Yoga for chronic low back pain in a predominantly minority population: A pilot randomized controlled trial

Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts, USA.
Alternative therapies in health and medicine (Impact Factor: 1.24). 11/2008; 15(6):18-27.
Source: PubMed


Several studies suggest yoga may be effective for chronic low back pain; however, trials targeting minorities have not been conducted. PRIMARY STUDY OBJECTIVES: Assess the feasibility of studying yoga in a predominantly minority population with chronic low back pain. Collect preliminary data to plan a larger powered study.
Pilot randomized controlled trial.
Two community health centers in a racially diverse neighborhood of Boston, Massachusetts.
Thirty English-speaking adults (mean age 44 years, 83% female, 83% racial/ethnic minorities; 48% with incomes < or = $30,000) with moderate-to-severe chronic low back pain.
Standardized series of weekly hatha yoga classes for 12 weeks compared to a waitlist usual care control.
Feasibility measured by time to complete enrollment, proportion of racial/ethnic minorities enrolled, retention rates, and adverse events. Primary efficacy outcomes were changes from baseline to 12 weeks in pain score (0=no pain to 10=worst possible pain) and back-related function using the modified Roland-Morris Disability Questionnaire (0-23 point scale, higher scores reflect poorer function). Secondary efficacy outcomes were analgesic use, global improvement, and quality of life (SF-36).
Recruitment took 2 months. Retention rates were 97% at 12 weeks and 77% at 26 weeks. Mean pain scores for yoga decreased from baseline to 12 weeks (6.7 to 4.4) compared to usual care, which decreased from 7.5 to 7.1 (P=.02). Mean Roland scores for yoga decreased from 14.5 to 8.2 compared to usual care, which decreased from 16.1 to 12.5 (P=.28). At 12 weeks, yoga compared to usual care participants reported less analgesic use (13% vs 73%, P=.003), less opiate use (0% vs 33%, P=.04), and greater overall improvement (73% vs 27%, P=.03). There were no differences in SF-36 scores and no serious adverse events.
A yoga study intervention in a predominantly minority population with chronic low back pain was moderately feasible and may be more effective than usual care for reducing pain and pain medication use.

