Yoga Versus Education for Veterans with Chronic Low Back Pain: a Randomized Controlled Trial

Author: Eric J Roseen1,2, Adlin Pinheiro3, Chelsey M Lemaster4,5, Dorothy Plumb4, Shihwe Wang6, A Rani Elwy6,7, Chris C Streeter8,9, Susan Lynch10, Erik Groessl11, Karen J Sherman12, Janice Weinberg3, Robert B Saper13
1 Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston University Medical Campus, 801 Massachusetts Ave, Second Floor, Boston, MA, 02131, USA.
2 Department of Physical Medicine and Rehabilitation and New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.
3 Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
4 Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
5 Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
6 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
7 Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
8 Department of Psychiatry and Neurology, Boston University School of Medicine, Boston, MA, USA.
9 Department of Psychiatry, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
10 There & Back Again, Inc., Wakefield, MA, USA.
11 Herbert Wertheim School of Public Health, University of California San Diego and VA San Diego Health Care System, San Diego, CA, USA.
12 Kaiser Permanente Washington Health Research Institute, Seattle WA and Department of Epidemiology, University of Washington, Seattle, WA, USA.
13 Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA.
Conference/Journal: J Gen Intern Med
Date published: 2023 Jan 17
Other: Special Notes: doi: 10.1007/s11606-023-08037-2. , Word Count: 300

Yoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans.

Determine whether yoga is more effective than an educational book for improving disability and pain among Veterans with cLBP.

Design, setting, and participants:
Veterans diagnosed with cLBP at a VA medical center enrolled in a randomized controlled trial from March to December of 2015.

Twelve weekly hatha yoga classes or education using The Back Pain Helpbook.

Co-primary outcomes were changes from baseline at 12 weeks in back-related disability on the modified Roland Morris Disability Questionnaire and pain on the Defense & Veterans Pain Rating Scale. Secondary outcomes were global improvement, patient satisfaction, pain medication use, and post-traumatic stress symptoms. An intention-to-treat approach was used in primary analyses.

One hundred twenty Veterans (mean age, 55.5 [SD = 16.9]; 11 [9%] women; mean number of chronic conditions, 5.5) were randomized to yoga (n = 62) and education (n = 58). At 12 weeks, reductions in back-related disability in yoga (mean difference [MD] = - 3.50, 95% CI: - 5.03, - 1.97) were not significantly different than education (MD = - 2.55, 95% CI: - 4.10, - 0.99; between-group difference: - 0.95 [95% CI: - 3.14, 1.23], p = 0.39). For pain, there was no significant difference between yoga (MD = - 1.01, 95% CI: - 1.67, - 0.35) and education (MD = - 0.81, 95% CI: - 1.36, - 0.27; between-group difference: - 0.20, 95% CI: - 1.06, 0.66, p = 0.65). More yoga than education participants reported being very much or extremely improved (39% vs 19%, OR = 3.71, 95% CI: 1.37, 10.02, p = 0.01) and very satisfied with treatment (60% vs 31%, OR = 4.28, 95% CI: 1.70, 10.77, p = 0.002). No differences in pain medication use or post-traumatic stress symptoms were observed at 12 weeks. No serious adverse events were reported in either group.

Twelve weekly yoga classes were not more effective than an education intervention for improving pain or disability outcomes among mostly older male Veterans with cLBP and multiple comorbid health conditions.

Gov identifier:

Keywords: Veteran; back pain; chronic pain; yoga.

PMID: 36650329 DOI: 10.1007/s11606-023-08037-2