The basics of chronic pain—and how yoga therapy can help
By Sarah Garden
Yoga is uniquely positioned to help people suffering from chronic pain. As a yoga therapist whose primary role is treating chronic pain—in both clinical and yoga studio environments—I have found that pain education is a crucial first step in that process.
What is pain?
Pain is an output of the brain and nervous system that is designed to keep us safe. If I step in a gopher hole and twist my ankle, the ankle hurts. For a short time after the injury, even as the pain dissipates, if I move the ankle in the direction that I injured it I will reproduce pain. The brain recognizes the movement that resulted in injury and produces pain in an effort to protect the ankle joint.
Typically pain goes away after a few weeks and one regains full range of motion. However, when pain lasts more than three months it is called chronic/persistent pain. It is one of the most common reasons people seek health care. Persistent pain can last for months or years.
Pain is typically broken down into three types:
- Nociceptive pain arises from damaged tissue such as trauma, surgery, or other injury or disease.
- Neuropathic pain arises from damage or irritation to sensory nerves, such as diabetic neuropathy, shingles, or sciatica.
- Nociplastic pain arises from a changed (plastic) interpretation of nociception—the physiological process that underlies the sensation of pain. The interpretation of danger is present in the nervous system despite a lack of evidence of actual or potential tissue damage.
Chronic pain often does not neatly fall into one category. Nociceptive and neuropathic pain can be complicated by nociplastic pain. In other words, someone with a disease that can cause nociceptive pain can have nociplastic pain at the same time.
Nociplastic pain is sometimes called “central sensitization” because it refers to the sensitization or hyper-reactivity of the nervous system and brain. When people have nociplastic pain they often find their pain is worse when they have stress, when they move, or for no discernible reason at all. The tissues become hypersensitive and the brain hyper-vigilant.
When the nervous system is sensitized it no longer only warns a person about dangerous things, it warns the person about things that we consciously know are not dangerous. The nervous system is dysregulated and hyper-protective. The brain and nervous system protect in a number of ways: by increasing pain; by making pain the primary focus; through weakness, anxiety, and other creative and often frustrating ways. Often the person with chronic pain becomes fearful of movement.
Yoga therapy and chronic pain
A cornerstone of treating chronic pain with yoga therapy is using yoga practices to help people feel safe when they move. Yoga is uniquely suited to treat pain—especially nociplastic pain.
When pain persists it becomes distracting. Yoga has a great deal of practices aimed at focus and attention. For thousands of years attention has been at the forefront of yoga practice. As far back as the composition of the Bhagavad Gita, an ancient Hindu scripture, yogis understood the value of stilling the mind:
“When meditation is mastered,
The mind is unwavering like the
flame of a lamp in a windless place.”
—Bhagavad Gita, 6.19
Pain is constantly wavering and unsettling the mind. Therefore, we begin with awareness practices to break the pain pattern. We build our internal awareness (interoception) to increase our understanding of the pain as well as other internal sensations and experiences. Tuning into the body initially brings attention to the pain, as well as neutral and pleasurable sensations. It also allows practitioners to notice patterns that result from and bolster pain—like muscle tension, breath holding, and upper chest breathing.
Addressing persistent pain: The A.R.M.S. method
Once practitioners build interoception, practices that help re-regulate the nervous system can be introduced. This interrupts pain patterns in the body and mind.
When working with people with persistent pain, I follow a 4-stage method I created called the A.R.M.S. of yoga therapy.
- Awareness: Body scans, conscious awareness, meditation, and other practices help tune practitioners into their breath, body, and mind. These build interoception.
- Regulation: Re-regulating the nervous system makes the mind less vigilant, thereby turning the volume down on pain. These practices can include conscious relaxation and breathing focused on exhalation.
- Movement: Integrating awareness and regulation is essential to remain calm and relaxed while introducing movement. The practitioner starts with simple movements that teach the body and brain to move with safety and keep the pain levels down.
- Strength and Coordination: Once the first three stages have been well established we introduce these practices. The practitioner will be able to stay calm and keep pain levels reduced or eliminated while strengthening.
Pain is complex and treatment is rarely straightforward—but introducing yoga therapy as a treatment modality can be a valuable addition to other medical interventions. Individuals learning yoga practices not only benefit from reduced central sensitization, but also get to play an active, informed role in their own therapeutic journey. This empowers the student and makes a crucial contribution by helping them feel safe when they move.
Sarah Garden, C-IAYT, has been a yoga therapist working in Canada for more than 20 years. She is the Director of Bodhi Tree Yoga Therapy and works as a yoga therapist and educator at the Regina Chronic Pain Clinic.
Find an IAYT-certified yoga therapist to help you or a loved one with chronic pain.
Learn more about yoga research and chronic pain here.