Chronic Pain, the Brain, and Yoga
Anyone who has lived with chronic pain has experienced a seemingly endless quest to find out the cause of the pain, leaving feelings of hopelessness. Physical Therapy researcher Lorimor Moseley defines pain as “a multisystem output that motivates and assists the individual to get out of a situation that the brain concludes is dangerous.” Peter Przekop, a researcher in chronic pain at the Betty Ford Center, defines pain as “any sensation with a negative context in the mind that is holding one from being able to heal.” People with symptoms of depression, negative thinking, and difficulty recognizing and coping with stress were more likely to have chronic pain. Chronic pain expert Neil Pearson, agrees that successful treatment of chronic pain must address the internalized emotions and underlying stressors that hold us captive to the sensations of pain. The brain is a powerful piece in the puzzle of persistent pain and yoga is the guide to arranging the pieces through the process of healing. The yoga philosophy states that dukkha, or suffering, is a human condition, which is why so many of us seek out this 5000-year-old discipline to find peace within suffering. In yoga, there are five koshas or sheaths: the physical body, the energy body, the mental body, the awareness body, and the bliss body. Through our life experiences, we store these impressions called samskaras within these five layers. The samskaras; the internalized emotions, perceptions, and thought patterns we hold within can keep us from living a full life.
Western Medicine’s Approach to Treating Pain
Traditional Western medicine focuses solely on isolating a body part, which may be partially effective for the management of symptoms, but the body is the sum of all the parts and by not getting to the root cause of the chronic pain, there will be no permanent healing. Since many medical professionals are poorly trained in assessing and holistically managing pain, they are inadequately equipped to design effective treatment for chronic pain outside of the usual opioid prescription.1 Chronic pain is one of the leading health problems facing our Western world. The Journal of Pain in 2015 estimated that 25.3 million American adults suffer from chronic pain. Pain is a result of a change in our nervous system and the good news is we have the power to change how our brain processes persistent pain with a little understanding of pain science.
If a person has problems within the body, he/she will not feel pain, unless the mind believes they are in danger.2 The brain only pays attention to what the brain concludes is most important. Think about your pain on vacation versus your pain at work. Most of us will describe feeling much less pain when we are sipping a daiquiri on the beach. Or consider having a large bruise, but no recollection of how it got there. Pain is inconsistent and the onset of pain begins because the brain has concluded there is a threat; like an alarm activating to warn us of damage or encroaching damage.3 These alarm responses in the human system are designed to protect and heal.
What Your Pain Tells Us
Pain is not an accurate indicator of injury or tissue damage and therefore not an accurate indicator of movement, the perception of pain is a process within the mind. What we perceive through our senses is not accurate. There are many factors that affect our pain; emotions, thoughts, sensations, experiences, memory, expectations, or the anxiety or attention given to pain.4 These perceptions make up our belief systems and define our reality. It is through the mind that we create our own private story. Our mind remembers and stores information that helps us to learn and recall the memory later and is capable of prioritizing or choosing aspects the perception causes the brain to send a message along the nerve to the spinal cord saying, “danger.” Within seconds of the incident, the brain receives and analyzes the input to create an experience that may or may not include pain. The mind begins to couple the newly arriving information with the vast amount already stored in the memory to construct a new chapter to the story. Messages that enter the brain get evaluated by the mind, which then makes a judgment and response, thus, perception becomes reality: “I feel pain.”5
As these stories are processed, they are perceived and preserved by the mind as actually happening, and are then presented to the physical brain and anatomical body as if they were, in fact, real. Every memory, every experience, is stored in the body, even when the memory is repressed. When we are in pain over an extended period of time, the pain pathways become dedicated neural pathways of favored and frequent communication of hurt. In essence, we have trained our brain to take uncomfortable sensations, activities, or experiences down the fast lane to pain, the most frequent road of travel. The nervous system becomes sensitive to the sustained hyper-activity of the endocrine and immune system, leading to other problems including inflammation, bone or joint damage, and/or nerve issues. This sensitized central alarm system creates a repeated cycle. Within this cycle, neurons that have learned to link together in the interpretation of a single input, called pain neurotags, are being constructed whenever you move in a way that you perceive as causing pain.6 It is within this chemical process happening in the brain that the mind decides that physical pain is preferable to the emotional issues driving the perceptions. These samskaras or impressions within our koshas, can prevent us from living a full life.
Yoga therapy has been proven to help people find new ways to move that are enjoyable without making the internal alarm activate. As the brain begins to change, so does the heightened sensitivity of the nervous system. Yoga therapy allows the therapist to tailor the treatment to the client and not the disease, giving them the experience and allowing them to choose what works for them at any given time. As we have likely experienced in the medical model of pain treatment, what works for one, won’t necessarily work for another. Treatment must be unique and built to the client’s particular habits, thought patterns, and belief system; yoga therapy meets the client where they are.
