Department of Physical Medicine & Rehabilitation, University of Colorado.
Pain Physician. 2024 Sep;27(7):E661-E675.
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.
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.
After thorough examination of the available published literature, this narrative review evaluated 24 articles examining yoga's benefits to CLBP patients.
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.
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.
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.
瑜伽因其对身心健康的诸多益处而备受认可。越来越多的文献支持瑜伽在慢性下背痛（CLBP）管理中的作用。鉴于相关残疾率和大量医疗保健费用较高，CLBP 是一个主要的公共卫生关注点。从生物心理社会角度看待这种疾病被认为是最有效和最合适的管理策略。当考虑到管理 CLBP 的复杂性的替代和综合方法时，瑜伽是一种安全、易于获得的辅助治疗选择。
本综述的目的是通过强调瑜伽对身心健康的益处以及与 CLBP 相关的病理生理学，证明瑜伽是一种有效的 CLBP 管理形式。我们的另一个目标是确定瑜伽包含了一种管理 CLBP 的生物心理社会方法。
在对现有已发表文献进行彻底检查后，本叙述性综述评估了 24 篇研究瑜伽对 CLBP 患者益处的文章。
CLBP 与焦虑、抑郁、慢性压力和疼痛灾难化的高发生率相关。许多研究支持瑜伽作为一种有效的干预措施，用于治疗抑郁、焦虑、慢性压力和疼痛灾难化，因为瑜伽对交感神经系统、内分泌系统和各种神经递质和脑区的影响，以及这些方面的改善可能会减轻 CLBP 患者的临床症状。从身体上看，CLBP 患者的症状包括疼痛、功能和活动受限、残疾、疲劳和药物依赖，根据文献，瑜伽已经被证明可以改善这些症状。此外，下背痛的慢性和持续性与中枢和外周敏感化有关，瑜伽可能会干预这些途径以最小化症状的传播。
本综述并非没有局限性。目前的文献缺乏关于哪些瑜伽姿势对 CLBP 患者是安全、合适和有效的标准化规定，这限制了瑜伽疗法的普遍性。此外，现有的前瞻性试验很少研究瑜伽在 CLBP 管理中的作用。尽管本综述中包括了许多随机对照试验（RCT），但大多数现有文献详细介绍了其他 RCT 的综述或分析，样本量较小，缺乏长期随访数据。此外，这些研究中的许多都包括自愿或自行选择尝试瑜伽疗法治疗背痛的患者，表明存在固有选择偏倚。
总体而言，CLBP 的当前管理策略并未包含有效的生物心理社会方法，而瑜伽等干预措施是该疾病有前途的辅助治疗方法。
