Yoga for People With Chronic Pain in a Community-Based Setting: A Feasibility and Pilot RCT

Improving Access to Yoga for Chronic Pain in a Spanish-Speaking Community: A Quality Improvement Initiative

BACKGROUND

The recent increase in opioid misuse and overdose among the Hispanic population signifies the need for an initiative to increase efforts in pain management in the Hispanic population. Yoga is an evidence-based therapeutic intervention that is effective for several pain-associated disorders. However, in the United States, it is primarily taught in English and not always accessible. This quality improvement (QI) project aimed to assess the outcome of implementing a yoga program on pain and quality of life in the Hispanic population.

METHODS

Twenty Spanish-speaking community center members participated in a linguistically-tailored yoga program over the course of 10 weeks that included educational, demonstration, and practice videos. Outcome measures of the QI program included changes in pain interference, physical function, opioid medication use, the overall impression of change in pain, satisfaction with the program, and the likelihood of continuation of yoga practice.

RESULTS

Data collected from participants (n = 16) after the 10-week period indicated that nearly 60% experienced an improvement in their overall impression of change in pain; their reported likelihood of continuation of yoga practice at home or another location were 6.8 and 7.4, respectively, on a 10-point scale. While pain interference was unaffected, there was an improvement in markers of physical function, including a two-fold improvement in general activity without limitations. The mean average intensity of pain decreased by 33%.

CONCLUSION

The use of a linguistically-tailored yoga program improved self-reported overall pain, physical function, average intensity of pain, and initiated an interest in participants in utilizing yoga practice for self-management of pain. This QI project provides results that can be used for further implementation initiatives at other sites and consideration of use in diverse populations.

Factors That Influence Meeting the Recommended Weekly Physical Activity Target Among Older People With Physical Multimorbidity: Evidence From 6 Low- and Middle-Income Countries

BACKGROUND

There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations.

RESULTS

Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%).

CONCLUSIONS

Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.

Āsana for Back, Hips and Legs to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64-93%), showing involvement of 34-60% for the low back and 15-25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems.

METHODS

Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization.

RESULTS

Over 60 Yogāsana-specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction-are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders.

CONCLUSIONS

A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body.

Mind-body practices, interoception and pain: a scoping review of behavioral and neural correlates

OBJECTIVE

Chronic pain is a significant source of suffering in the United States, and many individuals increasingly turn towards yoga for pain relief. However, little is known regarding how yoga improves pain. Herein we seek to examine the scope of the literature linking mind-body practices, pain and interoception; an emerging mechanism by which yoga may improve chronic pain.

METHODS

This scoping review followed the five-stage methodological framework proposed by Arksey and O'Malley to examine behavioral and neural correlates of interoception in mind-body practices and pain. A broad search of the Pubmed, CINAHL, SportDiscus, Scopus, PsychInfo, and SocIndex databases was conducted, utilizing three clusters of search terms: (1) interoceptive terms, (2) mind-body terms, and (3) pain terms.

RESULTS

A combined total of 690 articles were screened, and 24 findings included for analysis. Sixteen studies examined interoceptive outcomes in response to mind-body practices for chronic pain, and 8 studies examined interoceptive outcomes in response to evoked-pain tasks in experienced mind-body practitioners. Only three studies linked yoga, interoception and pain.

CONCLUSION

This review relied on the broader mind-body literature to inform our analyses as the literature examining yoga, pain and interoception remains limited. Interoceptive techniques including attending to and acceptance of bodily sensations, appear to be key therapeutic mechanisms in mind-body practices for chronic pain. Future yoga-based interventions would benefit examining interoceptive outcomes and integrating interoceptive strategies to facilitate the pain-modulating benefits of yoga.

Impact of mindfulness training and yoga on injury and pain-related impairment: a group randomized trial in basic combat training

Introduction

Service members are at risk for pain-related difficulties in functioning and physical injury. Previous studies suggest that mindfulness training (MT) and yoga may prevent these outcomes. The present study was designed to determine the impact of MT and yoga on the health, pain, and injury of Army trainees completing 10 weeks of basic combat training (BCT).

