Yoga may be beneficial in chronic low back pain

Yoga improved chronic low back pain compared to usual care, a new randomized trial has shown.

Researchers in the United Kingdom performed a parallel-group randomized, controlled trial from April 2007 to March 2010 at 13 facilities not affiliated with the U.K.'s National Health Service. Three hundred thirteen adults with chronic or recurrent low back pain were randomly assigned to receive yoga (n=156) or usual care (n=157). All participants were given an educational booklet on back pain, and the intervention group was offered a 12-class yoga program given by 12 teachers over a three-month period. The yoga classes were adapted for low back pain and became more challenging as time progressed (a video is available online) . Outcome measures, assessed via mailed questionnaire, were Roland-Morris Disability Questionnaire (RMDQ) scores (ranging from 0, indicating best, to 24, indicating worst) as well as pain, pain self-efficacy, and general health measures at three, six and 12 months. The results appear in the Nov. 1 Annals of Internal Medicine.

Seventy-seven percent of participants had current low back pain at randomization. Of the 156 patients assigned to yoga classes, 93 (60%) went to three or more of the first six sessions and at least three of the remaining sessions. Back function was significantly better in the yoga group than in the usual care group at three, six, and 12 months (adjusted mean RMDQ scores, 2.17 points, 1.48 points, and 1.57 points lower for yoga vs. usual care, respectively; P<0.001, P=0.011, and P=0.007, respectively). Back pain was similar in both groups at all three time points, while pain self-efficacy scores were higher in the yoga group at three and six months but not at 12 months. Adverse events, most commonly increased pain, were reported by two of the 157 usual care participants and 12 of the 156 yoga participants.

The authors noted that data were missing for the primary outcome (i.e., three-month RMDQ scores) in both groups and cautioned against comparing their findings directly with those from other randomized trials of exercise and manipulation for low back pain. However, they concluded that a 12-week yoga program in adults with chronic or recurrent low back pain yielded greater improvement than did usual care.

Another study, published early online Oct. 24 by Archives of Internal Medicine, compared the effects of yoga, stretching, and a self-care book on chronic low back pain in adults. In that study, 228 adults were assigned to 12 weekly yoga classes (n=93), stretching exercises (n=91), or a self-care book (n=45). The primary outcomes were back function as measured on a modified 23-point version of the Roland Disability Questionnaire and bothersomeness of pain on an 11-point scale at 12 weeks, with outcomes assessed at baseline and at six, 12, and 26 weeks. All patients were recruited from the Puget Sound area of Washington state.

At 12 weeks, after adjustment for baseline values, the yoga group had better outcomes in function and symptoms (mean differences, −2.5 points and −1.1 points, respectively) than the self-care group (P<0.001 for both comparisons). The yoga group continued to have better function at 26 weeks than the self-care group (mean difference, −1.8 points; P<0.001), but yoga was never found to be superior to stretching. The authors noted that because yoga and stretching yielded similar outcomes, the benefits of yoga were probably due to its physical rather than mental aspects. Limitations of the study included its use of participants from a single site and the lack of follow-up past 26 weeks. However, the authors concluded that compared to self-care, yoga can improve function and symptoms for several months in patients with low back pain.

An invited commentary accompanying the Archives article said the results show that exercise in patients with low back pain is “safe and moderately beneficial” and that clinicians can safely refer such patients to yoga classes or physical therapy. The commentary author called for more comparative effectiveness research on low back pain to help guide recommendations on policy and clinical practice.

The American College of Physicians recently published a guideline on diagnostic imaging for low back pain as part of its high-value, cost-conscious care initiative.