The purpose of this umbrella review is to synthesize the evidence from systematic reviews on the benefits and harms of exercise therapy and physical activity (PA) for the secondary prevention and management of low back pain (LBP).

An umbrella review was conducted to evaluate the effectiveness of exercise therapy and PA in the management and secondary prevention of LBP. A systematic search was performed in Medline via Ovid, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Physiotherapy Evidence Database (PEDro), including reference lists of relevant reviews, covering studies published between January 2010 and May 20, 2024. Eligible studies were systematic reviews of randomized controlled trials and observational studies, with or without meta-analyses. The primary outcome for secondary prevention was LBP recurrence, while for management, primary outcomes included pain intensity and disability, with adverse events as secondary outcomes. Data were extracted across immediate, short-term, intermediate, and long-term follow-up periods. The GRADE framework was used to assess the certainty of evidence, and the AMSTAR tool was applied by 2 independent reviewers (JC, QL, and/or DXMW) to evaluate the quality of the included reviews. The study was prospectively registered on the Open Science Framework (OSF) (registration DOI: https://doi.org/10.17605/OSF.IO/9P).

A total of 70 systematic reviews were included, 43 with meta-analyses, 7 with network meta-analyses, and 20 without meta-analyses. Six (out of 10) reviews with meta-analyses for secondary prevention indicated a small benefit from general exercises and leisure-time PA (low-to-moderate certainty). For LBP management, 35 (out of 36) reviews reported that exercise therapies such as Pilates, motor control, mixed exercise, Tai Chi, water-based exercises, and yoga showed small beneficial effects on pain and disability compared to minimal intervention mainly in the short-term (low-to-moderate certainty). Seven network meta-analyses favored motor control and Pilates over other forms of exercise to reduce pain (low certainty). Adverse events were reported in less than 31% of the reviews, predominantly involving post-exercise soreness and temporary increases in pain, mainly in yoga-related studies. Adverse events were considered minor, and no serious adverse events were reported.

There is low-to-moderate certainty that exercise therapy and leisure-time PA are beneficial for improving pain and preventing the recurrence of LBP. However, evidence on the potential harms of these interventions is limited, and adverse events related to exercise and PA remain under-investigated.

Despite increased calls for improved health equity, Black patients continue to experience worse pain and associated outcomes. Black patients are also offered fewer pain treatment options than White patients and report poorer quality communication with clinicians, including lower participation in shared decision-making. Comorbid depressive symptoms can impede effective pain management and participation in decision-making. The Equity Using Interventions for Pain and Depression (EQUIPD; NCT05695209) pilot study examined feasibility of a one-on-one coaching intervention, paired with a decision aid, to facilitate shared decision-making about evidence-based nonpharmacological pain treatments for Black patients with chronic musculoskeletal pain and symptoms of at least mild depression. We recruited and randomized 30 participants at a rate of 7.5 per month, with 90% retention at 3 months and 87% at 6 months. Intervention participation was high, with 94% of participants completing at least 3 of 4 coaching sessions. Fidelity was also high. Although not powered for effectiveness, most outcomes, including pain interference, depression, anxiety, patient engagement, and shared decision-making, improved, favoring the intervention, with effect sizes ranging from 0.30-0.75 at 3 months. Results indicate that EQUIPD holds promise as an intervention to support autonomy and shared decision-making for Black patients with chronic pain and elevated depressive symptoms. PERSPECTIVE: The EQUIPD intervention, which included one-on-one coaching combined with a decision aid to increase shared decision-making about nonpharmacological pain treatments, was feasible and shows promise in improving pain and related outcomes for Black patients with chronic musculoskeletal pain and depressive symptoms.

Chronic pain management includes treatment with the use of opioids, electrical stimulation and acupuncture. However, traditional understanding of chronic pain has recently been challenged in light of evidence supporting a key role of psycho-social factors and central sensitization in this population. Mindfulness-based stress reduction (MBSR), focuses on increasing awareness and acceptance of moment-to-moment experiences including difficult emotions and physical discomfort.

To examine the effects of a MBSR on chronic pain patients.

A two-arm, blinding randomized controlled clinical trial with repeated-measures design.

One pain management clinic in a general hospital.

Chronic pain patients (N = 149 patients).

The patients were randomly allocated to either psychoeducation (intervention group) or usual care (control group) (N = 75 vs 74 patients per group). The randomization was minimized, taking into account the imbalance between the groups over a number of prognostic clinical and demographic factors. The intervention included an 8-week MBSR program (2 hours per week) in a group format and the MBSR program was performed 2 times (1-2 months after enrollment and 7-8 months after enrollment). Study outcomes included Chronic pain (pain intensity and pain interference) assessed with Brief Pain Inventory (primary outcomes), and other secondary outcomes (i.e., quality of life, adherence to the intervention, mindfulness and self-awareness and drug assumption). We examined the differences at baseline (clinical-demographic data collected at enrollment), at 6 (T1) and 13 months (T2) between the intervention and control groups by means of chi-square and independent samples t tests. Normally distributed measurement data were represented by means and standard deviations.

Participants in the intervention group revealed significantly greater reductions on impact of chronic pain in terms of pain intensity (worst pain in the last 24 hours, p < .001; pain right now, p < .001) and in terms of pain interference (interference with mood, p = .002; interference with normal work, p = .043; interference with relationship with other people, p = .036) at T1, and in terms of pain intensity (worst pain in the last 24 hours, p < .001; pain on average, p =. 013; pain right now, p < .001) and in terms of pain interference (interference with mood, p < .001; Interference with sleep, p < .001) at T2. A significant difference emerged in the perceived quality of life, between two groups at T2 (55.9 vs 58.7, t(133) = - 2.053, p = .044).

Our study added values on the benefits of patients-focused MBSR to treatment of chronic pain. Future research can evaluate its long-term effects for patients of chronic pain with diverse socio-demographic and pain-related characteristics in a greater sample.

Italian Clinical Trial Registry (NCT05843409). Recruitment: April 2023 to April 2024.

Background and Objectives: Chronic low back pain is a widespread condition, particularly in older populations, contributing to physical, mental, and social burdens. Traditional treatments, such as medications and surgery, carry long-term risks, including dependency, side-effects, and complications from invasive procedures. Additionally, healthcare accessibility is limited due to high costs, long waiting times, and geographic disparities in healthcare services, particularly in rural areas. For these reasons, non-pharmacological approaches that address both physical and psychological aspects are increasingly recognized as effective. This study aimed to evaluate the effectiveness of a marine resource-based healing program in Taean, South Korea, in improving pain, physical function, and mental health in patients with non-specific chronic low back pain. Materials and Methods: This randomized controlled trial involved 46 participants with non-specific chronic low back pain (mean age, 68.7 ± 5.1 years), randomly allocated to either an experimental group (marine healing program) or a control group (core exercises). The experimental group participated in a 4-night, 5-day intervention comprising heated peat pack therapy, mindfulness meditation, core exercises, and local tourism. The control group performed core exercises without additional interventions. Key outcomes included pain, muscle properties, functional disability, lower extremity function, balance, gait, and depression. Results: The experimental group demonstrated significant reductions in resting pain (p < 0.001), improved pressure pain threshold at L3 (p < 0.001), decreased L3 muscle tone (p = 0.015), and improved functional disability scores (p < 0.001). Functional gains were observed in lower extremity function scores (p < 0.001), balance (sway area: p = 0.046), gait velocity (p < 0.001), and depression levels (p < 0.001). Conclusions: The marine healing program significantly improved pain, functional abilities, and mental well-being in patients with non-specific chronic low back pain, highlighting its potential as an integrative approach to chronic low back pain management. Further studies are recommended to explore long-term and generalized effects.

