Dr. Oliver recently met Elena, a 45-year-old woman who came to the ER with severe back pain. Elena said that she had always had "a bad back," but in the last few weeks her pain had become much worse. Her family doctor had prescribed an antiinflammatory medication, which Elena, whose name and identifying details have been changed to preserve patient confidentiality, was taking faithfully along with Tylenol. Nevertheless, Elena was severely limited in her daily activities because of her back pain.

Elena's mood was suffering and she was becoming increasingly tearful and irritable. Previous tests performed by her family doctor indicated that surgery would not be a remedy. Her family was growing worried, as Elena was in constant pain, so in frustration they brought her to the ER to seek other treatment options.

Cases like Elena's are common, and low back pain affects up to 85 per cent of the population at some point. Fortunately, most low back pain resolves relatively quickly on its own. But one in 10 people end up like Elena, with chronic back pain that imposes serious restrictions on their lifestyle. This minority of back pain sufferers actually account for the majority of doctor's visits and healthcare costs related to the condition. In 2001 in Alberta, more than a quarter of work-loss claims were associated with lower back pain.

While opioid medications like Tylenol 3 can be effective for low back pain, Elena was concerned about their possible side-effects. (And rightly so - these medications are associated with stomach upset, constipation, and some risk of addiction if taken improperly). And not all patients can take anti-inflammatory medications like Elena can, due to their adverse effects on the stomach and kidneys.

Are there other options other than medication for low back pain sufferers? Certainly. Different lifestyle therapies have been studied, including changing one's mattress, patient education, and exercise/ physiotherapy programs. The American Pain Society has previously stated that one form of yoga, called Viniyoga, can be a useful adjunct for patients with chronic low back pain.

The core strengthening, stretching, and relaxation exercises central to yoga practice are thought to address both the physical and mental aspects of chronic low back pain. While this seems intuitively sensible, is there hard proof that yoga could work for someone like Elena?

In fact, the benefits of yoga are not limited to the theoretical - there is a scientific basis for recommending yoga for back pain. In the Clinical Journal of Pain, researchers recently published the results from a combined analysis of ten separate studies looking at the effect of yoga on pain and quality of life in back pain sufferers. For the most part these studies looked at patients with at least several weeks of back pain. Through a process akin to a coin flip, patients were assigned to yoga or to effective alternatives such as exercise or physiotherapy.

In the first few weeks after starting yoga, patients experienced an almost 50 per cent reduction in pain, and a 60 per cent reduction in back-pain related limitations. One year out, the long-term benefits were not quite as impressive, but there were positive effects seen nonetheless. It's important to note that overall quality of life did not appear to improve with yoga - but only four of the 10 included studies measured quality of life so these results are less certain.

Now before we suggest that all chronic back pain suffers sign up for yoga classes there are a few issues to keep in mind. For one, the nature of these studies makes it possible for a strong placebo effect to come into play. When researchers test medications they can give patients a sugar pill that looks identical to the medication under study. This helps sort out whether any benefits seen are due to a true effect from the studied medication, or whether the simple act of taking a pill (even a sugar pill) is providing symptom relief.

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Yoga shows promise for back pain