Neuropathic Pain Reduction After Qigong Practice in Adults with Spinal Cord Injury

Abstract

INTRODUCTION Neuropathic pain is a debilitating pain that occurs in 40-50% of adults after a spinal cord injury (SCI) and hugely affects their daily life function. The first line of treatment for neuropathic pain after SCI is pharmacological treatment. However, pain medication has many side effects and carries a risk of addiction. In addition to medication, people with SCI are seeking other non-pharmacological pain treatment methods, such as mind and body approaches (i.e., Yoga, Tai Chi, Qigong). Based on previous studies in other populations showing that Qigong can reduce chronic pain, the goal of our study was to test whether remote Qigong practice could reduce neuropathic pain in adults with SCI.

AIM The first aim of this study was to evaluate the effect of 12 weeks of remote Qigong practice in addition to standard care (medication) to help reduce chronic neuropathic pain in adults with SCI. The secondary aim 1 was to verify whether the possible pain reduction could be maintained for at least 6 weeks when they stop practicing. The second aim of the study was to determine whether 12 weeks of remote Qigong practice would have a beneficial effect on symptoms commonly associated with neuropathic pain, such as interference of pain on mood, sleep, and function.

METHODS This pilot study used a quasi-experimental pre-post study design. Participants practiced Qigong with an online video, at least three times per week (41 min/session) for 12 weeks in their own homes. Their amount of practice was monitored on the website. After 12 weeks of practice, they stopped practicing Qigong and pain measures were assessed weekly during a 6-week follow-up period. We assessed neuropathic pain intensity weekly with the Numeric Pain Rating Scale (primary outcome) throughout the duration of the study (18 weeks). The secondary outcomes were pain interference of sleep, mood, and quality of life, assessed with the International SCI-Basic Pain Data Set (version 2.0); depression with the Patient Health Questionnaire-9 scale; and the ability to perform self-identified functional goals with the Patient Specific Functional Scale. The study was completely remote. Participants completed the questionnaires over Zoom at baseline, after 12 weeks of Qigong practice, and after the 6-week follow-up period (week 18).

RESULTS We recruited 18 participants with SCI (age: 59.61±11.54 years old, time since SCI: 15.17±11.16 years). Paired t-tests were performed to compare the scoring on the outcome measures between (1) pre-Qigong practice (baseline) and post-Qigong practice (week 12); as well as between (2) post-Qigong practice (week 12) and 6-week follow-up (week 18). Participants experienced significant reductions in highest neuropathic pain (p=0.000006, Cohen’s d=1.70), average pain (p=0.0002, d=1.12), and lowest pain intensity levels (p=0.0003, d=1.08) after 12 weeks of Qigong practice compared to baseline. After 12 weeks of Qigong practice, they also experienced a significant reduction in pain interference on mood (p=0.00004, d=1.36), sleep (p=0.0002, d=1.41), and daily activities (p=0.00004, d=1.14). They experienced a significant reduction in depression (p=0.008, d=0.71); and a significant improvement in function, reflected in a score towards achieving their three functional goals (p=0.0000004, d=2.18). There were no significant changes in our outcomes between week 12 and week 18, meaning that the improvements were maintained over the 6-week follow-up.

CONCLUSION Our pilot study indicated that 12 weeks of Qigong practice has the potential to reduce neuropathic pain in adults with SCI and that this pain reduction could be retained for at least 6 weeks. In addition, Qigong practice reduced interference of pain on mood, sleep, and daily activities, reduced depression, and improved their ability to perform functional goals. While this study shows promising results, it would be important to validate these findings in a large randomized controlled trial.