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A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia
Open accessAbstract
A mounting body of literature recommends that treatment for fibromyalgia (FM) encompass medications, exercise and improvement of coping skills. However, there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping. The aim of this randomized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping. A sample of 53 female FM patients were randomized to the 8-week Yoga of Awareness program (gentle poses, meditation, breathing exercises, yoga-based coping instructions, group discussions) or to wait-listed standard care. Data were analyzed by intention to treat. At post-treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue, and mood, and in pain catastrophizing, acceptance, and other coping strategies. This pilot study provides promising support for the potential benefits of a yoga program for women with FM.
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“Multiple position statements recommend that medications be accompanied by exercise and coping skills approaches.18”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [18]
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“Mind-body disciplines may fulfil the need for both exercise and coping skills components of FM treatment,7,18 and have been shown to improve balance.32”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [18]
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Cited by
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Physical exercise as non-pharmacological treatment of chronic pain: Why and when
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Aquatic exercise training for fibromyalgia
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ResultLanghorst, J., Klose, P., Dobos, G. J., Bernardy, K., & Häuser, W. (2012) · Rheumatology International · doi:10.1007/s00296-012-2360-1 · Cited by 200
“Table 2 Risk of methodological bias score of the studies Author reference Adequate randomisation Adequate concealment of treatment allocation Blinding of the outcome assessor Intention-totreat-analyse Calandre [34] Yes No Unclear Yes Carson [35] Yes Yes Yes Yes Haak [37] Unclear Unclear Unclear Yes Ide [36] Yes Unclea…”
MethodCarlson, L. E. (2012) · ISRN Psychiatry · doi:10.5402/2012/651583 · Cited by 182
“A comparison of a Yoga of Awareness program (which included meditation, breathing exercises, group discussion, as well as yoga postures) to usual care reported greater improvements in both pain levels and mood, as well as a range of coping strategies in the intervention group [76].”
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“The final analysis was conducted on 366 fulltext articles [135-500] reporting 312 RCTS with a total of 22,548 participants (Figure 1).”
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“Modifications and variations in postures and purposeful sequencing were used to accommodate the pathophysiology and functional changes associated with FM.(26) Slow transitions between asanas were used to address autonomic nervous system (ANS) dysregulation and restorative postures were interwoven throughout the class…”
InfluentialFibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies
Maffei, M. E. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21217877 · Cited by 150
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Holtzman, S., & Beggs, R. T. (2013) · Pain Research and Management · doi:10.1155/2013/105919 · Cited by 151
Estévez-López, F., Maestre-Cascales, C., Russell, D., Álvarez-Gallardo, I. C., Rodriguez-Ayllon, M., Hughes, C. M., Davison, G. W., Sañudo, B., & McVeigh, J. G. (2021) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.06.019 · Cited by 137
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The therapeutic value of yoga in neurological disorders
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Bidonde, J., Busch, A. J., Schachter, C. L., Webber, S. C., Musselman, K. E., Overend, T. J., Góes, S. M., Bello-Haas, V. P. M. D., & Boden, C. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013340 · Cited by 149
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“Yoga 1 pilot RCT (n = 53) of women with FM [119] FIQ fatigue Clinically meaningful improvement”
BackgroundMind and body therapy for fibromyalgia
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Ward, L., Stebbings, S. M., Cherkin, D. C., & Baxter, D. G. (2013) · Musculoskeletal Care · doi:10.1002/msc.1042 · Cited by 136
“Adherence ranged from 14% (Cox et al., 2010) to 91% (Williams et al., 2005), and only four studies reported acceptable 210 adherence (Carson et al., 2010; Sherman et al., 2011; Williams et al., 2005, 2009).”
