Comparing yoga, exercise and a self-care book for chronic low back pain

Annals of Internal Medicine.

2005 Dec 20;143(12):849-56.

Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA.

Group Health Cooperative and University of Washington, Seattle, Washington, USA. Sherman.k@ghc.org

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BACKGROUND:

Chronic low back pain is a common problem that has only modestly effective treatment options.

OBJECTIVE:

To determine whether yoga is more effective than conventional therapeutic exercise or a self-care book for patients with chronic low back pain.

DESIGN:

Randomized, controlled trial.

SETTING:

A nonprofit, integrated health care system.

 PATIENTS:

 101 adults with chronic low back pain.

INTERVENTION:

12-week sessions of yoga or conventional therapeutic exercise classes or a self-care book.

MEASUREMENTS:

Primary outcomes were back-related functional status (modified 24-point Roland Disability Scale) and “bothersomeness” of pain (11-point numerical scale). The primary time point was 12 weeks. Clinically significant change was considered to be 2.5 points on the functional status scale and 1.5 points on the bothersomeness scale. Secondary outcomes were days of restricted activity, general health status, and medication use.

RESULTS:

After adjustment for baseline values, back-related function in the yoga group was superior to the book and exercise groups at 12 weeks (yoga vs. book: mean difference, -3.4 [95% CI, -5.1 to – 1.6] [P < 0.001]; yoga vs. exercise: mean difference, -1.8 [CI, -3.5 to – 0.1] [P = 0.034]). No significant differences in symptom bothersomeness were found between any 2 groups at 12 weeks; at 26 weeks, the yoga group was superior to the book group with respect to this measure (mean difference, -2.2 [CI, -3.2 to – 1.2]; P < 0.001). At 26 weeks, back-related function in the yoga group was superior to the book group (mean difference, -3.6 [CI, -5.4 to – 1.8]; P < 0.001).

LIMITATIONS:

Participants in this study were followed for only 26 weeks after randomization. Only 1 instructor delivered each intervention.

CONCLUSIONS:

Yoga was more effective than a self-care book for improving function and reducing chronic low back pain, and the benefits persisted for at least several months.

Effect of Iyengar yoga therapy for chronic low back pain

Pain. 2005 May;115(1-2):107-17.

Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, Doyle EJ Jr, Gregory Juckett R, Munoz Kolar M, Gross R, Steinberg L.

Dept. Community Medicine, West Virginia University School of Medicine, Morgantown, WV 26505, USA. kwilliams@hsc.wvu.edu

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Low back pain is a significant public health problem and one of the most commonly reported reasons for the use of Complementary Alternative Medicine. A randomized control trial was conducted in subjects with non-specific chronic low back pain comparing Iyengar yoga therapy to an educational control group. Both programs were 16 weeks long. Subjects were primarily self-referred and screened by primary care physicians for study of inclusion/exclusion criteria. The primary outcome for the study was functional disability. Secondary outcomes including present pain intensity, pain medication usage, pain-related attitudes and behaviors, and spinal range of motion were measured before and after the interventions. Subjects had low back pain for 11.2+/-1.54 years and 48% used pain medication. Overall, subjects presented with less pain and lower functional disability than subjects in other published intervention studies for chronic low back pain. Of the 60 subjects enrolled, 42 (70%) completed the study. Multivariate analyses of outcomes in the categories of medical, functional, psychological and behavioral factors indicated that significant differences between groups existed in functional and medical outcomes but not for the psychological or behavioral outcomes. Univariate analyses of medical and functional outcomes revealed significant reductions in pain intensity (64%), functional disability (77%) and pain medication usage (88%) in the yoga group at the post and 3-month follow-up assessments. These preliminary data indicate that the majority of self-referred persons with mild chronic low back pain will comply to and report improvement on medical and functional pain-related outcomes from Iyengar yoga therapy.

 

 

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