Yoga and physical therapy (PT) are effective approaches to treating co-occurring sleep disturbance and back pain while reducing the need for medication, according to a new study from Boston Medical Center (BMC). Published in the Journal of General Internal Medicine, the research showed significant improvements in sleep quality lasting 52 weeks after 12 weeks of yoga classes or 1-on-1 PT, which suggests a long-term benefit of these non-pharmacologic approaches.
In addition, participants with early improvements in pain after 6 weeks of treatment were three and a half times more likely to have improvements in sleep after the full, 12-week treatment, highlighting that pain and sleep are closely related.
Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder.
Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications.
“Identifying holistic ways to treat these conditions could help decrease the reliance on these medications as well as keep patients safer and more comfortable,” said Eric Roseen, DC, MSc, a researcher in the department of family medicine at BMC, who led the study.
Previous research from BMC discovered that yoga and PT are similarly effective for lowering pain and improving physical function, reducing the need for pain medication.
In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.
The randomized controlled trial included 320 adults with cLBP from BMC and seven surrounding community health centers.
At the beginning of the study, over 90 percent of participants with cLBP were found to suffer from poor sleep. Participants were assigned one of three different therapies for cLBP: physical therapy, weekly yoga, or reading educational materials.
Previous research from BMC discovered that yoga and PT are similarly effective for lowering pain and improving physical function, reducing the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.
“The high prevalence of sleep problems in adults with chronic low back pain can have detrimental effects on a person’s overall health and well-being,” said Roseen, also an assistant professor of family medicine at Boston University School of Medicine.
“This really emphasizes the need for providers to ask patients with chronic low back pain about the quality of their sleep. Given the serious risks of combining pain and sleep medications, nonpharmacologic approaches should be considered for these patients.”
Funding: This study was funded by the National Center for Complementary and Integrative Health (NCCIH), under grant numbers 1F32AT009272-01 and 5R01-AT005956.
It has been widely recognized as the leading cause of disability, affecting work performance and general psychosomatic health and is associated with substantial economic and societal burden . The estimated lifetime prevalence of CLBP is 12% to 33% in industrialized countries (period prevalence: 22% to 65% per year) .
The prevalence rate of CLBP is higher in adults than children and adolescents , particularly among the working population . CLBP is widely treated with medications (e.g., nonsteroidal anti-inflammatory drug, analgesic, and muscle relaxant) to relieve pain, decrease inflammation, and reduce muscle tension .
Furthermore, the long-term use of medications remains financially unaffordable in economically disadvantaged areas . Other non-pharmacological treatments, such as physical therapy [8,9], spinal manipulation , and physical activity or exercise [11,12,13], have shown promising effects on improving CLBP-specific symptoms.
Tai Chi, Qigong (e.g., Baduanjin, Yijingjin, and Wuqinxi), and Yoga, also known as mindful exercises, are light-to-moderate intensity physical activities and have recently been popularized in both the fitness industry and clinical setting for disease prevention and symptomatic management [14,15,16,17].
Mindful exercises are typically performed at a slow pace, simultaneously integrated with mental focus on muscle and movement sense, rhythmic abdominal diaphragmatic breathing, and meditation [18,19,20,21].
These modalities may complement or act as an alternative practice to conventional rehabilitation programs [22,23,24]. Mindful exercises are beneficial for symptomatic management in a variety of diseases, such as multiple sclerosis [25,26], autism spectrum disorder , balance disorder [28,29], ankylosing spondylitis , mental illness [31,32], cerebrovascular disease , fibromyalgia , and knee osteoarthritis .
Recently, research has investigated the effects of mindful exercises in adults with CLBP. With the increasing number of experimental studies on this topic, two reviews were subsequently performed and published in 2013 [36,37].
Notably, these two systematic reviews only included eight to 10 randomized controlled trials (RCT) and focused on Yoga alone. Secondly, meta-analysis was only possible for the Yoga interventions versus non-active controls due to the small number of trials, lacking a direct comparison to active control conditions like conventional exercises or guideline-endorsed treatments.
Thirdly, previous reviews simply evaluated the effectiveness of Yoga, but the safety of the broader mindful exercises in adults with CLBP still remains unknown.
To fill these knowledge gaps, we therefore conducted an updated systematic review that includes all three most popular mindful exercises versus active and/or non-active controls while evaluating the safety and efficacy of mindful exercises in adults with CLBP.
Boston Medical Center
Jazmin Holdway – Boston Medical Center
The image is in the public domain.
Original Research: Closed access
“Yoga, Physical Therapy, and Back Pain Education for Sleep Quality in Low-Income Racially Diverse Adults with Chronic Low Back Pain: a Secondary Analysis of a Randomized Controlled Trial”. Eric Roseen et al.
Journal of General Internal Medicine doi:10.1007/s11606-019-05329-4.