Download Yoga and Back Pain - ND Center for Nursing

Running head: BACK PAIN
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Evidence Based Practice Critically Appraised Topic
Back Pain
Wendy Donaugh, RN, FNP-S
NUR 568
University of Mary
April 6, 2014
BACK PAIN
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Evidenced Based Practice Critically Appraised Topic: Low-Back pain
Clinical ScenarioA 46-year-old female who has been experiencing episodes of low back pain for the past
six months. She is unsure just what she did to injure her back but reports increasing achiness and
soreness in her lower back. Diagnostic imaging and testing ruled out malignant conditions,
arthritis, herniated disk, or spinal stenosis. Initial treatment included analgesics and a referral for
physical therapy (PT). After 2 weeks of PT, the patient asks if yoga would help her further
decrease her low back pain and hasten her recovery and improve her pain symptoms.
Clinical QuestionDoes adding yoga to the treatment plan result in better pain relief for individuals with
non-specific low-back pain versus patients that do not add yoga to their treatment plan?
Articles:
Chou, R., Qaseem, A., Snow, V., Casey , D., Cross, T., Shekelle, P., & Owens, D.
(2007). Diagnosis and treatment of low back pain: A joint clinical practice
Annals
of Internal Medicine, 147(7), 478-491. doi: 10.7326/0003-4819-
147-7-200710020-00006
Cramer, H., Lauche, R., Haller, H., & Dobos, G. (2013). A systematic review and
meta-analysis of yoga for low back pain. Clinical Journal of Pain, 29(5), 450460.
Hill, C. (2012). Is yoga an effective treatment in the management of patients with
chronic low-back pain compared with other care modalities- a systematic review.
Journal of complementary & integrative medicine, 10(1), 1-9. doi: 10.1515/
jcim-2012-0007
Summary and Appraisal of Key Evidence:
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Article 1
Cramer, H., Lauche, R., Haller, H., & Dobos, G. (2013), performed a systematic review
and meta-analysis of yoga for low back pain. Their results included ten randomized controlled
trials with 967 individuals suffering from low back pain (LBP). Providing a level 1 level of
evidence. Limitations of this study include the small number of randomized control trials, study
size, and methodological weakness of the studies that were included. The overall risk of bias was
low. The studies included in this review were performed in primary, secondary and tertiary
centers in North America, Europe and Asia. The patient population was primarily caucasian
women but studies that included only individuals of asian descent or emphasized inclusion of
ethnic minorities were also included. This allows the results to be applicable to a majority of
individuals suffering from LBP. Most of the included studies were single blind as it would be
difficult to double blind in a study such as this. Opportunity exists for further research on the
benefit of yoga for decreasing pain and increasing quality of life for individuals suffering from
low back pain. Studies that look at guideline endorsed treatment options and compare these to
yoga are needed. Consideration must be given to the length of yoga treatment as well as the
various types of yoga available. It is also important to look at any adverse effects yoga treatment
might have.
Article 2
Hill (2012), performed a systematic review comparing the use of yoga to other care
modalities for the treatment of low back pain. Providing a level 1 level of evidence. Four
randomized control trials (RCT) met the inclusion criteria and were used for this study. Inclusion
criteria included low back pain for more than three months, yoga as a defined treatment, human
subjects, completed randomized control trials that were in english. The sample size was to be
more than 50 individuals in order to increase study power. Studies were to be current (within the
last five years) in order to provide current, clinically relevant data. Limitations were found in all
four papers that were reviewed and range from the use of “usual care” as an ambiguous term to
the different methods of randomization as well as length of yoga treatment. The populations
studied were generalizable to a specific target population, appropriately so, as individuals
experiencing LBP are the focus of this study. These studies used many volunteer participants
which may affect validity as these individuals actively sought treatment. More research is needed
with regard to length of treatment and whether types of yoga can have an impact on results.
Clinical Bottom Line
Low back pain is the fifth most common reason for physician visits in the United States
(Chou, Qaseem, Snow, Casey , Cross, Shekelle & Owens, 2007). According to Cramer, Lauche,
Haller & Dobos (2013), low-back pain has become the largest category of medical claims which
places increased burden on the individuals experiencing low-back pain as well as the health care
systems that support them. Half of the individuals in the United States suffering from low-back
pain are likely to incorporate some type of complementary therapy into their treatment regimen.
The National Institute for Health and Care Excellence (NICE) guidelines recommend a
combined physical and psychosocial approach for the treatment of low back pain. Many
complementary therapies exist such as acupuncture, acupressure, neuroreflexotherapy, exercise,
hydrotherapy and yoga (Hill, 2012). Yoga is a fast growing, “trendy” complementary treatment
option that appears to be very safe and efficacious for individuals with low back pain. Yoga
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incorporates mind, body and spirit in the treatment plan (Hill, 2012). When cost of yoga therapy
is compared to invasive treatments, physician visits, medications and conventional physical
therapy options, yoga is a less expensive option for many individuals. Yoga can be self-taught
and is easily performed at home. Current research shows benefit with regard to pain
improvement as well as disability reduction for patients with LBP who incorporate yoga into
their treatment plan Therefore, in this age of such great concerns for rising costs of healthcare, it
is important to consider the effectiveness of yoga for decreasing the overall burden of low back
pain. Yoga is an effective treatment option for patients suffering with LBP and should be on the
list of recommended treatment options presented to patients by health care providers.
Practice Implications
Based on the outcomes of the above studies, I would recommend yoga as a
complementary therapy for patients suffering from Low back pain.
References
Chou, R., Qaseem, A., Snow, V., Casey , D., Cross, T., Shekelle, P., & Owens, D.
(2007). Diagnosis and treatment of low back pain: A joint clinical practice
guideline from the american college of physicians and the american pain society.
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Annals of Internal Medicine, 147(7), 478-491. doi: 10.7326/0003-4819-147-7-
200710020-00006
Cramer, H., Lauche, R., Haller, H., & Dobos, G. (2013). A systematic review and
meta-analysis of yoga for low back pain. Clinical Journal of Pain, 29(5), 450460.
Hill, C. (2012). Is yoga an effective treatment in the management of patients with
chronic low-back pain compared with other care modalities- a systematic review.
Journal of complementary & integrative medicine, 10(1), 1-9. doi:
10.1515/jcim-2012-0007