Understanding Pain

by Nina

The Black Finger Bandage by Berthe Morisot

If you stub your toe, cut your finger while chopping vegetables, burn your hand while taking something out of the oven, or twist your ankle while walking down the street, you experience a physically and emotionally unpleasant sensation. That�s because when something harmful or irritating occurs, your body reacts by creating an urge for you to stop it. And that urge is what we call pain. 

So as uncomfortable as it is, pain is actually beneficial. As part if your body�s protective mechanisms, its function is to: 

1. Motivate you to pull out from a damaging situation and prevent further damage to the tissue.
2. Allow the damaged tissue to rest and begin the healing process.
3. Avoid similar encounters.

But while pain is generally a good thing�people who suffer from congenital insensitivity to the pain response are easily injured and most die at an early age�pain is also a major symptom in several medical conditions and can interfere with your quality of life and general functioning. 

Besides being influenced by the type and intensity of the stimulus that causes your pain, the level of pain you feel is also influenced by how your brain perceives the experience. Several factors can influence your pain perception, including: 

Age. As brain areas degenerate with age so does brain circuitry, so older people have lower pain tolerance and sometimes face problems dealing with pain.

Memory. Our past experience dealing with pain can influence our neural responses to it, causing us to be more sensitive to pain.

This is exactly why yoga pain management techniques can be so effective. Using yoga, you can change your relationship to pain, influencing your pain perception, improving pain tolerance, and changing habitual ways of reacting to pain. 

Acute vs. Chronic Pain

Pain that is the result of injury, surgery, or illness and that lasts for short period of time is acute pain. Acute pain starts when there is a real threat to your body and leads to a reasonable protective response. It then recedes when the stimulus is removed or the damaged tissue has healed. Common examples of acute pain include sprained ankle, headache, paper cut, and stomach ache.

In a perfect body, pain occurs only when needed, and turns off when the initial stimulus is withdrawn and the tissue has healed. However, there are certain medical conditions, such as arthritis, chronic fatigue syndrome, and low back issues, in which pain is a constant feature and persists for at least three months. This is chronic pain. 

Typical causes of chronic pain include:

• Chronic neck and back conditions, such as a herniated disc or vertebra slippage. 
• Chronic conditions that have pain as a symptom, such as many forms of arthritis, chronic fatigue syndrome, fibromyalgia and related conditions, and Lyme�s disease.
• Cancer and/or post-cancer treatment pain from chemo and radiation therapy. 
• Terminal illnesses that cause immobility, such as severe emphysema, congestive heart failure, and Parkinson�s disease. 

In addition, there are chronic conditions that cause intermittent pain, such as migraine headaches, irritable bowel syndrome, and multiple sclerosis. Because this pain occurs regularly, it is essentially is a form of chronic pain and you can treat it as such. 

Chronic pain differs from acute pain in three ways: 

1. Your body can become more sensitive to the threat of possible pain symptoms leading to feelings of fear and anxiety.
2. Your brain can become more likely to interpret situations as threatening, and sensations as painful (eliciting a pain response).
3. With the experience of repeated reactions to pain, your ability to differentiate between the many aspects of the pain response (sensations, suffering, and stress) maybe become blurred.

So chronic pain is challenging because it goes beyond the physical presence of pain, and affects your mind-body connection. And the ongoing presence of chronic pain can affect your daily functioning due to changes in: 

• Breathing. Your breath can become more shallow and shaky, making exercise and even normal physical activities more challenging. 
• Muscle Tension. Because your body is in a constant state of �alert,� muscle tension can increase. This will limit your range of motion, which in turn will can worsen stiffness. 
• Movement Patterns. As you try to protect the area of pain, your movement patterns can change dramatically. Some people stop all inessential movement, obviously limiting what they can do in the short term and causing both stiffness and weakness in the long term. Other people grit and bear the pain, only stopping when the pain is so intense that they can�t continue, but they may be creating unhealthy movement patterns that result in uneven physical wear and tear. 
• Body Image. How you view yourself can change from physically capable to weak and incapable, which makes you less willing to take on physical challenges or even to keep yourself exercising regularly. 
• Thought Patterns. Chronic pain can cause you to become less optimistic about your pain and your life in general.
• Emotions. Your emotions may become generally more volatile, leading you to become angry, frustrated, tearful, and/or overwhelmed. 

