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Clinician Article

A systematic review and meta-analysis of yoga for low back pain.



  • Cramer H
  • Lauche R
  • Haller H
  • Dobos G
Clin J Pain. 2013 May;29(5):450-60. doi: 10.1097/AJP.0b013e31825e1492. (Review)
PMID: 23246998
Read abstract Read evidence summary
Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Special Interest - Pain -- Physician
    Relevance - 6/7
    Newsworthiness - 5/7
  • Physical Medicine and Rehabilitation
    Relevance - 5/7
    Newsworthiness - 5/7

Abstract

OBJECTIVES: To systematically review and meta-analyze the effectiveness of yoga for low back pain.

METHODS: MEDLINE, the Cochrane Library, EMBASE, CAMBASE, and PsycINFO, were screened through January 2012. Randomized controlled trials comparing yoga to control conditions in patients with low back pain were included. Two authors independently assessed risk of bias using the risk of bias tool recommended by the Cochrane Back Review Group. Main outcome measures were pain, back-specific disability, generic disability, health-related quality of life, and global improvement. For each outcome, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

RESULTS: Ten randomized controlled trials with a total of 967 chronic low back pain patients were included. Eight studies had low risk of bias. There was strong evidence for short-term effects on pain (SMD=-0.48; 95% CI, -0.65 to -0.31; P<0.01), back-specific disability (SMD=-0.59; 95% CI, -0.87 to -0.30; P<0.01), and global improvement (risk ratio=3.27; 95% CI, 1.89-5.66; P<0.01). There was strong evidence for a long-term effect on pain (SMD=-0.33; 95% CI, -0.59 to -0.07; P=0.01) and moderate evidence for a long-term effect on back-specific disability (SMD=-0.35; 95% CI, -0.55 to -0.15; P<0.01). There was no evidence for either short-term or long-term effects on health-related quality of life. Yoga was not associated with serious adverse events.

DISCUSSION: This systematic review found strong evidence for short-term effectiveness and moderate evidence for long-term effectiveness of yoga for chronic low back pain in the most important patient-centered outcomes. Yoga can be recommended as an additional therapy to chronic low back pain patients.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

LBP management continues to be a daily challenge for primary care. This meta-analysis includes new data about the effects of yoga on LBP. The methodology of the study was strong, and the risk of bias was low. The study found strong evidence for short-term and moderate evidence for long-term reduction of LBP and back-specific disability after yoga. On subgroup analysis, the effects of yoga were mixed against usual care, education and exercise. Yoga intervention does have different modalities, and not enough data was available to differentiate their effects on LBP. Overall, yoga has a low number of adverse events; and based on this study, it does show some benefits. Yoga could be advised to patients as an effective treatment option to treat LBP. Further studies should include specific yoga modalities and its effects on LBP.

Family Medicine (FM)/General Practice (GP)

Looks like Yoga is effective, but what`s the intervention and how is it different from exercise (which we know works)?

Family Medicine (FM)/General Practice (GP)

These are novel and important findings. There are limited evidence-based options for treatment of LBP. This meta-analysis suggest both short-term and long-term (although smaller effects) in pain- and LBP-related disability. Hopefully, this encourages health plans to cover this cost.

General Internal Medicine-Primary Care(US)

As a yoga practitioner myself, I have a few problems with this meta-analysis. Yoga is heterogeneous. Much depends on the style, teacher, and practitioner. Low-back pain is a challenging condition to treat, so any help, especially Yoga, is helpful.

General Internal Medicine-Primary Care(US)

Yoga appears to be a safe and effective method of treating the very common and frustrating problem of chronic back pain. It is an alternative to the common modalities of narcotic pain meds and NSAIDs that are fraught with side effects, particularly in the elderly.

General Internal Medicine-Primary Care(US)

Low-back pain is extremely common in primary care. This systematic review provides evidence to support the use of Yoga, particularly for short- and long-term pain management, as a legitimate alternative approach to care.

Special Interest - Pain -- Physician

Yoga appears to have benefit compared with no treatment at all for chronic pain, but benefits may be similar to other exercise-based interventions. Unfortunately, this issue was not highlighted in this review, making the review less useful for clinicians and patients. For example, the Sherman trial showed similar results when Yoga was compared with stretching exercises. The relatively similar benefits across duration of yoga may indicate a strong non-specific effect, which is also not sufficiently discussed.

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