Yoga versus education for veterans with chronic low back pain: a randomized controlled trial

Abstract: Background: Yoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans. Objective: Determine whether yoga is more effectivethan 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 arandomized controlled trial from March to December of 2015. Interventions: Twelve weekly hatha yoga classes or education using The Back Pain Helpbook. Measures: 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. Results: 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 backrelated 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; betweengroup 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. Conclusion: 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.