When in pain, it's hard to focus on anything else!
Chronic pain presents a significant healthcare challenge. As in any long-term health problem, the experience of chronic pain often leads to complications that extend beyond the initial physical symptoms. Ultimately and insidiously, it will affect one's entire quality of life.
From a pharmaceutical perspective, better living through chemistry will involve one (or a combination) of the following categories of pain managing medications: non steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, cox-2 inhibitors, antidepressants and anti-seizure drugs, and opioids. The pain management industry, estimated at almost 7 billion U.S. dollars is expected to grow to almost 13 billion by 2028. While many are certainly grateful these drugs exist as they can be highly effective in allowing the functioning of day-to-day activities, they can also come at a huge personal cost (both financially and health-wise). Optimally, their use will be aligned with other, more body-friendly approaches to long-term pain care.
Chronic pain and continuous stress often affect immune functioning. In addition to pharmaceutical and mainstream medical intervention, decades of research into pain management also supports the efficacy of combining talk therapy (psychotherapy) and stress management strategies to create a comprehensive treatment protocol, supporting recent advances in better understanding the wisdom of the mind-body connection. Developing and accelerating research in pain management supports that our emotions, thoughts, and beliefs can play a critical role in the perception of pain, and stress-management is a key player in this perception.
THE STRAIN IN PAIN LIES MOSTLY IN THE BRAIN
- Sean Mackey, M.D., Ph.D
THE MIND-BODY CONNECTION
Decades ago, it was believed that the immune system operated within itself rather than the well-integrated network in constant communication with the brain and nervous system that we now know it to be. Not only do these networks communicate, but they do so in profound ways. Each affects the other! Their synergy is both staggering and powerful, and collectively this integrated system is called psychoneuroimmunology, or PNI for short.
It comprises three major components
Psychological
Neurological
Immunological
The interplay between these three supports the strength of the mind-body connection. Once believed to be discrete entities, we now know they powerfully affect one another. Pain and its experience play a critical role in PNI.
NEUROPATHY
Neuropathy, also known as peripheral neuropathy, indicates an issue within the peripheral nervous system, which is the network of nerves outside your brain and spinal cord. Neuropathic pain (NP) can be quite debilitating, and can go undiagnosed (or misdiagnosed) for many years due to its complex array of symptoms.
Diabetes and spinal cord injuries are the largest contributors to neuropathy. Other causes can include infections, exposure to toxins, or inherited conditions. Etiology, diagnosis, and degree of damage will determine treatment recommendations and prognosis. In addition, treatments depend on the type of nerve damage, symptoms, and location. For example, over 60% of diabetics experience peripheral neuropathy as a complication. High levels of glucose in the blood can damage the peripheral nerves, causing decreased sensation in the feet and hands, as well as problems to the cardiovascular and digestive systems, and urinary tract.
There are a plethora of other neurological conditions that can create nerve pain, often described as a shooting, stabbing or burning sensation. Sensitivity to gentle touch or cold can be experienced as painful. Complicating the picture is the eventual sequela of depression.
THE LINK BETWEEN PAIN AND DEPRESSION
Pain and depression are closely related. Many presenting with signs and symptoms of depression also experience physical pain. One of the first questions asked in any psychiatric clinical interview will be about the patient's experience of pain. Depression is a causal factor in the experience of pain, and the experience of pain (especially unrelenting and chronic) is a causal factor in depression. A vicious cycle is created. Pain and its related challenges simply wear you down. It's difficult to focus, and feel good, functional and energized when in pain. It affects sleep and appetite, which can further hinder healing.
In recent times, the popularity of the terms alternative and complementary medicine has increased. While "alternative" describes a treatment or intervention used in lieu of conventional medicine, "complementary" is designated for treatments or interventions that are used in conjunction with standard medical care. Such treatments can include acupuncture, chiropractic, breathwork, hypnosis, aromatherapy, herbal remedies, massage, music therapy, and yoga. This presents a great segue into yoga and its many benefits.
HOW CAN YOGA HELP?
Lifestyle changes and complementary interventions can help mitigate the effects of neuropathy and chronic pain. One such lifestyle change is the practice of yoga.
The yogic approach to healing and healthcare is not without the support of science. With its recent enhanced attention in the scientific and medical communities, more and more studies are emerging showing its effectiveness.
A recent study conducted by Puymbroeck et al. (2018) had ten individuals with diabetic peripheral neuropathy undergo an 8-week Hatha yoga trial, resulting in the reporting of improved body functions, stress management, and sleep improvement.
Physician, Timothy McCall, M.D., author of Yoga As Medicine, references various studies that have found asana, meditation, or a combination of the two reduces pain in individuals with arthritis, back pain, fibromyalgia and carpal tunnel syndrome. Through this pain relief, a facilitation of healing occurs through an enhancement in mood and activity.