Although chronic pain can cause all these serious issues, they are all problems that you can address with yoga. And as you consciously address your chronic pain, you can reverse the physical, mental, and emotional damage that it has caused. 

Whew! Now that you�ve learned about the difference between acute and chronic pain, and about the side effects caused by periods of chronic pain, you�ll be better able to use the tools we describe in our posts Techniques for Managing Pain with Yoga and Changing Your Relationship with Pain.

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Friday Practical Pointers: Changing Your Relationship with Pain

by Baxter and Nina

Jim Coughlin, Age 60

Those of you with health conditions or injuries that have resulted in ongoing, chronic pain or intermittent pain, (think low back injuries, fibromyalgia, and chronic migraine headaches, to name just a few) may have developed a certain adverse relationship with pain over time in the form of feelings of anger, fear, worry, anxiety, despair, sadness, or loss. Unfortunately these responses to pain will often trigger your stress response, which typically increases your pain. And brooding about the pain in general can increase your perception of your pain levels, something we call �the pain on top of the pain.� 

In addition to allowing you to actually reduce your pain levels (as your pain reduces, your attitudes and feelings toward it may also shift), yoga enables you to actively change your adverse relationship to pain in the following ways: 

1. Because brooding or thinking excessively about your pain can distort your accurate perception of your true pain levels, using yoga stress management techniques to quiet your mind allows you to short-circuit your mind�s tendency to focus on pain. In your new, clear state of observation, you may discover that your true pain levels are lower, sometimes significantly, than the pain you experience while focusing on it. 
2. You can improve your pain tolerance by listening to your body and improving your overall self care. You can also improve pain tolerance by cultivating mental and emotional equanimity, which enables you to be more content with what you have and what you don�t have. 

The following sections provide details about how to use this techniques.

How to Quiet Your Mind While in Pain 

To short-circuit your tendency to brood about pain, use any stress management techniques that work for you. We particularly recommend:

• Breath Awareness. Repeatedly coming back to your sensations of breathing interrupts your thoughts about pain 
• Structured Breath Practices. Simple breath practices that require concentration, such as timed 1:1 or 1:2 inhale/exhale patterns and alternate nostril breathing, keep your mind focused on your breathing. 
• Guided Relaxation. Recorded or self-guided relaxation practices keep your mind engaged on physical relaxation or positive imagery. 

As you practice these techniques, your pain levels may decrease, your tolerance for pain may improve, and your typical mental-emotional responses to your pain may become less intense or may even dissipate. 

In addition to quieting your mind, meditating on positive emotions, such as gratitude or joy, or on positive images, enables you to transform feelings of sadness, frustration, fear and anger into more positive states of mind. One study showed that meditating on joy literally activated the areas of the brain that produce positive emotions. This surge of positive emotions may reduce your pain levels, while also improving your pain tolerance and your attitude about the pain.

Meditation also has the long-term benefit of teaching you about mental habits that might be contributing to your pain, allowing you to consciously choose new, healthier ones. For example, your chronic pain may have triggered stress eating, which led weight gain that is worsening your pain (which can happen, for example, with knee arthritis). By observing your thoughts during a meditation practice, you may become aware of the chain of events that leads to your stress eating and then choose a healthier response to the pain, such as taking a short movement break that actually lowers your pain, rather than turning to food. 

How to Improve Your Pain Tolerance 

Mindfulness practices where you focus on your physical sensations other than pain, such as meditation, breath awareness, and mindful practice of asanas, allow you to tune into your body and recognize its needs. These practices teach you to differentiate between chronic, low- level pain and acute surge in pain, which will allow you to have a better sense of when to exercise and when to rest, of how far you can safely move in various yoga poses, and of which practices actually help your pain. (Of course, If your pain becomes severely acute and disabling, it would be wise to get to your doctor urgently.) 

