Yoga
as treatment for Chronic Pain disorders
Elise
Koomen
Lesley
University
May,
2012
Introduction
As a person who
has suffered from chronic pain, I understand how discouraging it is to go from
treatment to treatment and experience little to no improvement. I have suffered from medications that
make me constantly tired or unable to sleep at all. I also understand how frustrating it would be if someone told
me that the chronic pain I have is all in my head. However, treatment of just the physical manifestation of pain
does not seem to work.
One in three people suffer from chronic pain and have decreased health-related
quality of life and psychological distress as a result of it (Rosenzweig,
2010). Half of all patients with chronic pain in America report their pain is
not under control (Rosenzweig, 2010). Chronic low back pain is a common problem, however all the
treatment options are modestly effective at best (Sherman, 2005.) Fibromyalgia,
a pain syndrome in muscles and connective tissue, affects millions of Americans
but is known for not responding well to drug treatment (Carson, 2010). It is clear that chronic pain is a big
issue in our society and that relying on drug treatments is not only expensive,
but also ineffective. This is why
it is so important to do research about alternative treatment options like
yoga, that are cost effective and free of the side effects often experienced
with drugs. This paper will
explore yogic methods of dealing with chronic pain both mentally and physically
and why that is essential when treating chronic pain.
Research
A study conducted by Dr. Sherman et al. (2005) tested the
effectiveness of three different treatment options for chronic back pain. Treatment options included traditional
exercise, yoga and a self-care book about treating chronic pain.
Sherman's study employed the use of viniyoga, a therapeutically
oriented style of yoga regarded as easy to learn and safe. Each class included opening and closing
breathing exercise, 5-12 poses and guided deep relaxation. Poses were not held for extended periods
of time. This yoga practice proved
to be slightly more effective in managing pain than exercise classes, and much
more beneficial than reading a self-care book about managing pain.
The chronic pain patients who participated in the yoga classes
reported that their pain had improved, however the yoga practice helped them in
other ways as well. Participants
found they were more flexible which allowed them to move with greater ease. They were also able to see how they had
been moving their body in “maladaptive ways” (Sherman, 2005) and were able to
correct these habits. Participants in the study found that the improvements
gained from the yoga practice lasted for months after the study.
A recent study by Carson (2010) explored the treatment of fibromyalgia
with a “yoga awareness” program. This
program was a compilation of breathing exercises, basic yoga poses, group
discussions, and yoga-based coping presentations. Compared to the study’s control group which did not practice
any yoga, the improvements in pain management patients found were significant. Fifty percent of the study group
recorded that they had 30% or higher reduction in pain, while no one in the
control group recorded any improvement.
While the outcome of this
study seem feasible, it relied on self-reporting for its data so the results could
be misleading. Also the long-term effects of the yoga practice were not
measured.
A 2010 study conducted by Rosenzweig sought to measure the
effectiveness of mindfulness as a treatment for chronic pain conditions. The group being studied went through an
8-week mindfulness meditation training where they were taught how to apply mindfulness
in day-to-day situations, how to cope with stress and pain and pay attention to
their body without reacting (especially negatively). After completing
this program patients reported feeling less distress over their pain when using
mindfulness strategies. They found
not only that pain did not inhibit daily activity, but that they experienced
less stress and less pain. They
reported that these results lasted years after their initial exposure to
mindfulness.
Discussion
Before discussing what the results of
these studies may mean for chronic pain treatment, there is an important distinction
that needs to be made: the distinction between pain and suffering. Pain is physical or emotional trauma; it
might be an injury like a broken bone or a rejection in a social scenario. Suffering, however, is how you deal with
this trauma. This is where the
mental aspect of chronic pain is important. Someone suffering from a physical
injury might have a high expectation of pain before completing a physical
endeavor; he may fear his pain will never go away or become stressed or
depressed about things his pain might stop him from doing (McGonigal,
2009). This mental distress
becomes a big part of the patient’s chronic pain and adds to his suffering. Being in a state of stress causes lack
of sleep, promotes weight gain and could increase inflammation (McGonigal,
2009). It is interesting to note that
doctors aim to treat and relive pain, but yoga has been
dealing with alleviating suffering for thousands of years (Carson, 2010).
A fundamental aspect of yoga is the idea that the mind and the body
are unavoidably linked. An ancient
yoga text the Bhagavad Gita defines yoga as "evenness of mind" (Marcaro,
1962). This suggests that when you
treat your mind your body receives benefits as well (Audette, 2008). Achieving clarity and peace within your
mind has potential to help your body function the way it ishould.
Perhaps
the reason yoga is so effective managing pain is because it’s effective in
managing stress. When you are stressed, your body reacts physically. Your breathing rate increases, muscles
become tense and your mood deteriorates; all of these factors make physical
pain worse. Pranayama, breathing control is possibly the most powerful method
that links the mind and the body in yoga (Moore, 2009). Breathing exercises and meditation work
to lower heart rate and relax muscles and also to help manage stress. The actuality that yoga promotes healing
for the mind and the body makes it a really good option for pain management, at
least as part of a treatment program. Studies have shown that when yoga is
practiced in addition to drug therapy, the side effects from the drugs are
diminished, and the patients are able to deal with the remaining side effects
better (McGonigal, 2009). Instead
of producing a stress or depression reaction yoga techniques teach that pain is
not an entirely negative thing. In his research about yoga awareness as a
coping strategy for fibromyalgia, Carson finds that "yoga promotes healthy
acceptance of pain and willingness to learn from it (Carson, 2010)."