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Self-citationComplementary and alternative exercise for fibromyalgia: a meta-analysis
Mist, S. D., Firestone, K. A., & Jones, K. D. (2013) · Journal of Pain Research · doi:10.2147/jpr.s32297 · Cited by 108
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BackgroundSelf-citationNon-pharmacological treatment of chronic widespread musculoskeletal pain
Hassett, A. L., & Williams, D. A. (2011) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2011.01.005 · Cited by 109
Adverse effects of yoga: a national cross-sectional survey
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Flexibility exercise training for adults with fibromyalgia
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Yoga intervention and functional pain syndromes: a selective review
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“(2013) Meta-analysis of RCTs including qigong, Tai chi, yoga 7 studies; 362 subjects Yoga Yoga was found to be beneficial in sub-group analysis in domains of pain, fatigue, depression, and HRQoL 3 Rudrud (2012) Case series 10 Hatha yoga Reduced fibromyalgia-related symptoms 4 Carson et al. (2012) Wait list controlled…”
BackgroundMethodInfluentialMindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations
Adler-Neal, A. L., & Zeidan, F. Z. (2017) · Current Rheumatology Reports · doi:10.1007/s11926-017-0686-0 · Cited by 101
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Self-citationEstablishing key components of yoga interventions for musculoskeletal conditions: a Delphi survey
Ward, L., Stebbings, S. M., Sherman, K. J., Cherkin, D. C., & Baxter, D. G. (2014) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-14-196 · Cited by 76
“Additionally, despite polarised views regarding home practice, the majority consensus of a minimum 30 minutes of practice, three times per week is also reflective of previous musculoskeletal interventions [67-72].”
BackgroundYoga for rheumatic diseases: a systematic review
Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. J. (2013) · Rheumatology · doi:10.1093/rheumatology/ket264 · Cited by 76
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Okifuji, A., Gao, J., Bokat, C. E., & Hare, B. D. (2016) · Pain Management · doi:10.2217/pmt-2016-0006 · Cited by 66
Komplementäre und alternative Verfahren beim Fibromyalgiesyndrom
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“Recent studies have reported beneficial results in FM patients using acupuncture [16], Yoga [17,18], or Tai Chi [19,20].”
ResultInfluentialEffects of Yoga Interventions on Fatigue: A Meta-Analysis
Boehm, K., Ostermann, T., Milazzo, S., & Büssing, A. (2012) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2012/124703 · Cited by 59
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Nonpharmacological Treatment of Pain in Rheumatic Diseases and Other Musculoskeletal Pain Conditions
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“Its ability to improve symptoms such as dyspnea has only been recently studied.(31) While the evidence supporting mind–body interventions for improving dyspnea is very preliminary, these interventions appear to be promising for improving the debilitating effects of dyspnea in COPD, especially dyspnea distress or anxie…”
A Systematic Review and Meta-Analysis of Qigong for the Fibromyalgia Syndrome
Lauche, R., Cramer, H., Häuser, W., Dobos, G., & Langhorst, J. (2013) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2013/635182 · Cited by 56
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Whole body vibration exercise training for fibromyalgia
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Follow-up of Yoga of Awareness for Fibromyalgia
Carson, J. W., Carson, K. M., Jones, K. D., Mist, S. D., & Bennett, R. M. (2012) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31824549b5 · Cited by 52
“*For more information on these analyses, see our previous publication comparing the immediate treatment group’s posttreatment scores relative with the wait-list group’s pretreatment scores.(7) wThree-month follow-up significantly better (ar0.”
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BackgroundInfluentialKöhn, M., Lundholm, U. P., Bryngelsson, I., Anderzén‐Carlsson, A., & Westerdahl, E. (2013) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2013/215348 · Cited by 45
“In previous studies showing effects on pain, yoga exercises were adapted to a specific pain location [31] or to specific diagnoses [14].”
BackgroundThe Effects of Meditation-Based Interventions on the Treatment of Fibromyalgia
Kozasa, E. H., Tanaka, L. H., Monson, C., Little, S. W., Leão, F. C., & Peres, M. F. P. (2012) · Current Pain and Headache Reports · doi:10.1007/s11916-012-0285-8 · Cited by 44
“They also improved in pain catastrophizing, acceptance and other coping strategies [27].”
