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Yoga For Chronic Back Pain?

Image result for yoga wikipedia A recent study found that yoga is as good as physical therapy in reducing chronic back pain in a diverse group of low-income patients. In those sticking with the program and attending the most yoga classes, yoga was better in the long-term than physical therapy and much better than just receiving educational advice about back pain. Both physical therapy and yoga reduced pain medication use by 20% at 12 weeks. These findings are supported by other research finding that yoga improves pain, function, reduces medication use, and practicing yoga long-term results in positive brain changes (such as more gray matter in the brain). From Medscape:

Yoga as Good as Physical Therapy for Back Pain

Yoga is as good as physical therapy (PT) in reducing chronic low back pain, the most common pain problem in the United States, new research shows. "Our study showed that yoga was noninferior to physical therapy for a diverse group of low-income patients," said Robert B. Saper, MD, director of integrative medicine, Boston Medical Center, Massachusetts. "Its effectiveness was most obvious in the most adherent patients." Dr Saper presented his study at the American Academy of Pain Management (AAPM) 2016 Annual Meeting. 

Previous research has shown that yoga improves pain and function and reduces medication use. For example, a 2013 meta-analysis demonstrated small to medium effect sizes for yoga in short-term and long-term back pain–related disability. Research also shows that PT is effective in treating patients with back pain. PT is considered a conventional therapy and is the most common nonpharmacologic referral by physicians for chronic low back pain, Dr Saper said. 

For this new study, researchers enrolled 320 adult patients from Boston-area community health centers who had chronic back pain with no obvious anatomic cause, such as spinal stenosis. The patients were predominantly nonwhite and low income, with a relatively low education level. The patients had "quite high" pain scores (average of 7 out of 10 on a pain scale) and were "quite disabled" in terms of their back pain, said Dr Saper. Almost three quarters were using pain medication, with about 20% taking opioids....Patients were randomly assigned to one of three groups: yoga, PT, or education.

To develop the structured yoga protocol, Dr Saper and his colleagues organized an expert panel, which reviewed the literature on the topic. The final product was a 75-minute weekly class with a very low student-to-teacher ratio. The classes began with short segment on yoga philosophy (nonviolence, moderation, self-acceptance). Participants were then given mats on which to do the simple yoga poses. They received a DVD to practice these at home. The PT group had 15 one-on-one 60-minute sessions that included aerobic exercise. PT personnel were trained to help coach patients on fear avoidance. The education group got a comprehensive book on back pain.

Both the PT and yoga sessions continued for 12 weeks, after which patients were followed to 52 weeks. During this postintervention period, patients in both the yoga and PT groups were randomly assigned to maintenance (drop in yoga classes or more PT sessions) or just at-home practice. Overall adherence was not great. The mean number of yoga classes and PT sessions attended during the initial phase was 7.

The primary question being addressed was whether yoga is not inferior to PT at 12 weeks. The study showed that for function (score on the Roland-Morris Disability Questionnaire), yoga and PT "are exactly the same, ie noninferior," said Dr Saper, adding that, "they are not terribly different from education at 12 weeks...."What that means is that for every two patients who go to yoga, about 50% of them are going to have a clinical response."....comparing the various interventions, "yoga is actually superior" to PT and is "quite a bit" superior to education, said Dr Saper. At baseline, about 70% of participants were using medication. At 12 weeks, such use was down by about 20% in both the yoga and PT groups, and hadn't changed in the education group. A similar number of yoga and PT subjects reported being "very improved" and "very satisfied," said Dr Saper.

Yoga proved to be safe, with only mild, usually transient exacerbations of back pain.....Larger studies are needed to develop better strategies to enhance adherence, he said. The new study "adds to our knowledge in suggesting that a) yoga is as good as the standard of care, non pharmacologic therapy, and b) it can be done in a diverse population, including a low income, non-English speaking population in Boston. So it takes away some of those barriers to recommending it."

There's also evidence that yoga has a positive impact on the brain. According to M. Catherine Bushnell, PhD, National Center for Complementary and Integrative Health, National Institutes of Health, long-time yoga practitioners have more gray matter than matched physically active controls. "Gray matter goes down with age, but yoga practitioners have a flat line; you don't see this age-related decrease in gray matter that you see in other healthy people,".... And there seems to be "quite a robust" relationship between how long a person has done yoga and positive brain changes, she said. "The number of years a person has practiced yoga, the more gray matter at multiple sites in the brain." Yoga influences areas of the brain that are important for pain modulation, said Dr Bushnell. It is a "complex activity" that involves not only exercise but also breath control and meditation.

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