Yoga for Low Back Pain

Below is a guest blog and personal commentary on the Cochrane review of yoga treatment for chronic nonspecific low back pain from Beth Novian Hughes, MS Yoga Therapy, C-IAYT, who has back pain and is a long-time practitioner and teacher of yoga.

The results of the Cochrane review of yoga treatment for low back pain don’t surprise me at all. As a sufferer of low back pain, as well as a yoga teacher and therapist, I have seen how yoga can work to help treat low back pain.

My own experience with back pain began years ago with on and off again episodes of pain. After an injury 18 months ago, the pain was no longer on and off again but constant, although low level. My back problems were then exacerbated last year by my taking a very long hike without a break, and the chronic pain became excruciating. At this point I turned to yoga therapy. You may be wondering why I needed a special yoga practice for my back if I was already a yoga practitioner and teacher. Yes, I had a mild practice of yoga, focused on the whole body. But like so many in this field over time I started leading classes with my voice not my body (which is great for the clients), and my practice became busy and my self-care became secondary. I needed to move my own practice to the forefront and focus on helping my back if I was going to live a pain-free life.

So, what yoga did I choose to do? As a yoga therapist with a Master’s degree in the subject, I was familiar with many options. When my back pain became chronic I experimented with Pilates, chiropractic, inversion therapy, and acupuncture as well as yoga therapy, and I read books; I became my own guinea pig. Some elements of these therapies seemed to help, some didn’t. What I put together was a yoga therapy routine that included core strengthening, stability, balance, self-care and meditation. It took me until September to settle into a steady routine. Once I got used to this it took about 15 minutes to do the poses and 15 minutes to meditate, and I practiced every morning, every day. My self-care came first, before clients, before anything. I scheduled it on my Google calendar. And I improved, I got stronger, I could feel the pain was decreased. When I attended group yoga I could feel the difference in my body. I could walk further without breaks. I started to get my life back.

It took about three months for me to see a marked improvement in my chronic back pain. Over Labor Day weekend, when I was just beginning my yoga routine, I saw my daughter for a visit/vacation that included hiking. I couldn’t walk very far without needing to take a break because of pain; I needed to sit down. When I next saw her at Thanksgiving I was much improved and able to walk a lot further, something she commented on. The yoga practice I designed for my back was clearly working. Although the Cochrane review doesn’t have much information on whether improvements in pain and functioning are maintained beyond six months of yoga practice, I plan to continue this practice indefinitely.

You may wonder why I didn’t use more conventional back exercises such as physical therapy. The Cochrane review didn’t find many studies comparing yoga to other types of back exercises, but the studies they did find seemed to show no difference in back pain and functioning between the two types of exercise. The review suggested that choosing between yoga and other types of back exercise is up to the individual. However, yoga includes three major branches: poses (asana), breathwork (pranayama), and meditation. Other exercise forms do not include all three of these areas. For me, the meditation time is vital to the success of the practice. During meditation one can slow down, breathe, and turn on the relaxation response. All of this has important effects on the physiology that one may not get from other forms of exercise. I believe that the combination of poses, breathwork, and meditation may set yoga apart and help decrease depression, stress, and anxiety, and increase quality of life, even if these outcomes haven’t been measured in many clinical trials. It is also encouraging to see from the review that although yoga shows an increased risk of minor adverse events compared to doing no exercise, yoga is no riskier than other forms of back exercise. This seems predicable to me, flares happen and it is possible for exercise to aggravate a flare.

It goes without saying that one should consult an experienced yoga teacher when beginning a journey to a happy back using yoga. It is certainly possible to injure yourself if your alignment is off or if you are practicing during a flare. The therapies in the Cochrane review came from different styles or schools of yoga, just as my own practice does, but all of the therapies were delivered by experienced yoga teachers. If you are thinking of using yoga to treat back pain, please consult a professional in the field, who can help minimize your risk of injury and maximize your chances of finding relief. You can find certified yoga therapists, C-IAYT, all over the world at http://www.iayt.org/search/custom.asp?id=4160 .

I’m so thankful for yoga therapy. It has truly saved my life.