Tuning into your physical sensations will also allow you to improve your self-care in general, as you, for example, realize you need more sleep or to schedule a health care treatment. Becoming an active participant in your self care can give you a sense of control, which can help you move past your adverse relationship towards chronic pain And improving self-care may even allow you to start participating more in the activities that matter to you, improving your overall quality of life.

Another way to improve your pain tolerance is to cultivate equanimity, the original aim of yoga:

When a man has mastered himself,
he is perfectly at ease in cold,
in heat, in pleasure or pain,
in honor or in disgrace. �Bhagavad Gita 

Studying yoga philosophy provides you with an alternative way of thinking about your life, enabling you to be more content with what you have and what you don�t have. And that includes accepting chronic pain as part of your life, which allows you to tolerate the pain more easily. In general, cultivating contentment as described in sutra 1.33 Patanjali�s Yoga Sutras, can be very helpful. 

1.33 Through cultivation of friendliness, compassion, joy, and indifference to pleasure and pain, virtue and vice respectively, the consciousness becomes favorably disposed, serene and benevolent.

Another particularly helpful technique for countering the negative reactions of your mind is pratipaksha bhavana, which means �cultivating the opposite.� 

3.3 When disturbed by negative thoughts, opposite [positive] ones should be thought of. �Swami Satchidananda 

Here�s an example of how to apply pratipaksha bhavana: If you had an increase in pain, your first thought might be, �I won�t be able to go to work today with this level of pain.� But practicing pratipaksha bhavana could allow you to reframe this thought to, �I will be able to work today, despite this pain level� or �Let�s see if I can work today, despite this pain level.� See Cultivating the Opposite for more information on pratipaksha bhavana.

But any yoga philosophy that speaks to you and helps you cultivate balance and equanimity in your mental and emotional life is going to help you increase your pain tolerance and improve the quality of your life.

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Techniques for Managing Pain with Yoga

by Baxter and Nina

Beams of Light by Melina Meza

This post recommends techniques for helping you manage acute and/or chronic pain. Although the causes of acute and chronic pain differ, depending on your condition on a given day, you can use similar techniques to reduce your pain.

Start by considering your pain levels both today and, if you are suffering from chronic pain, over time. By reviewing your pain levels through the course of a day, week, or month, you will begin to see patterns. To do this, you might find it useful to assign a rating to your pain and keep a journal of pain levels that you can periodically review. To get a better picture of how pain is affecting your entire being, you could also note your stress levels and your predominate mood. You can then use all this information to guide you to practice differently on different days. 

For chronic pain, on high pain days, start or stay with gentle poses, relaxing breath practices, and meditation. If your pain is very severe, focus on relaxation and breath practices, and maybe imagine the poses. And on low pain days, try carefully increasing the intensity of your practice.

For acute pain, if your pain is tolerable, this is a good time to practice asanas, which will increase oxygen flow to brain and muscle tissues, and release held tension from the muscles. But if your pain is severe, you should focus solely on relaxation and breath practices. 

For everyone, practicing stress management on a regular basis is very beneficial, as reducing stress levels can lower pain levels. We will compare and contrast some of the techniques below. 

How Often to Practice. For chronic pain, it is important to have rest days, where you are practice only restorative or extremely gentle poses, or skip the asana portion of your practice entirely. So we recommend that you practice more actively 3 to 4 times a week, and at least do breath practices and meditation on your resting days, if possible. 

For acute pain, follow a similar schedule. Because acute pain will ideally resolve more quickly, as your pain subsides and your functioning returns to normal, you can gradually increase your practice days to 5-6 days a week. 

Balanced Practice. We recommend that your active practice be a well-rounded one, including yoga poses from all the basic groups (as long as they are appropriate for you unique pain situation), in both dynamic and static variations. In addition to your poses, try to include breath work, resting poses, and mediation. Because down-regulating your sympathetic nervous system is so beneficial for pain management, we recommend that at least 25 percent of your practice be devoted to breath work, restorative poses and/or meditation.

