Yoga for chronic pain in veterans: A mixed methods study

Abstract

Yoga is an increasingly common practice used in the management of chronic pain, largely due to its safety and demonstrated effectiveness as an adjunctive treatment. There are important challenges to understanding the effect of yoga on chronic pain, notably yoga is rarely used in isolation and the specific content of yoga interventions varies widely between studies. Additionally, yoga and complementary practices in general are under-described in veteran populations even though veterans are more highly engaged with complementary practices than civilians. This dissertation seeks to inform the evidence base of veterans who practice yoga in three ways. First, I estimate the cross-sectional association between yoga practice and disability among veterans with pain using propensity score-matching. Yoga practice is not associated with a difference in prevalence of disability. Second, I identify differences in yoga practice between veterans with chronic pain and veterans without chronic pain. A mixed methods approach is employed with a qualitative strand that builds upon the quantitative strand to explain the differences observed. This analysis shows that yoga practitioners with chronic pain are regularly using self-directed practices more frequently than yoga practitioners without chronic pain. Interviews with study participants identify convenience as a facilitator of self-directed practice and feeling self-conscious as a barrier to instructor-led group practice among practitioners with chronic pain. Finally, I describe patterns of use of 19 different non-pharmacological health approaches among all members of the sample to show how modalities are being used in integrated ways. This dissertation makes several important contributions. I piloted of a self-report instrument for describing yoga practice, the Essential Properties of Yoga Questionnaire, and a self-report instrument of use of non-pharmacologic therapies, the Health Practices Inventory. Both instruments are ready for use by others. Also, I provide a detailed description of how veterans with pain are using and experiencing yoga.