Emerging literature has demonstrated deficits in interoception (i.e., the perception of physical sensations from inside the body) in individuals with chronic pain conditions. Mind-body therapies (MBTs) are purported to improve chronic pain in part through improving or restoring interoceptive abilities. The present systematic review and meta-analysis aimed to examine changes in interoception in MBTs for chronic pain conditions.

A systematic search of PubMed, PsycINFO, Scopus, CINAHL, and ProQuest Dissertation and Theses was conducted from database inception to February 2023. English language intervention studies evaluating the effect of MBTs on interoception in adults with chronic pain conditions were examined. Changes in pain (severity and interference) following treatment were examined as secondary outcomes.

A total of 11 studies (10 unique samples) were identified. Meta-analytic results reveal significant improvements in total interoceptive awareness (Becker's d = 1.168, p < .01) as well as improvements in seven of eight subdomains of interoceptive awareness (ds = 0.28 to 0.81). MBTs were also associated with reductions in both pain intensity (d = -1.46, p = .01) and pain interference (d = -1.07, p < .001).

Preliminary research suggests that MBTs demonstrate improvements in interoceptive awareness and reduce pain in adults with chronic pain. Literature on changes in other domains of interoception, such as interoceptive accuracy, following MBTs is severely lacking. Although more rigorous studies are needed to corroborate results, the present findings lay an important foundation for future research to examine interoception as a possible underlying mechanism of MBTs to improve pain outcomes.

The placebo effect can induce physiological or clinical neurological and organic responses despite the recipient receiving no active ingredients; these responses are based instead on the recipient's perceptions. Placebo effects come from the rostral anterior cingulate cortex, pontine nucleus, and cerebellum of the brain; this information provides a better understanding of placebo effects and can also help us understand the mechanism of the modulation of neurotransmitters from the use of psychedelic substances, activity of selective serotonin reuptake inhibitors, the process of transcranial magnetic stimulation, and deep brain stimulation, as well as aid in developing novel therapies, challenging the validity of controlled clinical trials (RCTs) that the regulatory agencies now appreciate. Education about how placebo effects bring in social, political, and religious beliefs and whether these can be modulated may help reduce global confrontations.

Chronic pain is an ever-increasing global challenge, and few strategies have been shown to significantly alter this trajectory, and a pure pharmaceutical approach, especially opioids, is not the answer. To truly impact a person with chronic pain's life, current best-evidence supports changing their cognitions (how they think about their pain), moving more, and calming the peripheral and central nervous system, including non-pharmacological strategies. All healthcare providers, however, must use a unified strategy regardless of their professional designation, skillset, and clinical setting. One variable that spans all patient interactions is communication. All healthcare providers talk to patients, be it during informal, casual conversation or during specific medical education tied to diagnosis, prognosis, treatment, reassurance, and more. Current evidence supports teaching patients more about their pain experience, called pain neuroscience education (PNE), which has significant clinical benefits. Any provider may offer PNE, from physicians, pharmacists, therapists, psychologists, nurses, etc. Pain neuroscience education is shown to positively influence self-reported pain, disability, fear-avoidance, pain catastrophizing, movement, and healthcare utilization in patients with chronic pain. This commentary aims to introduce all healthcare providers to PNE, and how, along with non-pharmacological treatments (PNE+) have the ability to positively impact people's lives living with chronic pain.

Chronic low back pain (CLBP) is a common condition with substantial impact on patients, in the form of physical and emotional suffering; health care costs; productivity; and health care professional burden. Although clinical guidelines recommend use of nonpharmacologic treatments first, such as yoga, there is a gap between guidelines and implementation in clinical practice.

To compare the effects of virtual yoga classes vs a wait-list control on CLBP intensity, back-related function, sleep quality, and pain medication use.

Single-blinded, 24-week, 2-arm, randomized clinical trial conducted from May 3, 2022, through May 23, 2023, comparing live streamed yoga classes (the yoga now group) with a wait-list control (the yoga later group, in which participants were offered the virtual intervention after the study but without assessments) among adults with CLBP. Adults 18 to 64 years of age with CLBP were recruited from the Cleveland Clinic Employee Health Plan, a large health system self-insured health plan. Inclusion criteria included a mean LBP intensity score of at least 4 on an 11-point numerical rating scale (scores ranged from 0 to 10, with higher scores indicating worse pain) and daily back pain interference about half or more of the days.

Twelve consecutive weekly, 60-minute, virtual, live streamed hatha yoga group classes.

Coprimary outcomes were mean pain intensity in the previous week on the 11-point numerical rating scale and back-related function as assessed using the 23-point modified Roland Morris Disability Questionnaire ([RMDQ], with higher scores reflecting poorer function) at 12 weeks. Secondary and exploratory outcomes included these measures at 24 weeks, pain medication use, and PROMIS sleep quality assessed using the Sleep Disturbance Short Form 8a, item 1 (scores ranged from 0 to 4, with higher scores reflecting better sleep quality). Analyses followed the intention-to-treat principle.

Among 140 participants enrolled (yoga now = 71; yoga later = 69), the mean (SD) age was 47.8 (11.7) years and most were female (113 [80.7%]) and college-educated (103 [73.5%]). Mean (SD) baseline pain intensity (5.7 [1.5]) and RMDQ ([12.1 [4.4]) scores reflected moderate back pain and impairment. At week 12, yoga now compared with yoga later had greater reductions in mean pain intensity (-1.5 [95% CI, -2.2 to -0.7] points; P < .001) and mean RMDQ (-2.8 [95% CI, -4.3 to -1.3] points; P < .001) scores. At 24 weeks, the improvements in pain (mean change, -2.3 [95% CI, -3.1 to -1.6] points; P < .001) and RMDQ (mean change, -4.6 [95% CI, -6.1 to -3.1] points; P < .001) scores were sustained. At 12 weeks, yoga now participants reported 21.4 (95% CI, 5.2-37.6) absolute percentage points less use of any analgesic medication during the past week than yoga later participants and at 24 weeks, 21.2 absolute percentage points (95% CI, 5.2%-37.3%). Improvements in sleep quality were greater for participants in yoga now than among participants in yoga later at 12 weeks (mean change, 0.4 [95% CI, 0.1-0.7] points; P = .008) and 24 weeks (mean change, 0.4 [95% CI, 0.1-0.7] points; P = .005).

Results of this randomized clinical trial of 140 adults with CLBP who were members of a large health system self-insured health plan suggest that virtual yoga classes may be a feasible, safe, and effective treatment option.

ClinicalTrials.gov Identifier: NCT05319691.

With the increasing prevalence of stress, stress reduction is getting more and more important. Yoga is being considered as a non-pharmacological treatment option for stress.

Investigation of the effects of yoga on stress in stressed adults from the general population.