For both types of pain, always begin your asana practice with gentle poses. Start with simple movements that improve breathing, such as Cat-Cow pose, seated or standing side-bends, and arm range-of-motion actions. Then, if you are feeling up to it, add in more active asana, dynamic or static, such as Arms Overhead pose, Warrior 1 and 2 poses, Downward-Facing Dog pose, and Locust pose, and any other basic poses that work well for your particular condition. Finish up with one or more relaxing restorative poses, such as Easy Inverted pose, Legs Up the Wall pose, Supported Child�s pose, or Supported Relaxation pose. 

Dynamic Poses. Use dynamic poses either to create a balanced practice or to address a particular area where you have pain. When you first try a dynamic pose that may stimulate the area of your pain, move slowly and mindfully in and out of the pose. If this movement stimulates pain, modify it so you come up to the edge of pain without fully triggering your pain response. When you find a way to practice that feels safe, you can move at a pace that feels good to you, be it slower or slightly faster.

Static Poses. Use static poses to stretch areas that are stiff and tight, and, if you have chronic pain, that may have developed limited mobility as a result of pain. Focus on the particular flexibility poses that will gently stretch your tight areas. For example, if you have low back pain and are tight in the backs of your legs, Reclined Leg Stretch could be a good choice. 

Also use static poses to strengthen muscles that have been become weak due to lack of use. For example, chronic low back pain often results in weakness for the lower back muscles. Focus on strength building poses that will gradually build strength in your weak areas, For example, for weak lower back muscles, choose poses that builds back strength, such as Locust pose, to regain lost strength.

As you work with both flexibility and strength building, practice mindfully and note if these poses also begin to reduce pain levels. If they do reduce pain levels, continue practicing the poses and gradually add in other similar poses. However, if they don�t reduce your pain levels, try reducing the time in each pose or consult with an experienced teacher to help you re-organize your practice choices.

For acute pain with no history of chronic pain, practicing strengthening poses is less important, because it takes time for weakness to develop. However, if the acute pain becomes chronic, we recommend adding strengthening poses to your practice to help prevent weakness from developing.

Breath Practices. You can use any breath practice you find helpful. Generally, we recommend starting with calming breath practices, such as:

• gently lengthening both inhalation and exhalation
• 1:2 ratio breathing
• alternate nostril breath

When you reach a point where you are working on stress hardiness or active strength building practices, you could try adding in a few more stimulating practices, such as 2:1 ratio breathing or Kapala Bhati, as these practices can help energize your body and mind, contributing to your strength and endurance. 

Restorative Poses & Focused Relaxation. All forms of focused relaxation are helpful for reducing stress. However, if you are in acute or severe pain, you may find recorded guided versions are easier to focus on, as your mind will be more attentive to the recording than your own attempts at moving your focus away from pain. 

In general, start with a comfortable relaxation pose, from simple Savasana (Relaxation pose) to any form of supported Savasana, or any symmetrical restorative pose. Then practice any conscious relaxation technique that works for you, such as simple breath awareness, a body scan or guided imagery, or the rotation of consciousness portion of yoga nidra. 

Meditation. For both acute and chronic pain, you can practice any form of meditation, from simple breath awareness to more formal practices that cultivate feeling of kindness towards your self. We especially recommend meditating on an image in your mind that is calming and joyful or a color that is peaceful and pleasant, or using the formal Vipassana Metta meditation (Loving Kindness Meditation). To get a handle on how much of your mental energy is going to thinking about your pain versus other topics, you can try simply observing your thoughts. Experiment with these various different techniques to see what works best for you (see Yoga Meditation Techniques).

Imagining Asana. For those with chronic pain, on days when you don�t feel up to moving, imagining you are doing an asana actually prepares your body to move with greater ease and comfort when you are ready to move again. To prepare yourself to do this, you may want to rehearse this technique on a low pain day while you are actively practicing. For example, as you using whatever method you normally use to practice, whether using a sequence from a book, a video, or an audio recording, or creating your own sequence, after each pose, stop, close your eyes, and do the pose or mentally, as a way of memorizing it. Then, the next day, try out a short practice mentally. As you improve at this technique, you will be able to easily access the mental practice on the days you don�t feel up to moving.

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