CAM in the News: Psilocybin and Depression

Over the last few months, media outlets ranging from NPR to The Guardian and the Times of India have featured stories on psilocybin and depression.  Psilocybin is the active ingredient in “magic mushrooms”. It is a powerful hallucinogen traditionally used in vision ceremonies and other religious rituals. Increasing counter-cultural use led to its criminalization in the 1960’s. However, psilocybin and other hallucinogens have recently gained attention as potential treatments for a variety of mental health woes. In 2015, noted science writer Michael Pollan published a lengthy article on the topic, which featured two research teams studying psilocybin and depression. In December of 2016, these researchers published their findings from their studies at New York University and Johns Hopkins University. Both studies looked at severely depressed patients with life-threatening cancers. The patients were given a single dose of psilocybin in a supportive, safe setting. Up to 80% of the people receiving the drug not only felt better immediately, but were also less depressed six months later. The most common reported side effects were headache and increased heart rate and blood pressure. Up to 32% reported a brief period of anxiety, paranoia, or other psychological distress. None of the participants experienced major side effects or required medical intervention.

Does this prove that psilocybin is safe and effective for depression? Not at all. These are only the results of two studies involving fewer than 80 patients. Two systematic reviews on hallucinogens and mental health were published in 2016. In June, a research team from the University of Sao Paulo reviewed studies of hallucinogens for anxiety, depression, and addiction. They found a total of 151 published studies, but only 6 studies were the randomized controlled trials needed to prove effectiveness. Only four, involving a total of 46 patients, were on psilocybin. In December, a team from Johns Hopkins University published a more focused review on hallucinogens and depression. They analyzed 19 relevant studies involving a total of 423 participants, and found that 79% of participants experienced improvement. However, none of the included studies were on psilocybin.

One key focus of future research should be safety. Unlike in standard home or hospital settings, every participant in the cancer studies at New York University and Johns Hopkins received special on-going monitoring and counselling. As summarized in the Johns Hopkins review on hallucinogens for depression, the reported risks of hallucinogens are very low compared to some other medications such as opiates. However, they are known to cause paranoia and psychosis. There are also reports of people endangering themselves and others while “tripping”. The researchers cautioned that larger, longer-term studies are needed before we decide if and how psilocybin can be used safely.

These new studies add to a small but promising body of evidence on psilocybin and depression. Up to 30% of depressed patients do not respond to existing medications, leaving millions of global sufferers in need of new options. According to an editorial by leading researchers, current regulations on hallucinogens make it nearly impossible to carry out needed studies. In the future, we hope there will be an adequate evidence base to assess effectiveness and safety via a Cochrane systematic review. These ancient substances may offer insight into new doorways out of depression for modern-day sufferers.

Cochrane Complementary Medicine Field Celebrates Its 20th Anniversary

As 2016 draws to a close, we here at the Cochrane Complementary Medicine Field (CAM Field) are celebrating an important milestone: our 20th birthday. In 1996, Dr. Brian Berman brought together a group of leading CAM researchers committed to developing and promoting evidence-based practice in complementary and integrative health.   They knew that more systematic reviews were needed on complementary medical interventions. They also knew that this information would have the greatest impact if it reached beyond researchers to the wider community of patients and healthcare professionals.

How are we doing in reaching our objectives? There are now more than 70,000 CAM-related randomized controlled trials included in Cochrane’s research database. Over a third of these studies cannot be found in standard databases such as MEDLINE, but were identified by searching often-overlooked research journals and databases. Making these studies available has significantly increased Cochrane’s ability to carry out CAM-related systematic reviews. As of December 2016, over 700 systematic reviews related to complementary and alternative medical practices have been completed, and more than 200 additional reviews are in progress.

To reach our community, we regularly publish summaries of Cochrane CAM review findings in the European Journal of Integrative Medicine and Explore: the Journal of Science and Healing. In 2014, we launched the Cochrane CAM website, which offers an A –Z directory of all Cochrane reviews on CAM therapies from acai to zinc. On the website, researchers and practitioners can sign up for regular Cochrane CAM updates and find tools to report a CAM trial or participate in a systematic review. Last year, we started the Cochrane CAM blog, which translates our findings into an engaging format accessible to the average consumer. This year we added a Cochrane CAM Facebook page and Twitter feed to offer new ways for our community to learn and engage.

