Kirsten Lung

Impact of Iyengar yoga on quality of life in young women with rheumatoid arthritis

Objective:Rheumatoid arthritis (RA) is a chronic, disabling disease that can greatly compromise health-related quality of life (HRQoL). The aim of this study was to assess the impact of a 6-week twice/week Iyengar yoga program on HRQoL of young adults with RA compared with a usual-care waitlist control group. Methods:The program was designed to improve the primary outcome of HRQoL including pain and disability and psychological functioning in patients. Assessments were collected pretreatment, posttreatment, and at 2 months after treatment. Weekly ratings of anxiety, depression, pain, and sleep were also recorded. A total of 26 participants completed the intervention (yoga=11; usual-care waitlist=15). All participants were female (mean age=28 y). Results:Overall attrition was low at 15%. On average, women in the yoga group attended 96% of the yoga classes. No adverse events were reported. Relative to the usual-care waitlist, women assigned to the yoga program showed significantly greater improvement on standardized measures of HRQoL, pain disability, general health, mood, fatigue, acceptance of chronic pain, and self-efficacy regarding pain at posttreatment. Almost half of the yoga group reported clinically meaningful symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects showed improvements in HRQoL general health, pain disability, and weekly ratings of pain, anxiety, and depression were maintained at follow-up. Conclusions:The findings suggest that a brief Iyengar yoga intervention is a feasible and safe adjunctive treatment for young people with RA, leading to HRQoL, pain disability, fatigue, and mood benefits. Moreover, improvements in quality of life, pain disability, and mood persisted at the 2-month follow-up.

Iyengar yoga for adolescents and young adults with irritable bowel syndrome.

Objectives:Irritable bowel syndrome (IBS) is a chronic, disabling condition that greatly compromises patient functioning. The aim of this study was to assess the impact of a 6-week twice per week Iyengar yoga (IY) program on IBS symptoms in adolescents and young adults (YA) with IBS compared with a usual-care waitlist control group. Methods:Assessments of symptoms, global improvement, pain, health-related quality of life, psychological distress, functional disability, fatigue, and sleep were collected pre- and posttreatment. Weekly ratings of pain, IBS symptoms, and global improvement were also recorded until 2-month follow-up. A total of 51 participants completed the intervention (yoga = 29; usual-care waitlist = 22). Results:Baseline attrition was 24%. On average, the yoga group attended 75% of classes. Analyses were divided by age group. Relative to controls, adolescents (14–17 years) assigned to yoga reported significantly improved physical functioning, whereas YA (18–26 years) assigned to yoga reported significantly improved IBS symptoms, global improvement, disability, psychological distress, sleep quality, and fatigue. Although abdominal pain intensity was statistically unchanged, 44% of adolescents and 46% of YA reported a minimally clinically significant reduction in pain following yoga, and one-third of YA reported clinically significant levels of global symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects for adolescents revealed global improvement immediately post-yoga that was not maintained at follow-up. For YA, global improvement, worst pain, constipation, and nausea were significantly improved postyoga, but only global improvement, worst pain, and nausea maintained at the 2-month follow-up. Conclusions:The findings suggest that a brief IY intervention is a feasible and safe adjunctive treatment for young people with IBS, leading to benefits in a number of IBS-specific and general functioning domains for YA. The age-specific results suggest that yoga interventions may be most fruitful when developmentally tailored.

Heart rate variability as a biomarker for autonomic nervous system response differences between children with chronic pain and healthy control children

Studies in adults have demonstrated a relationship between lowered heart rate variability (HRV) and poor health. However, less is known about the role of autonomic arousal in children’s well-being. The aim of the current study was to examine resting HRV in children with chronic pain compared to healthy control children and, further, to examine children’s HRV following a series of acute experimental pain tasks in both groups. Participants included 104 healthy control children and 48 children with chronic pain aged 8–17 years. The laboratory session involved a 5-minute baseline electrocardiogram followed by four pain induction tasks: evoked pressure, cold pressor, focal pressure, and a conditioned pain modulation task. After the tasks were complete, a 5-minute post-task electrocardiogram recording was taken. Spectral analysis was used to capture high-frequency normalized power and the ratio of low-to-high frequency band power, signifying cardiac vagal tone and sympathetic balance, respectively. Results revealed that children with chronic pain had significantly lower resting HRV (signified by low high-frequency normalized power and high ratio of low-to-high frequency band power) compared to healthy children; moreover, a significant interaction between groups and time revealed that children with chronic pain displayed a static HRV response to the pain session compared to healthy children, whose HRV was reduced concomitant with the pain session. These findings suggest that children with chronic pain may have a sustained stress response with minimal variability in response to new acute pain stressors.

Relationship of neuroticism and laboratory pain in healthy children: does anxiety sensitivity play a role?

