Yoga, Physical Therapy, or Education for Chronic Low Back Pain

Saper, Robert B.; Lemaster, Chelsey M.; Delitto, Anthony; Sherman, Karen J.; Herman, Patricia M.; Sadikova, Ekaterina; Stevans, Joel M.; Keosaian, Julia; Cerrada, Christian; Femia, Alexandra; Roseen, Eric J.; Gardiner, Paula; Barnett, Katherine Gergen; Faulkner, Carol; Weinberg, Janice

doi:10.7326/m16-2579

Cited by 161 publications

(174 citation statements)

References 39 publications

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“…A recent trial of yoga versus physical therapy (PT) for chronic low back pain in an undeserved population found response rates very similar to those in our study (35%). 78 Our previous study of individual acupuncture in this setting similarly found that roughly 1/3 of participants had a 30% or greater improvement in pain, 79 suggesting that this may be a more typical response in this population. Regarding the difference in outcomes between group and individual arms, it is possible that constraints on the physical environment may have contributed, in particular, the challenge of treating patients seated in chairs with limited capacity for accessing acupuncture points on the trunk and upper legs.…”

Section: Discussionmentioning

confidence: 88%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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Background Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations. Objective Acupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain. Design This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks. Participants Seven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability. Interventions Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks. Main Measures Primary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks. Key Results 37.5% of individual arm and 30.3% in group had > 30% improvement in pain interference (d = 7.2%, 95% CI − 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI − 4.2%, 11.4%). Conclusions Both individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown. Trial Registration Clinicaltrials.gov # NCT02456727

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Section: Discussionmentioning

confidence: 88%

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

et al. 2020

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“…A 2013 review found evidence for the benefits of yoga in the short-term as well as long-term effects in management of LBP. 35 Yoga has been found to be equivalent to both physical therapy 36 and to non-yoga exercise for LBP 37 and has specifically shown a benefit in veterans with chronic LBP when compared to usual care. 38 The ACP guidelines on LBP include a strong recommendation that yoga should be offered as a first-line treatment for chronic LBP.…”

Section: Exercise Therapymentioning

confidence: 99%

Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain

et al. 2018

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As a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Services Research and Development (HSR&D) held a state-of-the-art (SOTA) conference titled "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management" in November 2016. Goals of the conference were (1) to establish consensus on the current state of evidence regarding non-pharmacological approaches to chronic musculoskeletal pain to inform VHA policy in this area and (2) to begin to identify priorities for the future VHA research agenda. Workgroups were established and asked to reach consensus recommendations on clinical and research priorities for the following treatment strategies: psychological/behavioral therapies, exercise/movement therapies, manual therapies, and models for delivering multimodal pain care. Participants in the SOTA identified nine non-pharmacological therapies with sufficient evidence to be implemented across the VHA system as part of pain care. Participants further recommended that effective integration of these non-pharmacological approaches across the VHA and especially into VHA primary care, pain care, and mental health settings should be a priority, and that these treatments should be offered early in the course of pain treatment and delivered in a team-based, multimodal treatment setting concurrently with active self-care and self-management approaches. In addition, we recommend that VHA leadership and policy makers systematically address the barriers to implementation of these approaches by expanding opportunities for clinician and veteran education on the effectiveness of these strategies; supporting and funding further research to determine optimal dosage, duration, sequencing, combination, and frequency of treatment; emphasizing multimodal care with rigorous evaluation grounded in team-based approaches to test integrated models of delivery and stepped-care approaches; and working to address socioeconomic and cultural barriers to veterans' access to non-pharmacological approaches.

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“…Yoga practice has proved to be a useful tool to treat nCLBP and associated psychological problems 15 . Recently, Saper et al 16 published an article in which they demonstrated the efficiency of yoga, physical therapy and education in nCLBP treatment, concluding that yoga is very efficient and non-inferior to physical treatment for addressing this pathology. Wieland et al 17 in an interesting review discuss that yoga compared to non-exercise controls is able to reduce low-back pain symptoms with low-to moderate-certainty evidence.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of yoga combined with back school program on anxiety, kinesiophobia and pain in people with non-specific chronic low back pain: a prospective randomized trial

Giorgio

Padulo

Kuvačić

2019

Muscle Ligaments and Tendons J

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Introduction: The aim of this study was to investigate the efficacy of Yoga combined with Back school program intervention compared to Yoga program only in order to evaluate anxiety, kinesiophobia, back pain disability and quality of life in people affected by non-specific chronic low back pain. Methods: In this randomized controlled trial, 70 participants (age 37.97±5.54 years) with non-specific chronic low back pain were randomized to undergone experimental Yoga combined with Back school group (35 subjects; Intervention) or Hatha Yoga program group (35 subjects, Control) respectively. The intervention consisted of Yoga exercise sessions with Back school meetings, two times per week for 8 weeks. We investigate the effectiveness of these interventions through some psychological factors: anxiety (Hamilton anxiety scale HAM-A), kinesiophobia (Tampa Scale for Kinesiophobia TSK), back pain disability (Roland Morris Disabilities RMQ), and quality of life (36 Item Short Form Survey SF-36). Results: We found significant decrease in mean scores of all psychological variables (Anxiety F2,68=53.504, p<0.001; Kinesiophobia F2,68=52.244, p<0.001; Disability F2,68=128.343, p<0.001) and increase in health-related quality of life sub-scales (Bodily pain F1,34=20.907, p<0.001; General mental health F1,34=7.319, p=0.011; General health perceptions F1,34=7.879, p=0.008) in Intervention group. Both groups were significantly different in all psychological variables and three sub-scales relate to the quality life (Physical functioning, Bodily pain, and General health perceptions) at the end of 8 and 12 training interventions weeks. Conclusions: This study demonstrated effectiveness of Yoga combined with Back school intervention in people affected by nCLBP with lowering Anxiety, Kinesiophobia and Disability together with improving the quality of life. Level of evidence: Ib.

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Yoga, Physical Therapy, or Education for Chronic Low Back Pain

Abstract: National Center for Complementary and Integrative Health of the National Institutes of Health.

Cited by 161 publications

References 39 publications

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care—a Randomized Trial

Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain

Effectiveness of yoga combined with back school program on anxiety, kinesiophobia and pain in people with non-specific chronic low back pain: a prospective randomized trial

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