Working with Pain Conditions

It is estimated that 30-50% of medical issues could be related to chronic pain with around 10-15% of that group experiencing moderate to severe disabling pain. That's a lot of pain.

There are many medical treatments for persistent pain and these tend to focus on subduing the pain signals by using pain medications, having surgeries and by using anesthetics. But in persistent pain, these treatments may result in increased pain after the body adjusts to pain relief medication, addiction to medication, only temporary relief or challenging surgery which may be ineffective.

Some time ago in physical therapy, the focus was on “distraction” from pain, reducing “pain behaviours” and increased activity. Although it served and helped some, for many it was frustrating and not very helpful. [1]

Distraction from pain

The concept of distraction is to alter the signals ascending to the brain by flooding the brain with pain free signals from other areas such as the skin, joints and muscles, by decreasing painful physical signals and inflammatory signals and by focusing on gentle body movements. 

More recently, pain science suggests the opposite approach can be more useful; focusing on the sensory experience with discrimination or non-judgemental body-awareness, rather than pain suppression or distraction.

Yoga offers many tools for the senses, mind and body in a comprehensive and interconnected way, making it a holistic method for managing pain and accessing different parts of the experience of pain.

We can break down pain into various components; they've all have been shown to affect the amount of pain that somone feels: 

• Sensory - The sensory component includes how pain is felt and thr type of sensations, such as aching, burning, sharpness, or numbing.

• Cognitive - The cognitive component is what you think about the pain: what the cause is, whether you believe it is temporary or permanent, controllable or curable.

• Affective - The affective component consists of your feelings and emotions about the pain, such as fear, worry, anger, and resentment. A vicious cycle of pain, fear of pain, decreased activity, and worry can ensue.

  
  

Sensory 

Yoga is a powerful tool for this sensory component. Body awareness helps to recognise tension, posture, or movement patterns that contribute to discomfort and then to notice what can be adjusted and/or what changes.

Yoga with emphasis on gentle movements releases musculoskeletal tension and calms down pain pathways.

The brain can become hypersensitive to chronic pain so finding and experiencing ways of moving that do not hurt, can reduce the heightened experienced in the brain between movement and pain.

Controlled breathing techniques activate the parasympathetic nervous system, reducing stress and lowering inflammation, which can alter pain perception and can help downregulate pain signals from the body.

Yoga movement and conscious breathing can also help imbalances in the nervous system. This is considered to play a role in chronic pain conditions - it represents a dysregulated system with the loss of adaptive function (the ability to move and return to different states i.e. return to a relaxed state).

Pratyahara is the result of cultivating an inward focus. Attempting to suppress pain does not stop the complex internal processes that perpetuate the chronic pain experience, but it seems that the practice of observing the sensations with non-judgmental focus results in decreased reactivity to the senses and ultimately reduced pain and suffering.

Cognitive

This is how the brain interprets and responds to pain; the cognitive interpretation.

Yoga encourages awareness and acceptance, reducing the emotional distress that amplifies pain. Treatments such as Mindfulness Based Cognitive Therapy (MBCT) are well researched for pain management, particularly for chronic pain conditions, helping individuals change their relationship with pain rather than just trying to eliminate it. By cultivating a mindful connection to bodily sensations, people can respond to pain with relaxation and adjustment rather than fear or avoidance.

Knowledge and understanding about pain can change behaviour, provide an understanding of the treatment and decreases fear. By understanding something about pain, people are more likely to see their own important role in their pain management. 

Pratipakṣa bhāvana is using an opposite, in this case to reassess pain; for example voluntarily visiting both painful and pain-free areas on opposite sides of the body. Or by cultivating a different attitude to pain such as “it is there to protect me and to maintain my safety”. 

Affective

Emotional pain is recognised by the body-mind as part of the experience of pain and can be one layer of other layers in chronic pain. Think about how painful it is to experience heartbreak - the loss of a very meanful relationship.

Working with emotional pain involves cultivating self-awareness, acceptance, and healthy coping strategies, such as mindfulness, therapy, or expressive practices like journaling. By acknowledging and processing emotions rather than suppressing them, individuals can gradually heal and build resilience.

Stress Reduction 

Chronic stress worsens pain by heightening sensitivity in the nervous system. Meditative practice,  breathing and relaxation practices help activate the parasympathetic nervous system, promoting a calmer state that in turn reduces pain sensitivity.

Compassion in pain care 

Pain can cause frustration and anger; perhaps the internal dialogue is saying that you should be able to deal with it easily and quickly.  Self-compassion encourages acceptance that the present is a moment of suffering; noting our common humanity and recognising that other people share/have shared this experience also and we are not alone in this experience. This is also an opportunity to extend kindness towards oneself - ahimsa. Preliminary research on practising self compassion suggests positive effects for people living in pain. 

Pain as a loss to be grieved  

It is difficult to lose the use of the painful area or lose the idea of a pain-free life. Chronic pain can affect livelihood leading to loss of income, status or quality of life and/or loss of future plans and dreams. This cascade of losses can increase pain and be a contributing factor in the pain experience.

Purpose and meaning 

Living with chronic pain can necessitate a re-evaluation of expectations, goals and even beliefs around meaning or purpose in life. There may be a need to reassess identity, values and life goals - what once mattered may now not be accessible. This can lead to disillusionment and makes it important to look at a process of rediscovering renewed meaning and purpose in life. 

Our Starting Point is Acceptance

‘Even while we suffer, we can experience joy in life by opening up fully to our experience, not closing down.’

Darlene Cohen, Finding Joy Amid Pain

‘How is yoga helpful as a pain management technique? Whether the pain has a structural, physiological or psychological/emotional manifestation, yoga’s skill is in aiding the body’s capacity to optimize the functioning of all three of these areas. This happens by relieving unnecessary tension in the musculoskeletal structure, by opening the breathing and circulatory capacity, and by teaching the mind to detach itself from the struggle against the pain.’

Arthur Kilmurray, Mystic River Yoga