Methods

Platoons (≈40 trainees per platoon) were randomized to MT and yoga or training-as-usual in October to December 2020 at a large installation in the US. Self-reported outcomes were health, pain level, and pain impact on training, sleep, mood, and stress. Objective outcomes were injury-related medical encounters and number of diagnoses. The trial was registered at ClinicalTrials. Gov (NCT05550610).

Results

Intervention trainees reported significantly better health (OR = 1.05, 95% CI [1.00, 1.10]) and less impact of pain on training (OR = 0.81, 95% CI [0.74, 0.90]), sleep (OR = 0.88, 95% CI [0.81, 0.95]), mood (OR = 0.86, 95% CI [0.78, 0.96]), and stress (OR = 0.88, 95% CI [0.79, 0.98]). There was no significant difference in injury-related medical encounters (AOR = 0.70, 95% CI [0.48, 1.03]), but intervention trainees had fewer diagnoses (OR = 0.67, 95% CI [0.47, 0.95]) and were 30% less likely to have a first medical encounter at any time during BCT. This difference emerged 3 weeks into BCT.

Discussion

A combined MT and yoga intervention resulted in better trainee health. The US Army and other organizations requiring resilience under extreme stress should consider implementing MT and yoga to offset risks to employee health.

Characteristics of patients who use yoga for pain management in Indian yoga and naturopathy settings: a retrospective review of electronic medical records

Objectives

The aim of this study is to identify the characteristics of patients who underwent yoga therapy for pain in yoga and naturopathy clinical settings in India.

Methods

Electronic medical records of patients who received yoga therapy for pain in three inpatient yoga and naturopathy hospitals were reviewed retrospectively from January 2021 to September 2022. Demographic characteristics and details on pain condition, socioeconomic status, comorbidities, ancillary therapies received, and insurance status were collected. In addition, we prospectively collected data on adherence to yoga practice through a telephonic interview.

Results

A total of 984 patients were identified from a pool of 3,164 patients who received yoga therapy for pain for an average of 9.48 (1.13) days. Patients aged between 8 and 80 underwent therapy for varying pain conditions and diseases that include pain in the extremities, pain due to infection, trauma, degenerative diseases, autoimmune diseases, and spine and neurological diseases. The majority of the patients were females (66.3%), from middle class families (74.8%), and who did not have any insurance coverage (93.8%). Most of the patients were under naturopathy treatment (99.8%), followed by ayurveda (56%), and physiotherapy (49.3%), along with yoga therapy. All patients reported a significant reduction in pain post-integrated yoga therapy (p < 0.001). Adherence to yoga was significantly associated with underlying pain conditions, the presence of comorbidities, the types of therapies used, and socioeconomic status (p < 0.001).

Conclusion

This study highlights the real-time application of yoga in pain management in Indian yoga and naturopathy settings, as well as implications for future research.

How Does Meditation-Based Lifestyle Modification Affect Pain Intensity, Pain Self-Efficacy, and Quality of Life in Chronic Pain Patients? An Experimental Single-Case Study

INTRODUCTION

Chronic pain is a growing worldwide health problem and complementary and integrative therapy options are becoming increasingly important. Multi-component yoga interventions represent such an integrative therapy approach with a promising body of evidence.

METHODS

The present study employed an experimental single-case multiple-baseline design. It investigated the effects of an 8-week yoga-based mind-body intervention, Meditation-Based Lifestyle Modification (MBLM), in the treatment of chronic pain. The main outcomes were pain intensity (BPI-sf), quality of life (WHO-5), and pain self-efficacy (PSEQ).

RESULTS

Twenty-two patients with chronic pain (back pain, fibromyalgia, or migraines) participated in the study and 17 women completed the intervention. MBLM proved to be an effective intervention for a large proportion of the participants. The largest effects were found for pain self-efficacy (TAU-U = 0.35), followed by average pain intensity (TAU-U = 0.21), quality of life (TAU-U = 0.23), and most severe pain (TAU-U = 0.14). However, the participants varied in their responses to the treatment.

