Yoga therapy for chronic pain

Using yoga to manage chronic pain. By Heather Mason

Chronic pain is a problem that weighs heavily on society. For the people who live with chronic pain, the impact is often profound and far-reaching, with its adverse influence seeping into every facet of life. But the burden of this suffering hasn’t only been felt on a personal level - in the USA particularly, pain management has become a contentious issue in public health.

Unfortunately, there is no silver bullet in the treatment of chronic pain. With many medical interventions proving ineffective or dangerous (and sometimes, both) the medical community and pain sufferers are increasingly looking towards less obvious solutions. It is in this context that yoga and mindfulness has been stepping into the gap, and research is increasingly suggesting its efficacy.

Living with chronic pain
According to the National Centre of Health Statistics, in 2019 20.4% of adults in the US had chronic pain and 7.4% of adults had chronic pain that frequently limited life or work activities (referred to as high impact chronic pain) in the past three months. These numbers are startling, but while they can point to the scope of the problem, they do little to illuminate the millions of human experiences behind them.

Chronic pain is notoriously difficult to treat, and most especially when there is no obvious physical cause that doctors can focus on (which is the case in nearly a third of chronic pain sufferers). In fact, a large-scale study from 2018 found that low back pain is mismanaged globally, and highlighted how bedrest, prescription opioids and even surgery are implemented in treatment plans to little success.

The opioid crisis in the USA, while primarily being an account of pharmaceutical irresponsibility, is also a cautionary tale of what happens when chronic pain is treated as a solely physical problem. While there is no doubt that opioid painkillers have vital medical uses and are extremely effective in relieving acute pain, there is little evidence for their effectiveness over the long term, while the risk of addiction grows with every daily dose.

Unfortunately, addiction isn’t the only mental health issue that affects people with chronic pain. Chronic pain patients are also particularly vulnerable to comorbidities such as anxiety and depression, and attempts to treat the body while neglecting the mind are increasingly seen as incomplete. The experience of pain has a strong psychological component and can even, in some cases, be fully or partially psychogenic.

By the same token, the idea that symptoms are ‘all in the head’ (and therefore, in the public consciousness, somewhat exaggerated or hysterical) is also being abandoned as our understanding of the mind-body connection grows. As noted in an article from Harvard Health, “as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.”

Yoga for chronic pain
Yoga therapy can be extremely helpful for people living with chronic pain because it centres their individual experience, giving them a chance to fully explain their symptoms and the opportunity to co-create a tailored treatment plan that directly addresses their needs. As health institutions such as the NHS begin to emphasise “the importance of putting the patient at the centre of their care, and of fostering a collaborative, supportive relationship between patient and healthcare professional” in cases of chronic pain, using yoga in a clinical setting is becoming more widespread.

As there are more than 200 chronic pain conditions, there is no ‘one size fits all’ yogic technique that can cover every individual scenario. In many cases, it is in one-to-one work with a yoga therapist - who can devise an individualised treatment plan based on interviews with their client and a thorough assessment of their needs and capabilities - that the full potential of yoga to ease chronic pain can be felt.

As explained in one of the most comprehensive and up-to-date books on the subject, Yoga and Science in Pain Care, yoga therapy offers a treatment option where the “patient is an active and empowered participant [in their own recovery], as opposed to a model where the healthcare provider is ‘fixing’ the passive patient”. Asana and pranayama can be used as a pacing tool in the self-management of pain and reduce avoidance (and opioid-seeking) behaviours by lowering the intensity of pain and helping people to regulate their emotions during flare-ups.

Yoga can also help people become reacquainted with their physical selves, giving a safe and symptom-appropriate means through which to increase their body awareness after potentially many years of feeling alienated from or distrustful of it. And this sense of connection isn’t only focused within - yoga is often associated with cultivating a sense of ‘oneness’ with other people, and yoga classes can help ease isolation through direct interaction with others.

As a coping mechanism, means to boost mood and a way to develop self-compassion, yoga can be extremely powerful, and research suggests this impact can even lead to changes within the brain. Chronic pain is associated with negative structural and functional changes in the prefrontal cortex and hippocampus that are indicative of anxiety and depression - but yoga has been shown to have the near-opposite effect.

Mindfulness in particular has been linked to increased grey matter density and reduced volume in the amygdala (the part of the brain that governs our stress response), while long-term yoga practice has been associated with improvements in specific brain regions involved in executive function. This may give some indication of why mindfulness-based interventions, even after a brief introduction rather than years of practice, improve pain across a variety of disorders.

Yoga therapy
There is often no comprehensive and permanent solution to chronic pain, but yoga and yoga therapy does give people a way to direct at least some of their treatment and offers a tool for self-management. By addressing the whole human experience of pain, people are supported in both mind and body, and can empower themselves to live fully and happily despite the challenges that chronic pain can bring.

Heather Mason is a yoga therapist who aims to bridge the worlds of yoga and healthcare. She has undertaken extensive academic learning (including a MSc in Medical Physiology) and helped to establish both an All-Party Parliamentary Group on Yoga in Society, as well as founding alongside other directors the Yoga in Health Care Alliance (YIHA). She is the founder of The Minded Institute (themindedinstitute.com), a world leader in yoga therapy and mindfulness training for yoga and health professionals.