Jacobs B, Avins A, Epel E, Acree M, Maurer S, Goldberg H, Miaskowski C.

Iyengar yoga for the treatment of chronic low back pain: a randomized controlled pilot study.

Osher Center for Integrative Medicine, University of California, San Francisco, PO Box 1726, San Francisco, CA 94143-1726. jacobsb@ocim.ucsf.edu

PURPOSE: There are no clearly effective treatments for chronic back pain. Preliminary research suggests yoga may have clinical benefits. The purpose of this study was to obtain pilot data on the effect of Iyengar yoga for the treatment of chronic mechanical low back pain.

METHODS: 52 patients with chronic low back pain were randomly assigned to receive either twice-weekly Iyengar yoga (n=28) or wait-list control (N=24) for 12 weeks. The primary outcome was the change in the functional disability scores between baseline and study end (12 weeks) using the Roland-Morris Questionnaire (RMQ) and Oswestry Disability Index (ODI). Secondary outcomes included change in pain severity, general health status by SF-36, anxiety by State-Trait Anxiety Instrument (STAI), insomnia by the Impaired Sleep Index (ISI), and stress levels measured by salivary cortisol levels.

RESULTS: Baseline clinical and demographics variables were similar between groups, except for gender (65% female in the intervention group vs. 39% in the controls). Yoga was associated with a 2.5 point and 2.9 point improvement in RMQ and ODI when compared with wait-list controls (RMQ yoga change score= - 2.7 versus control change score= - 0.2 (p=0.07); ODI yoga change score= - 4.2 points versus control change score= - 1.3 points (p=0.07)). When compared with waitlist controls, the yoga intervention was associated with significant improvements in emotional well-being subscale of the SF-36 (p=0.03) and insomnia using ISI (p=0.02), as well as significant reductions in evening salivary cortisol levels among men (p=0.05). There were no differences between groups in pain intensity, anxiety, depression, and positive affect.

CONCLUSION: This pilot study found that yoga was associated with a large effect size for improvement in functional disability that approached statistical significance. Furthermore, yoga may be associated with improved emotional well-being, sleep, and salivary cortisol levels among people with chronic back pain. This study supports the need for adequately powered trials to evaluate the clinical effects of yoga among people with chronic back pain, and for trials to evaluate the mechanism through which yoga may have its clinical effects.

 

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