Yoga May Reduce Disability and Opioid Use In Veterans With Chronic Low Back Pain

MedicalResearch.com Interview with:

Erik Groessl PhD Associate Adjunct Professor Family Medicine and Public Health University of California, San Diego

Dr. Groessl

Erik Groessl PhD
Associate Adjunct Professor
Family Medicine and Public Health
University of California, San Diego

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Chronic low back pain (cLBP) is prevalent among military veterans, but cLBP treatment options have limited benefits and side effects. This has resulted in efforts to reduce opioid use and embrace nonpharmacological pain treatments.

Yoga has been shown to improve health outcomes and have few side effects in non-veteran community samples.

Our objective was to study the effectiveness and safety of yoga for military veterans with chronic low back pain.  In a study of 150 veterans with cLBP, we found that yoga participants had greater reductions in disability and pain than those receiving usual. Opioid medication use declined among all participants, and no serious side effects occurred.

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Electroacupuncture Reduced Leakage in Stress Urinary Incontinence

MedicalResearch.com Interview with:
Baoyan Liu, MD
Guang’an Men Hospital
China Academy of Chinese Medical Sciences
Beijing, China

Patient with Electroacupuncture

Patient with Electroacupuncture

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prevalence of stress urinary incontinence(SUI) is as high as 49% and varies according to the population studied and the definition of stress urinary incontinence.

SUI causes psychological burden, affects relationships, lowers physical productivity, and decreases quality of life in women. Yet, few effective therapies are available for treating stress urinary incontinence.

In this randomized clinical trial that included 504 women, the mean decrease in urine leakage, measured by the 1-hour pad test from baseline to week 6, was 9.9 g with
electroacupuncture vs 2.6 g with sham electroacupuncture, a significant difference.

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Yoga As Effective As Physical Therapy For Chronic Low Back Pain

MedicalResearch.com Interview with:

Robert B. Saper, MD, MPH Department of Family Medicine Boston Medical Center Boston, MA

Dr. Saper

Robert B. Saper, MD, MPH
Department of Family Medicine
Boston Medical Center
Boston, MA

MedicalResearch.com: What is the background for this study?

Response: There are a number of studies that show that yoga is effective for chronic low back pain (cLBP), but those studies included mostly white and middle-class individuals as research participants. cLBP disproportionately impacts those who are economically disadvantaged and minorities; they receive less referrals to specialists, less referrals to rehabilitation, and also less patient-education. Therefore, it was important to test whether yoga would be well- received by an underserved population, as well as be an effective form of treating chronic low back pain.

This study consisted of patients from diverse racial and economic backgrounds with multiple medical problems who were able to successfully participate and benefit from both yoga and physical therapy. This study used yoga classes that were specifically designed for people suffering from  chronic low back pain and compared the results of that treatment to those who did physical therapy.

MedicalResearch.com: What are the main findings?

Response: The results show that the yoga was as effective as physical therapy for reducing pain intensity and improving people’s physical function. Patients in the study who did yoga reported that their overall pain intensity went down, that they were able to be more physically active, and a number of patients were also able to reduce or even stop all of their pain medication. The study shows that when yoga is made available and affordable to a diverse population, people of both sexes, people who are disabled, and people of different races and economic backgrounds are both receptive to yoga and, more importantly, can benefit from it.

MedicalResearch.com: What should readers take away from your report?

Response: Doctors should know that a structured yoga program for cLBP is a reasonable, effective, and safe approach for patients with chronic  chronic low back pain. Patients with cLBP should talk with their doctors about different options for treatment of back pain, starting with non-drug approaches like yoga and physical therapy. Policy makers need to examine the potential benefits for patients and cost savings for covering non-pharmacological approaches to pain.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The cost effectiveness of yoga and physical therapy for chronic low back pain still needs to be looked at carefully, as well as how the medical community can implement yoga classes for back pain widely.

While medication, imaging and invasive procedures absolutely have their place, research and clinical guidelines show that non-pharmacological procedures as first treatment options may be best.

MedicalResearch.com: Is there anything else you would like to add?

Response: Yoga is increasingly popular in the United States, and many yoga teachers are available in urban areas. However, yoga teachers and yoga classes are still relatively rare in communities of color and disadvantaged areas. Therefore, it’s important that we begin to train, build, and make yoga more available to diverse communities. Changing the common view of yoga from a fitness exercise for the healthy and wealthy, to a therapeutic approach for people with chronic pain and other conditions, is also an ongoing challenge.

Finding that yoga is non-inferior to physical therapy makes a strong case that yoga programs like the one in this study should be covered by insurance and offered by health care facilities. When a therapy like yoga is shown to be as effective as standard therapies, it should be made available to everyone regardless of ability to pay. For patients who attended more classes or physical therapy sessions, their cLBP improvement was even greater.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. [Epub ahead of print 20 June 2017] doi: 10.7326/M16-2579

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

Glaucoma Patients Might Want To Avoid Downward Dogs

More on Ophthalmology on MedicalResearch.com
MedicalResearch.com Interview with:
Robert Ritch, MD, FACS
Shelley and Steven Einhorn Distinguished Chair
Professor of Ophthalmology
Surgeon Director Emeritus and Chief, Glaucoma Services
Founder, Medical Director and Chairman, Scientific Advisory Board
The Glaucoma Foundation
Jessica V. Jasien MEn
Einhorn Clinical Research Center

The New York Eye and Ear Infirmary of Mount Sinai
New York, NY 10003

Medical Research: What is the background for this study? What are the main findings?

