Effectiveness of Yoga on Depression and Anxiety in People with Chronic Primary Pain: A Meta-Analysis of Randomized Controlled Trials.

Chronic primary pain is persistent pain that leads to emotional distress, anxiety, and depression. It cannot be explained by any alternative diagnosis and disrupts daily functioning, including sleep and social activities. The present meta-analysis evaluated the impact of yoga on depression and anxiety in people with chronic primary pain; we also evaluated yoga's effect on pain, quality of life, adherence, and adverse effects. Randomized controlled trials involving patients with chronic primary pain and utilizing yoga as an intervention were included. The databases PubMed, Cochrane Library, CINAHL, and Ovid were searched to extract participant demographics, intervention characteristics, outcomes, and study quality. Data synthesis involved random-effects meta-analysis for effect sizes and subgroup analyses based on control groups. Among the six trials involving 382 subjects, yoga significantly improved depression (standard mean difference -1.54), anxiety (standard mean difference -1.56), pain (mean difference -1.56), and quality of life (standard mean difference -1.26) compared to controls; no significant adverse events were observed. Yoga has a positive effect on levels of depression, anxiety, and pain in people with chronic primary pain, improving their quality of life. The grade of evidence for depression and anxiety ranged from low to very low; however, in comparisons with active and passive control groups, yoga may serve as a valuable nonpharmacological intervention for managing both physiological and psychological symptoms in patients with chronic primary pain, complementing standard medical care. Future studies should explore the optimal duration/ frequency of yoga practices, along with different types of yoga practices and yoga traditions, which may help to formulate delivery models for chronic primary pain management.