Databases were searched up to March 17, 2023 (updated search on May 17, 2024). Randomised controlled trials (RCTs) of yoga for stressed adults were included if they assessed perceived stress. Further outcomes were quality of life and stress-related physiological measures. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. The quality of the included studies was assessed using the Cochrane tool, and the quality of the evidence for each outcome was graded according to the GRADE recommendations.

A total of 13 RCTs with 1026 participants were included in the qualitative analysis and nine RCTs in the quantitative analysis. The meta-analyses revealed low quality of evidence for short-term effects of yoga on stress compared to passive control groups (SMD=-0.69, 95%CI=-1.12- -0.25) and low quality of evidence for long-term effects on stress in favour of active control groups (SMD=0.23, 95%CI=0.06-0.40). There was moderate quality of evidence for short-term effects of yoga on quality of life compared to passive control groups (SMD=0.86, 95%CI=0.72-1.00). No adverse events occurred in the three safety reporting studies.

As there is low quality of evidence for short-term effects of yoga on perceived stress in stressed adults from the general population compared to passive control groups, yoga can be considered as a non-pharmacological treatment option for stress reduction.

https://inplasy.com/wp-content/uploads/2023/03/INPLASY-Protocol-4595.pdf INPLASY, identifier 202330062.

Nonpharmacological interventions for veterans are needed to help them manage chronic pain and posttraumatic stress disorder (PTSD) symptoms. Complementary and integrative health (CIH) interventions such as Mission Reconnect (MR) seek to provide veterans with the option of a partnered, self-directed intervention that teaches CIH skills remotely to support symptom management.

The purpose of this study was to describe the physical, psychological, and social outcomes of a self-directed mobile- and web-based CIH intervention for veterans with comorbid chronic pain and PTSD and their partners and qualitatively examine their MR user experience.

A sample of veteran-partner dyads (n=364) were recruited to participate in a mixed methods multisite waitlist control randomized controlled trial to measure physical, psychological, and social outcomes, with pain as the primary outcome and PTSD, depression, stress, sleep, quality of life, and relationships as secondary outcomes. Linear mixed models were constructed for primary and secondary patient-reported outcomes. The quantitative analysis was triangulated using qualitative interviews from a subsample of dyads (n=35) to examine participants' perceptions of their program experience.

Dyads were randomized to 2 groups: intervention (MR; 140/364, 38.5%) and waitlist control (136/364, 37.4%). No significant change was observed in overall pain, sleep, PTSD, quality of life, relationship satisfaction, overall self-compassion, or compassion for others. A significant reduction in pain interference in mood (P=.008) and sleep (P=.008) was observed among the veteran MR group that was not observed in the waitlist control group. We also observed a positive effect of the MR intervention on a reduction in negative affect associated with pain (P=.049), but this effect did not exceed the adjusted significance threshold (P=.01). Significant improvements were also observed for partners in the affection (P=.007) and conflict (P=.001) subdomains of the consensus and satisfaction domains. In contrast to quantitative results, qualitative data indicated that intervention impacts included improved sleep and reduced pain, anxiety, and stress and, in contrast to the survey data, overall improvement in PTSD symptoms and social relationships. Participants' overall impressions of MR highlight usability and navigation, perceptions on packaging and content, and barriers to and facilitators of MR use.

Adjunctive CIH-based modalities can be delivered using web and mobile apps but should be developed and tailored using established best practices. MR may be beneficial for veterans with pain and PTSD and their partners. Further pragmatic trials and implementation efforts are warranted.

ClinicalTrials.gov NCT03593772; https://clinicaltrials.gov/study/NCT03593772.

RR2-10.2196/13666.

Chronic low back pain is one of the most frequent reasons for medical consultation. It is important to make the correct diagnosis to select the most appropriate treatment in a stepwise approach. In this narrative review, we focus on the clinical examination, the diagnosis, and the conservative treatment of chronic non-specific low back pain. Belgian guidelines for low back pain were used as a basis, followed by a snowball search starting from two articles. Besides that, the Cochrane database was consulted using the following research areas: "multidisciplinary biopsychosocial rehabilitation", "physical examination of lumbar spine", and "rehabilitation back pain". Lastly, we took information from three handbooks. The diagnosis of low back pain starts with a thorough history, including red, yellow, orange, black, and blue flags. Physical, neurological, sensory, and motor testing is performed and complemented with specific tests for low back pain. With a focus on the conservative treatment, pharmacological and non-pharmacological treatments are possible. For CNSLBP, conservative management is advised, starting with reassurance and clear patient education about the condition. While additional treatments, such as manipulation, massage, and acupuncture, can be considered, their effectiveness is not well supported by evidence. Our center emphasizes exercise within a multidisciplinary biopsychosocial rehabilitation program, and although evidence for this approach is limited, we have seen positive outcomes, including improved mobility, strength, and higher return-to-work rates, particularly with the David Spine Concept (DSC).

Introduction: Severe pain, anxiety, and high opioid use are common following lumbar spine surgery (LSS). Yoga helps to reduce pain and anxiety, but it has not been considered for postsurgical care. The authors developed and tested the feasibility of a tailored yoga program designed for individuals undergoing LSS and explored clinical feasibility of yoga intervention on measures of pain, function, psychological status, and opioid use. Methods: Individuals scheduled for LSS were randomized into yoga versus control groups presurgery. Participants in the yoga group received tailored yoga sessions plus usual care, whereas participants in the control group received usual care only during the hospital stay post-LSS. In-person daily yoga sessions were individually presented and performed in the participant's hospital room. Feasibility was assessed by recruitment and retention rates, rate of yoga session completion, tolerance to yoga intervention, and ability to carry out planned assessment. Exploratory clinical outcomes included pain, psychological measures, Timed-Up-and-Go test, gait distance, and opioid use, during the hospital stay post-LSS. Results: Forty-one participants were enrolled, of which 30 completed. There were no dropouts. Planned assessments were completed within 45 min, suggesting no excessive burden on participants. Baseline variables were similar across both groups. The majority of participants participated in yoga intervention on the day of surgery or one day after surgery with acceptance rate of 100%. Participants showed good tolerance to yoga intervention on 0-4 tolerance scale and by their reports of exploratory clinical outcomes. Conclusion: This study indicates feasibility for a modified yoga program for postoperative care following LSS due to participant tolerance and retention. The results provide preliminary framework for future confirmatory studies that can assess the potential benefits of yoga in reducing pain, catastrophizing behavior, and opioid use and improving function. A modified yoga program focusing on diaphragmatic breathing, relaxation, and core isometric contraction exercises can be an important adjunct intervention for patients undergoing LSS. CTR Number: This trial was registered in UMIN CTR (https://rctportal.niph.go.jp/en/) with registration number: UMIN000032595.

