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. The AAPM recently changed its name to the Academy of Integrative Pain Management.

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.

“We know that yoga is effective, we know that PT is effective, but we don’t know their comparative effectiveness,” said Dr Saper. “To get a complementary health practice into mainstream healthcare, I would say that a minimal bar is that it has to be as effective as the conventional therapy, and perhaps offer other benefits, like cost-effectiveness.”

PT is considered a conventional therapy and is the most common nonpharmacologic referral by physicians for chronic low back pain, Dr Saper said. About 22% of patients with low back pain in primary care get referred for PT.

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.

“We had absolutely no problem recruiting patients” for this study, said Dr Saper. “That’s because people are suffering with chronic pain and their needs are not being met.”

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.