• Yoga therapy and chronic pain
  • Chronic pain: A background
  • Why use yoga as an adjunct therapy for chronic pain?
  • Important considerations for yoga therapists and health professionals 

The management of chronic pain is an issue which has entered the public consciousness in recent years. With researchers concluding that back pain is mismanaged on a global scale and the United States attempting to heal communities in the wake of the opioid crisis, both health professionals and patients are exploring new options in coping with this pressing public health issue. As people look for effective alternatives, the use of yoga for chronic pain is becoming increasingly embraced. 

The causes of chronic pain are complex, and as a health problem the term can cover anything from the pain caused by an underlying disorder (such as endometriosis) to musculoskeletal issues. In some cases, there is no identifiable cause for people’s pain, suggesting that pain receptors are (in layman’s terms) “misfiring” – a problem for which there is no easy solution. 

Yoga therapy and chronic pain

Tailoring a program of yogic techniques for individuals suffering with chronic pain can help them in a variety of ways. By designing yoga programs with the particular challenges of individuals in mind, not only can we offer an adjunct therapy in a clinical setting, we can empower people with tools they can use in their everyday lives. 

Yoga has the unique benefit of combining physical therapy with a system of mindfulness and breathing exercises, giving yoga therapists and health professionals a comprehensive way to tackle chronic pain both physiologically and psychologically. The experience of pain activates our autonomic nervous system, increasing stress levels and putting the body in a continuous “fight or flight” mode. Yoga has been shown in various trials to relieve this physiological state of high alert. 

Yoga can also provide a sense of community and belonging, giving pain sufferers the opportunity to connect and practice with others in a similar position to themselves. As one of the biggest social dangers to people who live with chronic pain is isolation, this can be truly valuable – alleviating the loneliness that can exacerbate many health issues. 

Chronic pain: A background

“Ongoing pain can develop a psychological dimension after the physical problem has healed. This fact alone makes pinning down a single course of treatment tricky, and it is why health care providers often find they have to try a number of different types of curative steps.” Web MD 

According to an assessment of the cost of pain in Australia in 2019, the causes of chronic pain can be broken down as follows: 

    • injury (38%)
    • unknown (31%)
    • musculoskeletal (24%), such as pain caused arthritis, rheumatic diseases, and headaches
    • other (7%), which includes pain caused by illnesses such as cancer. 

The fact that nearly a third of chronic pain has an undetermined cause illustrates one of the key challenges in addressing this problem, but even when we do know the cause of pain, relieving it is rarely straightforward over the long term. 

Opiate painkillers are perhaps the best treatment we have for acute pain (which describes intense immediate pain, such as what someone may experience if they’ve broken a bone), but they become far less effective as time goes on. Doses often have to be increased and the potential for addiction is high, with patients becoming physically and psychologically dependent.

Other medications, such as amitriptyline and gabapentin, are used to manage nerve pain, but patients sometimes find these imperfect solutions – still experiencing pain and requiring a planned withdrawal if they want to stop taking the drug. 

Doctors will also recommend physical therapy, exercise, relaxation techniques and counselling where appropriate. However, it can sometimes be difficult to refer people to these services when demand for them is high and the capacity to provide them is low. 

Why use yoga as an adjunct therapy for chronic pain?

“Practicing yoga has the opposite effect on the brain as chronic pain.” 

Catherine Bushnell, PhD

Over years of research, chronic pain has been linked to a large scope of negative health impacts, from a greater likelihood of developing mental illness to suffering from cardiovascular problems. Brain imaging scans have also associated chronic pain with structural and functional changes in areas such as the prefrontal cortex and hippocampus that indicate the development of anxiety and depression. These physical changes are a measurable indication of the profound burden pain puts on people’s mental wellbeing. 

The practice of yoga has been associated, on the other hand, with positive changes in brain scans. Mindfulness practice, in particular, has been associated with increased grey matter density and reduced volume in the amygdala (the part of the brain that governs our stress response).  Long-term yoga practice has also been linked to specific brain regions involved in executive function, specifically working memory, which has previously shown to improve with yoga practice.

These brain changes could offer a protective effect for people living with chronic pain, and may explain why mindfulness meditation–based interventions improve pain symptomology across a variety of disorders. Recent research suggests even a brief introduction to mindfulness changes people’s perception of pain and its associated negative emotional impact. 

Together, the effect that mindfulness and yoga appears to have on the way we experience pain, alongside its capacity to alleviate the physiological mechanisms behind anxiety and depression, is hugely promising. But yoga also offers the benefit, if it is applied by highly trained professionals, of offering a form of physical therapy which reintroduces pain sufferers to exercise and may even address the root cause of their symptoms. 

It has become increasingly clear in many cases of chronic pain that trying to avoid movement can actually worsen the problem, weakening muscles and affecting sufferers psychologically. Yoga is a gentle and adaptable exercise (which can, for example, be practiced sitting down) which improves strength and flexibility, as well as establishing a greater mind-body awareness. 

As always, the yoga and medical community would benefit from further robust studies into the subject, but research indicating the efficacy of yoga in the treatment of chronic pain is building. Some promising studies and recommendations include: 

  • Sharon Kolasinski MD, a professor of clinical medicine and a rheumatologist at the University of Pennsylvania, found that people who practiced modified Iyengar yoga classes once a week for eight weeks reported significant reductions in pain and improvements in physical function. 
  • Subhadra Evans, PhD, a researcher at the University of California at Los Angeles Medical Center found similar results for a group of women with rheumatoid arthritis in a smaller study.
  • The Arthritis Foundation recommends yoga (that has been tailored to the needs of sufferers) as a way to reduce physical and psychological symptoms, such as pain, stiffness, stress and anxiety. 
  • A meta-analysis of 17 studies that included more than 1,600 participants concluded that yoga can improve daily function among people with fibromyalgia osteoporosis-related curvature of the spine, while also improving psychosocial well-being. 
  • A pilot study on low back pain, which took place in 2010, found that participants practicing yoga reported (using the Aberdeen back pain scale) significantly less pain in a four week follow-up than the control group.
  •  A 2019 study reported that: “Yoga has been shown to decrease disability among people with pain… even the most basic yoga practices possess many of the components thought to be important in fostering resilience, yoga is a promising means of improving resilience and clinical outcomes for people with chronic pain.”

While by no means exhaustive, the studies above demonstrate a strong argument for further exploration into the use of yoga for chronic pain management, and a clinical basis for medical and yogic practitioners to design yoga programs with this health population in mind.