is related to the putative mechanism of action of yoga. The results will provide early stage feasibility data for a larger randomized controlled trial.
Telehealth is an exciting new modality that can overcome many barriers to health care. A new telehealth system has recently been introduced by the VA which allows patients to communicate with their health care providers from their home via a tablet computer. We will investigate the feasibility of using this technology for yoga instruction in the treatment of chronic musculoskeletal pain.
