New research suggests that people with chronic low back pain (cLBP) may have better outcomes from yoga and physical therapy than from reading evidence-based self-help materials. But a much larger effect was found among patients who were taking pain medication and who did not fear that exercise would make their back pain worse.
The study, led by researchers at Boston Medical Center, involved 299 participants with chronic lower back pain across 12 weeks of treatment. Patients were predominantly non-white and low-income.
The findings are published in the journal Pain Medicine.
The study also found that participants who expected to do well with yoga were more likely to have a meaningful improvement in their function if they received yoga compared to receiving physical therapy.
The results show that overall, 39 percent responded to one of the three treatment options with a greater response to yoga-or-physical therapy (42 percent) than the self-care group (23 percent).
There was no significant difference found in the proportion of people responding to yoga versus physical therapy in that both groups showed similar improvements in back-related physical function.
Among the study participants that were also using pain medication to treat chronic lower back pain, a large effect was observed among more participants in yoga (42 percent) or physical therapy (34 percent) compared with self-care (11 percent).
The findings highlight the effect that fear can have on patient outcomes. Among the participants identified to have less fear around physical activity, 53 percent were more likely to respond to yoga and 42 percent were more likely to respond to physical therapy than self-care (13 percent).
In contrast, among participants who started out with high fear avoidance around taking part in physical activity, the proportions of responders to the three treatment options showed no additional effect in response to treatment.
“Adults living with chronic low back pain could benefit from a multi-disciplinary approach to treatment including yoga or physical therapy, especially when they are already using pain medication,’ said Eric Roseen, D.C., M.Sc., a chiropractic physician at Boston Medical Center.
The yoga intervention involved 12 group-based weekly 75-minute hatha yoga classes incorporating poses, relaxation and meditation exercises, yoga breathing and yoga philosophy. Thirty minutes of daily home practice was encouraged and supported with at-home yoga supplies.
The physical therapy intervention consisted of 15 one-on-one 60-minute appointments over 12 weeks. During each appointment, the physical therapist utilized the Treatment-Based Classification Method and supervised aerobic exercise, while providing written instructions and supplies to continue exercises at home.
The self-care intervention involved reading “The Back Pain Handbook,” a comprehensive resource describing evidence-based self-management strategies for chronic lower back pain including stretching, strengthening, and the role of psychological and social factors. Participants received check-in calls regarding the reading every three weeks.
An analysis was performed identifying patient-level characteristics that predicted large improvements in physical function and/or modified the effectiveness of yoga, physical therapy, or self-care.
“Focusing on a diverse population with an average income well below the U.S. median, this research adds important data for an understudied and often underserved population,” said Roseen, also an assistant professor of family medicine at Boston University School of Medicine.
“Our findings of predictors are consistent with existing research, also showing that lower socioeconomic status, multiple comorbidities, depression, and smoking are all associated with poor response to treatment.”
Source: Boston Medical Center