CoChat
Sign Up
Cited by 38Opioid Use Disorder TreatmentMusculoskeletal pain and rehabilitationMindfulness and Compassion Interventions

A pilot study assessing acceptability and feasibility of hatha yoga for chronic pain in people receiving opioid agonist therapy for opioid use disorder

Open access
Uebelacker, Lisa A., Van Noppen, Donnell, Tremont, Geoffrey, Bailey, Genie, Abrantes, Ana, Stein, Michael·2019·Journal of Substance Abuse Treatment
DOI 10.1016/j.jsat.2019.07.015PMC PMC6709876
Open this paper in CoChat — free account

Abstract

The purpose of this project was to assess the feasibility and acceptability of a hatha yoga program designed to target chronic pain in people receiving opioid agonist therapy for opioid use disorder. We conducted a pilot randomized trial in which people with chronic pain who were receiving either methadone maintenance therapy (n = 20) or buprenorphine (n = 20) were randomly assigned to weekly hatha yoga or health education (HE) classes for 3 months. We demonstrated feasibility in many domains, including recruitment of participants (58% female, mean age 43), retention for follow-up assessments, and ability of teachers to provide interventions with high fidelity to the manuals. Fifty percent of participants in yoga (95% CI: 0.28-0.72) and 65% of participants in HE (95% CI: 0.44-0.87) attended at least 6 of 12 possible classes (p = 0.62). Sixty-one percent in the yoga group reported practicing yoga at home, with a mean number of times practicing per week of 2.67 (SD = 2.37). Participant mood improved pre-class to post-class, with greater decreases in anxiety and pain for those in the yoga group (p < 0.05). In conclusion, yoga can be delivered on-site at opioid agonist treatment programs with home practice taken up by the majority of participants. Future research may explore ways of increasing the yoga "dosage" received. This may involve testing strategies for increasing either class attendance or the amount of home practice or both.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.jsat.2019.07.015

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Of the 2 SUD trials only reporting end-of-treatment outcomes, both reported improved pain severity with a small-to-medium effect size.

    “Of the 2 trials only reporting end-of-treatment out­ comes, 23,35 both reported improved pain severity with a small-to-medium effect size.”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [35]

    In Results > Change in primary outcome over time (page not available), the paper describes a small-to-medium end-of-treatment effect only for pain interference among high attenders; the intent-to-treat comparison showed essentially no difference (d = 0.03). Results > Mood and pain pre-to post-class reports reduced pain severity, but that is a pre-to-post-class finding, not an end-of-treatment effect with the stated size. The paper also reports interim assessments, so it did not report only end-of-treatment outcomes. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Of the mental health outcomes examined in SUD trials, one trial only included measurement for anxiety but reported both within-and between-group reduction in anxiety symptoms.

    “Of the MH outcomes ex­ amined, one of them only included measurement for anxiety but reported both within-and between-group reduction in anxiety symptoms. 35”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [35]

    The Results section, “Mood and pain pre-to post-class” (page unavailable), reports a significant pre-to-post-class reduction in anxiety in both arms and a significantly greater reduction in the yoga arm. However, the Assessment Instruments section (page unavailable) says the trial also measured sadness, irritability, and fatigue, so anxiety was not its only measured mental-health outcome. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Of the 4 trials that examined a body-based intervention, no evident effect was reported on pain reduction and mental health outcomes for people with PTSD.

    “Of the 4 trials that examined a body-based interven­ tion, 33-36 no evident effect was reported on pain re­ duction and MH outcomes for people with PTSD.”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [35]

    The Results (Change in primary outcome over time; page unavailable) report no between-group difference in pain interference at three months, which supports one part of the claim. But this trial studied people receiving opioid agonist therapy for opioid use disorder, not people with PTSD, and the Results (Mood and pain pre-to post-class; page unavailable) report significantly greater immediate reductions in anxiety and pain with yoga. This paper therefore does not support a blanket finding of no evident effect on pain and mental-health outcomes for people with PTSD. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Of all 3 trials recording adverse events, no severe adverse events were reported related to the intervention.

