Musculoskeletal pain conditions are the most common diagnosed medical problems among Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) service members and Veterans, far surpassing the prevalence of other medical and mental health disorders. Chronic low back pain (cLBP) is the most common pain condition in the military, causing substantial physical and psychological suffering, reduction in force readiness, and high economic cost to the military. Identifying new safe and effective alternatives to opioids that address the physical and psychosocial dimensions of chronic low back pain is urgently needed. Yoga is one of several """"""""Tier 1"""""""" complementary modalities identified by The Army Surgeon General's Pain Management Task Force 2010 Report as priorities for DoD-VA research and possible integration. Yoga has been studied in 10 RCTs in civilian populations with cLBP suggesting it may be effective in reducing pain intensity, improving back-related function, and lowering pain medication use. Our two RCTs of yoga for predominantly minority low income men and women with moderate-severe cLBP showed similar results as well as a decrease in pain medication. Multiple differences exist between civilian and military populations with cLBP, making it necessary to adapt and test yoga for cLBP in military populations. Our proposal's primary aim is to evaluate the effectiveness of yoga for reducing pain in military personnel and Veterans with cLBP through a structured, reproducible 12-week series of hatha yoga classes, supplemented with home practice, compared to an education group. We hypothesize yoga will be clinically and statistically superior to education only. Additionally, the enormous mental health burden often shouldered by returning military personnel presents another important distinguishing factor. Thus, our secondary aim is to assess yoga's capacity to reduce post- traumatic stress symptoms (PTSS). Our third and final aim is to evaluate the cost-effectiveness of yoga for cLBP at 12 weeks and 24 weeks. The proposed RCT will (1) establish a structured reproducible yoga protocol uniquely suited to Veterans populations with cLBP and associated psychological comorbid symptoms;(2) develop web-based delivery systems to assist Veterans in practicing yoga at home;(3) increase our knowledge of the feasibility and impact of yoga for Veterans'cLBP, psychological comorbidities, and family functioning;and (4) provide a strong foundation for larger multi-site studies and implementation projects. These results will help determine whether yoga is an effective modality for addressing cLBP in a military population.

Public Health Relevance

Identifying new safe and effective alternatives to opioids that address the physical and psychosocial dimensions of chronic low back pain in veterans is urgently needed. While yoga has shown to be effective for reducing pain in the civilian population, these results cannot be directly translated to the military population due to the intrinsic differences between these two groups. This research will shed light on the impact of yoga for treating chronic low back pain and associated psychological comorbidities in this population.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Project (R01)
Project #
Application #
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Khalsa, Partap Singh
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Boston Medical Center
United States
Zip Code
Saper, Robert B; Lemaster, Chelsey; Delitto, Anthony et al. (2017) Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med 167:85-94
Saper, Robert B; Lemaster, Chelsey M; Elwy, A Rani et al. (2016) Yoga versus education for Veterans with chronic low back pain: study protocol for a randomized controlled trial. Trials 17:224
Keosaian, Julia E; Lemaster, Chelsey M; Dresner, Danielle et al. (2016) ""We're all in this together"": A qualitative study of predominantly low income minority participants in a yoga trial for chronic low back pain. Complement Ther Med 24:34-9
Tran, Huong H; Weinberg, Janice; Sherman, Karen J et al. (2015) Preference and Expectation for Treatment Assignment in a Randomized Controlled Trial of Once- vs Twice-weekly Yoga for Chronic Low Back Pain. Glob Adv Health Med 4:34-9
Stein, Kim M; Weinberg, Janice; Sherman, Karen J et al. (2014) Participant Characteristics Associated with Symptomatic Improvement from Yoga for Chronic Low Back Pain. J Yoga Phys Ther 4:151
Cerrada, Christian J; Weinberg, Janice; Sherman, Karen J et al. (2014) Inter-method reliability of paper surveys and computer assisted telephone interviews in a randomized controlled trial of yoga for low back pain. BMC Res Notes 7:227
Saper, Robert B; Sherman, Karen J; Delitto, Anthony et al. (2014) Yoga vs. physical therapy vs. education for chronic low back pain in predominantly minority populations: study protocol for a randomized controlled trial. Trials 15:67
Saper, Robert B; Boah, Ama R; Keosaian, Julia et al. (2013) Comparing Once- versus Twice-Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial. Evid Based Complement Alternat Med 2013:658030
Streeter, C C; Gerbarg, P L; Saper, R B et al. (2012) Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 78:571-9