CONCLUSION

The present results point to relevant clinical effects of MBLM for the multifactorial conditions of chronic pain. Future controlled clinical studies should investigate its usefulness and safety with larger samples. The ethical and philosophical aspects of yoga should be further explored to verify their therapeutic utility.

Acceptability of Online Yoga Among Individuals With Chronic Conditions and Their Caregivers: Qualitative Study

BACKGROUND

The online delivery of yoga interventions rapidly expanded during the COVID-19 pandemic, and preliminary studies indicate that online yoga is feasible across multiple chronic conditions. However, few yoga studies provide synchronous online yoga sessions and rarely target the caregiving dyad. Online chronic disease management interventions have been evaluated across conditions, life spans, and diverse samples. However, the perceived acceptability of online yoga, including self-reported satisfaction and online delivery preferences, is underexplored among individuals with chronic conditions and their caregivers. Understanding user preferences is essential for successful and safe online yoga implementation.

OBJECTIVE

We aimed to qualitatively examine the perceived acceptability of online yoga among individuals with chronic conditions and their caregivers who participated in an online dyadic intervention that merged yoga and self-management education to develop skills (MY-Skills) to manage persistent pain.

METHODS

We conducted a qualitative study among 9 dyads (>18 years of age; individuals experiencing persistent moderate pain) who participated in MY-Skills online during the COVID-19 pandemic. The intervention consisted of 16 online, synchronous yoga sessions over 8 weeks for both dyad members. After the completion of the intervention, participants (N=18) participated in semistructured telephone interviews for around 20 minutes, discussing their preferences, challenges, and recommendations for improved online delivery. Interviews were analyzed by using a rapid analytic approach.

RESULTS

MY-Skills participants were, on average, aged 62.7 (SD 19) years; were primarily women; were primarily White; and had a mean of 5.5 (SD 3) chronic conditions. Both participants and caregivers reported moderate pain severity scores (mean 6.02, SD 1.3) on the Brief Pain Inventory. The following three themes were identified related to online delivery: (1) participants indicated a preference for the intervention to be in person rather than online because they were distracted in the home setting, because they felt that in-person yoga would be more engaging, because the yoga therapist could physically correct positions, and because of safety concerns (eg, fear of falling); (2) participants indicated good acceptability of online MY-Skills delivery due to convenience, access, and comfort with being in their home; and (3) recommendations for improving online delivery highlighted a need for additional and accessible technical support.

CONCLUSIONS

Both individuals with chronic conditions and their caregivers find online yoga to be an acceptable intervention. Participants who preferred in-person yoga did so due to distractions in the home and group dynamics. Some participants preferred in-person corrections to ensure correct positioning, while others felt safe with verbal modifications in their homes. Convenience and access were the primary reasons for preferring online delivery. To improve online delivery, future yoga studies should include specific activities for fostering group engagement, enhancing safety protocols, and increasing technical support.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03440320; https://clinicaltrials.gov/ct2/show/NCT03440320.

Āsana for Neck, Shoulders, and Wrists to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol

