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Yoga May Help Low Back Pain. Mental Effects? Not So Much

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Yoga May Help Low Back Pain. Mental Effects? Not So Much

Our Review Summary

It is an interesting point to explore, since the study authors mentioned it as well. But the journalist could have dug a little deeper and noticed the study was never designed to prove this point—and didn’t. So the Wall St. Journal led with a mischaracterization of the study results.

The study found that yoga and intensive stretching exercises were equally effective in relieving pain and enhancing function—and that both were superior to a self-care educational booklet in the management of chronic back pain at the primary study endpoint of 12 weeks.

“Finding similar effects for both approaches suggests that yoga’s benefits were largely attributable to the physical benefits of stretching and not to its mental component,” the authors wrote in the discussion section.

But this is just an opinion. And it is just as possible that both group interventions—yoga and intensive stretching—had physical and mental benefits in the management of low back pain. A recent article in the Lancet pointed out that the causes of low back pain are generally obscure, as are the mechanisms of pain relief. (See Balagué et al., 2011)

The Wall St. Journal article offered a brief but useful description of the study, its background, and context. But as with a New York Times article on the same topic, there was a hole in the coverage. The journalist included the views of the study authors but offered no perspectives from independent experts.

The study had an important limitation that should have at least been mentioned. The researchers studied relatively affluent subjects with mild, uncomplicated back pain that did not result in substantial functional problems.

So the results may not apply to the individuals who bear the heaviest burden from chronic back pain and related disability: those on the lower rungs of the socioeconomic ladder, those with medicolegal dilemmas in the workplace, and those with other more complicated mental and physical health problems.

The study also did not compare yoga to the “usual treatments” for low back pain offered in the U.S. medical system. So yoga’s overall benefits may not be quite as clear as the Wall St. Journal article suggests.

            

 

Why This Matters

Chronic back pain is a huge social, economic, and medical problem. In the United States, back pain is the ninth most expensive medical condition for women, and the 10th for men, in terms of direct medical costs—with chronic back pain accounting for a disproportionate chunk of those expenses. And the costs of work absence and disability claims related to back pain vastly exceed the medical price tag.


Though Americans spend almost $35 billion per year on the medical treatment of back pain, the prevalence of chronic back pain appears to be rising—and self-rated spinal health among Americans appears be declining. (See Soni, 2011; Freburger et al., 2009; and Martin et al., 2008).


A number of nonsurgical treatments—analgesics, exercise, manual therapies, complementary/alternative therapies, psychological interventions, and multidisciplinary rehabilitation—are modestly effective in the management of chronic back pain. Yet for various reasons, Americans overuse ineffective treatments and underuse effective ones. (See Carey et al., 2009).

So the identification of treatments that facilitate recovery and are popular with patients is a key social and medical priority.

 

 

References for This Review:

Balagué F et al., Non-specific low back pain, Lancet, epub ahead of print, October 7, 2011; DOI:10.1016/S0140- 6736(11)60610-7.

Carey TS et al., A long way to go: Practice patterns and evidence in chronic low back pain care, Spine, 2009; 34(7):718–24. Medicine, 2007; 147(7):478– 91.

Freburger J et al., The rising prevalence of chronic low back pain, Archives of Internal Medicine, 2009; 169(3):251–8.

Martin BI et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299:656-664.  

Soni A, Top ten most costly conditions among men and women, 2008, Agency for Healthcare Quality and Research, Statistical Brief #331, 2011. www.meps.ahrq.gov/mepsweb/data_files/publications/st331/stat331.pdf.

 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The Wall St. Journal article did not discuss the costs or cost-effectiveness of any of the interventions.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

For a short article, the Wall St. Journal story framed and quantified the benefits adequately.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The article didn’t discuss adverse events related to yoga or intensive stretching. Yet the authors of the study reported on both. These are important issues, as many patients with chronic back pain fear that becoming physically active will exacerbate their symptoms.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

We have two reasons to judge this unsatisfactory.

  1. The Wall St. Journal article led with a point that was not proven in the study, i.e. that the benefits of yoga are more physical than mental.
  2. While the article accurately described the randomized controlled trial and its results, it did not detail an important limitation—i.e., that the results only appear to apply to a subgroup of individuals with mild-to-moderate chronic back pain that doesn’t result in major functional limitations.

Does the story commit disease-mongering?

Satisfactory

There was no obvious disease-mongering in the article. Chronic back pain is a common, vexing problem.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story could have benefitted substantially from independent commentary by a researcher or healthcare provider not associated with the study. There were no stated conflicts-of-interest in the study. So none needed to be identified in the article.

Does the story compare the new approach with existing alternatives?

Satisfactory

The clinical trial trial itself involved multiple alternatives: yoga, aerobic exercise and stretching, and a self-care educational intervention involving activity and lifetyle modification.

So that probably fulfills this criterion.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The journalist probably assumed that yoga and stretching programs are widely available in the U.S.—which is a reasonable assumption. So the article wins a “satisfatory” on this point.

But in fact, it is not all that clear that similarly standardized “viniyoga” classes designed to accommodate back pain patients are widely available—or whether most health insurance plans will cover them.  Intensive stretching classes would appear to be uncommon. So physical therapists or exercise physiologists might have to create them based on the study model.

Does the story establish the true novelty of the approach?

Satisfactory

The journalist probably assumed that neither yoga nor stretching programs are novel so didn’t address these issues in detail. And that is a reasonable assumption.

But as mentioned above, the intensive stretching intervention does appear to be somewhat novel. At least it is not widely available.  And the standardized “viniyoga” program is a rather distinctive program oriented around back pain patients.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The article was not based on a press release.

Total Score: 6 of 10 Satisfactory

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