BackgroundYoga as an Alternative and Complementary Therapy for Patients Suffering From Anxiety
Sharma, M., & Haider, T. (2012) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587212460046 · Cited by 45
Respiration-Induced Hypoalgesia: Exploration of Potential Mechanisms
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“…Medical diagnosis 22 YG:22 YG:03 47.4 13.7 ♀ Taibi and Vitiello (2011)63 Osteoarthritis Medical diagnosis 14 YG:13 YG: 01 65.2 6.9 ♀ Hennard (2011)63 Fibromyalgia Medical diagnosis 25 YG:25 YG:14 51 (27–70) ♀♂ Carson et al. (2010)65 Fibromyalgia ACR—1990 53 YG:25 CG:28 YG:03 CG:02 YG:…”
InfluentialEffects of Exergames in Women with Fibromyalgia: A Randomized Controlled Study
de Carvalho, M. S., Carvalho, L. C., Menezes, F. D. S., Frazin, A., Gomes, E. D. C., & Iunes, D. H. (2020) · Games for Health Journal · doi:10.1089/g4h.2019.0108 · Cited by 38
Sieczkowska, S. M., Casagrande, P. D. O., Coimbra, D. R., Vilarino, G. T., Andreato, L. V., & Andrade, A. (2019) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2019.07.006 · Cited by 37
Beyond the Pain: A Systematic Narrative Review of the Latest Advancements in Fibromyalgia Treatment
Ram, P. R., Jeyaraman, M., Jeyaraman, N., Nallakumarasamy, A., Khanna, M., Gupta, A., & Yadav, S. (2023) · Cureus · doi:10.7759/cureus.48032 · Cited by 38
“A recent study published in 2010 evaluated the effectiveness of yoga therapy on FM patients and that it was effective in reducing pain, anxiety, and depression, and improving physical function [63].”
BackgroundFibromyalgia’s Key Symptoms in Normal-Weight, Overweight, and Obese Female Patients
Aparicio, V. A., Ortega, F. B., Carbonell‐Baeza, A., Gatto-Cardia, C. M., Sjöstróm, M., Ruiz, J. R., & Delgado‐Fernández, M. (2011) · Pain Management Nursing · doi:10.1016/j.pmn.2011.06.002 · Cited by 36
Mindful Yoga for women with metastatic breast cancer: design of a randomized controlled trial
Carson, J. W., Carson, K. M., Olsen, M. K., Sanders, L. L., & Porter, L. S. (2017) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-017-1672-9 · Cited by 39
“Over the last several decades yoga interventions have been demonstrated to positively impact a variety of medical conditions, including hypertension [16, 17], asthma [18], multiple sclerosis [19], tuberculosis [20], back pain [21, 22], fibromyalgia [23, 24], and neck pain [25].”
BackgroundSelf-citationMovement Therapies for the Self-Management of Chronic Pain Symptoms
Lee, C., Crawford, C. C., Schoomaker, E. B., & Active Self-Care Therapies for Pain (PACT) Working Group (2014) · Pain Medicine · doi:10.1111/pme.12411 · Cited by 35
Göçmen, D. D., Altan, L., Korkmaz, N., & Arabacı, R. (2012) · Rheumatology International · doi:10.1007/s00296-012-2444-y · Cited by 35
“In addition to aerobic exercises, relaxation and stretching exercises, as well as programs such as Tai chi, Yoga, and Pilates, which have regained their popularity in the recent years, has been shown to be beneficial in controlling pain and other symptoms in patients with FM [7–9].”
