Yoga and Non-Narcotic Therapy for Veteran Low Back Pain

Introduction

Low back pain is a common health challenge for both active and former military service members. Among military veterans, low back pain places individuals at higher risk and has been shown to bear the potential for long-term disability (Bagg et al., 2017). There is a lack of effective treatment strategies, and thus military veterans often rely on pain management approaches and other medical interventions — including medical imaging, opioids, injections, and surgery. For both the Department of Defense (DoD) and the Department of Veterans Affairs (VA), the costs of care for members with low back pain have been rising, necessitating research into the effectiveness of available treatment and management methods.

Some of the methods available include non-narcotic pain medication, yoga stretches, and physiotherapy. These interventions can be administered in combination or individually (Bagg et al., 2017). This study assesses the effectiveness of non-narcotic pain medications combined with yoga and heat/cold therapy, and compares that combination with the use of non-narcotic pain medications alone in reducing low back pain among veterans (measured using the DVPRS pain scale) who have been diagnosed with low back pain for three months.

Background and Literature Review

The management or treatment of low back pain — whether acute, sub-acute, or chronic — has in practice shown less than desired outcomes. As a result, most veterans with low back pain have turned to one or several unconventional management methods. Some of these alternative strategies include non-narcotic medications, yoga stretches, and hot/cold therapy.

Non-narcotic analgesics are an effective strategy for dealing with mild to moderate low back pain. Examples include aspirin, acetaminophen (Tylenol), and NSAIDs such as fenoprofen, sulindac, carprofen, and ketoprofen (Qaseem et al., 2017).

Yoga stretches have also been shown to offer an effective intervention for persons experiencing low back pain. However, the findings regarding yoga are mixed, and studies that report effectiveness have notable limitations. That notwithstanding, yoga stretches have been reported to help address disability caused by low back pain and depression among low back pain patients; compared to control groups, pain levels were significantly lower for those practicing yoga stretches (Groessl et al., 2008; Williams et al., 2009).

Heat/cold therapy has also been shown by research to offer effective relief for both acute and moderate low back pain (Dehghan & FarahbOD, 2014). Even though the two modalities may not produce the same results in the same patient, they have been shown to work depending on the clinical situation. For example, heat therapy is especially effective when the cause of low back pain is poor contraction of smooth muscles, while cold therapy may work in the short term by numbing nerve endings.

Purpose and Search Strategy

Although research on the effectiveness of individual interventions for low back pain is wide and intensive, there is limited research on combinations of these interventions. In practice, persons suffering from low back pain frequently use several of these strategies simultaneously to alleviate pain. This study therefore compares the effectiveness of a combination of non-narcotic medication with yoga and heat/cold therapy against the use of non-narcotic medications alone.

A systematic literature review method was adopted for this study. Given the purpose of the study, this method is the most appropriate, as it allows for a review of previous research to determine existing findings and how they reflect on the current research problem.

The search was conducted across five electronic databases: Medline, CINAHL, Cochrane Library, PsycLIT, and EBSCOhost. Keywords used included: "low back pain," "multifaceted treatment," "treatment effectiveness," "yoga," "non-narcotic," and "physiotherapy."

The search was conducted by the principal researcher. Results were first analyzed by title and abstract to determine whether they met the inclusion criteria. Articles determined to fit were then further examined in full text to assess whether they addressed the specifics of the PICOT question.

Inclusion criteria: studies addressing the PICOT question; reporting on any low back pain treatment strategy; published in English; published no earlier than 2000; and presenting a research design with a sample population.

Exclusion criteria: unpublished studies; studies including participants under the age of 18; commentaries or opinion pieces; and studies published in a non-English language.

References

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