Summary Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID‐19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID‐19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti‐inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the COVID‐19 situation continues to evolve rapidly, these recommendations are based on the best available evidence and expert opinion at this present time and may need adapting to local workplace policies.
Objectives:Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, depression, and hypocortisolism. To date, published studies have not investigated the effects of yoga on cortisol in FM. This pilot study used a time series design to evaluate pain, psychological variables, mindfulness, and cortisol in women with FM before and after a yoga intervention.Methods:Participants (n = 22) were recruited from the community to participate in a 75 minute yoga class twice weekly for 8 weeks. Questionnaires concerning pain (intensity, unpleasantness, quality, sum of local areas of pain, catastrophizing, acceptance, disability), anxiety, depression, and mindfulness were administered pre-, mid- and post-intervention. Salivary cortisol samples were collected three times a day for each of two days, pre- and post-intervention.Results:Repeated measures analysis of variance (ANOVA) revealed that mean ± standard deviation (SD) scores improved significantly (p < 0.05) from pre- to post-intervention for continuous pain (pre: 5.18 ± 1.72; post: 4.44 ± 2.03), pain catastrophizing (pre: 25.33 ± 14.77; post: 20.40 ± 17.01), pain acceptance (pre: 60.47 ± 23.43; post: 65.50 ± 22.93), and mindfulness (pre: 120.21 ± 21.80; post: 130.63 ± 20.82). Intention-to-treat analysis showed that median AUC for post-intervention cortisol (263.69) was significantly higher (p < 0.05) than median AUC for pre-intervention levels (189.46). Mediation analysis revealed that mid-intervention mindfulness scores significantly (p < 0.05) mediated the relationship between pre- and post-intervention pain catastrophizing scores.Discussion:The results suggest that a yoga intervention may reduce pain and catastrophizing, increase acceptance and mindfulness, and alter total cortisol levels in women with FM. The changes in mindfulness and cortisol levels may provide preliminary evidence for mechanisms of a yoga program for women with FM. Future studies should use an RCT design with a larger sample size.
Objectives. Yoga is used for a variety of immunological, neuromuscular, psychological, and pain conditions. Recent studies indicate that it may be effective in improving pregnancy, labour, and birth outcomes. The purpose of this paper is to evaluate the existing literature on yoga for pregnancy. Methods. Six databases were searched using the terms “yoga AND pregnancy” and “yoga AND [post-natal OR post-partum]”. Trials were considered if they were controlled and evaluated a yoga intervention. All studies were evaluated for methodological quality according to the Jadad scale and the Delphi List. Results. Six trials were identified: three were randomized controlled trials (RCTs) and three were controlled trials (CTs). The methodological quality and reporting ranged from 0–5 on the Jadad scale and from 3–6 on the Delphi List. Findings from the RCT studies indicate that yoga may produce improvements in stress levels, quality of life, aspects of interpersonal relating, autonomic nervous system functioning, and labour parameters such as comfort, pain, and duration. Conclusions. The findings suggest that yoga is well indicated for pregnant women and leads to improvements on a variety of pregnancy, labour, and birth outcomes. However, RCTs are needed to provide more information regarding the utility of yoga interventions for pregnancy.
This study showed that during the postoperative period patients differed in terms of pain intensity profiles and that these differences were associated with outcomes for up to 6 weeks following surgery. Pain trajectories were not predictive of persistent postoperative pain status at 6 months. Nonetheless, these results highlight the importance of patient heterogeneity in acute postoperative pain and pain-related outcomes months after THA.
Introduction This article presents a study of the higher education experiences of students with visual impairments in Canada. Methods Students with visual impairments and the staff members of disability programs were surveyed and interviewed regarding the students’ experiences in entering higher education and completing their higher education requirements. Results Although the reported graduation rates were high, the students took more than four years to complete their studies. They thought that heavy reading requirements, work in groups, and an inability to participate in some activities were barriers to their full participation in higher education. Discussion The findings demonstrate that barriers exist that have a negative impact on the higher education experience of students with visual impairments. Implications for practitioners Students with visual impairments have challenges that require unique preparation for higher education.
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