Extensive literature reports an increase in physical disorders (pain, pathologies, dysfunctions) and mental malaise/uneasiness (stress, burnout) affecting dental professionals in relation to fast and pressing rhythms of work, long working hours, increasingly demanding patients, ever-evolving technologies, etc. This project has been conceived to bring the science of yoga around the world to dental professionals as a preventive (occupational) medicine and to provide knowledge and means for self-care. Yoga is a concentrative self-discipline of the mind, senses, and physical body, that requires regular daily exercise (or meditation), attention, intention, and disciplined action. M&M: The study aimed to design a Yoga protocol specifically devised for dental professionals (dentists, dental hygienists, and dental assistants) including positions (āsana) to be practiced/used in the dental office. The protocol is targeted for the upper body, namely neck, upper back, chest, shoulder girdle, and wrists, being areas greatly affected by work-related musculoskeletal disorders. This paper represents a yoga-based guideline for the self-cure of musculoskeletal disorders among dental professionals. Results: The protocol includes both sitting (Upavistha position) and standing (Utthana or Sama position) āsana, with twisting (Parivrtta), side bending (Parsva), flexion and forward bending (Pashima), and extension and arching (Purva) āsana to mobilize and decompress, and to provide nourishment and oxygen to the musculo-articular system. The paper delivers different concepts and theories developed and deepened by the authors and introduces and spreads yoga as a medical science among dental professionals for the prevention and treatment of work-related musculoskeletal disorders. We articulate notions ranging from stretching out using the vinyāsa method (breath-driven movement) and inward-focused attention to contemplative/concentrative science, interoceptive attention, self-awareness, the mind-body connection, and receptive attitude. The theory of "muscles are bone ties" is coined and delivered with regard to tensegrity musculoskeletal fascial structures connecting, pulling together, and nearing the bone segments where they are anchored. The paper describes over 60 āsana envisaged to be performed on dental stools or using the walls of a dental office or a dental unit chair. A detailed guideline on the work-related disorders that can find relief with the protocol is provided, including the description of breath control for the practice of āsana in vinyāsa. The foundations of the technique reside in the IyengarYoga method and ParināmaYoga method. Conclusions: This paper represents a guideline for self-cure in the prevention or treatment of musculoskeletal disorders affecting dental professionals. Yoga is a powerful concentrative self-discipline able to provide physical and mental well-being, representing great help and support in daily life and business for dental professionals. Yógāsana restores retracted and stiff muscles, giving relief to the strained and tired limbs of dental professionals. Yoga is not intended for flexible or physically performing persons but for people who decide to take care of themselves. The practice of specific āsana represents a powerful tool for the prevention or treatment of MSDs related to poor posture, forward head, chronic neck tension (and related headache), depressed chest, compressive disorders on wrists and shoulders as carpal tunnel, impingement syndromes, outlet syndrome, subacromial pain syndrome and spinal disc pathologies. Yoga, as an integrative science in medicine and public health, represents a powerful tool for the prevention and treatment of occupational musculoskeletal disorders and an extraordinary path for the self-care of dental professionals, sitting job workers, and healthcare providers suffering from occupational biomechanical stresses and awkward postures.

Yoga for chronic non-specific low back pain

BACKGROUND

Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines recommend exercise therapy. Yoga is a mind-body exercise sometimes used for non-specific low back pain.

OBJECTIVES

To evaluate the benefits and harms of yoga for treating chronic non-specific low back pain in adults compared to sham yoga, no specific treatment, a minimal intervention (e.g. education), or another active treatment, focusing on pain, function, quality of life, and adverse events.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was 31 August 2021 without language or publication status restrictions.

SELECTION CRITERIA

We included randomized controlled trials of yoga compared to sham yoga, no intervention, any other intervention and yoga added to other therapies.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methods. Our major outcomes were 1. back-specific function, 2. pain, 3. clinical improvement, 4. mental and physical quality of life, 5. depression, and 6.

ADVERSE EVENTS

Our minor outcome was 1. work disability. We used GRADE to assess certainty of evidence for the major outcomes.

