Thursday, June 20, 2013

Reflections on Teaching Yoga in a Chronic Pain Program

Artwork from:

This population is really limited... Some of them are addicted to prescription narcotics... Some of them have mental health challenges... They could be in a pain flare.

Do you think you can help?

The questions made me pause. Could I help? As I had been taught to do in yoga, I took a deep breath and checked in. I knew I wanted to help, but did I feel like I could be of service? The answer that came back was yes, so I laid out ideas and plans, and my interviewers glanced at each other and smiled at my enthusiasm. I was in a room filled with medical professionals who were redesigning their pain management program and wanted yoga, among other healing modalities, on the menu. I mentioned my own experiences with chronic pain, dating back to when I was a pre-teen, and how yoga had helped me. I was so full of idealism in that interview, and I was totally underprepared for what I was about to undertake. I’m grateful for that idealism, because I might have been scared off if not for it.

On my first day, there were 8-10 people in the room, and their pain was as diverse as them. Some could sit in chairs, and some could only sit for a few minutes; some preferred being on the ground, and some turned green at the thought of getting to the floor and back up again. We had chairs, a few padded mats, a few bolsters and some foam blocks. I had planned a yin yoga sequence, but realized quickly that this was not going to work. I started to worry,

what could I ask these people to do that wouldn’t hurt them?

I went through my yogic toolkit, and realized that all of these people could help themselves through pranayama. Good thing yoga isn’t solely about the body!

What they each had in common was that their nervous systems were stuck in a fight-or-flight mode because of their pain. As Dr. Palermo wrote in her post, pain triggers the stress response, and continual pain leaves the switch to the stress response fixed in the “on” position. My tool for the nervous system is always the breath. They might not all be able to get to the floor, or stand, or sit up, but they could all breathe. So, we started there.

Slowly, I eked out a sequence that supported most, if not all, of them. Together we found options for anyone who experienced pain or struggled to breathe during any part of the practice. I used Kelly McGonical’s book, Yoga for Chronic Pain Relief, as a guide, and I asked them to befriend their bodies and establish a relationship that wasn’t based on fear and pain. We joke about being less of a dictator and more of a coach of our bodies. Over and over, we emphasized – together – that the shape of the pose wasn’t the priority; the attitude, breathing, and observing were what really mattered.

When they weren’t doing yoga with me, they were practicing qi gong, walking or chair dancing, learning about their brains, their emotions, their diet and their habits. The team consists of psychologists, physicians, a pharmacist, a nurse, a Traditional Chinese Medical practitioner, a physical therapist, a Feldenkrais teacher and myself… a very well-rounded and holistic combination of providers.

Over the last year I’ve notices some patterns arise in the hundreds of patients that have come through the program. In the first few weeks, the patients are very fixated on their bodies and their sensations. The questions they ask me are indicative of this perspective: Am I doing this right? Is there a yoga pose for this body part / pain situation?

But at some point, the patients realize that 

it’s not about their body or their pain, but their relationship to both. 

For most people, that realization happens during the third week of the program, but some figure it out right away, while others report back months later that they now understand.

Pain and stress are on one side of a coin, with relaxation and service on the other, and emotions running along the edge of it. The tools that we offer them are mindfulness, compassion, presence, perspective and community; we use these tools to flip that coin from one side to the other. Some of the tools are packaged as yoga, and some are not, but the foundation is all the same.


  • Sunday, June 23rd: Lorien will be offering restorative yoga demonstrations as part of Kaiser's Seeds of Hope Cancer Survivor Day. See Events page for info.
Lorien's Healing Yoga for Wellness DVD is out! How to get your very own copy:
  • Order from Amazon for $27.95, plus tax and shipping 
  • Stop in to Breathe Los Gatos and get it today for $30, plus tax
  • Buy it directly from Lorien for $27.19 (tax included, no shipping, you must pick it up in class)
  • Coming soon to eBay, Kaiser Santa Clara, local yoga studios and many more...