Yoga and physical therapy (PT) are effective approaches to treating co-occurring sleep disturbance and back pain while reducing the need for medication, according to a new study from Boston Medical Center (BMC). Published in the Journal of General Internal Medicine, the research showed significant improvements in sleep quality lasting 52 weeks after 12 weeks of yoga classes or 1-on-1 PT, which suggests a long-term benefit of these non-pharmacologic approaches. In addition, participants with early improvements in pain after 6 weeks of treatment were three and a half times more likely to have improvements in sleep after the full, 12-week treatment, highlighting that pain and sleep are closely related.

Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications.

"Identifying holistic ways to treat these conditions could help decrease the reliance on these medications as well as keep patients safer and more comfortable," said Eric Roseen, DC, MSc, a researcher in the department of family medicine at BMC, who led the study.

The randomized controlled trial included 320 adults with cLBP from BMC and seven surrounding community health centers. At the beginning of the study, over 90 percent of participants with cLBP were found to suffer from poor sleep. Participants were assigned one of three different therapies for cLBP: physical therapy, weekly yoga, or reading educational materials. Previous research from BMC discovered that yoga and PT are similarly effective for lowering pain and improving physical function, reducing the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.

"The high prevalence of sleep problems in adults with chronic low back pain can have detrimental effects on a person's overall health and well-being," said Roseen, also an assistant professor of family medicine at Boston University School of Medicine. "This really emphasizes the need for providers to ask patients with chronic low back pain about the quality of their sleep. Given the serious risks of combining pain and sleep medications, nonpharmacologic approaches should be considered for these patients."