Exercise and diet are beneficial for pain, yet many patients do not receive such recommendations from providers. This may be due to biases related to gender, race, and weight. We recruited medical students (N = 90) to view videos of women with chronic back pain performing a functional task; patients varied by weight (overweight/obese) and race (Black/White). For each woman patient, providers rated their likelihood of recommending exercises or dietary changes. Ratings significantly differed across recommendations (F(2.75, 244.72) = 6.19, P < .01) in that providers were more likely to recommend flexibility exercises than aerobic exercises and dietary changes and were more likely to recommend strength exercises than dietary changes. Results also indicated that women with obesity were more likely to receive aerobic (F(1,89) = 17.20, P < .01), strength (F(1,89) = 6.08, P = .02), and dietary recommendations (F(1,89) = 37.56, P < .01) than were women with overweight. Additionally, White women were more likely to receive a recommendation for flexibility exercises (F(1,89) = 4.92, P = .03) than Black women. Collectively, these findings suggest that providers' exercise and dietary recommendations for women with chronic pain are influenced by the weight status and racial identity of the patient. Future studies are needed to identify the reasons underlying these systematic differences, including the stereotypes and attitudes that may be driving these effects. PERSPECTIVE: This article presents results on how patient weight and race impact providers' exercise and diet recommendations for women with chronic back pain. Provider recommendations for these modalities may be systematically biased in a way that impedes care and impacts patient functioning.

Introduction: The popularity of yoga has surged in recent years; however, yoga practitioners have remained a largely homogenous population. Research reflects that most practitioners are of a higher socioeconomic status. There are access barriers to yoga for lower income individuals, likely due to factors such as financial constraints and logistical challenges. The primary goal of this review was to synthesize literature on yoga research among low-income populations and better understand the feasibility and acceptability of such interventions. A secondary goal was to assess the consistency of metrics for reporting feasibility and acceptability across such studies using the CheckList Standardizing the Reporting of Interventions for Yoga (CLARIFY) guidelines as a framework. Third, the authors sought to propose additional standardized CLARIFY guidelines that may enhance reporting on the diversity of yoga research populations, adherence, and retention. Methods: The electronic databases PubMed, PsycINFO, Cochrane Central Register of Controlled Trials, and Google Scholar were searched in May 2022 using a prespecified search string. Articles assessing a yoga intervention in predominantly low-income adult populations were deemed eligible for inclusion. Results: The search resulted in 512 potential articles. Eleven were deemed eligible for inclusion. The included studies reported mostly positive effects of yoga on the target outcome (i.e., pain/disability, quality of life/wellness, and psychiatric symptoms). Recruitment and retention data showed generally good attendance and high study completion rates. Common study design components included recruitment embedded within preexisting medical settings, proximal yoga locations, and mitigation of yoga-related costs. Finally, the authors noted inconsistency in the reporting of adherence, retention, and other sociodemographic characteristics of participants and yoga instructors (e.g., race, ethnicity, and income). Discussion: Yoga may promote physical and mental health for low-income individuals. Important facilitators to access are noted, such as proximal study settings, as well as barriers such as the need for childcare that can be addressed in future research. In addition, several study design considerations could help address the specific needs of low-income participants in yoga research, such as compensating participants, recruiting within existing medical settings, and providing yoga-related equipment at no cost. Finally, the authors suggest specific ways to enhance reporting of study metrics related to socioeconomic diversity, by adding to the preexisting CLARIFY guidelines.

People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.

Breast cancer survivors commonly experience menopausal symptoms, specifically when undergoing antihormonal therapy. Unfortunately, they often have a restricted range of treatment options available to alleviate menopausal symptoms. The objective of this qualitative study was to explore breast cancer survivors' experiences and effects of a yoga and meditation intervention supplementing previously reported RCT outcomes.

The qualitative data included in this study were part of a larger randomized controlled trial which evaluated the efficacy and safety of a 12-week yoga and meditation intervention on menopausal symptoms in breast cancer survivors. All participants who underwent the yoga intervention (n = 19) were invited to take part in semi-structured interviews after all quantitative data collection had been completed. Interviews (n = 9) were recorded, transcribed, and then coded into superordinate themes using thematic analysis.

Nine female participants were interviewed, and the following themes emerged: (1) representations and expectations from the yoga intervention; (2) course structure and implementation; (3) perceptions and effects of the intervention (at emotional, physical, behavioral, and spiritual level); (4) differences between the study yoga intervention and other physical activities.

In accordance with the accounts of participants, yoga might offer a promising intervention for breast cancer survivors. All those interviewed either currently attended a yoga class or expressed a desire to continue practicing yoga. Additionally, our findings inform future studies regarding aspects such as the importance of extending outcome measures beyond specific cancer-related complains, the advantages of addressing homogenous groups (i.e., breast cancer specific), or considering that different intervention components might need different assistance to encourage long-term use.

Interventions that promote adaptive emotion regulation (ER) skills reduce pain in patients with chronic pain; however, whether the effects of yoga practice on chronic low back pain (CLBP) are due to improvements in ER remains to be examined.

This study will test whether the effects of yoga on CLBP (improved pain severity and interference) are mediated by improved ER, the extent to which effects are related to specific aspects of ER, and the role of pain sensitization as a mediator or moderator of effects. In this study, pain sensitization will be assessed by quantitative sensory testing and gene expression profiles to examine whether pain sensitization moderates yoga's effects on pain or whether yoga and ER abilities reduce pain sensitization, leading to decreased pain severity and interference.

For this 2-arm parallel group blinded randomized controlled trial, we will enroll 204 adults with CLBP who will be randomized to receive the yoga (n=102) or a control stretching and strengthening (n=102) intervention, which are delivered via web-based synchronous biweekly 75-minute sessions over 12 weeks. Participants are encouraged to practice postures or exercises for 25 minutes on other days using accessible prerecorded practice videos that are sent to participants digitally. Participants will be assessed at 5 time points: baseline, midintervention (6 weeks), postintervention (12 weeks), and 3- and 6-month follow-ups. Assessments of ER, pain severity and interference, pain sensitivity including somatosensory and gene expression profiles, and physical strength and flexibility will be conducted at each visit. The fidelity of the interventions is assessed using a manualized checklist to evaluate recorded group sessions to ensure consistent instructor delivery.

The primary outcome will be the mean change in pain severity as measured by the Brief Pain Inventory-Short Form at 12 weeks. The primary mechanism of action is ER measured by change in the Difficulties in Emotion Regulation Scale total score. Secondary outcomes include pain sensitivity, physical strength and flexibility, pain interference, and quality of life. A mediation path analysis and series of moderated mediation path analyses will be conducted to test the study hypotheses. As of January 2024, we have enrolled 138 participants. We expect the study to be completed by May 2025.

The study will provide important data for evaluating whether improvements in ER are responsible for reduced pain perception and pain sensitivity as well as increased quality of life in the context of chronic pain. The study findings have important implications for determining the mechanism of action for yoga and possibly other mind-body interventions as nonpharmacological therapies for pain management. The results of the study will inform the content, delivery, and measures for intervention trials involving yoga as a modality for relieving pain and improving function.

ClinicalTrials.gov NCT04678297; https://clinicaltrials.gov/study/NCT04678297.

DERR1-10.2196/56016.

Low back pain (LBP) is a musculoskeletal condition that affects many individuals. While physiotherapy and acupuncture are frequently used treatments, determining their specific contributions when used alongside integrated yoga and naturopathy (IYN) therapy for relieving chronic LBP symptoms and enhancing quality of life is important.

In the present prospective randomized comparative trial, a total of 60 participants were divided into the following two groups: physiotherapy with IYN and acupuncture with IYN. The treatment duration was 10 days, and assessments were conducted both before (baseline) and after the intervention. Various assessment tools, such as the visual analog scale (VAS), Oswestry Disability Index (ODI), fingertip-to-floor test (FTF), State-Trait Anxiety Inventory (STAI), and Short Form 36 (SF-36), were utilized. The statistical analysis was performed using SPSS version 21.0 (Armonk, NY: IBM Corp).

