Tai Chi for Chronic Pain Management: An AIDriven Analysis

Tai chi is an ancient Chinese martial art. But it is more than just a means of self-defense. In fact, in recent decades the self-defense aspects of tai chi have been ignored for the most part, and replaced with a focus on its health benefits, which are many [1-10]. Numerous studies have found it to be an excellent supplementary treatment for a wide range of ailments [11-35]. It is safe, has no adverse side-effects and is cost-effective, since it does not involve expensive (or any) drugs. It can be learned by taking instruction with a practitioner, or can even be learned by watching videos, although this approach is not recommended because videos are incapable of matching the quality of a live instructor. In recent years, the use of artificial intelligence has gained much ground in medical research. It has many medical applications, both in practice and research. The present study does not examine this literature, but many studies of its use are available [36-62]. The purpose of this study is two-fold. One objective was to learn what studies have been conducted on the use of tai chi to address the issue of pain management. Another objective was to see how effective an artificial intelligence assistant could be in processing and analyzing the studies.

The PubMed database [63] was searched for studies that included “pain” in the title or abstract and that used Tai Chi as a treatment. Ten studies were selected at random [64-73]. Grok 3 [74], an artificial intelligence assistant, was then asked to summarize the content, demographics, methodologies and findings of these studies in an essay, and then to summarize the results in a Table 1. The results are presented below.

Table 1:The following table summarizes the pain management findings from eight studies on mind-body therapies, focusing on Tai Chi and related interventions. Two protocol studies [62,67] are excluded as they lack results.

Grok 3 reply (edited)

Comprehensive review of mind-body therapies for chronic pain management: Chronic pain affects millions worldwide, significantly impacting quality of life, particularly among older adults and those with musculoskeletal conditions. Mind-body therapies, such as Tai Chi, have gained attention as non-pharmacological interventions for pain management. This report synthesizes ten studies exploring the efficacy of mind-body therapies, with a focus on Tai Chi, for managing chronic pain. The studies cover content, demographics, methodology, and findings, emphasizing pain management outcomes.

Study summaries Allende S et al. [61]:

A. Content: This secondary analysis of a Randomized Controlled Trial (RCT) investigated the dose-response relationship between Tai Chi practice time, pain, and mood in participants with chronic nonspecific neck pain.
B. Demographics: Participants in the Tai Chi arm had a mean age of 52.03±10.92 years, with 73.68% female (n=38).
C. Methodology: The study analyzed data from a previous RCT, examining cumulative and home practice time effects on pain intensity, with anxiety and depression as moderators.
D. Findings: Cumulative Tai Chi practice time was associated with reduced neck pain intensity, but home practice alone was not. Anxiety moderates the relationship, with low/moderate anxiety linked to less practice during high-pain weeks and high anxiety linked to more practice. Depression did not moderate outcomes. This suggests Tai Chi’s pain relief benefits may depend on consistent practice and psychological factors [61].

Cheng ST et al. [62]:

A. Content: This study protocol outlines an RCT to test a multicomponent intervention combining physical exercise and cognitive behavioral techniques for chronic pain in older adults.
B. Demographics: The target population includes older adults aged ≥60 years with chronic musculoskeletal pain (planned n=160).
C. Methodology: The double-blind, cluster-randomized trial compares the intervention to pain education over 10 weekly 90-minute sessions, with follow-ups at post-intervention, 3 and 6 months. Outcomes include pain intensity, interference, self-efficacy, coping, and quality of life.
D. Findings: As a protocol, no results are available. The study aims to provide evidence for a scalable, non-pharmacological pain management program [62].

Hall AM et al. [63]:

A. Content: This RCT evaluated Tai Chi versus a waitlist control for persistent low back pain.
B. Demographics: Participants were adults aged 18-70 years with nonspecific low back pain (n=160).
C. Methodology: The Tai Chi group attended 18 sessions over 10 weeks, with outcomes measured as bothersomeness of back symptoms, pain intensity, and disability.
D. Findings: Tai Chi significantly reduced bothersomeness by 1.7 points (0-10 scale), pain intensity by 1.3 points and disability by 2.6 points (Roland-Morris Disability Questionnaire). With over 90% follow-up, Tai Chi was deemed safe and effective for low back pain [63].

