Research shows positive back pain relief outcomes from engaging in yoga, qigong or tai chi.
While studies looking specifically at back pain are limited, these movement-based, mind-body interventions appear to provide back pain relief, improve pain-related disability and patients’ quality of life.
Nurse practitioners and other providers who care for back pain patients should consider introducing these interventions to promote back pain relief, especially in patients at high risk for adverse effects from medications, including opioids, according to a recently published narrative review.
The review of movement-based, mind-body interventions — yoga, tai chi and qigong — for back pain was published in the January/February issue of the journal Holistic Nursing Practice.
“I think it’s important for nurses to keep abreast of approaches for chronic pain, whether it’s back pain or headache, any type of pain,” said review author Cheryl A. Krause-Parello, PhD, RN, FAAN, who serves as a professor of holistic health and is a faculty fellow, at the Institute for Human Health and Disease Intervention. “That includes looking at pharmacological approaches, which we know alleviate symptoms, but also non-pharmacological interventions.”
Nurses need back pain relief
About 8 in 10 U.S. adults suffer low back pain during their lives, and back pain is the most common cause of job-related disability, according to the National Institute of Neurological Disorders and Stroke.
Nurses, many whose jobs require they lift and turn patients and spend long hours on their feet, might suffer even more from back pain than other professionals and need back pain relief methods.
Researchers studying the frequency and severity of low back pain in 114 nurses working in ICUs found more than 84% of nurses experienced low back pain and 66.7% of those described the pain as moderate severity, according to a January 2014 study published in the Pakistan Journal of Medical Sciences.
Low back pain is the biggest issue impacting quality of life, work productivity, absenteeism and disability among nurses, Iranian researchers reported in 2014 in Trauma Monthly. They found acute low back pain and chronic low back pain were associated not only with the ergonomic factors of frequent bending and lifting but also physical violence experiences.
A case for mind-body interventions
Evidence-based guidelines recommend using nonpharmacologic treatments, including exercise and mind-body interventions, to promote back pain relief and manage chronic low back pain symptoms.
“We’re beginning to see people looking for alternatives, especially with skyrocketing opioid addiction rates and opioid deaths,” said Krause-Parello, who also is director of the Canines Providing Assistance to Wounded Warriors program at Florida Atlantic University’s Christine E. Lynn College of Nursing, Boca Raton, Fla.
Mind-body interventions include meditation, mindfulness, hypnosis and movement-based therapies, such as yoga, tai chi and qigong, according to authors of the Holistic Nursing Practice review.
Yoga, tai chi and qigong focus on the mind-body connection with mental exercise and body awareness. While many know about yoga, far fewer understand tai chi and qigong, both of which include slow, controlled movements and a focus on breathing to enhance the body’s energy, qi or chi, according to the review.
Yoga review findings
Krause-Parello and coauthors evaluated the effects of yoga, tai chi and qigong on back pain by reviewing literature. Thirty-two randomized and nonrandomized studies, with a total of 3,484 subjects ranging from 33 to 73 years old, met the criteria for review.
Twenty-five of those took part in yoga intervention, while four did tai chi and three did qigong for back pain. All but one of the studies looked at chronic versus acute back pain.
The research showed generally positive back pain relief outcomes, including reduced pain or psychological distress, reduced pain-related disability and improved ability to function. These interventions appear to be safe, with low risk for adverse events, and attrition rates that are relatively low for all three therapies. Still, little is known about the effects on back pain from these movement-based, mind-body interventions, especially qigong and tai chi, the authors wrote.
Twenty of the 25 yoga studies reported positive outcomes in variables such as pain, psychological distress or energy. Yoga “doses” in the studies were from 20 to 75 minutes over two to 12 weeks. The researchers found longer duration and high-dose yoga interventions showed reductions in back pain.
In one study of 88 nurses working at a tertiary care hospital with chronic low back pain, researchers found yoga improved physical, psychological and social health better than physical exercises.
Tai chi and qigong review findings
Drawing conclusions from the four tai chi studies was limited because of low methodological quality and small sample sizes.
One of the four studies reviewed by researchers showed tai chi reduced acute lower back pain and promoted back pain relief in males in their 20s. Tai chi also was more effective than stretching for lower back pain in young males.
A clinical trial assessing the effects of a 10-week tai chi program in patients with low back pain showed greater reductions in pain intensity, perception of pain symptoms and pain-related disability in the tai chi group than among controls.
It remains unclear if qigong is a useful intervention for treating chronic lower back pain. But one study published last year in the Journal of Body Work and Movement Therapies looking at the effects of qigong practice in office workers with chronic low back pain suggests qigong might have a positive effect on back pain.
Researchers found the qigong group experienced significantly decreased pain intensity providing back pain relief and back functional disability compared to baseline. The comparison group, which did not do qigong, received only general advice on back pain management and experienced no such significant changes compared to baseline.
“Comparing the two groups, qigong exercise significantly improved pain intensity, back functional impairment, range of motion, core muscle strength, heart rate, respiratory rate and mental status,” researchers wrote.
More consistent evidence is needed to encourage nurse practitioners and other healthcare providers to refer back pain patients to certified yoga, tai chi or qigong interventionists for back pain management, according to the authors.
In the meantime, there is some evidence the interventions might help with little risk of harm, according to Krause-Parello. Taking medications, having back surgery or getting injection-based treatments come with a high risk of adverse effects, she said.
Nurses caring for back pain patients could ask what they’re using for pain management and possibly suggest trying a mind-body movement intervention. Nurses also can partner with professionals who offer these interventions in the community so they can refer patients.
“There are a lot of gyms and facilities that will let people do a free class,” Krause-Parello said.
And if one mind-body movement intervention doesn’t work, a patient can always try another.
“Really, there’s not a one-size-fits-all when it comes to pain management,” Krause-Parello said. “We focused on chronic back pain because of the paper we were writing, but these interventions have been known to decrease stress and help with mobility. Exercise, itself, is a good thing.”
Take these courses to learn more about violence in various settings:
Recognizing, Diagnosing and Managing Emergent Causes of Low Back Pain
(1 contact hr)
Low back pain is a common complaint that will present in a variety of practice settings. While most cases of acute low back pain are benign, self-limited, and musculoskeletal in origin, a small minority can be life-threatening. Thus, it is critical to identify red flag signs and symptoms that point to “can’t miss” serious diagnoses that might lead to permanent disability or death if not diagnosed and treated in a timely manner. The goal of this course is to provide clinicians with a focused and structured approach for differentiating patients who have benign causes of pain from those who will need a medical workup and possibly advanced imaging.
Safer Patient Handling Saves Nurses’ Backs
(1 contact hr)
Nurses ranked 9th among all occupations for the highest incidence rates of musculoskeletal disorders and nursing assistants ranked 4th highest of all occupations. The risk for “lifetime prevalence” of MSD has been identified with nurses reporting 52.7% sustained MSD in their first 5 years of working as a nurse, and 82% reporting MSD pain in the last 12 months. A safe patient handling program has the potential to substantially increase patient safety and decrease injuries, while increasing nurse retention and recruitment.
Low-Back Pain: The Nurse’s Nemesis
(1 contact hr)
Healthcare workers consistently rank among professions with the most days away from work because of injuries with back sprains and strains. Understanding that low-back pain can be the result of multiple factors and knowing when to use conservative versus aggressive therapy are warranted. Stress reduction, assistive lift technologies, and exercise are valuable tools in the prevention of low-back pain.