Thursday, June 13, 2013

Yoga and Chronic Pain

I teach yoga as part of a chronic pain management and rehabilitation program through Kaiser. I asked one of the psychologists to write me a post that explains how chronic pain occurs. Here is the post from our wonderful Dr. Cassie Palermo:

Artwork by George Camacho
"From the first time that I practiced yoga, I was drawn to it. I appreciated the centering, calming, meditative aspect of it. It provides me with a path back to equilibrium when I lose my way. At times I feel compelled to prove my worth – both to myself and my team, as I judge myself against the more seasoned professionals with whom I work. I also lose balance when I strive for "more" and overdo it in my daily routine, and this imbalance takes me out of the moment. With its emphasis of "keeping my yoga on my own mat," focusing on my breath, and being aware of my body movement, posture, and alignment, I practice what I need to restore my sense of balance.

A year or two after I began incorporating yoga into my own routine, yoga became part of my work, as well. I am a psychologist in a chronic pain program and the program now includes a yoga component. It turns out that yoga, among other smooth and gentle movement practices, is a healing approach for the management of chronic pain.

I say "it turns out," not because this discovery is coincidental, but because I have not always known as much about chronic pain and its management as I do now. What I have learned has come from observing the patients in the pain program and doing my own research.

Chronic pain is essentially a disorder of the central nervous system, 

though it becomes quite complex when looking at all that is involved in the way the brain processes pain. However, we must first understand that pain actually serves a purpose.

We are hardwired to interpret signals – sent by nerve endings – as pain, in order to avoid physical damage and/or death. For example, if we put our hand on a burner we do not initially know is hot, we are able to respond by pulling our hand away before we consciously become aware that the burner will indeed singe our skin. Likewise, when something startles us, our system shows a response before we make sense of what has caused the alarm. Once we realize that a friend has jokingly jumped out to scare us, we then experience our rapid heart rate, our tense muscles, and the surge of adrenaline that is already starting to drain. When we feel this, we are experiencing the sensations related to the "fight or flight" response.

In this automatic response, the central nervous system receives input that that there is danger and the potential for harm, and takes action to either gear up and fight to protect, or take flight to distance or avoid. Our brain, part of the central nervous system, is wired so we do not have to wait to consciously weigh our options of what to do. Before it's at the conscious level, our brain sends signals to increase heart rate, make our breath more shallow and rapid, decrease blood flow to the extremities so more is available for the vital organs, speed up our thoughts within the primal part of the brain focused on survival, increase adrenaline to delay the sense of pain and provide a surge of energy, and tense our muscles so as to gear up to meet the situation.

This happens with acute pain situations, such as putting your hand on a burner. Unfortunately, this also occurs with chronic issues, such as spinal stenosis, arthritis, degenerative disc disease, and multiple sclerosis

Since the trigger for danger is always present (chronic in nature, i.e. cannot be cured), the signals are continually being sent, translated as pain, and the central nervous system is responding with the fight or flight response. Right idea but wrong situation since, with the above-named issues, we cannot figuratively remove our hand from the burner nor is there necessarily further damage being done.

Chronic pain is the constant signaling of danger, resulting in over activity of the central nervous system and the fight or flight response.

So, what can we do to deal with this automatic response? We actually have more control over our brains than we originally thought, and we can initiate the opposite (parasympathetic) response in our nervous system – and initiate it earlier and earlier, to catch and reverse these survival responses in order to return our system to a calmer, more sustainable state of operation. Practices like yoga, meditation, QiGong, and changing our thinking patterns do just that.

Seeing this transformation among the patients enrolled in the pain management program is profoundly rewarding. Having yoga be a part of that transformation reminds me of my own practice. I'm included in a larger system of change, and that encourages me that my part of the whole is enough; it brings me peace and balance, and makes my job worth doing."


  • 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! Go to Amazon to order yours today!