Body awareness as pain management

By Neil Pearson

We don’t know why, but sometimes when pain persists—becomes chronic—helping people feel the sensations of their bodies and spending time each day doing so can help to decrease that pain.

The experience of persisting pain is often paired with distortions of body awareness.* This isn’t surprising if you think about the last time you banged your thumb or stubbed your toe so hard you felt like a living cartoon character. Oddly, in the past animators paid more attention to the connection between pain and distorted body sense—picture that outsized, red, throbbing thumb—than scientists and medical practitioners. Usually, just like pain, these distortions are temporary, yet sometimes, like pain, they persist.

A personal example

My most recent low back episode included an irritated nerve and a constant “line” of intense electrical pain down my right leg. After it was mostly resolved, I noticed a vagueness to the non-pain sensations of my right lower leg. At first, the (totally inaccurate) sensations of my right lower leg being crushed captured my attention, but as the periods of less-intense pain lengthened, I noticed quite a difference between my right and left legs. My legs didn’t seem different when I looked at them or explored them with my hands, but when I closed my eyes and tried to feel the sensations of my leg with my mind, they sure felt different. As you might imagine, this seemingly impossible contradiction between awareness, vision, and touch reinforced the importance of always asking patients and clients about such changes in their own experiences of their bodies.

As tempting as it is to try to totally ignore or distract ourselves from an area of pain, I have learned from others that suppression and distraction are not particularly helpful long-term recovery strategies.** Attending to non-pain sensations in the area of pain, and doing so with as much calm as possible, is much more effective in the long run. My self-prescribed therapy included spending 3–4 minutes, three times each day, shifting focused awareness of subtle sensations from my left lower leg to the right; then, while exercising or doing yoga asana practice, I divided my attention to include focus on subtle non-pain sensations of my right calf throughout the movements.

Yoga therapy help for others in pain

I have found this same type of process to be helpful for many. Sometimes yoga therapists can help clients use movement, touch, and self-massage to feel normal bodily sensations and decrease the pain. Other times, focused awareness from a place of stillness works best. Years ago, I worked with a woman who described her right leg not so much as distorted in size or shape, but as eggshell-thick and filled with intense pain. When she first tried an awareness practice, she was able to remain calm, yet all she could feel was the leg pain. It was as if her leg didn’t really exist for her brain or mind anymore, except for the pain. We came up with a plan for her to first notice the subtle sensations of her non-painful left leg, then to acknowledge the right leg pain before trying to find those same sensations there. It took practice, patience, self-compassion, and persistence, but within weeks not only was the distorted body awareness decreasing, but so was the pain. And with more time, the relief became less and less temporary.

In the presence of persistent pain, body distortions may be more common than previously thought. Although we don’t yet know what the link is, there exists a connection between resolving body distortions and decreasing pain, and the practices of yoga therapy can be vital to both.

Neil Pearson, PT, MSc, BA-BPHE, C-IAYT, E-RYT 500, is a physical therapist, yoga therapist, and clinical assistant professor in Canada. Pain Care U, which he co-founded, is an IAYT member school offering mentorship and certificate training. Neil also co-edited the forthcoming book Yoga and Science in Pain Care: Treating the Person in Pain.

*Distorted mental representations in various clinical conditions have been described by researchers including Moseley, Gallace, & Spence; Moseley; and Gilpin et al.
**Research on distraction as a coping strategy for chronic pain includes studies by Flink et al.; Goubert et al.; and Burns.
Note that the above references may require a subscription for full access.