Yoga and pain: A mind-body complex system

Introduction The human body's response to pain is indicative of a complex adaptive system. Therapeutic yoga potentially represents a similar complex adaptive system that could interact with the pain response system with unique benefits. Objectives To determine the viability of yoga as a therapy for pain and whether pain responses and/or yoga practice should be considered complex adaptive systems. Methods Examination through 3 different approaches, including a narrative overview of the evidence on pain responses, yoga, and complex system, followed by a network analysis of associated keywords, followed by a mapping of the functional components of complex systems, pain response, and yoga. Results The narrative overview provided extensive evidence of the unique efficacy of yoga as a pain therapy, as well as articulating the relevance of applying complex systems perspectives to pain and yoga interventions. The network analysis demonstrated patterns connecting pain and yoga, while complex systems topics were the most extensively connected to the studies as a whole. Conclusion All three approaches support considering yoga a complex adaptive system that exhibits unique benefits as a pain management system. These findings have implications for treating chronic, pervasive pain with behavioral medicine as a systemic intervention. Approaching yoga as complex system suggests the need for research of mind-body topics that focuses on long-term systemic changes rather than short-term isolated effects.

Closeness The value of closeness centrality, or closeness, determines the distance each vertex is from every other vertex. Points with high closeness tend to be highly correlated with the trends of the broader network.
In this study closeness reflects many of the same patterns as degree centrality with slight variations due to interpreting limited quality from its connections, meaning connection to other highly connected vertices increases the value. This indicates a highly interdependent part of the network.
As seen in Table 2, the nodes with the largest closeness values were TOPICS, especially related to pain pathways, yoga interventions, and inflammation. Complex systems ranked relatively low as a TOPIC. STUDIES were significantly lower in value and were led by nodes related to pain pathways, inflammation, sensitization/catastrophization, and mind-body treatments. No KEYWORDS were present in the top 30.

Influence of a periodized circuit training protocol on intermuscular adipose tissue of patients with knee osteoarthritis: protocol for a randomized controlled trial
Study closeness 0.013976

Biopsychosocial Influence on Shoulder Pain: Influence of Genetic and Psychological Combinations on Twelve-Month Postoperative Pain and Disability Outcomes
Study closeness 0.013494

Common Brain Mechanisms of Chronic Pain and Addiction
Study closeness 0.01253

Assessing for unique immunomodulatory and neuroplastic profiles of physical activity subtypes: a focus on psychiatric disorders
Study closeness 0.012048  Table 2 Degree centrality & indegree

Low-Versus High-Intensity Plyometric Exercise During Rehabilitation After Anterior Cruciate Ligament Reconstruction
The measurement of degree centrality, or degree, involves a basic, undirected count of the total connections linked to a vertex. It is solely based in quantity; the quality of connections does not affect the value. Degree centrality can be useful for identifying popular connectors or local hubs, but it does not necessarily reflect the behavior of the broader network. For the purposes of this study, degree centrality generally tracks studies which the largest number of relevant keywords. Indegree is a submetric of degree centrality that exclusively measures a node's incoming connections. Nodes that have disproportionate incoming connections tend to be destinations for information or have an output outside of the network.
As seen in Table 3, KEYWORDS were the largest group in degree centrality and the only group for indegree metrics. For both groups demographic identifiers were the highest ranking, followed by nodes related to yoga, pain, and pain pathways. Pain responses and yoga's efficacy were the highest ranking TOPICS. Only one STUDY was in the top 30, related to neurological measurements of pain.  Table 4 Reach efficiency Reach measures the portion of the network within two steps of an element. In general, elements with high reach can spread information through the network through close friend-of-a-friend contacts. Reach efficiency normalizes reach by dividing it by size (number of neighbors). In general, elements with high reach efficiency are less connected but gain more exposure through each direct relationship. Reach efficiency is useful for determining influence as well as indicating how coherent and consistent that influence is.
As seen in Table 5, reach efficiency was mostly split between KEYWORDS and STUDIES in terms of quantity, but the highest values were among STUDIES. The leading STUDY nodes all involved complex systems and pain. The leading KEYWORDS were highly heterogeneous and patterns were not readily identifiable.  Table 5 Synthesis All nodes (studies, topics, and keywords) were mapped through the network analysis and the highest 30 values for each network metric isolated. Every node was cross-referenced and any node that had multiple high network metric values were highlighted for examination. Leaders in this synthesis will be helpful in identifying the similarities in keywords and patterns of topics between fields that are not usually linked.
As seen in Table 6, several nodes were high ranking across three metrics, potentially acting as indicators of the broader pattern of the research.  The majority of the most influential nodes were STUDIES relating to complex systems and nodes relating to pain pathways. This suggests there are significant intersections between the study of complex systems and pain.
As seen in Table 7, a larger number of nodes were leaders among two metrics, and could be considered part of a larger, defining pattern between the fields of pain management and mind-body therapies. Table 7 Setting aside demographic identifier KEYWORDS, the nodes that were leading in two separate metrics tend to involve pain management, chronic pain, neuroscience, pain education, sensitization/catastrophization, and yoga or meditation. This suggests that the broader literature review highlights the close connections between chronic pain and mind-body therapies.
Combining the blocks of synthesized findings provides evidence that the fields of study regarding complex systems, pain management, and mind-body therapies share many of the same topics, keywords, and published studies. The literature review suggests the fields share significant patterns.