"Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. Other health problems, such as fatigue, sleep disturbance, decreased appetite, and mood changes, often accompany chronic pain. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and stamina. This difficulty in carrying out important and enjoyable activities can lead to disability and despair" (National Institute of health). 

 

 

 

 

 

 

 

 

 

 

 

One of the reasons why chronic pain is so challenging is that it goes beyond just a physiological presence of pain, and begins to affect the mind-body connection, often resulting in new issues to contend with, such as the fear of worsening or triggering pain, and the anxiety around the persistence of pain.  

 

And the presence of chronic pain starts to affect other parts of our daily function: 

  • Breathing changes. The breath is more shallow and shaky. 

  • Muscle tension changes because the body is in a constant state of “alert.” 

  • How we move changes dramatically as we try to protect the area of pain. Sometimes people will stop all movement that they deem extraneous while others will grit and bear it only stopping when the pain is so intense that they can’t continue. 

  • Body image (how we view ourselves) changes. 

  • Thinking patterns change: we are less optimistic and our emotions may be more changeable. 

  • Despite the seemingly unchanging nature of chronic pain for those who suffer with it, yoga is actually quite beneficial in both decreasing the pain and in changing our relationship and response to pain.

Asanas (Yoga postures)

Asanas bring steadiness, health and lightness to physical body and optimize tissue functioning. Yoga poses are very useful for skeleton realignment and posture correction. It opens up the vital flow of energy through the body, which is subjectively perceived as positive sense of wellbeing. Well chosen culturing and balancing asanas can strengthen muscles and correct the posture. This, coupled with relaxation and stretching, breaks pain patterns.Various asanas have compressive/de-compressive effects on the blood flow and lymph flow of underlying tissues through abdominal muscular stretches and contraction in combination with appropriate spinal movements [1]. 

 

Asanas stabilize the autonomic nervous system. They influence the endocrine system and nerve plexuses by increasing local blood flow by gravity (sarvangasana on thyroid) contraction of surrounding muscle (bhujangasana on lumbar plexus) or by pressure release (mayurasana on celiac plexus) [2]. Studies done in regular practitioners show a decrease in cortisol and cholinesterase levels, which reflect quietening of the stress response. There is evidence of endogenous opioid release during sustained stretching of muscles [3]. 

 

When using asana, always start out with a gentle practice, such as cat-cow posture, seated or standing side-bends. Then, add in more active asanas, such as warrior 1 and warrior 2, shalabhasana and downward-facing dog posture (with knees bent). After that practice restorative postures such as viparita karani and child’s posture. Relaxation asanas such as makarasana and shavasana followed by stretching postures ardhakati chakrasana and twistings also helps very well. But be careful, introduction of strengthening asanas too early can aggravate the pain.

 

Pranayama (Breathing practices)

People in chronic pain often default to short, shallow breathing, which can set off the body's fight-or-flight response and trigger the release of stress hormones like cortisol. Breathing deeply release stress by stimulating the vagus nerve. Running from the brain to the diaphragm, the vagus nerve activates the parasympathetic nervous system. It is impossible to stay angry or anxious while breathing in a slow, deep and reflective manner. Diaphragmatic breathing is probably the single most valuable thing that a patient in chronic pain can learn on the road to recuperation.Also deep yogic breathing with prolonged exhalation relaxes most skeleton muscles.

 

To try it, lie in shavasana posture. Inhale and exhale slowly and deeply, focusing on how the air feels as it passes through the nose, into the body, and back out. Visualize this healing breath filling the whole body. Let each new inhalation bring energy to expand and soften, cleanse and release. With the exhalation, let the tension and heaviness of the pain flow out of the body. Continue until you feel quiet and more relaxed. You can practice any breath practice you find helpful, from simple breath awareness, to more complex types of pranayama such as Nadi Shodhana (alternate nostril breathing).

 

Meditation practices

You can practice any form of meditation, including simple breath awareness techniques to practices that cultivate feelings of kindness towards yourself. There has been research on different kinds of meditative practices (transcendental meditation, guided imagery, progressive relaxation, tai chi, loving kindness, etc) and its positive influence on pain states [4].

 

During self-awareness-based meditation techniques, the person attempts to cultivate the role of an impartial observer and a detached witness of all subjective phenomena including pain. In this way the frame of reference in which pain is experienced, changes. Using mediation to perceive pain may be also considered as a paradoxical technique decreasing the fear of pain.

You may start practice meditation with simple body scanning and breath awareness. Then move on to many other forms of guided relaxation such as Yoga Nidra (learn more about this practice).

 
References

1. Perspectives on Yoga Inputs in the Management of Chronic Pain, Indian J Palliat Care

2. Study on the therapeutic potential of some hathayogic methods in the management of irritable bowel syndrome. Int J Yoga.

3. Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature review, JAJ Altern Complement Med.

4. Mind-body interventions for chronic pain in older adults, Pain Med. J.

5. Pathophysiological mechanisms of central neuropathic pain after spinal cord injury, PubMed

6. Psychosomatics of back pain and the use of yoga. Int J Psychosom.

7. Mind-body interventions for chronic pain in older adults: a structured review, Pain Med.

 

Chronic back pain. How yoga can help?