    “Of the all 3 trials recording AEs, 35,36,45 no severe AEs were reported related to the intervention.”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [35]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 44

  1. Agarwal RP, Kumar A, & Lewis JE (2015). A pilot feasibility and acceptability study of yoga/meditation on the quality of life and markers of stress in persons living with HIV who also use crack cocaine. Journal of Alternative and Complementary Medicine, 21(3), 152– 158. doi: 10.1089/acm.2014.0112 25695849 PMC4365434 · DOI
  2. Athanasos P, Ling W, Bochner F, White JM, & Somogyi AA (2019). Buprenorphine maintenance subjects are hyperalgesic and have no antinociceptive response to a very high morphine dose. Pain Medicine, 20(1), 119– 128. doi: 10.1093/pm/pny025 29514333 PMC6329438 · DOI
  3. Barrett K, & Chang YP (2016). Behavioral interventions targeting chronic pain, depression, and substance use disorder in primary care. Journal of Nursing Scholarship, 48(4), 345– 353. doi: 10.1111/jnu.12213 27149578 · DOI
  4. Beazley D, Patel S, Davis B, Vinson S, & Bolgla L (2017). Trunk and hip muscle activation during yoga poses: Implications for physical therapy practice. Complementary Therapies in Clinical Practice, 29, 130– 135. doi: 10.1016/j.ctcp.2017.09.009 29122250 · DOI
  5. Berg KM, Arnsten JH, Sacajiu G, & Karasz A (2009). Providers’ experiences treating chronic pain among opioid-dependent drug users. J Gen Intern Med, 24(4), 482– 488. doi: 10.1007/s11606-009-0908-x 19189194 PMC2659151 · DOI
  6. Brands B, Blake J, Sproule B, Gourlay D, & Busto U (2004). Prescription opioid abuse in patients presenting for methadone maintenance treatment. Drug and Alcohol Dependence, 73(2), 199– 207. 14725960
  7. Bussing A, Ostermann T, Ludtke R, & Michalsen A (2012). Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. Journal of Pain, 13(1), 1– 9. doi: 10.1016/j.jpain.2011.10.001 22178433 · DOI
  8. Cleeland CS, & Ryan KM (1994). Pain assessment: global use of the Brief Pain Inventory. Annals, Academy of Medicine, Singapore, 23(2), 129– 138. 8080219
  9. Cramer H, Haller H, Dobos G, & Lauche R (2016). A systematic review and meta-analysis estimating the expected dropout rates in randomized controlled trials on yoga interventions. Evidence-Based Complementary and Alternative Medicine, 2016, 5859729. doi: 10.1155/2016/5859729 PMC4927989 27413387 · DOI · Paper page
  10. Desikachar TKV (1999). The Heart of Yoga: Developing a Personal Practice, Revised Edition. Rochester, Vermont: Inner Traditions International.
  11. Dhawan A, Chopra A, Jain R, Yadav D, & Vedamurthacha r. (2015). Effectiveness of yogic breathing intervention on quality of life of opioid dependent users. International Journal of Yoga, 8(2), 144– 147. doi: 10.4103/0973-6131.154075 26170596 PMC4479894 · DOI
  12. Dworkin RH, Turk DC, Peirce-Sandner S, Burke LB, Farrar JT, Gilron I, (2012). Considerations for improving assay sensitivity in chronic pain clinical trials: IMMPACT recommendations. Pain, 153(6), 1148– 1158. doi: 10.1016/j.pain.2012.03.003 22494920 · DOI
  13. Edelman EJ, Tetrault JM, & Fiellin DA (2014). Substance use in older HIV-infected patients. Current Opinion in HIV and AIDS, 9(4), 317– 324. doi: 10.1097/COH.0000000000000069 24824888 PMC4175926 · DOI
  14. Eyler EC (2013). Chronic and acute pain and pain management for patients in methadone maintenance treatment. American Journal of Addiction, 22(1), 75– 83. doi: 10.1111/j.1521-0391.2013.00308.x 23398230 · DOI
  15. Garland EL, Manusov EG, Froeliger B, Kelly A, Williams JM, & Howard MO (2014). Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. Journal of Consulting and Clinical Psychology, 82(3), 448– 459. doi: 10.1037/a0035798 24491075 PMC4076008 · DOI · Paper page
  16. Haibach JP, Beehler GP, Dollar KM, & Finnell DS (2014). Moving toward integrated behavioral intervention for treating multimorbidity among chronic pain, depression, and substance-use disorders in primary care. Medical Care, 52(4), 322– 327. doi: 10.1097/MLR.0000000000000098 24556895 · DOI
  17. Hayaki J, Stein MD, Lassor JA, Herman DS, & Anderson BJ (2005). Adversity among drug users: relationship to impulsivity. Drug and Alcohol Dependence, 78(1), 65– 71. doi: 10.1016/j.drugalcdep.2004.09.002 15769559 · DOI
  18. Hayden JA, van Tulder MW, & Tomlinson G (2005). Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine, 142(9), 776– 785. 15867410
  19. Hruschak V, Cochran G, & Wasan AD (2018). Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature. Journal of Opioid Management, 77(5), 345– 358. doi: 10.5055/jom.2018.0467 30387858 · DOI
  20. Ikai S, Uchida H, Mizuno Y, Tani H, Nagaoka M, Tsunoda K, (2017). Effects of chair yoga therapy on physical fitness in patients with psychiatric disorders: A 12-week single-blind randomized controlled trial. Journal of Psychiatric Research, 94, 194– 201. doi: 10.1016/j.jpsychires.2017.07.015 28750232 · DOI
  21. Jensen MP, Chen C, & Brugger AM (2003). Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. Journal of Pain, 7(7), 407– 414. 14622683
  22. Jiao JM, So E, Jebakumar J, George MC, Simpson DM, & Robinson-Papp J (2016). Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization. Pain, 157(4), 931– 937. doi: 10.1097/j.pain.0000000000000462 26683238 · DOI