MAIN RESULTS

We included 21 trials (2223 participants) from the USA, India, the UK, Croatia, Germany, Sweden, and Turkey. Participants were recruited from both clinical and community settings. Most were women in their 40s or 50s. Most trials used iyengar, hatha, or viniyoga yoga. Trials compared yoga to a non-exercise control including waiting list, usual care, or education (10 trials); back-focused exercise such as physical therapy (five trials); both exercise and non-exercise controls (four trials); both non-exercise and another mind-body exercise (qigong) (one trial); and yoga plus exercise to exercise alone (one trial). One trial comparing yoga to exercise was an intensive residential one-week program, and we analyzed this trial separately. All trials were at high risk of performance and detection bias because participants and providers were not blinded to treatment, and outcomes were self-assessed. We found no trials comparing yoga to sham yoga. Low-certainty evidence from 11 trials showed that there may be a small clinically unimportant improvement in back-specific function with yoga (mean difference [MD] -1.69, 95% confidence interval [CI] -2.73 to -0.65 on the 0- to 24-point Roland-Morris Disability Questionnaire [RMDQ], lower = better, minimal clinically important difference [MCID] 5 points; 1155 participants) and moderate-certainty evidence from nine trials showed a clinically unimportant improvement in pain (MD -4.53, 95% CI -6.61 to -2.46 on a 0 to 100 scale, 0 no pain, MCID 15 points; 946 participants) compared to no exercise at three months. Low-certainty evidence from four trials showed that there may be a clinical improvement with yoga (risk ratio [RR] 2.33, 95% CI 1.46 to 3.71; assessed as participant rating that back pain was improved or resolved; 353 participants). Moderate-certainty evidence from six trials showed that there is probably a small improvement in physical and mental quality of life (physical: MD 1.80, 95% CI 0.27 to 3.33 on the 36-item Short Form [SF-36] physical health scale, higher = better; mental: MD 2.38, 95% CI 0.60 to 4.17 on the SF-36 mental health scale, higher = better; both 686 participants). Low-certainty evidence from three trials showed little to no improvement in depression (MD -1.25, 95% CI -2.90 to 0.46 on the Beck Depression Inventory, lower = better; 241 participants). There was low-certainty evidence from eight trials that yoga increased the risk of adverse events, primarily increased back pain, at six to 12 months (RR 4.76, 95% CI 2.08 to 10.89; 43/1000 with yoga and 9/1000 with no exercise; 1037 participants). For yoga compared to back-focused exercise controls (8 trials, 912 participants) at three months, we found moderate-certainty evidence from four trials for little or no difference in back-specific function (MD -0.38, 95% CI -1.33 to 0.62 on the RMDQ, lower = better; 575 participants) and very low-certainty evidence from two trials for little or no difference in pain (MD 2.68, 95% CI -2.01 to 7.36 on a 0 to 100 scale, lower = better; 326 participants). We found very low-certainty evidence from three trials for no difference in clinical improvement assessed as participant rating that back pain was improved or resolved (RR 0.97, 95% CI 0.72 to 1.31; 433 participants) and very low-certainty evidence from one trial for little or no difference in physical and mental quality of life (physical: MD 1.30, 95% CI -0.95 to 3.55 on the SF-36 physical health scale, higher = better; mental: MD 1.90, 95% CI -1.17 to 4.97 on the SF-36 mental health scale, higher = better; both 237 participants). No studies reported depression. Low-certainty evidence from five trials showed that there was little or no difference between yoga and exercise in the risk of adverse events at six to 12 months (RR 0.93, 95% CI 0.56 to 1.53; 84/1000 with yoga and 91/1000 with non-yoga exercise; 640 participants).

AUTHORS' CONCLUSIONS

There is low- to moderate-certainty evidence that yoga compared to no exercise results in small and clinically unimportant improvements in back-related function and pain. There is probably little or no difference between yoga and other back-related exercise for back-related function at three months, although it remains uncertain whether there is any difference between yoga and other exercise for pain and quality of life. Yoga is associated with more adverse events than no exercise, but may have the same risk of adverse events as other exercise. In light of these results, decisions to use yoga instead of no exercise or another exercise may depend on availability, cost, and participant or provider preference. Since all studies were unblinded and at high risk of performance and detection bias, it is unlikely that blinded comparisons would find a clinically important benefit.

Merging Yoga and self-management Skills (MY-Skills) to influence self-efficacy among individuals with persistent pain: A pilot study

CONTEXT

Individuals with persistent pain-related disability have lower self-efficacy, which impacts daily function and health.

AIM

To explore self-efficacy among individuals with persistent pain who were part of a dyad (caregiver and care-recipient) who completed the Merging Yoga and self-management Skills intervention (MY-Skills).

METHODS

Participants completed MY-Skills, an 8-week group, dyadic-based self-management and yoga program. Self-efficacy outcomes were collected using the Chronic Pain Self-Efficacy Scale; PROMIS® Self-Efficacy for Managing Daily Activities; and PROMIS® Self-Efficacy for Managing Symptoms.

RESULTS

Eight participants completed the study (50.23 ± 14.77 years old, 77% female, (69%) with pain >10 years). Self-efficacy improved across all measures and domains, with significant improvement for physical function self-efficacy (38.97 ± 19.45 vs. 59.10 ± 18.60, p = .004).