The results revealed significant differences in VAS score, ODI, FTF score, STAI score, and SF-36 score between the physiotherapy and acupuncture groups (p<0.001). A t-test for the equality of means and a Mann-Whitney U test were used to compare the two groups; these tests revealed a significant difference in disability levels, range of motion, and state of anxiety. The acupuncture group showed a significant difference in the ODI (15.9 {12.6, 19.3}; p <0.001) and state anxiety (23.0 {20.0, 26.0}; p<0.001) compared to the physiotherapy ODI (22.4 {18.5, 26.4}) and state anxiety (27.5 {25.0, 30.0}). The physiotherapy group showed a significant difference in range of motion (7.7 {5.7, 9.7}; p<0.001) compared to the acupuncture group (11.6 {9.8, 13.5}).

The present study findings revealed that both physiotherapy and acupuncture, as interventions along with integrated yoga and naturopathy may be considered an effective treatment strategy for chronic LBP.

Posttraumatic stress disorder (PTSD) commonly co-occurs with pain and has been implicated in the maintenance of chronic pain. However, limited research has examined whether intervening for PTSD can hinder or optimize treatment outcomes for co-occurring pain and PTSD. In the present study, we examined changes in pain, PTSD, and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. We also explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Linear mixed models revealed that participants' pain interference decreased throughout treatment, d = 0.15, p = .039. Higher levels of pretreatment pain interference were associated with higher PTSD, p = .001, and depressive symptom severity, p = .014, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, β = -.03; p < .001, but not depressive symptoms. These findings indicate that ITPs for PTSD can reduce pain interferences, albeit to a small degree, and that reductions in pain interference can contribute to reductions in PTSD symptom severity. Future studies should examine which treatment components contribute to larger changes in symptom severity for veterans with co-occurring pain and PTSD.

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64-93%), showing involvement of 34-60% for the low back and 15-25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems.

Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization.

Over 60 Yogāsana-specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction-are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders.

A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body.

Endometriosis is a painful gynecological disorder that affects many women. Constant treatments and contraception changes affect women looking for solutions to treat and limit the problems caused by endometriosis. The current narrative review discusses the effects of physical activity on the management, pain, and quality of life in patients with endometriosis. Findings suggest that body awareness practices such as Hatha yoga, the Jacobson method, and progressive muscle relaxation reduce pain and stress and improve the quality of life associated with endometriosis. It also highlights the current knowledge gap on available evidence and future research. Moreover, care must be taken when considering patients' physical abilities and goals and avoiding intense physical activities. The forms of endometriosis and its symptoms vary from one woman to another, so it is important to perform studies with various nonmedicinal or surgical techniques. It is important to continue randomized controlled trials to obtain more data on the benefits of physical activity in women with endometriosis and also to identify what types of activities could be beneficial to combat pain symptoms and improve the daily lives of women with endometriosis.

Chronic pain affects around 3 million people in Germany. The drug therapies used are only effective to a limited extent and sometimes have considerable side effects. Methods of mind-body medicine (MBM) including especially mindfulness-based stress reduction (MBSR), meditation and yoga, can significantly reduce the perceived intensity of the pain. Combined with evidence-based complementary medicine, MBM as mind-body medicine in integrative and complementary medicine (MICOM) is an effective instrument for self-efficacy and self-care with very few side effects. The reduction of stress plays a key role in this process.

The present study aims to examine whether combining hatha yoga practice with self-compassion meditation could influence kinesiophobia, emotions, perceived stress, and perceived disability among individuals with chronic low back pain when compared with hatha yoga alone.

The randomized controlled study included 70 participants with chronic low back pain (CLBP) who were randomly assigned to a Hatha yoga group (HY; n = 35) or a Hatha yoga group plus self-compassion meditation (HYSCM; n = 35). Participants followed a protocol for 8 weeks, and the assessments were carried out before and after the intervention, with a follow-up evaluation conducted after one month. The participants completed the PANAS, PSS, TSK, and RMQ questionnaires. A Generalized Estimating Equation was used to explore the effect of interventions.

Both HY and HYSCM groups improved kinesiophobia, perceived disability, and stress at the follow-up. However, the HYSCM group shown a more significant reduction in kinesiophobia compared to the HY group. Moreover, significant improvement in positive affect and a reduction in negative affect over time in the HYSCM group were observed.

Hatha yoga practice when combined with self-compassion meditation led to extra benefits by exhibiting a prolonged effect, especially on kinesiophobia positive and negative effects.

Objective: This randomized controlled trial aimed at investigating the effects of tele-yoga on physical function, disease activity, spinal mobility, flexibility, muscular endurance, exercise capacity, balance, sleep quality, stress, depression, anxiety, quality of life (QoL), and mindfulness in patients with ankylosing spondylitis (AS). Methods: Sixty patients with AS were randomly assigned to the tele-yoga group (TYG) or wait-list control group (CG). In addition to their medical treatments, TYG participants attended online yoga classes three times per week for 8 weeks. The CG continued their standard medical treatment. Data were collected at baseline and after 8 weeks. The primary outcome measure was physical function as assessed by the Bath AS Functional Index (BASFI). Secondary outcome measures included the Bath AS Disease Activity Index (BASDAI), Bath AS Patient Global Score (BAS-G), Assessment of SpondyloArthritis International Society Health Index (ASAS HI), Bath AS Metrology Index (BASMI), sit-and-reach test, sit-up test, push-up test, incremental shuttle walk test, Balance Master test, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), 36-Item Short Form Health Survey (SF-36), and Mindful Attention Awareness Scale (MAAS). Results: Compared with the CG (n = 27), participants in the TYG (n = 28) demonstrated significant improvements in BASFI (p = 0.001). The TYG also showed significant improvements in disease activity, spinal mobility, flexibility, muscular endurance, balance, sleep quality, stress, depression, and QoL compared with the CG (p < 0.05). Conclusions: Tele-yoga practice appears to be a safe and promising intervention for patients with AS and should be considered as a part of holistic disease management because of its potential physical and psychological benefits. Clinical Trial Registration: NCT04803383.

Evaluate the effects of 10 min/day of yoga for 1 month on musculoskeletal discomfort and mood disturbance of home-office workers.

The COVID-19 pandemic forced many people to switch to teleworking. The abrupt change from an office setting to an improvised home-office may negatively affect the musculoskeletal and emotional health of workers. By providing mental and physical exercises, yoga may be effective in reducing adverse effects.

Fifty-four participants (42 women, 12 men) followed a 1-month yoga program, while 40 participants (26 women, 14 men) continued with their common work routine. The Cornell Musculoskeletal Discomfort Questionnaire was used to evaluate severity, interference with work and frequency of pain, and to obtain a total discomfort score for 25 body areas. Mood disturbance was evaluated with the Profile of Mood States questionnaire. Both groups completed both questionnaires, before and after the experimentation period.

After 1 month, for the yoga group only, significant reductions were observed in the discomfort of eyes, head, neck, upper and lower back, right wrist, and hips/buttocks, as well as reductions in discomfort severity, frequency and interference for the neck, upper and lower back. Total mood disturbance was also significantly reduced for the yoga group only. No favorable changes occurred for the control group.