What are our goals for 2017? Continuing to increase the number of CAM-related research and reviews. Expanding our efforts to reach CAM consumers. Engaging patients and practitioners alike in new prioritization activities to help ensure that we address the issues most relevant to affected communities. Strengthening our research knowledge translation skills to ensure we communicate to multiple audiences effectively. Developing new resources to encourage care providers to incorporate evidence-based CAM information into their interactions with patients.

Although Cochrane CAM started as one man’s vision, it is the efforts of hundreds of volunteers around the world that make this vision a reality – a true collaboration to carry out CAM-related systematic reviews. We also are deeply grateful to the National Institutes of Health’s National Center for Complementary and Integrative Health, whose funding makes possible the staff and materials necessary to achieve our objectives. Thanks to the hard work of the Cochrane CAM community, we help ensure that patients receive effective CAM treatments and evidence-based information. We look forward to seeing these efforts expand in 2017 and beyond.

Soothing Songs: How Music may Improve Quality of Life for Cancer Patients

The tap of a drum. The hum of a lullaby. A chorus of voices raised in joy. Wherever you find people, you find music. Hard-wired into the human brain, music activates a wide variety of neural pathways. It is uniquely able to express emotions and evoke deep memories. Music can affect more than our thoughts and memories. A number of studies have found evidence that music interventions may decrease pain and stress for patients who are critically ill or have had surgery. But can it reduce the pain, stress, and anxiety that comes with cancer treatment? A recent Cochrane review found promising evidence that it can.

The reviewers identified 52 studies of music interventions involving a total of 3,731 cancer patients. Some studies used music as part of a therapeutic process offered by a specially-trained music therapist. In other studies, patients were played pre-recorded music during standard medical care. The studies measured a wide range of physical and psychological outcomes. The reviewers did not find enough evidence to make any conclusions about music’s impact on physical functioning or immune response. But multiple studies showed that music interventions reduced patient anxiety, pain and fatigue. A smaller positive impact was seen on heart rate and blood pressure. No negative effects of music therapy were reported. Given these benefits, the reviewers recommended that music interventions be considered as a treatment strategy to improve quality of life in cancer patients.

But what if your medical team does not offer music interventions? The great thing about this review is that it found that formal music therapy was not necessary. Just listening to recorded music was effective at improving well-being. If you enjoy music, bring your headphones to your treatment sessions. Make music a part of your everyday life. Free online music technology like Spotify make it easy to discover new tunes and re-discover old favorites. Ask friends and family to make you playlists instead of lasagna. Even if you are too sick to read or talk, you may be able to listen to a familiar melody. Whatever way you experience it, music may offer a unique ability to comfort, distract, and improve well-being.

Exercise, Brain Health, and Dementia: What the Research Says

Everyone knows that exercise improves your physical well-being. It helps you fit in your jeans and open pickle jars. It can lift your mood and your sex drive. More recently, researchers have shown how exercise improves our brain’s ability to reason, concentrate, and remember. A 2013 research review concluded that exercise improves brain function in children and adults. New brain imaging technology has documented the positive changes that occur in our brain when we exercise. A more recent research review looked at exercise, cognition, and normal aging. It found clear evidence that exercise helps our brains stay healthy as we age.

But what about the impact of exercise on people with dementia? A recent Cochrane review examined studies on exercise and Alzheimer’s disease. They found 17 studies involving a total of 1,067 participants. The studies looked at whether exercise could improve Alzheimer’s symptoms. Some of the studies measured cognitive tasks like memory, reasoning, and spatial abilities. Others looked at psychological function, behavior, mental health, and the ability to do daily activities. The studies used a wide variety of exercise programs and lasted for different amounts of time. Combined results from six studies showed that patients who exercised were better able to do daily tasks, but no firm conclusions could be made since the studies were small and the results variable. There was no evidence of improved thinking, behavior, or psychological or mental health.

Why the difference between this review and the findings on normal aging? It is possible that bigger, better studies will show that exercise improves brain function in dementia. The reviewed studies on normal aging included more than 33,000 subjects, over thirty times as many as the Alzheimer’s studies in the Cochrane review. It is also possible that whatever causes Alzheimer’s is not affected by exercise.  What we do know for sure is that exercise helps keep normal brains healthy and happy, and can protect us from heart disease, diabetes, and many other diseases.  Both the Alzheimer’s Association and the National Institute on Aging recommend making exercise a part of your daily routine.

