PEP Topic 
Chronic Pain

Yoga is an ancient Eastern science that incorporates stress-reduction techniques such as regulated breathing, visual imagery, and meditation, as well as various postures. Hatha yoga is one type of yoga. Yoga has been examined as an intervention for anxiety, depression, chemotherapy-induced nausea and vomiting, hot flashes, cognitive impairment, sleep-wake disturbances, pain, and fatigue in patients with cancer. It has also been examined as an intervention for caregiver strain and burden.

Effectiveness Not Established

Systematic Review/Meta-Analysis

Buffart, L.M., van Uffelen, J. G., Riphagen, I. I., Brug, J., van Mechelen, W., Brown, W. J., & Chinapaw, M. J. (2012). Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer, 12, 559.

doi: 10.1186/1471-2407-12-559


STUDY PURPOSE: Evaluate effects of yoga on physical and psychosocial symptoms
TYPE OF STUDY:  Meta Analysis & Systematic Review

Search Strategy:

DATABASES USED: AMED, CINAHL, British Nursing Index, CENTRAL, EMBASE, PEDro, psycINFO, PubMed and SPORT-Discus
KEYWORDS:  States detailed search profiles available on request
INCLUSION CRITERIA:  RCT, adults with any cancer diagnosis, yoga intervention including physical postures, control group non exercise
EXCLUSION CRITERIA:  Yoga included as part of a larger intervention such as mindfulness based stress reduction were excluded

Literature Evaluated:

EVALUATION METHOD AND COMMENTS ON LITERATURE USED Study method quality evaluated using a Delphi list previously developed and tested.  Low quality defined as <50% of possible total score.

Sample Characteristics:

KEY SAMPLE CHARACTERISTICS:  12 studies involved breast cancer patients, 1 was in lymphoma

Phase of Care and Clinical Applications:

PHASE OF CARE:  Mutliple phases of care


Physical outcomes: Pain was evaluated in 4 studies, meta analysis of 2 of these showed a large effect size (d=-0.63, 95% CI -0.98, -0.31)
Psychosocial outcomes: Reduced anxiety (d=-0.77; 095% CI -1.08, -0.46) fatigue (d=-.051, 95% CI -0.79,-0.22)  Effects on sleep disturbance were small and insignificant.
Dropout rates ranged from 0-38%
Interventions ranged from planned 6 -15 sessions.  Some studies involved supervised yoga classes, and some involved home practice only.  Studies involved patients in active treatment and others involved cancer survivors who had completed treatment.


Findings suggest that yoga may be helpful to reduce anxiety and fatigue in patients with cancer.


States 3 studies included participant blinding or double blinding – it is unclear how a participant would not know they were receiving a yoga intervention.  Varied methods of measurement were used in the studies included – there is no description of how these were handled in meta analysis.  There is no report of heterogeneity findings.   Most studies were very small sample sizes.  There was a wide range of drop -out rates and no information about how this was handled in analysis.  Studies did not include attentional control conditions, so it is unclear how much effect was due to group support versus the actual yoga activity.  No differentiation was made between group session interventions versus patients who did home practice alone after instruction.

Nursing Implications:

Findings do not provide strong support for effectiveness of yoga for sleep.  Findings do suggest that yoga may be helpful for patients to reduce anxiety and fatigue.  Nurses can support involvement in this type of activity for patients who are interested in participating in yoga.

Research Evidence Summaries

Galantino, M.L., Desai, K., Greene, L., Demichele, A., Stricker, C.T., & Mao, J.J. (2012). Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor–associated arthralgias. Integrative Cancer Therapies, 11, 313–320.

doi: 10.1177/1534735411413270

Study Purpose:

To establish feasibility of studying the effects of yoga on function, pain, and quality of life in women with aromatase inhibitor–associated arthralgias

Intervention Characteristics/Basic Study Process:

Women who had joint pain attributed to aromatase inhibitor treatment were studied. Patients met two times per week for eight weeks for yoga sessions taught by certified instructors. The protocol used was inspired by Iyengar yoga involving precise postures, and meditation using relaxation and combinations of static and active stretching and isometric and dyunamic strengthening. Sessions were done among groups of 5–10 women, and an abbreviated version was given for home practice during week 2. Patients were asked to perform home practice for 15 minutes three times per week on days when sessions did not take place. Study assessments were done at baseline and at the end of the program.

Sample Characteristics:

  • The study reported on 10 female patients.
  • Median patient age was 58 years, with a range of 50–71 years.
  • All patients had breast cancer and joint pain,  were post-menopausal, and in active treatment with aromostase inhibitors.
  • Of the sample, 90% were Caucasian, 40% were employed, and 60% had at least college-level education.


  • Multisite
  • Outpatient setting
  • New Jersey

Phase of Care and Clinical Applications:

Patients were undergoing active antitumor treatment.

Study Design:

This was a quasi-experimental feasibility study.

Measurement Instruments/Methods:

  • Functional reach and sit and reach testing
  • Self-reported Patient Specific Functional Scale
  • Functional Assessment of Cancer Therapy–Breast (FACT-B)
  • Brief Pain Inventory (BPI)


Of the sample, 80% reported adherence to home practice as recommended. Participants had significant improvement in functional reach (p = 0.048) and sit and reach (p = 0.009). Participants experienced significant reduction in pain severity (3.9–2.79, p = 0.016).


The yoga protocol used here was associated with improvement in flexibility and pain associated with aromatase inhibitor–induced arthralgia.


  • The study had a small sample, with less than 30 participants.
  • The study had risk of bias due to no control group, no blinding, and no random assignment, and due to sample characteristics.
  • Findings are not generalizable.
  • Effects were related to arthralgia-related function and pain only.

Nursing Implications:

There is limited evidence regarding interventions to reduce arthralgia pain in patients undergoing cancer treatment. This study shows that a yoga intervention is feasible and may provide some promising results. Further research in this area is warranted.