The yoga intervention program appears to reduce musculoskeletal discomfort and mood disturbance of home-office workers.

Sedentary workers may benefit from 10 min/day of yoga during the workday to attenuate potential physical and emotional discomfort during the current pandemic and beyond.

Yoga is a non-pharmacological conservative therapeutic modality that can be employed for the management of chronic low back pain (CLBP). In this overview, we have summarized and evaluated data from current systematic reviews (SRs) on the use of yoga for CLBP.

We comprehensively searched SRs on the use of yoga for CLBP in nine electronic databases from inception to September 2023. The methodological quality was evaluated using the Assessment of Multiple Systematic Review Scale-2 (AMSTAR-2). The reporting quality of the included SRs was evaluated using the Preferred Reporting Item for Systematic Review and Meta-Analysis-2020 (PRISMA-2020), and the quality of data was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Two independent researchers performed the screening, data extraction, and quality assessment process of SRs.

A total of 13 SRs were included. The results of the AMSTAR-2 indicated that the methodological quality of the included studies was relatively low. The PRISMA-2020 checklist evaluation results indicated that methodological limitations in reporting, especially regarding data processing and presentation, were the main weaknesses. The GRADE assessment indicated that 30 outcomes were rated moderate, 42 were rated low level, and 20 were rated very low level. Downgrading factors were mainly due to the limitations of the included studies.

Yoga appears to be an effective and safe non-pharmacological therapeutic modality for the Management of CLBP. Currently, it may exhibit better efficacy in improving pain and functional disability associated with CLBP. However, the methodological quality and quality of evidence for SRs/MAs in the included studies were generally low, and these results should be interpreted cautiously.

Yoga is effective for the management of chronic low back pain as it improves muscle strength and endurance. The objective of the current study was to assess trunk and hip muscle activation during Yoga poses usually prescribed for patients with chronic LBP. The study included 22 healthy Yoga trained subjects (mean age: 24.4 ± 2.6 years; 16 females, 6 males). The testing involved collecting surface electromyography data from Rectus Abdominis (RA) and Transverse Abdominis (TA), Gluteus Medius (GM), and Erector Spinae (ES) as subjects attained and held 16 different Yoga poses in standing, kneeling, supine, or prone positions in random order. The signal of each muscle was processed and normalized to its maximum voluntary isometric contraction (MVC). Statistical comparisons were made across selected poses and phases (attaining and holding) for each muscle using repeated-measures ANOVA. The data was also descriptively analyzed for sorting muscle activity. The activation of trunk flexors was significantly higher during boat pose (>50% MVC) followed by plank pose (∼30% MVC), activation of ES was significantly higher during reverse boat (41.7% ± 3.3 MVC) as compared to bow, snake, backward-sway, and warrior poses. The GM activation was significantly less in standing poses than during side-lying and Tiger poses (32-42% MVC). The cat-camel, kneeling camel, downward dog, backward-sway, swaying-palm tree, and warrior poses activated all tested muscles fairly (<20% MVC). The study helps the grading of Yoga positions according to the challenge imposed. The challenging poses may be used to develop graded rehabilitation programs to improve muscle strength/endurance.

Prolonged standing is a part of several professions, which can have physical and psychosocial implications. Yoga as a mind-body therapy may be useful to prevent and manage such health issues. However, there is a lack of a standardized yoga module addressing the health issues of workers with prolonged standing.

Thus, the present study was undertaken to design and validate a specific yoga module for the target population.

A yoga module was prepared by reviewing yoga texts for the specific needs of the target population. This was validated for content validity for the experts on a Likert scale. 71 yoga experts validated the module. The content validity ratio (CVR) above 0.70 was considered to be valid.

The validated yoga module consists of joint loosening and strengthening exercises, asana, pranayama and relaxation techniques. The average CVR for the module was found to be 0.80.

The designed yoga module is found to be valid by the experts. The module needs to be assessed for feasibility and efficacy in the target population.

Yoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans.

Determine whether yoga is more effective than an educational book for improving disability and pain among Veterans with cLBP.

Veterans diagnosed with cLBP at a VA medical center enrolled in a randomized controlled trial from March to December of 2015.

Twelve weekly hatha yoga classes or education using The Back Pain Helpbook.

Co-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.

One 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.

Twelve 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.

NCT02224183.

Chronic pain is a growing worldwide health problem and complementary and integrative therapy options are becoming increasingly important. Multi-component yoga interventions represent such an integrative therapy approach with a promising body of evidence.

The present study employed an experimental single-case multiple-baseline design. It investigated the effects of an 8-week yoga-based mind-body intervention, Meditation-Based Lifestyle Modification (MBLM), in the treatment of chronic pain. The main outcomes were pain intensity (BPI-sf), quality of life (WHO-5), and pain self-efficacy (PSEQ).

Twenty-two patients with chronic pain (back pain, fibromyalgia, or migraines) participated in the study and 17 women completed the intervention. MBLM proved to be an effective intervention for a large proportion of the participants. The largest effects were found for pain self-efficacy (TAU-U = 0.35), followed by average pain intensity (TAU-U = 0.21), quality of life (TAU-U = 0.23), and most severe pain (TAU-U = 0.14). However, the participants varied in their responses to the treatment.

The present results point to relevant clinical effects of MBLM for the multifactorial conditions of chronic pain. Future controlled clinical studies should investigate its usefulness and safety with larger samples. The ethical and philosophical aspects of yoga should be further explored to verify their therapeutic utility.

To assess the effectiveness of mind-body (MB) exercise interventions provided by physical therapists for reducing pain and disability in people with low back pain (LBP).

MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for articles published in English between December 2010 and June 2020.

Randomized controlled trials evaluating the effects of Pilates, yoga, and tai chi interventions performed by physical therapists on pain or disability outcomes in adults with musculoskeletal LBP were included.

Data were extracted by 2 independent reviewers. Quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework and Cochrane risk of bias tools, respectively.

21,230 exercise trials were identified; 161 progressed to full-text review. Eight trials, 7 reporting on Pilates and 1 reporting on yoga, were included. Short-term outcomes for pain (SMD: -0.93; 95% confidence interval [CI]: -1.65 to -0.021) and disability (SMD: -0.74 95% CI: -1.36 to -0.012) indicated MB exercise was more effective than control intervention. Tests for subgroup differences between studies with exercise vs non-exercise control groups revealed a moderating effect on short-term outcomes where larger effects were observed in studies with non-exercise comparators. Long-term outcomes for pain (SMD: -0.60; 95% CI:-1.43 to 0.23) and disability (SMD: -1.05; 95% CI:-3.51 to 1.41) suggested that MB exercise is not more effective than control interventions for pain or disability. Quality of the evidence ranged from very low to low.

Physical therapist-delivered MB exercise interventions, which overwhelmingly consisted of Pilates, were more effective than control in the short and long-term for pain and in the short-term for disability, with differences in the short-term effects lessened when compared with an active intervention. Pilates interventions delivered by physical therapists represent a viable tool for the clinical management of chronic LBP.

Asthma is one of the most common non-communicable diseases. Yoga with physical postures, breathing exercises, meditation, and relaxation may play an essential role in the complementary management of lower respiratory diseases. The study aimed to evaluate the impact of yoga (posture, breathing exercises, and meditation) on pulmonary function tests, asthma control tests, and health-related quality of adult asthmatic patients.

