Yoga for Pain Management

Research Paper by Rebel Tucker

According to the research, we can have confidence that the practices of yoga provide a viable drug-free treatment option for chronic pain. As both students and teachers of Yoga and Yoga Therapy, we can be assured that there is a growing body of evidence to support yoga as part of a pain management strategy.

Pain affects the lives of many Australians. See the two Summary Pages (here and here) that show the impacts of pain and some of the yogic practices that we can practice and teach our students.

Yoga can assist with the management of both acute and chronic pain. The potential for relief of chronic pain by establishing some regular yogic practices is a subject receiving attention by researchers such as Catherine Bushnell, PhD, and Chantal Villemure. Acute pain is a signal that something needs attending to immediately. Long term pain is a complex issue that involves some maladaptations of the brain to perceive and deal with neural input. With chronic pain, the body becomes more sensitive to pain signals and interprets minor inputs as threats.

Bushnell is scientific director of the National Center for Complementary and Integrative Health at the US National Institutes of Health (NIH), where she oversees a program on the brain’s role in perceiving, modifying, and managing pain. She has found that people experiencing chronic pain show changes in their brain — specifically, a decrease in grey matter and alterations in neural circuitry. These brain changes can result in memory impairment, emotional problems and decreased cognitive functioning. Bushnell says “Practicing yoga has the opposite effect on the brain as does chronic pain. There is a causative link between yoga and grey matter increases.”

Bushnell shares her discoveries about how non-drug options can affect the brain and therefore assist in the management of pain on a great podcast. (1)

Bushnell teaches that when we focus on pain, it amplifies the pain. She also has found that ‘negative’ emotional states can amplify the pain and ‘positive’ thoughts dampen pain. Our thought processes can dampen or amplify pain. (2)

When it comes to pain, science and yoga agree that our current pain and suffering have their roots in our past pain, trauma, stress, loss, and illness. The best way to unlearn chronic stress and pain responses is to give the mind and body healthier responses to practice. This will in turn affect the production of pain relieving chemicals (endogenous opioids) in our body.

Villemure’s theory is that the benefits of yoga for dealing with chronic pain might be related to the stress reducing effects on the autonomic nervous system. Her research is looking at how yoga practitioners might have a different method of coping with the anticipation of pain. She has found (3) that even when yogis expect pain their nervous system tends to maintain more parasympathetic nervous system activation and less fight and flight response. The ‘stress’ response tends to increase cortisol and the experience of pain. Yoga reduces this response.

In 2010 The Indian Journal of Palliative Care published an article (4) that demonstrated that pranayama, and relaxing asanas, can help people deal with the emotional aspects of chronic pain, effectively reduce anxiety and depression, and improve the perceived quality of life.

Migraine is a condition of chronic pain that affects over 3 million Australians. The great news is yoga can help. So says research shared in The International Journal of Yoga (5). We can help ourselves and our students to reduce the frequency and/or severity of their migraine episodes and reduce their requirement for medications.

Yoga philosophy establishes a distinction between pain and suffering. The Yoga Sutras remind us that transcending the Kleshas — the 5 Causes of Suffering — reduces suffering.

Yoga Sutras 2.10–2.11 explain that we can use concentration and meditation to reduce the tendency of the mind to be caught up in ruminations that then affect us. In other words, when we practice yoga and we learn to focus and refine the activity of our mind, we can gain greater insights into our mind, body and emotions, and thereby reduce suffering.

Pain is our actual physical and physiological response to a stimulus. It is rooted in the body. Suffering is our perception of that pain based on our previous experiences and our future expectations. It is rooted in the mind. Yoga enables us to condition our mind so that we do not react to the smallest felt sensations with a full-blown pain response. A modern terminology for this is ‘cognitive reframing”. Tara Brach presents a beautiful explanation to further this in her TED talk (6). She explains how resistance increases our suffering.

A technique we can use and teach to ‘reframe pain’ is pratipaksha bhavana — cultivating the opposite. Yoga sutra 2.33 recommends: When disturbed by negative thoughts, cultivate the opposite mental attitude.

The pain of arthritis can be debilitating. Many Australians use over the counter medicines, and often require stronger prescribed medications to deal with this pain. These medications unfortunately come with potential side-effects. Studies are emerging to show that yoga can help them deal with their pain and overcome some of the challenges to mobility that can come with arthritis. (7) (8)

There is an interesting article in The Frontiers in Human Neuroscience (9) that dives deep into how yoga affects our neurophysiology and neurocognition. It effectively links Polyvagal Theory as a potential explanation. This article is a great but rather lengthy read.

Statistics show that General Practitioners refer to pain specialists in less than 15% of consultations where the pain is managed and that medications are used in close to 70% of GP consultations for chronic pain management. 63% of medications prescribed for pain are opioid medications which have some side-effects which many patients are keen to avoid. This makes yoga teachers and therapists well-placed to support those experiencing chronic pain as part of a wider pain management plan. I would encourage you to consider approaching your local GPs to let them know you are offering yoga for pain management. Perhaps provide them with a leaflet that explains a little about how yoga, along with medical care, can assist their patients experiencing pain.

There is a burgeoning resource of research emerging that all points to the effectiveness of yoga in the management of pain, as such yoga students, teachers and therapists can have confidence in using yoga as a strategy for pain management.

Rebel Tucker www.yogarebel.com.au @Jul2020

1. Bushnell Podcast. https://relief.news/the-brain-changes-during-chronic-pain-but-non-drug-treatments-can-change-it-back-a-podcast-with-catherine-bushnell/
2. Bushnell MC, Ceko M, Low LA. (2013). Cognitive and emotional control of pain and its disruption in chronic pain. Nat. Rev. Neurosci. 14, 502–511. DOI: 10.1038/nrn3516 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465351/
3. Villemure C, Ceko M, Cotton VA, Bushnell MC. (2014). Insular cortex mediates increased pain tolerance in yoga practitioners. Cerebral Cortex. 24(10), 2732–40. DOI: 10.1093/cercor/bht124 https://pubmed.ncbi.nlm.nih.gov/23696275/
4. Vallath.N. (2010). Perspectives on Yoga Inputs in the Management of Chronic Pain. Indian J Palliat Care. Jan-Apr; 16(1): 1–7. DOI: 10.4103/0973–1075.63127 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936076/
5. Ravikiran , MU, Meghana, Raghavendra, Nalini, Bindu, Chindanda Murthy, Raju, Sathyaprabha. (2014) Effect of Yoga on migraine: A comprehensive study using clinical profile and cardiac autonomic functions. Int J Yoga. Jul-Dec; 7(2): 126–132. DOI: 10.4103/0973–6131.133891 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4097897/
6. Tara Brach TED Talk https://www.youtube.com/watch?v=3JywTh5O8ys
7. Kan, Zhang, Yang, Wang.(2016) The Effects of Yoga on Pain, Mobility, and Quality of Life in Patients with Knee Osteoarthritis: A Systematic Review. Hindawi Journals Volume 2016. Article ID 6016532. DOI: 10.1155/2016/6016532 https://www.hindawi.com/journals/ecam/2016/6016532/
8. Telles, Sayal, Nacht, Chopra, Patel, Wnuk, Dalvi, Bhatia, Miranpuri, Anand. (2017). Yoga: Can It Be Integrated with Treatment of Neuropathic Pain. Int Med International. Vol.4, 1–2. DOI:10.1159/000463385 https://www.karger.com/Article/FullText/463385
9. Porges et al. (2018) Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience. Front Hum Neurosci. 2018; 12: 67. DOI: 10.3389/fnhum.2018.00067. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835127/