Yoga Improves Health Outcomes in Veterans With Chronic Low Back Pain

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Major efforts to reduce opioid use have resulted in physicians embracing nonpharmacological pain treatments, including yoga.
Major efforts to reduce opioid use have resulted in physicians embracing nonpharmacological pain treatments, including yoga.

Hatha yoga, consisting of movement sequences, focused attention, and regulated breathing, was shown to improve health outcomes in military veterans with chronic low back pain (cLBP), in a study published in the American Journal of Preventive Medicine.1

Erik Groessl, PhD, of the department of family medicine and public health at the University of California, San Diego, and colleagues, selected 150 veterans with cLBP for a randomized clinical trial (ClinicalTrails.gov identifier: NCT02524158) seeking to examine the effects of yoga in this population. Study participants were randomly assigned to participate in a 12-week yoga program (intervention group, n=75) or the same program with a 6-month delay (control group, n=75). The yoga program consisted of two 60-minute sessions per week led by an instructor and at-home practice sessions using a manual on all other days.

The mean Roland-Morris Disability Questionnaire (RMDQ, 24 questions), evaluating current back pain-related functional limitation, was the primary outcome. Pain intensity was assessed with the Brief Pain Inventory, and was the trial's secondary outcome.

Both groups had similar reductions in RMDQ scores after 12 weeks.  However, at the 6-month assessment, RMDQ scores continued to decrease in the intervention group (–3.37; 95% Cl,–4.51 to –2.23), while returning to baseline in the control group (–0.89; 95% Cl, –2.02 to 0.23), with a between-group difference of –2.48 (95% Cl, –1.05 to –0.13; P =.013).

In addition, veterans who started the yoga regimen early vs late reported decreased pain intensity at 6 weeks (–0.39 vs 0.35; between-group difference, –0.75; 95%Cl, –1.20 to -0.30; P =.001), at 12 weeks (–0.61 vs 0.04; between-group difference, –0.65; 95% Cl, –1.10 to –0.20; P =.005), and 6 months (–0.44 vs 0.15;  between-group difference, –0.59; 95% Cl, –1.05 to –0.13; P =.013). The investigators note that this observed effect size did not reach clinical significance.

Yoga may contribute to improvement in health outcomes for patients with cLBP, and as it is associated with few and mild adverse events, may represent a valid adjunct therapy in this population. Although opioid use was not significantly reduced in the early vs late yoga group, fewer study participants were using these medications over time, with 20% of patients taking opioids at baseline, 11% at 12 weeks (P =.007), and 8% at 6 months (P <.001).

“By demonstrating that yoga is an evidence-based treatment for cLBP in military veterans, complementary and integrative health researchers and [Veterans Affairs] administrators are in a position to begin implementing yoga programs more formally,” noted Dr Groessl and colleagues.

“Yoga is being offered at >50% of VA facilities nationwide, yet most programs are not well integrated into primary care services, may not be delivered with a systematic protocol, capacity may be limited, and awareness of the programs may be low,” they remarked.

Study Limitations

  • the same yoga instructor taught all yoga sessions, which may have influenced participant receptivity, outcomes, and attendance 
  • attrition did not exceed the suggested guidelines, which makes bias more likely
  • because yoga is a multidimensional practice and the exact components that target cLBP have not been identified, determining an adequate yoga program remains a challenge

 

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Reference

  1. Groessl EJ, Liu L, Chang DG, et al. Yoga for military veterans with chronic low back pain: a randomized clinical trial [published online July 20, 2017]. Am J Prev Med. doi:10.1016/j.amepre.2017.05.019
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