Reflections on 20 Years of Research on Tai Chi for Chronic Musculoskeletal Pain: An Updated Review.

purpose of reviewChronic musculoskeletal pain (CMP), including osteoarthritis (OA), rheumatoid arthritis (RA), fibromyalgia, and chronic low back pain (cLBP), contributes substantially to disability and reduced quality of life. Contemporary pain science supports biopsychosocial, multimodal management addressing nociceptive, neuropathic, and nociplastic mechanisms. Tai Chi is a multicomponent mind-body exercise integrating gentle movement, breathing, relaxation, balance, and attentional focus. This narrative review summarizes approximately 20 years of research on Tai Chi for CMP and considers its evolving evidence in contemporary rheumatology and pain management. RECENT

findingsFindings are strongest for knee and hip OA, with randomized trials and systematic reviews demonstrating improvements in pain, mobility, physical function, and stiffness compared with non-exercise controls. For cLBP, studies suggest potential improvements in pain and physical function, although heterogeneity and limitations in the certainty of evidence warrant cautious interpretation. In fibromyalgia, Tai Chi may improve pain and selected symptoms, but findings remain variable and the certainty of evidence is limited. In RA, research is sparse and inconsistent, with insufficient data to establish clinically meaningful effects on disease activity, pain, or physical function. Across conditions, Tai Chi has a generally favorable safety profile, although variations in interventions and outcome measures limit direct comparisons. Over two decades, research on Tai Chi for chronic musculoskeletal pain has expanded from relatively small efficacy trials to larger randomized studies, as well as mechanistic and pragmatic investigations. Findings are most supportive for knee and hip OA, whereas evidence for cLBP and fibromyalgia remains promising but heterogeneous, with limitations in the certainty of evidence. Evidence for RA remains insufficient to draw firm conclusions. Overall, Tai Chi appears to be a feasible and generally safe nonpharmacological intervention that may complement multimodal management of musculoskeletal pain. Further high-quality studies are needed to establish the magnitude and clinical relevance of its benefits, determine comparative effectiveness and optimal dose and delivery, and evaluate longer-term outcomes.