Routine practice of Qi Gong (chi kung) seemed to significantly improve pain in patients with fibromyalgia and lessened the impact of the disorder, a randomized trial showed.
After 8 weeks of regular practice of this « meditative movement, » pain as measured on a 10-point scale decreased by 1.55 points, compared with a change of only 0.02 points in controls (P<0.001), according to Jana Sawynok, PhD, and colleagues from Dalhousie University in Halifax, Nova Scotia.
And on the 100-point Fibromyalgia Impact Questionnaire, which quantitates the effects of multiple disease components including pain, function, sleep, and psychological distress, there was a decrease of 18.45 points compared with a change of 0.93 points in controls (P<0.001), the researchers reported online in Arthritis Research & Therapy.
Treatments for fibromyalgia — a syndrome of widespread pain — include the approved medications pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella), as well as psychological interventions, exercise programs, and alternative approaches, but all of these strategies have only limited efficacy.
Because some previous research has suggested the possibility of benefit with Qi Gong, the Canadian researchers enrolled 100 patients with longstanding fibromyalgia, assigning them to an immediate treatment group or a wait-list group who served as controls for 6 months.
After 6 months, the controls entered the treatment program, and in the analysis were referred to as the delayed-treatment group.
The type of Qi Gong used was Chaoyi Fanhuan Qi Gong, initially taught in a 3-day workshop. It includes seven specific movements and related exercises that emphasize relaxation, release, and distribution of « qi, » or energy, throughout the body.
Participants returned for hour-long practice sessions once each week for 2 months, and were asked to perform the movements and exercises at home for 45 to 60 minutes each day for 6 months.
After 8 weeks, patients reported practicing for a mean time of 4.9 hours each week. By 4 months and 6 months, respectively, mean weekly practice times were 2.9 and 2.7 hours.
Almost all participants were women. Mean age was 52, and disease duration averaged 9.6 years.
Additional pain diagnoses included back pain in 44%, headache in 58%, osteoarthritis in 38%, and rheumatoid arthritis in 9%.
Previous treatments included medications, acupuncture, chiropractic, and massage, while current medications included anticonvulsants in 25% to 30%, antidepressants in 32% to 38%, nonsteroidal anti-inflammatory drugs in 49% to 57%, and opioids in 23% to 36%.
Results in the delayed-treatment group were similar to those seen in the immediate-treatment group, with pain scores at 8 weeks decreasing by 1.28 points (P=0.01) and impact scores falling by 17.97 points.
The impact scores rebounded slightly after 4 and 6 months, but remained significantly improved.
Sleep quality also improved during the 8 weeks of practice, as was shown by decreases on a sleep quality index of 3.29 points (P=0.001) in the immediate-treatment group and 2.69 (P=0.009) in the delayed-treatment group.
Physical and mental well-being also showed consistent benefits. At 8 weeks, increases of 5.08 points (P<0.001) were seen on the short form-36 questionnaire–physical component in the immediate-treatment group and 3.17 points (P=0.01) in the delayed-treatment group.
On the mental component, the increases were 5.29 points (P=0.002) in the immediate-care group and 6.99 (P=0.004) in the delayed-treatment group.
When the researchers combined the results of the two groups, they found sustained effects on pain at 4 months (P<0.001) and 6 months (P=0.003).
Sustained benefits through 6 months also were reported in the combined groups for impact scores, sleep, and physical and mental function.
Minimally clinically important differences have been established for pain (2 points) and impact scores (8.8 points) in fibromyalgia. A total of 38% to 51% of patients in the treatment groups reached this degree of pain relief at different time points, as did 56% to 71% for the impact score.
The 52% of participants who practiced 5 hours each week had higher rates of clinically important differences across the various domains.
For example, those who practiced for that amount of time had decreases of 23.71 points at week 8 on their impact scores, compared with 6.55 points for those who practiced less than 3 hours per week (P=0.001).
A strength of the study was its use of immediate and delayed treatment groups, which suggested reproducibility for the results, and the use of clinically important endpoints.
A limitation was its lack of blinding. In addition, it focused on a single type of Qi Gong, but hundreds of types exist throughout the world, the authors said.
« Given the multiplicity of forms and their geographic representations, research into the medical potential of Qi Gong will need to attend to common elements, as well as to exploring whether particular forms of Qi Gong are more effective than others, » the researchers observed.
They concluded that Qi Gong may have long-term benefits and may be « a useful adjunct in the management of fibromyalgia. »
by Nancy Walsh
Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner