Yoga as a treatment for chronic low back pain: A systematic review of the literature

Douglas G Chang, Jacquelyn A Holt, Marisa Sklar, Erik J Groessl, Douglas G Chang, Jacquelyn A Holt, Marisa Sklar, Erik J Groessl

Abstract

Objectives: Chronic low back pain (CLBP) affects millions of people worldwide, and appears to be increasing in prevalence. It is associated not only with pain, but also with increased disability, psychological symptoms, and reduced quality of life. There are various treatment options for CLBP, but no single therapy stands out as being the most effective. In the past 10 years, yoga interventions have been studied as a CLBP treatment approach. The objective of this paper is to review the current literature supporting the efficacy of yoga for CLBP.

Methods: A literature search through the beginning of 2015 was conducted in Pub Med for randomized control trials addressing treatment of CLBP with yoga.

Results: In this review we evaluate the use of yoga as a treatment for CLBP. Specifically we evaluate how yoga impacts physical functioning and disability, pain, and associated psychological symptoms. We also evaluate possible mediators of the effect of yoga and the safety of yoga.

Discussion: With few exceptions, previous studies and the recent randomized control trials (RCTs) indicate that yoga can reduce pain and disability, can be practiced safely, and is well received by participants. Some studies also indicate that yoga may improve psychological symptoms, but these effects are currently not as well established.

Keywords: Chronic pain; Complementary therapies; Low back pain; Muscle stretching exercises; Yoga.

Figures

Figure 1
Figure 1
Flow chart representing the search and selection of articles for review.

References

    1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976) 2006;31:2724–2727.
    1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581–585.
    1. Benoist M. The natural history of lumbar disc herniation and radiculopathy. Joint Bone Spine. 2002;69:155–160.
    1. Hicks GS, Duddleston DN, Russell LD, Holman HE, Shepherd JM, et al. Low back pain. Am J Med Sci. 2002;324:207–211.
    1. van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):S169–S191.
    1. Nguyen TH, Randolph DC. Nonspecific low back pain and return to work. Am Fam Physician. 2007;76:1497–1502.
    1. McIntosh G, Hall H. Low back pain (acute) BMJ Clin Evid 2011
    1. Axen I, Leboeuf-Yde C. Trajectories of low back pain. Best Pract Res Clin Rheumatol. 2013;27:601–612.
    1. Crown S. Psychological aspects of low back pain. Rheumatol Rehabil. 1978;17:114–124.
    1. Manchikanti L, Pampati V, Beyer C, Damron K, Barnhill RC. Evaluation of psychological status in chronic low back pain: comparison with general population. Pain Physician. 2002;5:149–155.
    1. Jain R. Pain and the brain: lower back pain. J Clin Psychiatry. 2009;70:e41.
    1. Sullivan MJ, Reesor K, Mikail S, Fisher R. The treatment of depression in chronic low back pain: review and recommendations. Pain. 1992;50:5–13.
    1. Currie SR, Wang J. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107:54–60.
    1. Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health. 1999;89:1029–1035.
    1. Burstrom K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res. 2001;10:621–635.
    1. Kosinski MR, Schein JR, Vallow SM, Ascher S, Harte C, et al. An observational study of health-related quality of life and pain outcomes in chronic low back pain patients treated with fentanyl transdermal system. Curr Med Res Opin. 2005;21:849–862.
    1. Prabhupāda AC. Bhagavad-Gita as it is: with the original Sanskrit text, roman transliteration, English equivalents, translation and elaborate purports. Bhaktivedanta Book Trust; Los Angeles, California, USA: 2001.
    1. Stiles M. Structural yoga therapy: adapting to the individual. Samuel Weiser; York Beach, ME: 2000.
    1. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;10:1–23.
    1. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491.
    1. Groessl EJ, Sklar M, Chang DG. Yoga as a treatment for low backpain: a review of the literature. In: Norasteh A, editor. Low Back Pain, Rijeka, Croatia, InTech Open Access. 2012. pp. 333–353.
    1. Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013;29:450–460.
    1. Holtzman S, Beggs RT. Yoga for chronic low back pain: a meta-analysis of randomized controlled trials. Pain Res Manag. 2013;18:267–272.
    1. Ward L, Stebbings S, Cherkin D, Baxter GD. Yoga for functional ability, pain and psychosocial outcomes in musculoskeletal conditions: a systematic review and meta-analysis. Musculoskeletal Care. 2013;11:203–217.
    1. Ward L, Stebbings S, Cherkin D, Baxter GD. Components and reporting of yoga interventions for musculoskeletal conditions: a systematic review of randomised controlled trials. Complement Ther Med. 2014;22:909–919.
    1. OCEBM Levels of Evidence Working Group. Oxford Centre for Evidence-based medicine-levels of evidence. 2011.
    1. Jeremy H. The philosophy of evidence-based medicine. Wiley-Blackwell, BMJ Books; Chichester, West Sussex, UK: 2011.
    1. Galantino ML, Bzdewka TM, Eissler-Russo JL, Holbrook ML, Mogck EP, et al. The impact of modified Hatha yoga on chronic low back pain: a pilot study. Altern Ther Health Med. 2004;10:56–59.
    1. Williams KA, Petronis J, Smith D, Goodrich D, Wu J, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107–117.
    1. Williams K, Abildso C, Steinberg L, Doyle E, Epstein B, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976) 2009;34:2066–2076.
    1. Tekur P, Singphow C, Nagendra HR, Raghuram N. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008;14:637–644.
    1. Tekur P, Chametcha S, Hongasandra RN, Raghuram N. Effect of yoga on quality of life of CLBP patients: A randomized control study. Int J Yoga. 2010;3:10–17.
    1. Evans DD, Carter M, Panico R, Kimble L, Morlock JT, et al. Characteristics and predictors of short-term outcomes in individuals self-selecting yoga or physical therapy for treatment of chronic low back pain. PM R. 2010;2:1006–1015.
    1. Ulger O, Yagli NV. Effects of yoga on balance and gait properties in women with musculoskeletal problems: a pilot study. Complement Ther Clin Pract. 2011;17:13–15.
    1. Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011;171:2019–2026.
    1. Tilbrook HE, Cox H, Hewitt CE, Kang’ombe AR, Chuang LH, et al. Yoga for chronic low back pain: a randomized trial. Ann Intern Med. 2011;155:569–578.
    1. Ruta DA, Garratt AM, Wardlaw D, Russell IT. Developing a valid and reliable measure of health outcome for patients with low back pain. Spine (Phila Pa 1976) 1994;19:1887–1896.
    1. Williams NH, Wilkinson C, Russell IT. Extending the Aberdeen back pain scale to include the whole spine: a set of outcome measures for the neck, upper and lower back. Pain. 2001;94:261–274.
    1. Leahy E, Davidson M, Benjamin D, Wajswelner H. Patient-Reported Outcome (PRO) questionnaires for people with pain in any spine region. A systematic review. Man Ther. 2015 Epub ahead of print.
    1. Saper RB, Boah AR, Keosaian J, Cerrada C, Weinberg J, et al. Comparing once-versus twice-weekly yoga classes for chronic low back pain in predominantly low income minorities: a randomized dosing trial. Evid Based Complement Alternat Med. 2013;2013:658030.
    1. Kim SS, Min WK, Kim JH, Lee BH. The effects of VR-based Wii fit yoga on physical function in middle-aged female LBP patients. J Phys Ther Sci. 2014;26:549–552.
    1. Groessl EJ, Weingart KR, Aschbacher K, Pada L, Baxi S. Yoga for veterans with chronic low-back pain. J Altern Complement Med. 2008;14:1123–1129.
    1. Groessl EJ, Weingart KR, Johnson N, Baxi S. The benefits of yoga for women veterans with chronic low back pain. J Altern Complement Med. 2012;18:832–838.
    1. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143:849–856.
    1. Nambi GS, Inbasekaran D, Khuman R, Devi S, Shanmugananth, et al. Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study. Int J Yoga. 2014;7:48–53.
    1. Cox H, Tilbrook H, Aplin J, Semlyen A, Torgerson D, et al. A randomised controlled trial of yoga for the treatment of chronic low back pain: results of a pilot study. Complement Ther Clin Pract. 2010;16:187–193.
    1. Sherman KJ, Wellman RD, Cook AJ, Cherkin DC, Ceballos RM. Mediators of yoga and stretching for chronic low back pain. Evid Based Complement Alternat Med. 2013;2013:130818.
    1. Lee M, Moon W, Kim J. Effect of yoga on pain, brain-derived neurotrophic factor, and serotonin in premenopausal women with chronic low back pain. Evid Based Complement Alternat Med. 2014;2014:203173.
    1. Kamper SJ, Stanton TR, Williams CM, Maher CG, Hush JM. How is recovery from low back pain measured? A systematic review of the literature. Eur Spine J. 2011;20:9–18.
    1. Chou R, Huffman LH American Pain Society, American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:492–504.
    1. Latimer J, Maher CG, Refshauge K, Colaco I. The reliability and validity of the Biering-Sorensen test in asymptomatic subjects and subjects reporting current or previous nonspecific low back pain. Spine (Phila Pa 1976) 1999;24:2085–2089.
    1. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363–370.
    1. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med (Lond) 2001;51:124–135.
    1. Chou R, Huffman LH American Pain Society, American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:505–514.
    1. Pence PG. Bringing yoga to the Veterans Administration Health Care System. Wisdom from the journey. J Yoga Service. 2013;1:49–58.
    1. Saper RB, Sherman KJ, Cullum-Dugan D, Davis RB, Phillips RS, et al. Yoga for chronic low back pain in a predominantly minority population: a pilot randomized controlled trial. Altern Ther Health Med. 2009;15:18–27.

Source: PubMed

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