1. 2024;27;E661-E675Yoga as an Adjunctive Treatment for Chronic Low Back Pain: A Narrative Review
   Narrative Review
   Andrea Nikolis, MD, Louis Nikolis, MD, and Adele Meron, MD.

BACKGROUND: Yoga has been recognized for its many mental and physical health benefits. A growing body of literature supports yoga’s indication in chronic low back pain (CLBP) management. CLBP is a major public health concern, given its high rates of associated disabilities and large healthcare costs. A biopsychosocial approach has been deemed the most effective and appropriate management strategy for this condition. When alternative and comprehensive approaches for managing the complexity of CLBP are considered, yoga poses a safe, accessible adjunctive treatment option.

OBJECTIVES: The goal of this review is to demonstrate, by highlighting yoga’s benefits on mental and physical health and the pathophysiology associated with CLBP, that yoga is an effective form of CLBP management. Our other goal is to establish that yoga encompasses a biopsychosocial approach to managing CLBP.

STUDY DESIGN AND METHODS: After thorough examination of the available published literature, this narrative review evaluated 24 articles examining yoga’s benefits to CLBP patients.

RESULTS: CLBP is associated with high rates of anxiety, depression, chronic stress, and pain catastrophizing. Numerous studies support yoga as an effective intervention for depression, anxiety, chronic stress, and pain catastrophizing, given yoga’s effects on the sympathetic nervous system, endocrine system, and various neurotransmitters and brain regions, and improvements in these areas may ameliorate the clinical symptoms experienced by CLBP patients. Physically, symptoms experienced by those with CLBP include pain, impaired function and mobility, disability, fatigue, and medication dependence, all of which, according to the literature, yoga has been shown to improve. Additionally, the chronicity and persistence of low back pain are related to central and peripheral sensitization, and yoga may intervene in these pathways to minimize symptom propagation.

LIMITATIONS: This review is not without limitations. The current literature lacks standardization regarding which yoga poses are safe, appropriate, and effective for CLBP patients, which limits the generalizability of yoga therapy. Additionally, few existing prospective trials study yoga in the management of CLBP. Though numerous randomized controlled trials (RCTs) are included in this review, most of the current literature details other reviews or analyses of RCTs, includes smaller sample sizes, and lacks long-term follow-up data. Furthermore, many of these studies include patients who have volunteered or self-selected to trial yoga therapy for their back pain, indicating inherent selection bias.

CONCLUSION: Overall, the current management strategies for CLBP do not encompass an effective biopsychosocial approach, and an intervention such as yoga is a promising adjunctive treatment for the condition.    

KEY WORDS: Yoga, chronic low back pain, back pain, chronic pain, pain management, biopsychosocial approach, mental health, physical health, central sensitization