Yoga for Chronic Pain, Part 2
In Part 1, we discussed how stress reduction and greater postural awareness—especially as aided by asana practice—can be part of the yogic approach to managing and alleviating chronic pain. In Part 2, we'll discuss the role of breathwork and meditation in pain management.
Breathing for Relaxation
Pranayama can be a powerful way to quickly relax the nervous system, shifting the balance from the fight-or-flight sympathetic side to the more restorative parasympathetic division. Such practices as simply slowing the breath, lengthening the exhalation relative to the inhalation, and pausing briefly after the exhalation, all tend to shift the balance of the nervous system to the parasympathetic side. Better still, these simple pranayama techniques can be done almost anywhere, without others even necessarily being aware of what you are doing—and the relaxing effects begin almost immediately.
Students can do these breathing exercises sitting up on the floor if their alignment is reasonably good and they're comfortable. If not, don't hesitate to use props liberally, or encourage them to use a chair. If they're uncomfortable for any reason, it will interfere with relaxation and defeat the purpose of the exercises. It's also quite useful to do pranayama lying down in a supported position on the floor. Try placing narrowly folded blankets (or a specially designed pranayama bolster) lengthwise along the spine, and support the head and neck as necessary to keep the chin lower than the forehead. An eye bag can facilitate pratyahara, the turning of the senses inward, deepening the relaxation.
Meditation may be the most powerful yogic tool of all for managing chronic pain. And breathwork—particularly alternate-nostril breathing, or Nadi Shodhana—is a wonderful way to prepare students to meditate. Encourage students who feel like they "can't" meditate due to their busy minds to try a minute or two of Nadi Shodhana before they attempt to meditate. Doing so may allow them to slip into the practice more easily than would otherwise be possible. While both alternate-nostril breathing and meditation can be done while supine, yogis believe that it's generally preferable to do them in a seated position.
The practice of meditation can also become a powerful method of self-study, or svadhyaya. When you sit down to meditate, you observe the recurrent thoughts that crop up, and you begin to see how these thoughts—the story you tell yourself about your life—can have a profound effect on your experience.
Yoga differentiates pain and suffering. Pain can't be avoided entirely, but how much it affects you—how much you suffer, in other words—is largely a matter of the mind. Crucial to the yogic approach to pain is the ability to differentiate your pain itself from your thoughts about it and your emotional reactions to it. Often people with chronic pain fuel the fires of their suffering with negative thinking: This is never going to get better. I'm not going to be able to work. I won't be able to pay my rent. Such recurring thoughts are distressing and tend to activate the sympathetic nervous system, making matters worse.
Long-term mediation appears to change the wiring of the brain in a beneficial way. Meditation seems to increase the activation of the left prefrontal cortex, a finding that has been associated with greater levels of happiness and equanimity. There is also evidence that meditation can reduce the transmission of pain signals from the thalamus, a major relay center in the brain, to the higher brain centers, where pain signals are interpreted.
Learn More: In Yoga for Chronic Pain: Part 3, the final installment, we'll explore using sounds, such as those in chanting and some breathing practices, to bring relief of pain.
Dr. Timothy McCall is a board-certified specialist in internal medicine, Yoga Journal's Medical Editor, and the author of book Yoga as Medicine: The Yogic Prescription for Health and Healing.