The Mind-Body Approach to Pain
The prevalence and cost of persistent pain is a major physical and mental health care problem in the United States today. In a study released by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics one-fifth of adults over the age of 65 reported pain that lasted more than 24 hours, with three-fifths of these older adults reporting that their pain had lasted for more than one year. The study also revealed that one in four U.S. adults reported a pain experience that lasted a full day during the previous month, and 1 in 10 reported an experience of pain lasting a year or more. (1) As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its causes, assessment, and treatment.
A Bio-psycho-social Look at Long-Standing Pain
The biopsychosocial model views a physical disorder as the result of an intricate and dynamic interaction among biological, psychological, and social factors that can often antagonize the pain condition. This model recognizes that when information reaches the brain, a complex communication process takes place among many brain areas. These regions include those involved with body location and the quality of sensation in the area, your emotions and your thoughts. (2) Now it's known that long-standing pain is often driven by increased sensitivity of the central nervous system - known as central sensitization - rather than a physical injury. (3)
“The biopsychosocial model has led to the development of the most therapeutic and cost-effective interdisciplinary pain management programs and makes it far more likely for the chronic pain patient to regain function and experience vast improvements in quality of life.” according to pain specialists Robert J. Gatchel, PhD, ABPP and Krista J. Howard, PhD. By using appropriate assessments to adopt the most suitable interdisciplinary treatment program, the chronic pain client is far more likely to regain function and to show vast improvements in his/her quality of life. These programs far exceed any of the earlier overly-simplistic biomedical reductionist approaches to the treatment of pain. (4)
Evolution of the Biopsychosocial Model of Pain
The earliest theories of pain had focused primarily on the understanding of the biological or the disordered physiological processes associated with pain. Cartesian Dualism, or separation of the mind and the body, dates back to the 17th century when Rene Descartes conceptualized pain as a process within the sensory nervous system, excluding our thoughts and feelings about the pain experience. (5) At that time, diseases and illnesses were described purely as mechanistic biological processes. Even without empirical evidence, it was conceived that the experience of pain was conveyed directly to the brain from the skin, without any psychosocial components. Termed biomedical reductionism, this point of view remained constant through the late 19th century.
Since then other theories have evolved. Brain imaging has given us a better look at what is going on within the brain and shown many areas “light up” when someone is reporting pain. Developments in the field of psychological research and treatment continue to play an important role in our understanding of pain.
There is much more to say on this subject, but for our purposes today we will keep it a very short introduction to a vast subject matter. It is an evolving science with much more research currently taking place and more to come in the future.
Addressing Pain in the Field of Yoga Therapy
Graded Exposure to Physical Activity
Many people come to the physical practice of yoga looking to regain previous levels of activity that they once had before an injury or illness. When pain is involved, as it usually is, activities are avoided, progressive deconditioning occurs. This can bring greater levels of pain and further avoidance of previously pleasurable and utilitarian activities. These losses can add to the cycle of pain continuing and further increase pain. This is a vicious cycle that as a Yoga Therapists I work to break through engaging the client in participation in physical activity with a calm and non-judgmental attitude.
After accessing their prior and current level of activity we start working with a protocol that feels accessible to them while providing some level of challenge. As they continue their practice of yoga the postures and movements are slowly adjusted to progress to greater levels of strength and endurance. Sometimes there as setbacks, as is to be expected. Recovery is never a straight line! But, with a commitment to regular practice, there are often new stages of physical health reached. When this occurs there is a decrease in pain, which enables further participation in the activities that bring joy and greater independence. This is motivation to continue further conditioning of the body and the cycle continues.
Working with the Mind and Emotions
Oftentimes, individuals who experience a painful encounter will exhibit various emotional responses such as depression, anxiety, and fear. (5) These experiences are known to increase ones perception of pain. Questions a Yoga Therapist may ask their client to access their mental perception of pain include:
What thoughts do you have when you're in pain?
Does the pain trigger any memories?
What emotions do you feel when you're in pain?
With this information the teacher is able to develop a personalized program of relaxation and meditation techniques to induce more positive emotions. As the client develops a greater capacity for hope and interest in life it decreases their sense of pain. (6)
This is just a big-picture outline of how yoga therapy can help in terms of long-standing pain. It can take time and be difficult to make the necessary changes to end pain, but our brains capacity for neuroplasticity, or it's ability to reorganize itself by forming new pathways and connections, is what makes these changes possible. Working with the “whole” person is far more important than focusing merely on a disease.
References
1. National Center for Health Statistics. Health, United States, 2006, with Chartbook on Trends in the Health of Americans with Special Feature on Pain. Press Release. Available at: www.cdc.gov/nchs/ pressroom/06facts/hus06.htm. Accessed November 29, 2006.
McManus C. How the Nervous System Generates Pain.
Butler DS, Moseley GL, Sunyata. Explain Pain. Adelaide, South Australia: Noigroup Publications; 2013
https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach
Gatchel RJ. Clinical Essentials of Pain Management. American Psychological Association. Washington, DC. 2005.
https://brainworksrehab.com/contain-your-pain-breaking-the-pain-cycle/