Abstract
BACKGROUND: Chronic pain impacts approximately 20% of the United States adult population and 50–75% of Veterans. It is treatment-resistant, and medications include the risk of addiction or overdose. The VA is promoting complementary and integrative health (CIH) for use along with existing treatments. Yoga can provide effective treatment for many health problems, including pain. Some of the challenges of providing yoga in healthcare include barriers such as space, time, and transportation. We studied the feasibility of conducting a randomized controlled trial (RCT) treating Veterans with chronic musculoskeletal pain with yoga delivered online versus in-person. METHODS: We developed a yoga protocol for treating chronic musculoskeletal pain online using online cohorts (n = 9, 15) with chronic musculoskeletal pain. Optimal treatment parameters were established. The resulting yoga protocol consisted of 12 weekly 75-minute classes with home-practice on 5 non-class days/week. The second phase of the study established the feasibility of conducting an RCT comparing in-person and online yoga. Thirty-four participants (30 male) were randomized to in-person (n = 16) or online yoga (n = 18). Measures were collected at baseline and end-of-treatment. RESULTS: We successfully met our Veterans participant recruitment goals for the study. Furthermore, the retention rates were 83% for tele-yoga and 68% for in-person yoga, which exceeded our a priori feasibility target of 65%. Protocol adherence was 8.62 classes (71.8%, range = 2–12) in the tele-yoga group and 9.25 classes (77.1%, range = 4–12) for in-person yoga, again exceeding our feasibility rate of 65%. Treatment satisfaction was measured using a 33-item questionnaire where each item was rated on a 0–4-point scale. Average treatment satisfaction was 3.2 in the tele-yoga group and 3.6 in the in-person group, exceeding the feasibility target of ≥ 2. There were no serious adverse events. Yoga fidelity was assessed by scoring 20% of the classes and was 91% overall. Analysis of secondary outcome measures showed that only the tele-yoga group experienced a statistically significant reduction in pain. CONCLUSION: It is feasible to conduct an RCT comparing tele-yoga to in-person yoga to treat chronic musculoskeletal pain in Veterans. Treatment may provide a reduction in pain severity and pain interference. TRIAL REGISTRATION: clinicaltrials.gov NCT04074109, August 29, 2019. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12906-026-05345-y.