Villemure et al. in their 2016 published study on the effects of the insular cortex on pain tolerance in yoga practitioners wrote, "Several studies, including randomized controlled trials, have directly examined yoga as a potential treatment for pain and found evidence for the beneficial and safe use of yoga to alleviate different painful conditions."
The practice of yoga has a powerful effect on mind and body, regardless of your present level of health.
When recommending yoga, there is sometimes a push back or a resistance due to the belief that yoga is solely about flexibility or requires pretzel-like poses. This could not be further from the truth. Anyone can do yoga. Yoga, originating over 5000 years ago in India, is a system incorporating mental, physical and spiritual disciplines.
While there are many forms of yoga, in essence, the practice involves various body postures and movements and breathing techniques, referred to as asanas and pranayama, respectively. Through the mindful coordination of breath with movement, a deep sense of relaxation is felt throughout the body. This effect often lingers for hours post practice. These movements can be incredibly gentle, such as with restorative yoga , or highly energized, such as in an invigorating power vinyasa class. There is a yoga practice for every body!
Yoga practitioners are invited to adopt an emotionally detached observation of the present moment. This serves to promote mindfulness, which is correlated with improved pain tolerance. Mindfulness helps recalibrate our mind and body. It is the act of paying attention to the present moment with a non-judgmental attitude. Consistently practiced and over time, as with yoga, a mindfulness practice is brain restorative. It helps to change the neural circuitry to one of equanimity and peace.
As incoming stimuli is typically judged as good or bad, positive or negative, mindfulness helps us to see these "as is" with no need to evaluate or judge.
We consciously meet the stimuli with a calm strength and presence, and we would be training our minds to transition from reactivity to simply being.
In addition to mindfulness, yoga also involves a meditation aspect, both in its final resting pose (known as savanna), and through the practice itself, typically connecting breath with movement in a "moving" meditation manner.
Meditation
Meditation is a mental training involving quieting and slowing down the mind. There are many different types of meditation, mostly falling under the categories of guided and unguided (or silent). While there is not a universally accepted or "best" method, there are components to meditation that are consistent across practices. They include: focused attention, breath awareness, quiet and comfortable setting, and an attitude of non-judgement or "observer." By lowering stress levels, which serves to lower the pain's intensity, the practice of meditation can be a significant contributor to your pain management protocol. The "best" meditation is the one that is "best" for you and the one that you will consistently do.
Yoga & Your Nervous System
Yoga enhances and energizes the mind and body. It both strengthens the nervous system while simultaneously calming it. Yoga stimulates the vagus nerve which plays a central role in elevating both emotional and physical health. The vagus nerve represents the main component of the parasympathetic nervous system, your network of nerves that bring about relaxation.
Stimulating the vagus nerve has a regulating effect on your mind and body, strengthening this connection. It helps in regaining balance, and decreasing pain, anxiety and fatigue. A stronger and calmer nervous system is one of your best defense against pain.
Yoga, a fairly inexpensive and easily accessible intervention with a plethora of benefits and few (if any) side-effects if practiced responsibly, has been shown to promote good health in as little as a few hours per week. Whether practiced privately or within a group setting, in-studio or on-line, yoga's popularity has made it increasingly available.
Attending a full 60 or 75-minute class is not necessary to get the benefits of yoga; although there is a powerful healing energy and effect in a group yoga practice. However, when attempting to manage chronic pain or a concerning neurological condition, an in-person class may be highly impractical. Fitting in a few minutes of yoga here and there in your day will still reap benefits. You will need a book or a video describing the basic movements or relaxation/restorative poses and a mat, and you may also wish to have a strap, bolster and/or block handy. You are now good to go. Keeping a Journal nearby in which you capture your thoughts and feelings of your practice may help enhance mindfulness and personal discovery, especially if helpful insights are generated during your yoga practice that directly relate to your health and/or pain.
Through controlled breathing exercises, meditation and body postures, yoga and other related mindfulness based programs help invoke the relaxation response, which in turn helps to ease discomfort and pain.
The calmer your mind and body, the lower your sensation of pain will be.
McCall, Timothy Yoga as Medicine: The Yogic Prescription for Health and Healing: A Yoga Journal Book, photographs by Michal Venera, Bantam Books (New York, NY), 2007.
Puymebroeck, Atlet, Portz, & Schmid (2018). Multidimentional Improvemetns in Health Following Hatha Yoga for Individuals with Diabetic Peripheral Neuropathy. International Journal Yoga Therapy 71-78.
Villemure C, Ceko M, Cotton VA, Bushnell MC. Insular cortex mediates increased pain tolerance in yoga practitioners. Cereb Cortex. 2014 Oct;24(10):2732-40. doi: 10.1093/cercor/bht124. Epub 2013 May 21. PMID: 23696275; PMCID: PMC4153807.
The information presented in this blog is intended for general knowledge and is not a substitute for medical advice or treatment. Consult with your medical professional before starting any yoga practice.
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THE MIND-BODY CONNECTION 
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HOW CAN YOGA HELP?
Meditation
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