CONCLUSIONS

MY-Skills improved self-efficacy to varying degrees, which may contribute to participants' confidence in performing activities. Further research is needed to examine dyadic outcomes among caregivers and care-recipients.

Manual development for a multi-modal, dyadic intervention for persistent pain: A Qualitative Study

Background

People who experience persistent pain often require help from a family member, partner, or friend. These caregivers frequently have pain but are often not included in interventions. Caregivers and care receivers who both experience pain are more likely to be socially isolated, and experience communication conflict and decreased quality of life. Interventions should target caregiving dyads to help them manage their pain together. However, there are few intervention manuals or research protocols developed to support the dyad.

Objective

The purpose of this qualitative study was to explore the needs of caregiving dyads, including input from dyads and medical and allied health experts to inform the development of an intervention manual for dyads with persistent pain.

Method

A total of 16 caregiving dyads experiencing persistent pain, one care receiver (caregiver could not participate), and 8 health experts, recruited from the community, participated in focus groups. Data were transcribed verbatim, uploaded into NVivo software, and analyzed using constant comparison qualitative methods.

Results

Findings identified the importance of a new intervention to focus on modifiable approaches to managing pain as a dyad, addressing the emotional and psychological effects of experiencing pain as a dyad, and careful consideration of logistics to implement an intervention with dyads in persistent pain.

Conclusion

These results highlight important considerations to meet the needs of caregiving dyads with pain. This study informed the development of the MY-Skills intervention, a novel program that merges self-management education with adaptive yoga to treat persistent pain in caregiving dyads.

Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions

ABSTRACT

The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.

Improved cancer coping from a web-based intervention for prostate cancer survivors: A randomized controlled trial

OBJECTIVES

Prostate cancer (PCa) survivors report poor physical functioning alongside negative psychological outcomes as they cope with treatment side effects and practical concerns after treatment completion. This study evaluated PROGRESS, a web-based intervention designed to improve adaptive coping among PCa survivors.

METHODS

Localized PCa patients (N = 431) within one year of treatment completion were randomized to receive educational booklets or PROGRESS + educational booklets. Surveys completed at baseline, 1-, 3-, and 6-months assessed patient characteristics; functional quality of life and coping (primary outcomes); and psychosocial outcomes (e.g., self-efficacy, marital communication; secondary outcomes). Intent-to-treat and as-treated analyses were completed to assess change in outcomes from baseline to 6 months using linear mixed effects regression models.

RESULTS

In the intent-to-treat analyses, participants randomized to the intervention group had improved diversion coping (i.e., healthy redirection of worrying thoughts about their cancer), but more difficulties in marital communication (ps < 0.05). However, PROGRESS usage was low among those randomized to the intervention group (38.7%). The as-treated analyses found PROGRESS users reported fewer practical concerns but had worse positive coping compared to PROGRESS non-users (ps < 0.05).

CONCLUSIONS

The findings suggest PROGRESS may improve certain aspects of adaptive coping among PCa survivors that use the website, but does not adequately address the remaining coping and psychosocial domains. Additional research is needed to better understand the gaps in intervention delivery contributing to low engagement and poor improvement across all domains of functional quality of life and adaptive coping.

Yoga for Caregiving Dyads Experiencing Chronic Pain: Protocol Development for Merging Yoga and Self-Management to Develop Skills Intervention

CONTEXT

Caregivers often provide unpaid care for family members and friends with physical disabilities, often to the detriment of their health and well-being. Caregivers often experience pain, and individuals with physical disabilities also are likely to experience pain. Merging yoga and self-management to Develop Skills Study (MY-Skills) is an intervention that merges self-management education with yoga for dyads experiencing chronic pain.

AIM

This article presents the yoga protocol for the MY-Skills intervention.

METHODS

The yoga protocol was revised based on feedback from six caregiving dyads. The protocol focuses on reducing pain interference and supporting the caregiving dyad.

RESULTS

The final yoga protocol incorporated the following elements: Centering and mantra, prana vidya and pranayama, asanas, mudra, and guided savasana/dhyana.

CONCLUSION

The MY-Skills yoga protocol was modified by a yoga therapist with feedback from study participants. Revisions focused on the caregiving dyad, with specific attention to reducing pain interference.