Lauche R et al. [64]:

A. Content: This secondary analysis of an RCT explored whether postural awareness contributes to pain reduction in Tai Chi and neck exercises for chronic neck pain.
B. Demographics: Participants included 75 patients, 78.7% female, with a baseline pain intensity of 50.7±20.4mm on the Visual Analog Scale (VAS).
C. Methodology: Data from an RCT comparing 12 weeks of Tai Chi or neck exercises were analyzed using regression to assess predictors of pain reduction, including postural awareness.
D. Findings: Pain reduction (average 21.4±21.3mm VAS) was significantly associated with increased postural awareness, higher baseline pain and reduced anxiety, explaining 40.6% of variance. This suggests postural awareness is a key mechanism in exercise-based pain relief [64].

Liu J et al. [65]:

A. Content: This RCT compared Chen-Style Tai Chi, Core Stabilization training and a control group for chronic nonspecific low back pain in older adults.
B. Demographics: Participants were aged ≥50 years with chronic low back pain (n=43).
C. Methodology: The 12-week intervention included three 60-minute Tai Chi sessions weekly, with pain (VAS) and proprioception (joint position sense) measured.
D. Findings: Both Tai Chi and Core Stabilization significantly reduced pain (p<0.01) but did not improve lower limb proprioception, suggesting Tai Chi’s benefits are primarily pain related [65].

Tsai PF et al. [66]:

A. Content: This pilot cluster-RCT tested a 20-week Tai Chi program for elders with cognitive impairment and osteoarthritic knee pain.
B. Demographics: Participants were older adults (mean age 82.5 years, n=55), mostly female, with cognitive impairment and knee osteoarthritis.
C. Methodology: The Tai Chi group attended three weekly sessions, compared to a control group receiving health/ cultural classes. Outcomes included WOMAC pain, stiffness and function.
D. Findings: Tai Chi significantly reduced pain (p=0.006) and stiffness (p=0.010), with borderline improvements in physical function (p=0.071) and cognitive status (p=0.096). No adverse events were reported, indicating Tai Chi’s suitability for this population [66].

Tse MM et al. [67]:

A. Content: This study protocol describes an RCT using peer volunteers in an integrative pain management program for frail older adults with chronic pain.
B. Demographics: The study plans include 30 nursing home residents and 30 peer volunteers.
C. Methodology: The 8-week intervention involves 16 one-hour sessions, with outcomes including pain levels, mobility, physical activity, loneliness, happiness and non-pharmacological method use.
D. Findings: As a protocol, no results are available. The study emphasizes social support to enhance intervention adherence [67].

Wang C, et al. [68]:

A. Content: This RCT compared Tai Chi with standard physical therapy for knee osteoarthritis.
B. Demographics: Participants were adults with knee osteoarthritis (n=204), mean age 60 years, 70% female, 53% white.
C. Methodology: The 52-week single-blind trial involved Tai Chi (12 weeks, twice weekly) or physical therapy (6 weeks, twice weekly, followed by 6 weeks home exercise). The primary outcome was WOMAC score at 12 weeks.
D. Findings: Tai Chi reduced WOMAC scores by 167 points, like physical therapy’s 143 points, with no significant betweengroup difference. Tai Chi showed greater improvements in depression and quality of life, with benefits sustained up to 52 weeks [68].

You T et al. [69]:

A. Content: This RCT pilot study evaluated Tai Chi for older adults with chronic multisite pain.
B. Demographics: Participants were aged ≥65 years (n=54), average age 75±8 years, 96.3% white, 75.9% female.
C. Methodology: The 12-week intervention randomized participants to Tai Chi or light physical exercise, assessing feasibility, pain severity, interference, fear of falling and gait.
D. Findings: Tai Chi significantly reduced pain severity (4.58 to 3.73, p<0.01), pain interference (4.20 to 3.16, p<0.05), fear of falling (90.82 to 96.84, p<0.05), and improved gait variables. Light exercise showed no significant changes, supporting Tai Chi’s feasibility for larger trials [69].

Zeliadt SB et al. [70]:

A. Content: This prospective cohort study examined how initial perceptions of mind-body CIH therapies influence long-term adherence in a pragmatic trial for chronic pain.
B. Demographics: The study included 1713 Veterans with chronic musculoskeletal pain using self-care therapies (yoga, Tai Chi/Qigong, meditation).
C. Methodology: Over 6 months, linear regression assessed predictors of therapy sessions, focusing on perceived effectiveness in pain, mental health, fatigue and well-being.
D. Findings: 56% of participants reported positive initial perceptions, associated with 2.5 more therapy sessions (95% CI: 1.3 to 3.6). Older individuals and meditation users were more likely to have positive perceptions, highlighting the role of expectations in adherence [70].

