Orthographic knowledge mediates the link between environmental print attention and early reading ability.

More than 100 million people in the United States (US) undergo surgical procedures each year. These individuals are at risk of developing persistent post-surgical pain (PPSP), with prevalence estimates typically between 20-60%. PPSP, defined as pain in the surgical area that lasts more than 3 months after surgery, is a unique chronic pain syndrome. Prior studies suggest that the development of PPSP may involve inflammatory and neuropathic mechanisms that induce both peripheral and central sensitization, as well as loss of inhibitory synaptic transmission (i.e., disinhibition) and weakening of the endogenous central opioid and endocannabinoid systems. PPSP provides a unique model for translational and clinical research involving interventions that may address underlying pathophysiological mechanisms. Pharmacological treatment is the main strategy for managing post-surgical pain. However, long-term use of potent analgesics, including opioids and nonsteroidal anti-inflammatory drugs (NSAIDs), is associated with untoward side effects, including cardiovascular and renal risks. In addition, the use of NSAIDs may alter the resolution phase of inflammation by inhibiting enzymes involved in the biosynthesis of pro-resolution lipid mediators. Both pharmacological treatment strategies may increase susceptibility to PPSP. A growing body of research supports the potential benefits of yoga in treating chronic pain. However, the precise biological processes underlying its therapeutic benefits remain largely unclear. Preclinical and clinical studies suggest that yoga has the potential to alter circulating levels of inflammatory mediators (e.g., cytokines), increase activity of the anti-inflammatory glucocorticoid receptor, and reduce activity of the pro-inflammatory transcription factor nuclear factor kappa B (NF-kB) through movement and stretching, as well as to modulate the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS). Given that maladaptive inflammatory responses to surgical injury may contribute to more severe and prolonged postoperative pain, yoga practice may mitigate the development of PPSP by modulating circulating levels of inflammatory mediators. Regular yoga practice has also been shown to modulate circulating endocannabinoid (eCB) levels, as well as other neuromodulators, such as brain-derived neurotrophic factor (BDNF). In a prospective observational study of meditators attending an intensive yoga retreat, circulating levels of the endocannabinoid 2-arachidonoylglycerol (2-AG) increased significantly, suggesting that yoga-based practices may exert endogenous analgesia by upregulating the endocannabinoid system. Evaluating the links between yoga and post-surgical pain, including modulation of circulating levels of these mediators, is a significant and novel area of inquiry. However, a program adapted to meet the needs of patients with PPSP after an array of different surgeries has not been developed. We therefore developed Persistent Relief, a yoga program for patients with PPSP adapted from a previously validated chronic low back pain (cLBP) yoga program through a modified Delphi validation process.