Response: Glaucoma is the leading cause of irreversible blindness in the United States and elevated intraocular pressure (IOP) is the most common known risk factor for glaucomatous damage. At the current time, IOP is the only modifiable risk factor for which treatment has a proven effect on preventing or slowing the progress of the disease.

The story behind this study goes back to 1980, when we saw a 45-year-old woman with severe damage from normal-tension glaucoma, which then was thought to be a disease of the elderly and also thought to be rare, which we now realize was erroneous. The causes of normal-tension glaucoma were also poorly understood. It turned out on questioning that this particular patient had been performing yoga and standing on her head for 20 minutes a day for 20 years. We measured her IOP in this position and it rose from 15 mmHg in the sitting position to 60 mmHg. When measured lying flat, it was 30 mmHg. We measured everyone working in the department standing on their heads and the IOP roughly doubled in each of them. This was our first inkling that marked changes in IOP could result from changes in body position.

The background for this study came from the lack of knowledge of IOP rises during yoga inversions, other than the headstand position. We looked at four common inverted yoga positions in glaucoma patients and healthy patients who were all experienced in practicing yoga. The four positions tested were downward facing dog, plow, legs up the wall, and forward bend. Each position showed a direct increase in IOP immediately assuming the yoga position, however the IOP dropped once assuming the seated position after two minutes in the yoga position. The most significant increase in IOP was seen during the downward facing dog position. IOP of each study participant was taken seated (baseline), immediately assuming the yoga position, which was held for two minutes, again at the two minutes of the yoga position, immediately in the seated position following the yoga position, and again after 10 minutes in the seated position. Each position was tested once in this order of IOP measurements.

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Yoga Has Potential To Improve Cardiovascular Risk Factors

MedicalResearch.com Interview with:
Paula Chu Doctoral candidate
Harvard University’s Health Policy Program
Boston MA

Medical Research: What is the background for this study? What are the main findings?

Response: This study was borne out of a mutual interest in the effects of yoga and wellness in general between myself and my coauthors.

​We had heard and read about yoga’s effects on certain conditions like anxiety and pain, and we wanted to see if there was scientific evidence on yoga’s impact on measurable physiological cardiovascular ​outcomes.

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Yoga May Improve Cognitive Health in Older Adults

Neha P. Gothe, PhD Division of Kinesiology Health and Sport Studies Wayne State University Detroit, MI 48202.Medical Research Interview with:
Neha P. Gothe, PhD
Division of Kinesiology, Health and Sport Studies
Wayne State University
Detroit, MI 48202.

Medical Research: What are the main findings of the study?

Dr. Gothe: The yoga group was speedier and more accurate on tests of information recall, mental flexibility and task-switching than it had been before the intervention. Participants in the yoga group showed significant improvements in working memory capacity, which involves continually updating and manipulating information. They were also able to perform the task at hand quickly and accurately, without getting distracted.
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Asthma Symptoms and Control Found Not Improved By Yoga

Holger Cramer, PhD Director of Yoga Research University of Duisburg-Essen | Faculty of Medicine Department of Internal and Integrative Medicine | Kliniken Essen-Mitte Essen  Germany MedicalResearch.com Interview with:
Holger Cramer, PhD
Director of Yoga Research
University of Duisburg-Essen | Faculty of Medicine
Department of Internal and Integrative Medicine
Essen  Germany

MedicalResearch: What are the main findings of the study?

Dr. Cramer: There is a number of randomized trials available on yoga for asthma. Based on those trials, there is evidence that yoga can improve asthma symptoms, asthma control, and pulmonary function in patients with asthma. However, yoga does not seem to be superior to sham procedures or breathing exercises and generally the evidence was quite weak. Yoga seems to be relatively safe in this patient population.
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Yoga Effects on Blood Pressure and Quality of Life

MedicalResearch.com Interview with
Dr. Moa Wolff
Center for Primary Health Care Research
Department of Clinical Sciences in Malmö, Lund University
Jan Waldenströms gata 35, Skåne University Hospital, Malmö 205 02, Sweden

MedicalResearch.com: What are the main findings of the study?

Dr. Wolff: We investigated the effects of two yoga interventions on blood pressure and quality of life in patients in primary health care diagnosed with hypertension. Our study showed that a short yoga program practiced daily at home had an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to controls.
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Yoga and Effect on Menopause Symptoms

MedicalResearch.com Interview with:
Katherine Newton, PhD
Senior Investigator at Group Health Research Institute in Seattle

MedicalResearch.com: What are the main findings of the study?

Answer: We found that when women took a 12-week yoga class and practiced yoga at home, they had significantly less insomnia than did women who did not. This was the only statistically significant finding in this MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Network randomized controlled trial. We also found that being in the yoga class did not decrease the number of hot flashes or night sweats. Yoga  was linked to better sleep quality and less depression—but  these effects were not statistically significant. In separate papers, published slightly earlier, our MsFLASH group reported that a non-yoga exercise program seemed linked to slightly improved sleep and less insomnia and depression—but these effects were not statistically significant. And an omega-3 (fish oil) supplement was not linked to any improvement in hot flashes, night sweats, sleep, or mood.

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