Worldwide, 1 in every 5 adults suffers from chronic pain (Breivik, Hattori & Moulin 2005). In the United States, the number is even higher. A recent survey found that more than half of Americans live with chronic or recurring pain that interferes with their mood, sleep, ability to work and enjoyment of life (ABC News 2005). The National Institutes of Health (NIH), citing pain as the number-one reason Americans seek medical care, estimates that the annual total cost of pain in the U.S. is more than $100 billion in health care and lost productivity (NIH 2003). To address this growing problem, Congress officially declared 2000–2010 the “Decade of Pain Control and Research.” Halfway through this 10-year period, yoga has emerged as a powerful tool to help relieve the suffering associated with chronic pain.
Understanding Chronic Pain
Chronic pain triggers vary broadly and include traumatic injury, autoimmune disorders and musculoskeletal problems. Whatever the initial cause, all chronic pain shares a common effect: the frustration it causes to both sufferers and healthcare providers. By its very definition, chronic pain—pain that lasts 3 months or longer—has not been successfully managed through medical treatment or self-care. Individuals with chronic pain have typically tried—and found little relief from—an exhausting number of remedies, including over-the-counter and prescription medications, massage, chiropractic care and physical therapy.
Yoga Research Reiew
Because chronic pain is a mind-body phenomenon, many researchers and chronic-pain sufferers are turning to yoga for pain relief. Yoga integrates physical movement, which can play an important role in pain recovery, with mindful practices that address the cognitive and emotional components of pain. Studies show that yoga can reduce not only the experience of pain itself but also the emotional distress and physical disability associated with it, as well as the use of pain medication (Kolasinski et al. 2005; Garfinkel et al. 1998; Gaur et al. 2001). Two recent clinical trials demonstrated the benefits of yoga for back pain, the most commonly experienced form of pain among adults in the U.S. (ABC News 2005).
Research suggests that self-efficacy, the belief that you can cope with the stress and challenges of a specific situation, is an important part of recovering from, or adjusting to, chronic pain (Turner, Ersek & Kemp 2005). Greater self-efficacy is associated with less pain-related disability and depression, even when controlling for pain intensity. Self-efficacy also predicts individuals’ willingness to use physical exercise and stretching as a way to manage pain.
Dealing with Fear of Activity
Chronic pain and fear of pain can become part of a vicious cycle: Fear leads to avoiding any activity that might trigger pain, and inactivity leads to greater physical disability and pain (Boersma & Linton 2005). Research shows that breaking this cycle, and being willing to engage in activity, is an important predictor of improvements in both physical function and emotional suffering (McCracken & Eccleston 2005).
In yoga, mindfulness is the ability to notice sensation, to focus attention on the present moment and to move with conscious intention. This turns out to be incredibly important for individuals with chronic pain, as they learn to face their fear of activity and develop new ways of being present in their bodies. Along with avoidance, many individuals have learned to rely on distraction as a coping strategy. Distraction makes it possible to ignore pain and perform an activity in the short term. However, people who use distraction as a coping strategy during activity experience more pain afterward than those who stay mentally engaged (Goubert et al. 2004).
Chronic pain is a complex and frustrating phenomenon. The good news is that effective yoga for chronic pain classes do not need to be either complicated or overwhelming. Research and experience suggest that the most beneficial interventions distill the practice of yoga to its core lessons: how to breathe; how to take care of yourself through conscious movement and a balance of rest and activity; and how to make peace with the present moment. These, of course, are useful lessons for all of us—not just those in chronic pain. But for those in pain, the lessons of yoga may mean the difference between the usual moment of suffering and the much-sought-after moment of ease in mind and body.
Excerpts from Yoga for Chronic Pain: Adapted practices and interventions from hatha yoga help pain sufferers learn how to cope and thrive. By Kelly McGonigal, PhD