The Yoga Philosophy
The first step at applying yoga philosophy to the treatment of a person with chronic pain is to identify the threats that are contributing to the pain. Learning how the brain, mind, and body function together to create our own unique pain experience can give the client an explanation and reassurance that their pain can change. Instead of avoiding or pushing through the pain we begin to respect it, without fear, and develop a plan for recovery. A yoga therapist can empower the clients to change their thought patterns and begin to adjust the level at which they feel pain.
Yoga Mantras and Meditation
Through mantra or meditation, we can remind ourselves that pain doesn’t necessarily mean something is physically wrong. It is in this unconscious level that mind and body communicate. In this state of mental clarity, we can overcome daily stress from today’s chaotic lifestyle by teaching us how to eliminate negative thought patterns, the very thought patterns that create the cycle of persistent pain.7
Creating a mindset that can redirect your attention and retrain your brain might be done with a sankalpa. A sankalpa is a short, positive, present tense statement of intention that is a guide to creating new, pain-free pathways in the brain. With body awareness and knowledge of how much power the mind has over our being, we can work mindfully in moving the body, finding a baseline for movement and working gradually from that point with patience to progression.8 It is the skill of awareness that pulls our attention from pain to the present. The memory of a particular pain may not go away, but the conscious mind can be refocused. The mindset’s emphasis should be on observing the personal story without judgmental or emotional interpretation and elimination of the perceived physical pain by making peace with it.
A yoga therapist uses the physical movements of yoga to adapt functional movements safely to gradually get back to a life you deserve. Changing the position in which you perform the exercise, in varying locations such as in water, a bed, on a chair, or by varying the sensory aspects of the practice with eyes closed or with music playing can all change thought patterns. Simple lifestyle changes can challenge the minds perception and the movement we once feared, gaining back confidence and trust in our bodies.9
“As you think, so you become.” We may have developed a pattern of thought that is unhealthy and wreaking havoc on the physical body, but luckily for us evidence proves the brain is pliable, the mind is powerful, and new thought patterns can be created through yoga therapy. This can give clients suffering from chronic pain a new hope. The solution may not be a simple magic pill that makes the pain go away, but instead an understanding of the underlying source of the chronic pain, pain science and the dedication to retraining the brain and its habitual thought patterns, with a little bit of guidance and support from a yoga therapist.
I’d be happy to answer your questions via email here or give me a call at (316) 201-6047.
Article contributed by Sarah Cummins, RYT500,E-RYT200, YACEP, YWT, certified Pain Care Yoga teacher, and a C-IAYT yoga therapist in training with Inner Peace Yoga Therapy and ACE Personal Trainer in training. Sarah is a military spouse, currently stationed in Wichita, KS where she teaches yoga and workshops in the area. She has been teaching group yoga classes, workshops, and private sessions since 2014. She passionately believes that humans have the power within to heal themselves and she is honored to teach clients how to use yoga practices to heal from the inside out. She plans to open a retreat and therapy center on her land near Huntsville, AL after military retirement. Learn more about Sarah’s group classes, workshops, retreats and individual sessions here. This article is an excerpt from a complete research paper. The full paper can be read here.
Butler, David, and Lorimer Moseley. 2016. Explain Pain. Adelaide, South Australia:
Fulford, Robert C. 1996. Dr. Fulford’s Touch of Life: The Healing Power of the Natural
Life Source. New York, NY: Pocket Books.
Pearson, Neil. 2012. “Know Pain? A Brief Guide to Understanding Pain for Yoga
Therapists.” Yoga Therapy Today 14-16.
—. 2018. Life Is Now Pain Care. https://lifeisnow.ca/.
Przekop, Peter. 2015. Conquer Chronic Pain: An Innovative Mind~Body Approach. Center City, MN: Hazelden Publishing.
1 Przekop, Peter. 2015. Conquer Chronic Pain: An Innovative Mind~Body Approach. Center City, MN: Hazelden Publishing.
2 Butler, David, and Lorimer Moseley. 2016. Explain Pain. Adelaide, South Australia: NoiGroup Publications.
3 Pearson, Neil. 2018. Life Is Now Pain Care. https://lifeisnow.ca/.
5 Przekop, Peter. 2015. Conquer Chronic Pain: An Innovative Mind~Body Approach. Center City, MN: Hazelden Publishing.
6 Butler, David, and Lorimer Moseley. 2016. Explain Pain. Adelaide, South Australia: NoiGroup Publications.
7 Fulford, Robert C. 1996. Dr. Fulford’s Touch of Life: The Healing Power of the Natural Life Source. New York, NY: Pocket Books.
8 Butler, David, and Lorimer Moseley. 2016. Explain Pain. Adelaide, South Australia: NoiGroup Publications.