Feasibility of a yoga intervention to decrease pain in older women: a randomized controlled pilot study

BACKGROUND

A significant proportion of older women suffer from chronic pain, which can decrease quality of life. The objective of this pilot randomized study was to evaluate the feasibility of a flow-restorative yoga intervention designed to decrease pain and related outcomes among women aged 60 or older.

METHODS

Flow-restorative yoga classes were held twice weekly for 1 hour and led by a certified yoga instructor. Participants randomized to the intervention group attended the yoga classes for 12 weeks and received supplemental materials for at-home practice. Those randomized to the control group were asked to maintain their normal daily routine. Feasibility was evaluated using recruitment and retention rates, class and home practice adherence rates, and participant satisfaction surveys. Outcome measures (self-reported pain, inflammatory markers, functional fitness, quality of life, resilience, and self-reported physical activity) were assessed at baseline and post-intervention. Paired t-tests or Wilcoxon signed-rank tests were used to examine changes in outcome measures within treatment groups.

RESULTS

Thirty-eight participants were recruited and randomized. Participants were primarily white, college-educated, and higher functioning, despite experiencing various forms of chronic pain. Attendance and retention rates were high (91 and 97%, respectively) and the majority of participants were satisfied with the yoga program (89%) and would recommend it to others (87%). Intervention participants also experienced reductions in pain interference and improvements in energy and social functioning.

CONCLUSIONS

This pilot study provides essential data to inform a full scale randomized trial of flow-restorative yoga for older women with chronic pain. Future studies should emphasize strategies to recruit a more diverse study population, particularly older women at higher risk of disability and functional decline.

TRIAL REGISTRATION

Clinicaltrials.gov , NCT03790098 . Registered 31 December 2018 - Retrospectively registered.

Yoga improves balance, mobility, and perceived occupational performance in adults with chronic brain injury: A preliminary investigation

BACKGROUND AND PURPOSE

This was a preliminary investigation to investigate potential benefits of group yoga, as past work has indicated that one-on-one yoga can improve functional deficits in adults with brain injury.

MATERIALS AND METHODS

Participants served as their own controls. Nine participants with chronic brain injury were recruited, and seven (four female) completed the study. Performance measures of balance and mobility and self-reported measures of balance confidence, pain, and occupational performance and satisfaction were used. Data were collected 3 times: baseline (study onset), pre-yoga (after an 8-week no-contact period), and post-yoga (after 8 weeks of yoga). Group yoga was led by a yoga instructor/occupational therapist, and sessions lasted 1 h and occurred twice a week.

RESULTS

No participants withdrew due to adverse effects from yoga. There were no significant changes between baseline and pre-yoga. Significant improvement was observed post-yoga in balance (p = 0.05), mobility (p = 0.03), and self-reported occupational performance (p = 0.04).

CONCLUSION

We observed significant improvements in balance, mobility, and self-reported occupational performance in adults with chronic brain injury.

The Use of Yoga as a Group Intervention for Pediatric Chronic Pain Rehabilitation: Exploring Qualitative and Quantitative Outcomes

Purpose:

With the increase in opioid use over the last decade, mind–body approaches to pediatric pain management have been trending. To date, there is limited research regarding the use of yoga with pediatric chronic pain. This study aims to gauge the effectiveness of group yoga as part of chronic pain rehabilitation and one's ability to continue practicing independently by exploring qualitative and quantitative information.

Methods:

A single therapist used yoga as a group physical therapy intervention once a week for 60 minutes. Yoga education, iyengar yoga components, relaxation, and stretching were incorporated into the therapeutic yoga session. Qualitative and quantitative information was collected.

Results:

Qualitative outcomes provided valuable data about distractions and benefits. Quantitative outcomes showed that there were significant improvements in areas such as mental tension, emotional tension, muscle tension, and pain (all P < 0.001 significant).

Conclusion:

Pediatric chronic pain patients can identify many benefits after a single group yoga session. It combines the physical and cognitive aspects of interdisciplinary pain rehabilitation for continued use after discharge. The use of yoga is an economical means of physical activity after discharge to promote long-term benefits.