  23. Khanna S, & Greeson JM (2013). A narrative review of yoga and mindfulness as complementary therapies for addiction. Complementary Therapies in Medicine, 27(3), 244– 252. doi: 10.1016/j.ctim.2013.01.008 PMC3646290 23642957 · DOI
  24. Kuppili PP, Parmar A, Gupta A, & Balhara YPS (2018). Role of yoga in management of substance-use disorders: a narrative review. Journal of Neuroscience in Rural Practice, 9(1), 117– 122. doi: 10.4103/jnrp.jnrp_243_17 PMC5812135 29456355 · DOI
  25. Levine JL, & Schooler NR (1986). SAFTEE: a technique for the systematic assessment of side effects in clinical trials. Psychopharmacology Bulletin, 22, 343– 381. 3774930
  26. Mallik D, Bowen S, Yang Y, Perkins R, & Sandoz EK (2019). Raja yoga meditation and medication-assisted treatment for relapse prevention: A pilot study. Journal of Substance Abuse Treatment, 96, 58– 64. doi: 10.1016/j.jsat.2018.10.012 30466550 · DOI
  27. Moore BA, Fiellin DA, Cutter CJ, Buono FD, Barry DT, Fiellin LE, (2016). Cognitive Behavioral Therapy improves treatment outcomes for prescription opioid users in primary care buprenorphine treatment. Journal of Substance Abuse Treatment, 71, 54– 57. doi: 10.1016/j.jsat.2016.08.016 27776678 PMC5119533 · DOI · Paper page
  28. Nguyen TD, Attkisson CC, & Stegner BL (1983). Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. Evaluation and Program Planning, 6(299– 313). 10267258
  29. Park CL, Elwy AR, Maiya M, Sarkin AJ, Riley KE, Eisen SV, (2018). The Essential Properties of Yoga Questionnaire (EPYQ): psychometric properties. International Journal of Yoga Therapy, doi: 10.17761/2018-00016R2 PMC6937207 29498893 · DOI
  30. Rosenblum A, Parrino M, Schnoll SH, Fong C, Maxwell C, Cleland CM, (2007). Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug and Alcohol Dependence, 90(1), 64– 71. doi: 10.1016/j.drugalcdep.2007.02.012 17386981 · DOI
  31. Samet JH, O’Connor PG, & Stein MD (2018). Substance Use and Addiction Medicine, An issue of Medical Clinics of North America. Medical Clinics of North America, 102(2). 29933831
  32. Saper RB, Sherman KJ, Delitto A, Herman PM, Stevans J, Paris R, (2014). Yoga vs. physical therapy vs. education for chronic low back pain in predominantly minority populations: study protocol for a randomized controlled trial. Trials, 15, 67. doi: 10.1186/1745-6215-15-67 24568299 PMC3944007 · DOI
  33. Sarkar S, & Varshney M (2017). Yoga and substance use disorders: a narrative review. Asian Journal of Psychiatry, 25, 191– 196. doi: 10.1016/j.ajp.2016.10.021 28262148 · DOI
  34. Shaffer HJ, LaSalvia TA, & Stein JP (1997). Comparing hatha yoga with dynamic group psychotherapy for enhancing methadone maintenance treatment: a randomized clinical trial. Alternative Therapies in Health and Medicne, 3(4), 57– 66. 9210777
  35. Stein MD, Anderson BJ, Thurmond P, & Bailey GL (2015). Comparing the life concerns of prescription opioid and heroin users. Journal of Substance Abuse Treatment, 48(1), 43– 48. doi: 10.1016/j.jsat.2014.07.001 25171955 PMC4250324 · DOI
  36. Stein MD, Herman DS, Bailey GL, Straus J, Anderson BJ, Uebelacker LA, & Weisberg RB (2015). Chronic pain and depression among primary care patients treated with buprenorphine. Journal of General Internal Medicine, 30(7), 935– 941. doi: 10.1007/s11606-015-3212-y 25678375 PMC4471032 · DOI
  37. Tsui JI, Herman DS, Kettavong M, Alford D, Anderson BJ, & Stein MD (2010). Physician introduction to opioids for pain among patients with opioid dependence and depressive symptoms. Journal of Substance Abuse Treatment, 39(4), 378– 383. doi: 10.1016/j.jsat.2010.06.012 20727704 PMC3129653 · DOI
  38. Uebelacker LA, Tremont G, Gillette LT, Epstein-Lubow G, Strong DR, Abrantes AM, (2017). Adjunctive yoga v. health education for persistent major depression: a randomized controlled trial. Psychological Medicine, 47, 2130– 2142. doi: 10.1017/S0033291717000575 28382883 PMC5548599 · DOI
  39. Vlaeyen JW, & Linton SJ (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317– 332. 10781906
  40. Volkow ND, & McLellan AT (2016). Opioid abuse in chronic pain--misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253– 1263. doi: 10.1056/NEJMra1507771 27028915 · DOI
  41. Voon P, Hayashi K, Milloy MJ, Nguyen P, Wood E, Montaner J, & Kerr T (2015). Pain among high-risk patients on methadone maintenance treatment. Journal of Pain, 16(9), 887– 894. doi: 10.1016/j.jpain.2015.06.003 26101814 PMC4556532 · DOI
  42. Weiss RD, Potter JS, Griffin ML, McHugh RK, Haller D, Jacobs P, D. (2014). Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain. Journal of Substance Abuse Treatment, 47(2), 140– 145. doi: 10.1016/j.jsat.2014.03.004 24814051 PMC4074437 · DOI
  43. Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, & Berman BM (2017). Yoga treatment for chronic non-specific low back pain. Cochrane Database Systematic Review, 1, CD010671. doi: 10.1002/14651858.CD010671.pub2 PMC5294833 28076926 · DOI
  44. Zhuang SM, An SH, & Zhao Y (2013). Yoga effects on mood and quality of life in Chinese women undergoing heroin detoxification: a randomized controlled trial. Nursing Research, 62(4), 260– 268. doi: 10.1097/NNR.0b013e318292379b 23715475 · DOI

