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Combined Neuromodulation and Yoga Intervention for Chronic Pain
Niki P Sabetfakhri1, Alexandra L Aaronson1,2, Kelly Krese3,4
1Department of Psychiatry, University of Illinois Chicago, Chicago.
Focus (American Psychiatric Publishing)
|August 11, 2026
Summary
Combining intermittent theta burst stimulation (iTBS) with yoga offers a synergistic approach for chronic pain management. This nonpharmacologic strategy showed feasibility, safety, and significant pain reduction in a pilot study.
Area of Science:
- Neuroscience
- Pain Management
- Integrative Medicine
Background:
- Chronic pain is a complex syndrome often co-occurring with psychiatric disorders, requiring effective nonpharmacologic treatments.
- Current management strategies for chronic pain are often inadequate, necessitating novel therapeutic approaches.
- Multimodal, nonpharmacologic interventions are increasingly recommended for long-term chronic pain management.
Purpose of the Study:
- To provide a rationale for combining intermittent theta burst stimulation (iTBS) with yoga as a synergistic treatment for chronic pain.
- To review the mechanisms of action for both iTBS and yoga in pain modulation.
- To present preliminary findings from a pilot trial investigating this combined therapy.
Main Methods:
- A narrative review of literature identified through PubMed searches and reference list reviews.
- Synthesis of evidence for iTBS (transcranial magnetic stimulation) and yoga as standalone treatments for pain.
- Description of a pilot trial combining iTBS with manualized group yoga in veterans with chronic pain and mild traumatic brain injury.
Main Results:
- iTBS enhances cortical excitability and engages descending pain inhibition, creating a window for neuroplasticity.
- Yoga utilizes bottom-up mechanisms including autonomic regulation, sensorimotor integration, and cognitive reframing.
- The pilot trial demonstrated that iTBS followed by yoga was feasible, safe, and led to significant pain improvement.
Conclusions:
- Combining iTBS with yoga presents a promising synergistic strategy for chronic pain management.
- This multimodal approach leverages both top-down neuromodulation and bottom-up physiological regulation.
- Further research is warranted to optimize and validate this combined treatment for chronic pain.
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