Does yoga have an impact on chronic pain?

What is pain?

The WHO defines pain as “(…) an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in such terms”

Pain is above all a useful and positive mechanism, which informs us about the environment with which we interact, and which protects us. It prevents us from putting our hand on a hot stove, from recognizing appendicitis or even a fracture after having fallen. According to the WHO, pain is above all a sensory and emotional experience, it is therefore a physiological alarm system to protect us, but which can be pathological when it is not adapted or disproportionate and when it becomes chronic.

It is still necessary to distinguish between acute pain and chronic pain. The former being easier to treat medically than the latter. Chronic pain develops over time with more acute painful phases but with a constant presence whose variability and intensity change. Any pain that persists for more than 3 to 6 months is called chronic pain. This pain, in the long run, leads to another form of moral, emotional, and social suffering with often an inability to work and disabling consequences preventing a fulfilling social and family life. We then speak of total pain. It is often accompanied by irritability, depression, feeling of abandonment, loss of confidence in oneself and in one's body and one's abilities, guilt, despair, and helplessness. Medical care is often multimodal and multidisciplinary. It encompasses conventional and complementary medicine, involving medication ranging from analgesics, anti-inflammatory drugs, opioids, antidepressants, antiepileptics, sometimes with successful or unsuccessful surgery, psychotherapy, physiotherapy, the use of TENS and a whole range of complementary therapy such as acupuncture, phytotherapy…

On top of it, the often-invisible nature of pain ads yet another challenge especially when it is not objectified by doctors, such as fibromyalgia or other pain linked to a dysfunction of the pain control systems. The entourage, not seeing the pain, often does not understand the suffering person. However, the pain is real and not psychosomatic or imaginary.

It is part of a complex system with several levels of pain and suffering of various origins which intersect and influence each other.

Pain can have several origins, distinct or cumulative: Nociceptive, neuropathic, or linked to the central nervous system which incorrectly relays information to the brain.

Nociceptive pain involves the pain receptor that carries pain information to the spinal cord. This pain is often linked to an injury due to trauma or inflammation.

Neuropathic pain characterizes damage to the nerves of the peripheral and central nervous system. (The PNS includes the motor, sensory nerves and those that control the organs. The CNS includes the brain, cerebellum, brain stem and spinal cord).

The consequences are often disabling, even harmful and considerably reduce the quality of life of the sufferer. They are often accompanied by depression, work leave, disability, and severely affect social and emotional life.

What is the pain circuit?

You pinch your finger in a door. The message is being transferred from the finger to the brain. This passage is relayed by 3 neurons at 3 different levels: 1. from the pain receptor (nociceptor) to the spinal cord, 2. from the spinal cord to the center of the brain where the thalamus is located, and 3. from the thalamus to the cortex. The cortex interprets the information as painful.

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We will see later how the practice of yoga intervenes at each level and reduces the painful sensation.

At the same time as the body transmits these pain messages to the brain, the brain sends information downwars to block the pain impulse. The body has 3 endogenous systems to protect itself against pain.

The 3 pain inhibiting systems:

The first is located at the level of the spinal cord, the second at the level of the brainstem and the third at the level of the thalamus.

The 1st system is "The gate control” at the medullary level (spinal cord). It is sensitive to touch and was discovered by Wall and Melzack in 1965.

When you bang your arm, the nociceptor carries the information to the brain. You are arm is hurting. But if you rub it immediately, you feel less pain than if you do nothing. This is explained as follows:

Friction follows a faster path than pain. Tact fibers carry a message faster to the brain than pain and sends a message of tactile sensation back from the brain that blocks the pain at the level of the spinal cord. The feeling of pain is less. The same is true for the proprioceptive fibers.

The 2nd pain inhibitory system is called the "descending inhibitory control" and is located at the level of the brainstem:

The brain releases neurotransmitters. It is the descending response from the brain to the periphery: from the cortex -> thalamus -> brainstem -> to the periphery. The brain releases noradrenergic and serotonergic secretions, and natural endorphins similar to morphine. These substances partially block pain impulses at the medullary and central level.

There is also the "diffuse inhibitory control" which is an endocrine brake sensitive to stress. In short, one pain blocks another pain. The brain releases endorphins and interneurons to block the pain.

The 3rd pain inhibitory system is at the level of the thalamus which acts as a sorting center. Located in the center of the brain and near the emotional seat and memory, it sorts painful information according to the person's experience, memory (of pain), emotions and history. A fulfilled and loving person would feel less of a bee sting than a person who has just lost their job or spouse.

Yoga therapy strengthens these three endogenous pain protection systems.

What is therapeutic yoga or “adapted” yoga?

It is a set of tools adapted to the specific needs of the person, taking into consideration the person as a whole with his experiences of life, pain, his lifestyle, his diet, his rhythms of wakefulness / sleep, his social, family and professional experiences. This approach puts the person at the center of the treatment.

The tools adopted come from classical yoga and include a set of

postures, breathing exercises, relaxations, visualizations, and meditations. They include elements of cognitive and emotional behavioral therapies. Yoga therapy follows the philosophy of yoga as stipulated in ancient texts such as the Yoga Sutras of Patanjali or Hatha Yoga Pradipika. It also introduces nutrition and micro-nutrition as well as herbal medicine.

It sounds like a magical formula, which it isn’t. This approach only works with the motivated participative commitment of the sufferer. He has a major role to play in pain management. He must actively participate in learning and applying the tools to tame his body and calm the pain. He is an actor and not a spectator. He will have daily exercises to do for a period of 20 minutes between each consultation. The results obtained are proportional to the time spent doing them. It takes at least 3 hours a week, or 20 minutes a day to feel an improvement. It is the regularity of the exercises that bears fruit in the pain management process.

Together with conventional medicine and complementary therapies, the person will have their toolbox to live better with this disease.

How does yoga work on pain?

The holistic approach of yoga provides a global and effective solution. It intervenes at all levels of pain and strengthens the 3 inhibition systems. The practice of yoga helps fight inflammation, promotes the secretion of key neurotransmitters in pain management, improves sleep often disturbed by pain, and strengthens reconditioning to effort.

1. Yoga acts at the level of the nociceptors (pain receptors) at the local level, through Musculo-capsular stretching; through slow and gentle movements synchronized with the breath; through the action on the spinal ganglia eliminating reflex dermalgia.

2. Yoga intervenes at the level of the spinal cord through proprioception, and thus acts on the gate control and modulates pain.

3. Yoga has an action on the brainstem. It acts directly on the wakefulness and sleep system. It not only improves the quality of sleep but also acts on the state of alertness by balancing the sympathetic and parasympathetic systems of the autonomic nervous system. It strengthens the endogenous pain modulation system by promoting the release of neurotransmitters.

4. Yoga impacts the activity of the thalamus through conscious focus and emotional feeling, as well as on memory. Sorting center, it colors the pain by increasing or decreasing it.

5. Through movement itself and visualizations of movement (in case of immobility), yoga acts at the level of the cortex.