The Bahagavad Gita (Marcaro, 1962) illustrates how a "yogic way
of life" can help people adopt better attitudes towards their pain. Viveka,
roughly translated as discrimination,
includes the ability to determine what can change from what cannot change and
what is necessary from what is not. When someone is in pain it is important to discern the things
that needs to change about their lifestyle to alleviate the pain and what part
of the pain they must be willing to accept. Also dealing with acceptance, Vairaga means detachment, or being open and flexible to whatever
result may come (Audette, 2008).
McGonigal (2009) writes, "Most Chronic pain has roots in physical
injury or illness, but it is sustained by how that initial trauma changes not
just the body but also the mind-body relationship." Studies have shown a connection
between emotions and the physical location of pain. For example, low back pain can be related to anger. For people
with chronic low back pain, anger can trigger tension in deep muscles of the
back, triggering pain. Research on
forgiveness has shown to help decrease lower back pain (McGonigal, 2009). Pain is both a physical reaction and a
mental one. It makes sense that you should treat both mind and body to
experience relief.
Yoga compared to exercise
People
who experience chronic pain are more easily tired than those without it,
because cardiovascular and respiratory reserves become weak (O'Hara, 2002). This can make exercise difficult and
chronic pain sufferers injury prone. While exercise is helpful in dealing with chronic pain and
recommended by many doctors, there is evidence that yoga is even more
effective. A well-designed yoga
program takes the body through a full range of movements, giving a more
thorough experience than most sports or exercises (Audette, 2008). The previously mentioned study by
Sherman (2005) found that yoga classes were more beneficial than exercise
classes. This could be
because of therapeutic yoga’s emphasis on alignment. When someone is misaligned, tendons, muscles and ligaments
are under constant strain and can cause a lot of pain. Constantly contracted muscles become
weak and perpetuate more pain throughout the body. Yoga practice has the potential to improve alignment when
conducted with a trained instructor, thus supporting symmetrical functioning
and reduced pain (Audette, 2008).
Therapeutic Yoga
Hatha yoga is a popular form of yoga that is practiced today. It combines poses (asanas), controlled
breathing and relaxation. One type
of yoga that is safe for people with pain conditions is called Iyengar yoga. Iyengar yoga is a form of hatha yoga that
has therapeutic uses because of its use of props and emphasis on alignment. It is safe for people with medical
conditions like chronic pain when done with qualified instructors who can help
make adjustments (O’Hara, 2002). The factor of individualization in therapeutic
yoga is essential because everyone has specific symptoms and pains. In Inyengar yoga, a yoga program is
matched to the health care needs of the patient, and the program changes with
the health of the patient.
Based on the teachings of B.K.S Iyengar, Iyengar yoga integrates
orderly and progressive moves and employs the use of props such as blocks,
belts and blankets to give the student more support. As with all therapeutic yoga the correct alignment in all
poses is very important. Iyenger
yoga teachers must have 5 years of training before they are certified to teach.
It is important for someone
teaching patients with chronic pain to understand human physiology so they can
tailor a program to a specific patient.
The fact that practicing yoga is so involved is significant. The patient is not being poked and
prodded by doctors, he is not taking pills or putting his health in the hands
of someone else; all the mental and physical gains one experiences when
practicing yoga comes from the individual. Beth Sternlieb, an Iyengar teacher, explains, “Iyengar yoga
offers a feeling of mastery, through students’ own skill and actions they can
take charge of their healing and solve their chronic pain problem by virtue of
their own effort (Zeltzer, 2005)."
The effectiveness of a yoga practice depends wholly on the individual;
while this increases confidence that the patient is able to receive benefits,
it can also be negative. If he
does not put in any effort, he will not reap the benefits. One’s own motivation,
confidence in the practice, ability to understand his condition and ability to
sustain the practice will determine its effectiveness; this is both a benefit
and a downfall (Kraftsow, 1999).
Conclusion
The
stigma of yoga practice in American society is perhaps one of the reasons it is
not often seen as a viable treatment for pain. Yoga is often marketed as a form of exercise; there is a
commercial side to yoga that marries the practice with special yoga pants,
mats, water bottles etc. It makes
sense that a person suffering from pain who does not know much about
traditional yoga would be apprehensive to treat his pain using yoga methods. It is because of the stigma that it is
so important to do more research and increase awareness for yogic treatments. Sternlieb explains, "Yoga is not
just a series of exercises simply designed to build strength and flexibility. It is a vehicle for developing
awareness. It is a process that
develops strength of will, trust, confidence and a willingness to look at one's
self without judgment (Zeltzer, 2005)."
It is widely agreed that mind-body practice will help people suffering
with chronic pain, but only 20% of chronic pain patients report using mind-body
methods in the past year (Rosenzweig, 2010). In light of all of the research explored in this paper, the
future for people suffering from chronic pain seems bright. A better understanding of mindfulness
and yoga practice could help integrate these practices with conventional
medicine, hopefully giving chronic pain patients a well-rounded and effective
treatment.
WORKS CITED
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Integrative Pain Medicine: The science and practice of complementary and
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Randomized Controlled Trial of the Yoga Awareness Program in the Management of
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Healing with the Timeless teachings of Viniyoga. New York, NY: Penguin Compass
J. Mascaro (Trans.). (1962) The Bhagavad
Gita. New York: Penguin Books: New York, NY.
K. McGonigal. (2009) Yoga for
pain relief: Simple practices to calm your mind and your chronic pain. Oakland,
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