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    • "In comparison to the control group, the yoga group reported significant reduction in perceived stress and back pain, and a substantial improvement in psychological well-being. In a pilot randomized controlled trial, Hatha yoga was found more effective than usual care.[31] "
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    ABSTRACT: Back pain is an increasing economic and health problem affecting nearly 80% of the general population. Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide effective and cost-effective treatments. Patients with CLBP are often unsatisfied with conventional medical treatment and seek complementary and alternative therapies, such as massage, acupressure, and other mind-body techniques. Mind-body techniques, such as yoga, tai chi, sensory awareness, body awareness therapy, and breath therapy are said to help patients with low back pain by enhancing body awareness. Yoga plays a significant role in enhancing one's psychological and physical health. Many CLBP patients seek relief using complementary therapies such as yoga. For this review, 12 randomized controlled trials (RCT's) have been reviewed from different databases. Details of the all RCT which suggest the management and prevention of CLBP through yoga are mentioned in the text. Based on the available researches, it appears that yoga is the most effective treatment approach to low back pain when comparing other CAM treatments.
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    • "Many cLBP patients have longstanding pain. For example, 80% of patients in our previous studies of predominantly low-income minorities with cLBP had back pain lasting more than one year; 21% reported back pain for more than nine years [26,28]. However, few non-pharmacologic intervention studies for cLBP have included ongoing structured maintenance components beyond an initial 8–16-week intervention period. "
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    ABSTRACT: Chronic low back pain causes substantial morbidity and cost to society while disproportionately impacting low-income and minority adults. Several randomized controlled trials show yoga is an effective treatment. However, the comparative effectiveness of yoga and physical therapy, a common mainstream treatment for chronic low back pain, is unknown. This is a randomized controlled trial for 320 predominantly low-income minority adults with chronic low back pain, comparing yoga, physical therapy, and education. Inclusion criteria are adults 18-64 years old with non-specific low back pain lasting >=12 weeks and a self-reported average pain intensity of >=4 on a 0-10 scale. Recruitment takes place at Boston Medical Center, an urban academic safety-net hospital and seven federally qualified community health centers located in diverse neighborhoods. The 52-week study has an initial 12-week Treatment Phase where participants are randomized in a 2:2:1 ratio into i) a standardized weekly hatha yoga class supplemented by home practice; ii) a standardized evidence-based exercise therapy protocol adapted from the Treatment Based Classification method, individually delivered by a physical therapist and supplemented by home practice; and iii) education delivered through a self-care book. Co-primary outcome measures are 12-week pain intensity measured on an 11-point numerical rating scale and back-specific function measured using the modified Roland Morris Disability Questionnaire. In the subsequent 40-week Maintenance Phase, yoga participants are re-randomized in a 1:1 ratio to either structured maintenance yoga classes or home practice only. Physical therapy participants are similarly re-randomized to either five booster sessions or home practice only. Education participants continue to follow recommendations of educational materials. We will also assess cost effectiveness from the perspectives of the individual, insurers, and society using claims databases, electronic medical records, self-report cost data, and study records. Qualitative data from interviews will add subjective detail to complement quantitative data.Trial registration: This trial is registered in, with the ID number: NCT01343927.
    Trials 02/2014; 15(1):67. DOI:10.1186/1745-6215-15-67 · 1.73 Impact Factor
    • "Principal differences between participant demographics were found in Greendale et al. (2009), with an older population (average age 76 years); Carson et al. (2010), who selected for a female population because of gender differences in fibromyalgia prevalence; and Saper et al. (2009), who selected for ethnicity (83% racial/ ethnic minority). Five MSCs were investigated: LBP (Attanayake et al., 2010; Cox et al., 2010; Galantino et al., 2004; Jacobs et al., 2004; Saper et al., 2009; Sherman et al., 2005, 2011; Tekur et al., 2008, 2010; Tilbrook et al., 2011; Williams et al., 2005, 2009), kyphosis (Greendale et al., 2009), OA (Ebnezar et al., 2011; Garfinkel et al., 1994), RA (Bhandari and Singh, 2009) and fibromyalgia (Carson et al., 2010). The average duration of MSCs, where reported, ranged from ten (Tilbrook et al., 2011) to 15 (Williams et al., 2009) years for LBP, and 12 years for fibromyalgia (Carson et al., 2010). "
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    ABSTRACT: Objectives: Musculoskeletal conditions (MSCs) are the leading cause of disability and chronic pain in the developed world, impacting both functional ability and psychosocial health. The current review investigates the effectiveness of yoga on primary outcomes of functional ability, pain and psychosocial outcomes across a range of MSCs. Methods: A comprehensive search of 20 databases was conducted for full-text, randomized controlled trials of yoga in clinically diagnosed MSCs. Result: Seventeen studies met the inclusion criteria, involving 1,626 participants with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), kyphosis or fibromyalgia. Studies were quality rated, and analysed for the effect of yoga on primary outcomes, immediately post-intervention. Twelve studies were rated as good quality. Yoga interventions resulted in a clinically significant improvement in functional outcomes in mild-to-moderate LBP and fibromyalgia, and showed a trend to improvement in kyphosis. Yoga significantly improved pain in OA, RA and mild-to-severe LBP. Psychosocial outcomes were significantly improved in mild-to-moderate LBP and OA. Meta-analysis of good-quality studies showed a moderate treatment effect for yoga of -0.64 (95%CI -0.89 to -0.39) for functional outcomes and -0.61 (95%CI -0.97 to -0.26) for pain outcomes. Conclusions: Evidence suggests that yoga is an acceptable and safe intervention, which may result in clinically relevant improvements in pain and functional outcomes associated with a range of MSCs. Future analysis of outcomes which take into account the amount of yoga received by participants may provide insight into any putative duration or dosage effects of yoga interventions for MSCs.
    Musculoskeletal Care 12/2013; 11:203-217. DOI:10.1002/msc.1042
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