• Eric J Roseen, Adlin Pinheiro, Chelsey M Lemaster, Dorothy Plumb, Shihwe Wang, A Rani Elwy, Chris C Streeter, Susan Lynch, Erik Groessl, Karen J Sherman, Janice Weinberg, and Robert B Saper.
• Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston University Medical Campus, 801 Massachusetts Ave, Second Floor, Boston, MA, 02131, USA. eric.roseen@bmc.org.
• J Gen Intern Med. 2023 Jul 1; 38 (9): 211321222113-2122.

BackgroundYoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans.ObjectiveDetermine whether yoga is more effective than an educational book for improving disability and pain among Veterans with cLBP.Design, Setting, And ParticipantsVeterans diagnosed with cLBP at a VA medical center enrolled in a randomized controlled trial from March to December of 2015.InterventionsTwelve weekly hatha yoga classes or education using The Back Pain Helpbook.MeasuresCo-primary outcomes were changes from baseline at 12 weeks in back-related disability on the modified Roland Morris Disability Questionnaire and pain on the Defense & Veterans Pain Rating Scale. Secondary outcomes were global improvement, patient satisfaction, pain medication use, and post-traumatic stress symptoms. An intention-to-treat approach was used in primary analyses.ResultsOne hundred twenty Veterans (mean age, 55.5 [SD = 16.9]; 11 [9%] women; mean number of chronic conditions, 5.5) were randomized to yoga (n = 62) and education (n = 58). At 12 weeks, reductions in back-related disability in yoga (mean difference [MD] = - 3.50, 95% CI: - 5.03, - 1.97) were not significantly different than education (MD = - 2.55, 95% CI: - 4.10, - 0.99; between-group difference: - 0.95 [95% CI: - 3.14, 1.23], p = 0.39). For pain, there was no significant difference between yoga (MD = - 1.01, 95% CI: - 1.67, - 0.35) and education (MD = - 0.81, 95% CI: - 1.36, - 0.27; between-group difference: - 0.20, 95% CI: - 1.06, 0.66, p = 0.65). More yoga than education participants reported being very much or extremely improved (39% vs 19%, OR = 3.71, 95% CI: 1.37, 10.02, p = 0.01) and very satisfied with treatment (60% vs 31%, OR = 4.28, 95% CI: 1.70, 10.77, p = 0.002). No differences in pain medication use or post-traumatic stress symptoms were observed at 12 weeks. No serious adverse events were reported in either group.ConclusionTwelve weekly yoga classes were not more effective than an education intervention for improving pain or disability outcomes among mostly older male Veterans with cLBP and multiple comorbid health conditions.Gov IdentifierNCT02224183.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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