Synthesis of pain management outcomes

The studies collectively suggest that Tai Chi is a promising intervention for chronic pain management across various conditions:
Neck pain: Tai Chi reduces pain intensity, with cumulative practice and postural awareness enhancing outcomes [61,64].
Low back pain: Tai Chi significantly alleviates pain and disability, comparable to other active interventions [63,65].
Knee osteoarthritis: Tai Chi matches physical therapy in reducing pain and improving function, with additional benefits in depression and quality of life [68].
Multisite pain and special populations: Tai Chi reduces pain, fear of falling, and improves mobility in older adults with multisite pain or cognitive impairment [69,66].
Adherence factors: Positive initial perceptions of therapy effectiveness increase long-term engagement, particularly for mind-body therapies [70].

Methodological considerations

The studies employ diverse methodologies, including RCTs, secondary analyses, pilot studies and protocols. RCTs provide robust evidence [63,68], while pilot studies and secondary analyses offer insights into feasibility and mechanisms [69,64]. Protocols indicate ongoing research interest [62,67]. Limitations include small sample sizes in some studies, specific populations (e.g., Veterans, older adults) and lack of results for protocols, which may limit generalizability.

Implications for pain management

Mind-body therapies, particularly Tai Chi, offer a nonpharmacological approach to chronic pain management, suitable for diverse populations, including older adults and those with comorbidities. The integration of psychological components, such as cognitive behavioral techniques or social support, may enhance outcomes [62,67]. Factors like postural awareness and patient expectations are critical for maximizing benefits [64,70].

The evidence suggests that Tai Chi and other mind-body therapies are effective for managing chronic pain, offering benefits comparable to traditional treatments like physical therapy. These interventions improve pain, function, and psychological well-being, particularly in older adults. Future research should focus on larger, more diverse trials, explore mechanisms like postural awareness, and develop strategies to enhance adherence through social support and positive expectations.

Grok 3 did an excellent job of organizing and summarizing the data but failed to create a summary Table 1, so it was asked a second time to create a Table 1. The results are produced below.

Summary table of pain management findings

The following Table 1 summarizes the pain management findings from eight studies on mind-body therapies, focusing on Tai Chi and related interventions. Two protocol studies [62,67] are excluded as they lack results.

Concluding comments

The Table omitted two of the ten studies-Cheng & Tse [62,67]. They were omitted because they lacked results. Grok included some additional information after the table, but much of it was a repeat of what it gave after the first command and so is omitted in this article. Grok did a good job organizing and synthesizing the information. Researchers who would like to use an AI assistant as a research tool can be heartened by the results of this study. However, as was seen, Grok did not produce all the requested data on the first iteration because it omitted the requested table. There is one more study I would like to discuss before concluding this article. Kong et al. [75] conducted an excellent study on the very topic of the present article-utilizing tai chi for pain management-that has been cited many times in the literature. They reviewed 18 randomized control trials on the use of Tai Chi in pain management. From analyzing the results of those RCTs they concluded that tai chi could provide immediate relief from osteoarthritis pain (p<0.05). The relief of low back pain was significant (p<0.05). Their overall conclusion was that “clinicians may consider Tai Chi as a viable complementary and alternative medicine for chronic pain conditions.” Their findings conform with those found in other studies, some of which are mentioned in the current article. Their findings provide further evidence that tai chi can be used as a supplementary treatment for arthritis pain sufferers.

The methodology employed in this study can be replicated by researchers who wish to obtain basic summary information quickly and easily. However, deeper research is needed if the researchers in question want to implement tai chi as a primary or secondary treatment because numerous studies have found that AI can produce incomplete, inaccurate or flawed results [76-83], although there have been rapid improvements in technology in the last few years. The quality and accuracy of AI assistants have improved remarkably in a very short time, but due diligence is still required before proceeding to the next step in the research project. The purposes of this study have been achieved. We were able to learn very quickly what studies have used tai chi as a treatment for pain management, and we saw how effectively artificial intelligence could be used to process and analyze medical data.