BackgroundSamami, E., Shahhosseini, Z., & Elyasi, F. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09794-0 · Cited by 34
Poole, J. L., & Siegel, P. (2017) · American Journal of Occupational Therapy · doi:10.5014/ajot.2017.023192 · Cited by 41
Erden, A., Altuğ, F., & Cavlak, U. (2013) · Southern Clinics of Istanbul Eurasia · doi:10.5505/jkartaltr.2013.20438 · Cited by 33
Rodríguez‐Almagro, D., Moral‐García, M. D., López‐Ruiz, M. D. C., Cortés‐Pérez, I., Obrero‐Gaitán, E., & Lomas‐Vega, R. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1170621 · Cited by 39
“1%) presented good quality (Gowans et al., 2001; King et al., 2002; Schachter et al., 2003; Redondo et al., 2004; Da Costa et al., 2005; Kingsley et al., 2005; Hammond and Freeman, 2006; MunguíaIzquierdo and Legaz-Arrese, 2007; Rooks, 2007; Günendi et al., 2008; Mannerkorpi et al., 2009; Tomas-Carus et al., 2009; Toma…”
BackgroundInfluentialZhang, K., Wang, L., Zhang, Z.-H., Zhang, D., Lin, X., Meng, T., & Qi, F. (2022) · Journal of Pain Research · doi:10.2147/jpr.s384215 · Cited by 32
Koçyiğit, B. F., Sagtaganov, Z., Yessirkepov, M., & Akyol, A. (2022) · Rheumatology International · doi:10.1007/s00296-022-05267-1 · Cited by 32
Tomás-Carús, P., Branco, J., Raimundo, A. M. D. M., Parraça, J. A., Batalha, N. M. P., & Printes, C. B. (2018) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2017.0335 · Cited by 36
Yoga Practice Predicts Improvements in Day-to-Day Pain in Women With Metastatic Breast Cancer
Carson, J. W., Carson, K. M., Olsen, M. K., Sanders, L. L., Westbrook, K. E., Keefe, F. J., & Porter, L. S. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.10.009 · Cited by 31
Self-citationWard, L., Stebbings, S. M., Cherkin, D. C., & Baxter, D. G. (2014) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2014.08.007 · Cited by 31
Umeda, M., Corbin, L. W., & Maluf, K. S. (2014) · Disability and Rehabilitation · doi:10.3109/09638288.2014.984878 · Cited by 30
The Effects of Exercise Training on Anxiety in Fibromyalgia Patients
McDowell, C. P., Cook, D. B., & Herring, M. P. (2017) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001290 · Cited by 34
“The most frequently used anxiety measures were the anxiety subscale of the Fibromyalgia Impact Questionnaire (k = 11) (7,20,31,44,55,56,61) and State-Trait Anxiety Inventory— State Anxiety subscale (k = 6) (2,21,61).”
MethodThe Benefits of Yoga for Musculoskeletal Disorders: A Systematic Review of the Literature
McCaffrey, R. G. (2012) · Journal of Yoga & Physical Therapy · doi:10.4172/2157-7595.1000122 · Cited by 29
“[32] studied an 8-week yoga awareness program or wait-listed standard care.”
BackgroundInfluentialEl-Shewy, K. M., Kunbaz, A., Gad, M. M., Al-Husseini, M. J., Saad, A. M., Sammour, Y. M., & Abdel-Daim, M. M. (2019) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2018.10.157 · Cited by 29
“The results revealed more significant improvements in pain, fatigue, and mood among the group of patients who practiced yoga [103].”
Saud, A., Abbasi, M., Merris, H., Parth, P., Jones, X. M., Aggarwal, R., & Gupta, L. (2022) · Clinical Rheumatology · doi:10.1007/s10067-022-06280-2 · Cited by 28
Simplifying fibromyalgia assessment: the VASFIQ Brief Symptom Scale
Boomershine, C. S., Emir, B., Zlateva, G., & Wang, Y. (2011) · Therapeutic Advances in Musculoskeletal Disease · doi:10.1177/1759720x11416863 · Cited by 29
“Although the FIQR shows promise as a screening tool, it has only been tested in two studies: an online and focus group study [Bennett et al. 2009], and an interventional pilot study [Carson et al. 2010].”
MethodBarceló-Soler, A., Morillo-Sarto, H., Fernández-Martínez, S., Monreal-Bartolomé, A., Chambel, M. J., Gardiner, P., López-del-Hoyo, Y., García-Campayo, J., & Pérez-Aranda, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20054438 · Cited by 26
“Fourteen studies used daily logs, of which two studies specified doing so online [35,52]; another two studies used pen and paper [55,59]; one study used both depending on the resources of the participants [42]; the others did not specify how they collected information [26,34,43,44,49,53,56,60,61].”