TENS and Pain Relief: The Shock that Soothes

Thousands of years before the first battery or light bulb, our ancestors began using electricity to help patients heal. What was their power source?  One of many species of electric fish that exist throughout the world. In 43 CE Scribonius Largus, physician to Emperor Claudius, recommended putting a torpedo fish on your head to cure even the worst headache. When the first electricity-producing machines were built in the 18th century, many were used to treat a wide variety of ailments. Today, transcutaneous electrical nerve stimulation, or TENS, is increasingly used to help relieve pain. Unlike an electric eel, TENS devices give patients a mild “tingly” sensation via electrodes on the skin. In 2014 the FDA approved the first TENS device designed to help prevent migraines.  A Cochrane team recently reviewed existing studies on TENS and pain relief to determine what we know about its effectiveness for treating acute pain.

The review team found 19 studies using TENS to treat acute pain associated with surgery, injury or medical procedures. The sources of pain in the reviewed studies ranged from rib fractures to blood draws. Some of the studies compared TENS to no other treatment. Others compared it to pain medication or other pain treatments. Six studies compared TENS to a placebo, or “fake” TENS treatment in which no current was delivered. The reviewers found that TENS was more effective than a placebo in treating acute pain. However, many of the studies were small and had problems with design and reporting. Therefore, the reviewers made clear that these findings were tentative. Although some people reported mild itching or discomfort, no serious harms from TENS were reported. The reviewers concluded that TENS may offer a promising option for managing acute pain.

If you are interested in trying TENS for a pain condition, talk to your healthcare team about whether TENS might be an option for you. Some pain specialists may be able to lend you a machine to try before you buy.  TENS devices range widely in price, so make sure you research all your options.  The National Health Service in the UK offers many more useful TENS tips in its online guide to home TENS use.    More research is needed on the effectiveness of TENS for both acute and chronic pain. We may find that although the TENS device has changed, Scribonius Largus’ prescription for pain relief still holds true today.

 

Cannabis for Cancer: What the Evidence Tells Us

Since 1995, the U.S. death rate from cancer has dropped 23%.  We have more treatment options than ever before to help cancer patients live longer.  But along with cancer cells, these treatments can also kill day-to-day well being. According to the NIH, about half of all cancer patients experience nausea and vomiting caused by cancer treatments. Over 90% report a big impact on their quality of life.  Although many anti-nausea drugs are now available, they often don’t work.  Only half of all patients on these drugs experience relief from their symptoms. Despite its illegality, many cancer patients turn to cannabis (marijuana) to ease their stomach. But does it actually help? A recent Cochrane review looked at the evidence on cannabis and chemotherapy-caused nausea and vomiting.

The reviewers identified 23 studies looking at the how effective cannabis was at reducing nausea and vomiting in chemotherapy patients. Most found cannabis to be more effective than a placebo (fake drug). Many also found it to be as effective as anti-nausea drugs. Overall, the review found promising evidence that cannabis can help. But cannabis side effects caused problems for many patients. Not surprisingly, patients using cannabis reported higher levels of dizziness, euphoria, and “feeling high”. A number of patients withdrew from the studies due to these side effects.

All of the reviewed studies were done between 1975 and 1991. In the early 1990’s, changes in drug laws led to a dramatic decrease in cannabis research. Since that time many new anti-nausea drugs have been developed. This means that the reviewed studies only compared cannabis to older, possibly less-effective drugs. Many of the studies also had design and reporting problems. The reviewers called for more high-quality studies comparing cannabis to newer drugs.

So if you are a cancer patient struggling with chemotherapy, is cannabis an option for you? If you live somewhere that medical or recreational marijuana is legal, the answer could be yes. However, this decision should only be made in partnership with your cancer care team. You also should consider how the side effects might impact your day-to-day functioning. The American Cancer Society offers an online guide to cannabis and cancer treatment. Like many medical organizations, the American Cancer Society has called for an easing of legal restrictions on medical cannabis research. With more research, we may identify new ways to use this ancient treatment to help improve well-being for millions of people now living with cancer.