MEDLINE, PubMed, Embase, Cochrane, Scopus, Google Scholar, ResearchGate, Clinical Key, and Academia electronic search engines were explored to search the relevant literature. The present study included adult asthmatic patients (age -18 and 60 years) with mild to moderate asthma, per GINA (Global Initiative for Asthma) guidelines. The effect of yoga was assessed on the following outcomes; pulmonary function tests, including FeV1 (Forced expiratory volume 1 s), FVC (Forced vital capacity), FeV1/FVC, peak expiratory flow rate (PEFR), health-related quality of life, and asthma control test. A fixed-effect model was applied to compute significance for statistical heterogeneity. P-value <0.05 was considered for statistical significance.

Finally, fifteen articles were included for meta-analysis. The forest plot for overall effect of yoga intervention and usual care favors the yoga intervention for improvement in pulmonary function as FeV1 (SMD = 0.96, CI = 0.77-1.14, I2 = 54%), FVC (SMD = 0.35, CI = 0.14-0.55, p = 0.11, I2 = 50%), Fev1/FVC (SMD = 0.18, CI = -0.38-0.02, p = 0.02, I2 = 50%), PEFR (SMD = 0.38, CI = 0.18-0.58, p = 0.0003, I2 = 0%), asthma control test (SMD = 0.16, CI = 0.15-0.48, p = 0.31, I2 = 86%) and health-related quality of life (SMD = 0.26, CI = 0.18-0.34, p = 0.02, I2 = 51%) of asthmatic patients.

This meta-analysis provides a moderate level of evidence regarding yoga as a complementary therapy in managing mild to moderate asthmatic patients. It also adds to the current knowledge of the same.

The human body's response to pain is indicative of a complex adaptive system. Therapeutic yoga potentially represents a similar complex adaptive system that could interact with the pain response system with unique benefits.

To determine the viability of yoga as a therapy for pain and whether pain responses and/or yoga practice should be considered complex adaptive systems.

Examination through 3 different approaches, including a narrative overview of the evidence on pain responses, yoga, and complex system, followed by a network analysis of associated keywords, followed by a mapping of the functional components of complex systems, pain response, and yoga.

The narrative overview provided extensive evidence of the unique efficacy of yoga as a pain therapy, as well as articulating the relevance of applying complex systems perspectives to pain and yoga interventions. The network analysis demonstrated patterns connecting pain and yoga, while complex systems topics were the most extensively connected to the studies as a whole.

All three approaches support considering yoga a complex adaptive system that exhibits unique benefits as a pain management system. These findings have implications for treating chronic, pervasive pain with behavioral medicine as a systemic intervention. Approaching yoga as complex system suggests the need for research of mind-body topics that focuses on long-term systemic changes rather than short-term isolated effects.

Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs ("red flags") indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.

Exercise has positive effects on musculoskeletal pain. In this project, the impact of exercise was studied on improving health-related quality of life in persons with musculoskeletal pain.

The study design was a systematic review and meta-analysis. A search was conducted to find original studies in four sources, including PubMed, Web of Science, the Cochrane Library and Scopus, and this search was limited to the original articles published until April 2021, which were in English. For each study, the effect size was calculated. The analysis was based on the random-effects method.

Twenty-Seven randomised control trial studies were included in the meta-analysis. The total population of participants in the meta-analysis was 1927 persons. Exercise improves health-related quality of life in these persons and the hedges' g was 0.66 (95% CI = 0.38-0.94; I2  = 88.29%).

Overall, based on the findings, exercise is associated with improving the health-related quality of life of persons with musculoskeletal pain, and therefore the health implications of this finding are beneficial to the general population and professionals.

OBJECTIVE: To investigate how risk of bias and intervention type modify effect sizes of exercise interventions that are intended to reduce chronic low back pain intensity. DESIGN: Systematic review with meta-epidemiologic regression analysis. LITERATURE SEARCH: PubMed, CENTRAL, Embase, and CINAHL (until January 31, 2021). STUDY SELECTION CRITERIA: Systematic reviews with meta-analyses of randomized controlled exercise trials. DATA SYNTHESIS: The dependent variable was pain, calculated as standardized mean difference (SMD). Potential effect modifiers were risk of bias, exercise modes, study, and meta-analyses characteristics. Multilevel meta-regressions and inverse variance-weighted meta-regressions with random intercepts were modelled. RESULTS: Data from 26 systematic reviews (k = 349 effect sizes, n = 18,879 participants) were analysed. The overall mean effect was SMD: -0.35 (k = 349, [95% CI -0.02 to -0.7]). There was a clinically relevant effect overestimation in studies with a high risk of bias due to missing outcomes (each k = 197, Beta coefficient = -1.9 [95% CI -2.9 to -.9]) and low sample size (B = 0.01 [.001 to .01], [ie, one participant more leads to an SMD decrease of 0.01]). There was a clinically relevant underestimation of the effect when studies were at high risk of bias in allocation concealment (B = 1.3 [.5 to 2.1]) and outcome measurement (B = 1.3 [.44 to 2.0]). Motor control and stabilization training (B = -1.3 [-2.3 to -.37]) had the largest effects; stretching (B = 1.3 [-.03 to .5]) had the smallest effect. CONCLUSIONS: The effects of exercise trials at high risk of bias may be overestimated or underestimated. After accounting for risk of bias, motor control and stabilization exercises may represent the most effective exercise therapies for chronic low back pain. J Orthop Sports Phys Ther 2022;52(12):792-802. Epub: 12 August 2022. doi:10.2519/jospt.2022.11149.

Non-specific low back pain (LBP) is the leading cause of years lived with disability worldwide. Physical activity is an integral part of LBP treatment.

To critically review available evidence regarding the efficacy of physical activity for people with LBP.

Up to date critical narrative review of the efficacy of physical activity for the managment LBP. The process of article selection was unsystematic; articles were selected based on authors' expertise, self-knowledge and reflective practice.

Therapeutic physical activity for LBP includes a wide range of non-specific and specific activities. The efficacy of physical activity on pain and activity limitations has been widely assessed. In acute and subacute LBP, exercise did not reduce pain compared to no exercise. In chronic low back pain (CLBP), exercise reduced pain at the earliest follow-up compared with no exercise. In a recent systematic review, exercise improved function both at the end of treatment and in the long-term compared with usual care. Exercice also reduced work disability in the long-term. We were unable to establish a clear hierarchy between different exercise modalities. Multidisciplinary functional programs consistently improved pain and function in the short- and long-term compared with usual care and physiotherapy and improved the long-term likelihood of returning to work compared to non-multidisciplinary programs.

Physical activity of all types is an effective treatment for CLBP.

Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines recommend exercise therapy. Yoga is a mind-body exercise sometimes used for non-specific low back pain.

To evaluate the benefits and harms of yoga for treating chronic non-specific low back pain in adults compared to sham yoga, no specific treatment, a minimal intervention (e.g. education), or another active treatment, focusing on pain, function, quality of life, and adverse events.

We used standard, extensive Cochrane search methods. The latest search date was 31 August 2021 without language or publication status restrictions.