Summary Both neuroticism and anxiety sensitivity share strong relationships with laboratory pain responses, although anxiety sensitivity at least partly explains the relationship between neuroticism and pain across most tasks. Abstract Both neuroticism, a higher‐order, stable personality trait, and anxiety sensitivity (AS), a lower‐order pain‐related construct, have been associated with pain, although no research exists examining the relationship of both these constructs to acute pain in children. In the current study, 99 healthy children (53 girls) completed self‐report measures of neuroticism and AS before undergoing pain tasks involving cold and pressure pain. We hypothesized that both neuroticism and AS would be correlated with acute pain responses, but that AS would at least partially mediate the relationship between neuroticism and pain responses. Results indicated significant correlations between neuroticism, AS, and anticipatory anxiety, pain intensity and pain bother. Mediational models revealed that AS partially mediated relationships between neuroticism and pain intensity/bother, and fully mediated relationships between neuroticism and anticipatory anxiety. These data suggest that, at least in children, neuroticism may be best understood as a vulnerability factor for elevated pain responses, especially when coupled with a fear of bodily sensations.

Maternal Anxiety and Children's Laboratory Pain: The Mediating Role of Solicitousness

There has been limited empirical examination of how parent variables such as anxiety and solicitousness collectively impact child pain response. We sought to examine the relationships among maternal anxiety, solicitous parenting, and children’s laboratory anxiety and pain intensity in children with chronic pain. Participants included 80 children and adolescents (ages 8–18) with chronic pain and their mothers. Children completed questionnaires and lab pain tasks measuring their parents’ solicitous parenting, pressure, cold and heat pain anticipatory anxiety and pain intensity. Using bootstrapping analysis, maternal anxiety predicted child anticipatory anxiety and pain intensity in girls with chronic pain, which was mediated by the child’s report of parental solicitousness. For boys with chronic pain, maternal anxiety predicted boys’ anticipatory anxiety and pain intensity, with no support for mediation. This study adds to the growing literature demonstrating the impact of maternal anxiety on children’s pain. The study highlights the importance of considering parents in treatment designed to reduce children’s pain.

Sex differences in the relationship between maternal fear of pain and children’s conditioned pain modulation

Background Parental behaviors, emotions, and cognitions are known to influence children’s response to pain. However, prior work has not tested the association between maternal psychological factors and children’s responses to a conditioned pain modulation (CPM) task. CPM refers to the reduction in perceived pain intensity for a test stimulus following application of a conditioning stimulus to a remote area of the body, and is thought to reflect the descending inhibition of nociceptive signals. Methods The present study examined sex differences in the association between maternal anxiety about pain and children’s CPM responses in 133 healthy children aged 8–17 years. Maternal pain anxiety was assessed using the Pain Anxiety Symptoms Scale-20. In addition to the magnitude of CPM, children’s anticipatory anxiety and pain-related fear of the CPM task were measured. Results Sequential multiple linear regression revealed that even after controlling for child age and general maternal psychological distress, greater maternal pain anxiety was significantly related to greater CPM anticipatory anxiety and pain-related fear in girls, and to less CPM (ie, less pain inhibition) in boys. Conclusion The findings indicate sex-specific relationships between maternal pain anxiety and children’s responses to a CPM task over and above that accounted for by the age of the child and the mother’s general psychological distress.

The effect of hypnosis on pain and peripheral blood flow in sickle-cell disease: a pilot study

Background Vaso-occlusive pain crises (VOCs) are the “hallmark” of sickle-cell disease (SCD) and can lead to sympathetic nervous system dysfunction. Increased sympathetic nervous system activation during VOCs and/or pain can result in vasoconstriction, which may increase the risk for subsequent VOCs and pain. Hypnosis is a neuromodulatory intervention that may attenuate vascular and pain responsiveness. Due to the lack of laboratory-controlled pain studies in patients with SCD and healthy controls, the specific effects of hypnosis on acute pain-associated vascular responses are unknown. The current study assessed the effects of hypnosis on peripheral blood flow, pain threshold, tolerance, and intensity in adults with and without SCD. Subjects and methods Fourteen patients with SCD and 14 healthy controls were included. Participants underwent three laboratory pain tasks before and during a 30-minute hypnosis session. Peripheral blood flow, pain threshold, tolerance, and intensity before and during hypnosis were examined. Results A single 30-minute hypnosis session decreased pain intensity by a moderate amount in patients with SCD. Pain threshold and tolerance increased following hypnosis in the control group, but not in patients with SCD. Patients with SCD exhibited lower baseline peripheral blood flow and a greater increase in blood flow following hypnosis than controls. Conclusion Given that peripheral vasoconstriction plays a role in the development of VOC, current findings provide support for further laboratory and clinical investigations of the effects of cognitive–behavioral neuromodulatory interventions on pain responses and peripheral vascular flow in patients with SCD. Current results suggest that hypnosis may increase peripheral vasodilation during both the anticipation and experience of pain in patients with SCD. These findings indicate a need for further examination of the effects of hypnosis on pain and vascular responses utilizing a randomized controlled trial design. Further evidence may help determine unique effects of hypnosis and potential benefits of integrating cognitive–behavioral neuromodulatory interventions into SCD treatment.