This article was updated on 10/22/2020.
A new study from the Uniformed Services University of the Health Sciences (USU) reported “clinically meaningful” improvements in patients with low back pain (LBP) after an eight-week yoga program.
Researchers in the RESTORE (Restorative Exercise and Strength Training for Operational Resilience and Excellence) program, a pilot randomized controlled trial, recruited participants from Walter Reed National Military Medical Center, in Bethesda, Md. (Arch Phys Med Rehabil 2018;99[1]:91-98). The 68 patients were asked to report their pain level at one, four and eight weeks and at six-month follow-up of the yoga program.
“This pilot study demonstrates the need for further research that may provide meaningful data regarding yoga for the clinician to consider as a component of a pain management plan of care,” said Pain Medicine News editorial advisory board member Susan Pendergrass, MSN, MEd, FNP-BC, a nurse practitioner in Fernandina Beach, Fla. “Yoga may provide both physical and psychological benefits to managing chronic/persistent pain with an opioid-sparing approach. As always, risk versus benefit of any intervention should be evaluated after a thorough history/physical/psychological/diagnostic examination has been conducted.”
According to the study authors, participants reported clinically meaningful improvements in past 24-hour pain, disability, physical functioning and symptom burden while they were in the program. Moreover, “a higher proportion of RESTORE participants reported clinically meaningful changes in all outcomes at three-month follow-up and in symptom burden at six-month follow-up [compared to controls].”
According to lead author Krista Highland, PhD, a senior scientist at the USU Henry M. Jackson Foundation for the Advancement of Military Medicine, the benefits of the program were most evident while participation was occurring. “When it ended at eight weeks, we saw symptom levels return to baseline.”
“What this study points out is the biopsychosocial experience of pain,” said Chester Buckenmaier III, MD, the director of the USU Defense & Veterans Center for Integrative Pain Management, and a study author. “Those parameters got better much faster in the group exposed to yoga than the group exposed to [standardized care].”
Dr. Highland said the study’s small sample size limited the findings to preliminary status. “With an adequate sample size, we can start to understand what types of patient-related factors lend themselves to one treatment over the other—anything from pain catastrophizing to social support to physical functioning at baseline.”
Dr. Buckenmaier agreed that much work needs to be done, stating that “this is not the last word. This is a pilot study to determine [the intervention] was worth looking at. Honestly, I was pleased and surprised by the results. I expected some improvement, but not the dramatic improvement the yoga group received in a very short amount of time and the fact that those elements predicted overall outcome.”
Heather Tick, MD, Gunn-Loke Endowed Professor of integrative pain medicine at the University of Washington School of Medicine, in Seattle, seconded Dr. Buckenmaier’s sentiments. “There is enough preliminary [data] from this study that more research is needed and that yoga should be implemented as part of a comprehensive pain program while the further studies are going on.”
She added, “Treatments like physical therapy and yoga are better long-term options than medications and procedures. Yoga can be seen as a stand-alone therapy in conjunction with physical therapy. Because of the cultural awareness, acceptance and easy availability of yoga and because there is a meditative component to it, it is a practice that [can be easily integrated] into [a person’s] lifestyle.”
The investigators concluded that yoga “may be a viable nonpharmacological treatment for low-back pain with minimal side effects.”
Dr. Highland thought yoga could be added to a provider’s list of treatment options, saying, “It’s up to their clinical judgment. If a provider feels comfortable with it, go with it.”
“Integrative medicine is using all modalities effectively and that’s what physicians are supposed to do,” Dr. Buckenmaier said. “They’re supposed to be aware of all options and prescribe what works for the individual’s physical and emotional history.”
—Sherree Geyer