We included randomized controlled trials of yoga compared to sham yoga, no intervention, any other intervention and yoga added to other therapies.

We followed standard Cochrane methods. Our major outcomes were 1. back-specific function, 2. pain, 3. clinical improvement, 4. mental and physical quality of life, 5. depression, and 6.

Our minor outcome was 1. work disability. We used GRADE to assess certainty of evidence for the major outcomes.

We included 21 trials (2223 participants) from the USA, India, the UK, Croatia, Germany, Sweden, and Turkey. Participants were recruited from both clinical and community settings. Most were women in their 40s or 50s. Most trials used iyengar, hatha, or viniyoga yoga. Trials compared yoga to a non-exercise control including waiting list, usual care, or education (10 trials); back-focused exercise such as physical therapy (five trials); both exercise and non-exercise controls (four trials); both non-exercise and another mind-body exercise (qigong) (one trial); and yoga plus exercise to exercise alone (one trial). One trial comparing yoga to exercise was an intensive residential one-week program, and we analyzed this trial separately. All trials were at high risk of performance and detection bias because participants and providers were not blinded to treatment, and outcomes were self-assessed. We found no trials comparing yoga to sham yoga. Low-certainty evidence from 11 trials showed that there may be a small clinically unimportant improvement in back-specific function with yoga (mean difference [MD] -1.69, 95% confidence interval [CI] -2.73 to -0.65 on the 0- to 24-point Roland-Morris Disability Questionnaire [RMDQ], lower = better, minimal clinically important difference [MCID] 5 points; 1155 participants) and moderate-certainty evidence from nine trials showed a clinically unimportant improvement in pain (MD -4.53, 95% CI -6.61 to -2.46 on a 0 to 100 scale, 0 no pain, MCID 15 points; 946 participants) compared to no exercise at three months. Low-certainty evidence from four trials showed that there may be a clinical improvement with yoga (risk ratio [RR] 2.33, 95% CI 1.46 to 3.71; assessed as participant rating that back pain was improved or resolved; 353 participants). Moderate-certainty evidence from six trials showed that there is probably a small improvement in physical and mental quality of life (physical: MD 1.80, 95% CI 0.27 to 3.33 on the 36-item Short Form [SF-36] physical health scale, higher = better; mental: MD 2.38, 95% CI 0.60 to 4.17 on the SF-36 mental health scale, higher = better; both 686 participants). Low-certainty evidence from three trials showed little to no improvement in depression (MD -1.25, 95% CI -2.90 to 0.46 on the Beck Depression Inventory, lower = better; 241 participants). There was low-certainty evidence from eight trials that yoga increased the risk of adverse events, primarily increased back pain, at six to 12 months (RR 4.76, 95% CI 2.08 to 10.89; 43/1000 with yoga and 9/1000 with no exercise; 1037 participants). For yoga compared to back-focused exercise controls (8 trials, 912 participants) at three months, we found moderate-certainty evidence from four trials for little or no difference in back-specific function (MD -0.38, 95% CI -1.33 to 0.62 on the RMDQ, lower = better; 575 participants) and very low-certainty evidence from two trials for little or no difference in pain (MD 2.68, 95% CI -2.01 to 7.36 on a 0 to 100 scale, lower = better; 326 participants). We found very low-certainty evidence from three trials for no difference in clinical improvement assessed as participant rating that back pain was improved or resolved (RR 0.97, 95% CI 0.72 to 1.31; 433 participants) and very low-certainty evidence from one trial for little or no difference in physical and mental quality of life (physical: MD 1.30, 95% CI -0.95 to 3.55 on the SF-36 physical health scale, higher = better; mental: MD 1.90, 95% CI -1.17 to 4.97 on the SF-36 mental health scale, higher = better; both 237 participants). No studies reported depression. Low-certainty evidence from five trials showed that there was little or no difference between yoga and exercise in the risk of adverse events at six to 12 months (RR 0.93, 95% CI 0.56 to 1.53; 84/1000 with yoga and 91/1000 with non-yoga exercise; 640 participants).

There is low- to moderate-certainty evidence that yoga compared to no exercise results in small and clinically unimportant improvements in back-related function and pain. There is probably little or no difference between yoga and other back-related exercise for back-related function at three months, although it remains uncertain whether there is any difference between yoga and other exercise for pain and quality of life. Yoga is associated with more adverse events than no exercise, but may have the same risk of adverse events as other exercise. In light of these results, decisions to use yoga instead of no exercise or another exercise may depend on availability, cost, and participant or provider preference. Since all studies were unblinded and at high risk of performance and detection bias, it is unlikely that blinded comparisons would find a clinically important benefit.

The goal of this study is to evaluate the feasibility and efficacy of an auricular point acupressure smartphone app (mAPA) to self-manage chronic musculoskeletal pain.

A prospective, longitudinal, randomized, controlled pilot trial was conducted using a three-group design (self-guided mAPA (n = 14); in-person mAPA (n = 12); and control (n = 11)). The primary outcomes included physical function and pain intensity.

After a 4-week APA intervention, participants in the in-person mAPA group had improved physical function of 32% immediately post-intervention and 29% at the 1M follow-up. Participants in the self-guided mAPA group had higher improvement (42% at post-intervention and 48% at the 1M follow-up). Both mAPA groups had similar degrees of pain intensity relief at post-intervention (45% for in-person and 48% for the self-guided group) and the 1M follow-up (42% for in-person and 45% for the self-guided group). Over 50% of the participants in each group reached at least 30% reduced pain intensity at post-intervention, and this was sustained in the mAPA groups at the 1M follow-up. Approximately 80% of the participants in both mAPA groups were satisfied with the treatment outcomes and adhered to the suggested APA practice; however, participants in the self-guided group had higher duration and more frequency in APA use. The attrition rate was 16% at the 1M follow-up. No adverse effects of APA were reported, and participants found APA to be beneficial and the app to be valuable.

The study findings indicate that participants effectively learned APA using a smartphone app, whether they were self-guided or received in-person training. They were able to self-administer APA to successfully manage their pain. Participants found APA to be valuable in their pain self-management and expressed satisfaction with the intervention using the app.

An umbrella review of systematic reviews with a meta-analysis was developed to summarize the evidence on the effectiveness of qigong, tai chi, and yoga in chronic spinal pain outcomes. The CINAHL, Cochrane Library, Embase, PsycINFO, PubMed and SPORTDiscus databases were searched. Pain, psychological factors, and quality of life (QOL) were the outcomes of interest. The methodological quality of the reviews was evaluated using the AMSTAR-2 tool. The overlap was calculated using the corrected covered area. A total of 72 meta-analyses drawn from 20 systematic reviews were included and often were rated at a critically low quality. The effects of qigong on chronic low back and neck pain (CLBP and CNP, respectively) were inconsistent, although it improved the physical component of QOL after 12 weeks for CNP. Tai chi was superior to the controls in reducing CLBP; no reviews of interest were found on CNP. Yoga was superior to multiple controls in reducing CLBP, but no relevant effects on depression or QOL were found. QOL, anxiety, depression, and general mood improved with yoga for CNP. Inconsistencies arose related to yoga and CNP. Our findings mainly supported the potential effects of yoga and tai chi on pain-related outcomes, psychological factors, and QOL in populations with CLBP and NP. Clinical and methodological considerations were discussed.