Cited by

Sorted by citations

Authors
Uebelacker, L. A., Van Noppen, D., Tremont, G., Bailey, G., Abrantes, A., & Stein, M.
Affiliations
  • Brown University (US)
  • Boston University (US)
Corresponding author
Uebelacker, Lisa A.
ORCID
Venue
Journal of Substance Abuse Treatment
Publisher
Elsevier BV
Published
2019-10
Volume
105
Pages
19-27
ISSN
0740-5472 (ISSN-L)
DOI
10.1016/j.jsat.2019.07.015
PMC
PMC6709876
OpenAlex
W2964098072
Cited by
38
References
14
Citations by year
2026: 2 · 2025: 6 · 2024: 10 · 2023: 6 · 2022: 7 · 2021: 3 · 2020: 4
FWCI
3.22
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Substance Abuse Treatment (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Center for Complementary and Integrative Health (R34AT009432, NCCIH)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
hatha yoga, chronic pain, opioid use disorder, opioid substitution therapy, methadone maintenance treatment, buprenorphine, feasibility, acceptability, home practice, anxiety, mood, health education
MeSH terms
Adult, Analgesics, Opioid, Buprenorphine, Feasibility Studies, Female, Health Education, Humans, Male, Methadone, Opioid-Related Disorders, Pilot Projects, Yoga, Opiate Substitution Treatment, Chronic Pain

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review