BackgroundInfluentialThe Effects of Tele-Yoga in Ankylosing Spondylitis Patients: A Randomized Controlled Trial
Acar, Y., İlçin, N., & Sarı, İ. (2023) · Journal of Integrative and Complementary Medicine · doi:10.1089/jicm.2023.0022 · Cited by 26
Traditional Chinese Medicine Diagnoses in a Sample of Women with Fibromyalgia
Mist, S. D., Wright, C. L., Jones, K. D., & Carson, J. W. (2011) · Acupuncture in Medicine · doi:10.1136/acupmed-2011-010052 · Cited by 26
Self-citationTherapeutic validity of exercise interventions in the management of fibromyalgia
Álvarez‐Gallardo, I. C., Bidonde, J., Busch, A. J., Westby, M. D., Kenny, G. P., Delgado‐Fernández, M., Carbonell‐Baeza, A., Rahman, P., Angelis, G. D., & Brosseau, L. (2019) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.18.08897-7 · Cited by 27
The impact of a daily yoga program for women with fibromyalgia
Schreiber, K. L., Lazaridou, A., Koulouris, A., Dorado, K., Chai, P. R., & Edwards, R. (2019) · International Journal of Yoga · doi:10.4103/ijoy.ijoy_72_18 · Cited by 24
Anderzén‐Carlsson, A., Lundholm, U. P., Köhn, M., & Westerdahl, E. (2014) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.3402/qhw.v9.23033 · Cited by 24
“…of yoga on stress (Köhn et al., 2013; Granath, Ingvarsson, von Thiele, & Lundberg, 2006), pain (Büssing, Ostermann, Lüdtke, & Michalsen, 2012b; Carson et al., 2010; Michalsen et al., 2012), hypertension (Cohen et al., 2011), anxiety (Köhn, Persson Lundholm, Bryngelsson, AnderzenCarlsson,…”
The effectiveness of yoga as a form of exercise in the management of rheumatic diseases
Kocyigit, B. F., Sagtaganov, Z., & Yessirkepov, M. (2023) · Rheumatology International · doi:10.1007/s00296-023-05291-9 · Cited by 24
Liu, C., Qin, M., Zheng, X., Chen, R., & Zhu, J. (2021) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2021/9980940 · Cited by 23
A Survey of Conventional and Complementary Therapies Used by Youth with Juvenile-Onset Fibromyalgia
Verkamp, E., Flowers, S. R., Lynch-Jordan, A. M., Taylor, J., Ting, T. V., & Kashikar‐Zuck, S. (2012) · Pain Management Nursing · doi:10.1016/j.pmn.2012.02.002 · Cited by 23
“In a recent trial of a yoga intervention for women with FM (n ¼ 53; mean age 53.7 years), Carson et al. (2010), found that a comprehensive 8-week yoga program, including yoga poses, meditation, breathing, and yoga-based coping skills, led to a significant reduction in pain, fatigue, stiffness,…”
InfluentialAre people who do yoga any better at a motor imagery task than those who do not?
Wallwork, S. B., Butler, D. S., Wilson, D., & Moseley, G. L. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2012-091873 · Cited by 23
Metadata
- Authors
- Carson, J. W., Carson, K. M., Jones, K. D., Bennett, R. M., Wright, C. L., & Mist, S. D.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Carson, James W.
- Venue
- Pain
- Published
- 2010-11
- Volume
- 151
- Issue
- 2
- Pages
- 530-539
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC5568071
- OpenAlex
- W2125478121
- Cited by
- 284
- References
- 64
- Citations by year
- 2026: 15 · 2025: 12 · 2024: 4 · 2023: 15 · 2022: 14 · 2021: 9 · 2020: 65 · 2019: 12 · 2018: 8 · 2017: 15 · 2016: 14 · 2015: 10 · 2014: 21 · 2013: 23 · 2012: 33
- FWCI
- 15.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Oregon Health & Science University Medical Research Foundation
- Fibromyalgia Information Foundation
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- fibromyalgia, yoga, pain catastrophizing, coping strategies, meditation, breathing exercises, fatigue, mood, acceptance, women, non-pharmacological treatment
- MeSH terms
- Adult, Aged, Awareness, Postural Balance, Fatigue, Female, Fibromyalgia, Humans, Middle Aged, Movement Disorders, Pain, Perceptual Disorders, Pilot Projects, Surveys and Questionnaires, Retrospective Studies, Yoga, Muscle Stretching Exercises, Catastrophization
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