Tai Chi Helps Relieve Chronic Neck Pain
Interview with Romy Lauche, MSc, PhD
For patients suffering from chronic neck pain, the incorporation of complementary medicines can provide significant relief. The findings of a new study suggests some therapies, particularly tai chi, could be just as effective as traditional exercise therapy to help treat chronic neck pain.
In the study published in The Journal of Pain,1 researchers performed a randomized, controlled trial to see how patients’ pain intensity levels responded to a weekly series of tai chi sessions, compared to sessions of conventional neck exercises.
After 12 weeks, researchers found tai chi was effective at reducing pain in patients compared to placebo. They also found tai chi showed similar efficacy compared with traditional neck exercises.
Nondrug Solutions for Chronic Neck Pain
Tai chi is a form of meditative exercise based on Traditional Chinese Medicine (TCM), which has gained popularity in the West. Described as a moving form of yoga, tai chi uses a choreographed set of exercises to help focus and calm the mind, relieve stress, and improve posture and balance. Tai chi also is touted for its focus on correcting bad movement patterns that can contribute to tension and injury.
Musculoskeletal pain syndromes are common in industrialized nations, and chronic neck pain especially is a prevalent source of chronic pain for patients, with an annual prevalence approaching 50%.2 People who suffer from nonspecific chronic neck pain often work repetitive, high-demand occupations, that require them to remain seated and sedentary most of the day.2
Exercise therapy is a typical nondrug therapy for chronic neck pain, using various isometric and isotonic exercises to help improve neck strength and endurance in the neck.3-4 Research has demonstrated tai chi’s effectiveness for treating chronic nonspecific neck pain sans the use of high-risk analgesics, like opioids.5-8 But up to this point, there had never been a randomized, controlled study comparing tai chi side-by-side with conventional neck exercises as an intervention for relieving nonspecific chronic neck pain.
In the current study, patients were excluded if they had initiated or modified their drug regimen recently, especially patients who were taking opioid medications. According to Romy Lauche, MSc, PhD, lead author of the study from the University of Duisburg-Essen in Essen, Germany, this allowed the research to avoid the possible confounding factor of opioid use.
“The prime motivation was that we did not want opioid medication to influence the results. If patients take opioids we assume they have very severe neck pain, and interventions such as Tai Chi are not suitable in such cases,” said Dr. Lauche.
Patients suffering from severe neck pain likely are candidates for other first-line therapies, instead. It also should be noted opioids can cause side effects, including dizziness, sedation, nausea, and constipation, which could increase the risk of injury during exercise interventions, Dr. Lauche told Practical Pain Management.
“Any other pain medications were acceptable, if they had been on a stable regimen 4 weeks before and during the trial. From what we know most patients who used analgesics took (nonsteroidal anti-inflammatory drugs [NSAIDs]) only, and participants took very little medication overall. From the analysis of the medication log, we can be sure that they have not influenced our results.”
Thirty-eight patients placed in the tai chi group met once a week for sessions lasting 75 to 90 minutes for 12 weeks total. Utilizing the Yang style9 of tai chi, a certified teacher taught them the exercises, and patients also were asked to practice their movements at home at least 15 minutes a day.
In the other study group, 37 patients placed in the exercise group received weekly 60- to 75-minute sessions of standard neck exercises, many of which typically are employed in rehabilitation programs for improving neck strength and endurance and relieving pain. For the control group, 39 patients were placed on a wait list.
After 12 weeks, more patients taking tai chi (n=24; 63.2%) or neck exercise sessions (n=27; 73.0%) reported a ≥30% reduction in their pain, compared to patients on the wait list (n=15; 38.5%) (P = 0.007). A similar pattern was found for patients reporting a ≥50% reduction in pain. When their self-reported pain tolerability limits also were accounted for, far more tai chi (n=14; 36.8%) and exercise patients (n=16; 43.2%) cut their pain scores by half or more compared to the placebo group (n=6; 15.4%) (P = 0.023).
The results could have valuable implications on clinical practice, since patients commonly are recommended neck strengthening exercises for their nonspecific chronic neck pain. The majority of the patients in the study were middle-aged (49.4 ±11.7 years-old on average) and had received physiotherapy and medication for their neck pain prior to the study.
Because tai chi appears to have efficacy at relieving pain symptoms comparable to these exercise programs, tai chi may be an alternative for patients more interested in complementary therapies, the authors concluded. Tai chi also showed excellent safety and patient satisfactory ratings.
Some patients in the study also suffered co-occurring back pain and other problems, and while the study did not analyze how tai chi may have helped these other problems, “the study participants’ feedback indicates that interventions (like) tai chi or yoga are of real benefit, even if not all of the benefits are reflected by the outcome measures,” Dr. Lauche told Practical Pain Management.
Dr. Lauche and his colleagues plan to conduct more studies into tai chi, as well as yoga, to further understand how such complementary therapies could be beneficial to chronic pain patients.
Study co-author Peter M. Wayne is the founder and sole owner of the Tree of Life Tai Chi center. His possible conflicts of interest were reviewed and managed by the Brigham and Women’s Hospital and Partner’s HealthCare in accordance with their conflict of interest policies. All other authors had no conflicts of interest to declare.