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Yoga - A Container for Pain Care



'Yoga as a container for pain care' - this is a statement Niamh and I have used in various writings and presentations but what does it actually mean? Let’s start with a couple of stories for illustration purposes. Picture this Peanuts comic strip, Lucy is acting as a therapist and Charlie Brown is sitting on the patient side of the cardboard box-office. “Therapist Is In,” is hand written overhead. Lucy says, “You know what the problem is with you Charlie Brown, it’s You.”

Maybe that feels a little offensive, but if we remove the protective response for a moment we may be able to see the immense wisdom Lucy is sharing with Charlie Brown.

Perhaps, this story will feel more accessible. When I first moved to Haines from Southern California, a homesteader here named, Guy Hoffman, helped to teach me the ways of living in a small, remote, community in the wilds of Alaska. As he watched me struggle with some of the transitions from a California to Alaska lifestyle, he said, “sometimes in life you have to be your own medicine.”

As the science and evidence behind effective pain treatment strategies evolved a common theme quickly spread to clinicians. Interventions need to be delivered from a biopsychosocial approach. To me the only way this seemed genuinely possible was to get to know the depth of my patients. Which would mean they had to also know themselves, intimately.

Ultimately, yoga is the study of You. It is designed to offer us a complete ‘container’ to hold what we need to know our selves, biopsychosocially, as a means to fulfillment or a ‘blissful’ life. Niamh and I began the conversation that eventually led to writing, Pain Science Yoga Life with this realization - If yoga can offer the container of self-study to each of us exactly as we are, surely it can also be adapted to lead us from the suffering of pain back to a functional life.

Yoga, meaning to yoke, or bring together, the aim of a yoga practice is to unite the physical body, the thinking mind, and the spirit (how you connect from your inner-self to the world around). The traditions of yoga offer a number of different domains including the 8 Limbs, Yoga Sutras, and Chakras to name a few. In Pain Science Yoga Life, we chose the 8 limbs to act as our access points to the container. Each one can help facilitate self-study and care to help shift an individual’s pain experience from suffering to functioning. This is what the Pain and Yoga Mandala (Figure below) starts to illustrate. In chapter two of Pain Science Yoga Life, we offer a thorough introduction into each one of the 8 limbs and connect them directly to pain-care. Below, is a short overview of the 8 limbs of Yoga.


The Pain and Yoga Mandala (c) Moloney & Hartman, Pain Science Yoga Life. Handspring Publishing Ltd.



The 8 Limbs of Yoga and Pain Care:

1. Yamas – self-restraint. There are five subcategories. Each represent a moral discipline or vow. In general, the yamas offer us a guide to act with kindness and honesty toward others as well as ourselves. This limb also offers guidance toward recognizing our tendencies toward grasping and encourages a positive outlook on our life.

Putting Yamas to practice in pain care could be as simple as encouraging optimism for recovery. Rather than focusing on what is no longer feasible due to pain, why not recognize what is still possible. We can also learn to turn our inner dialogue into kind words and gentle nourishment.


2. Niyamas – self-study, self-observance. Niyamas also has five subcategories. These facilitate learning and caring for ourselves, with discipline and flexibility in body, mind and spirit.

Putting Niyamas to practice in pain care is the ideal opportunity to begin an open dialogue regarding our thoughts, emotions and beliefs about pain. It takes inner strength or will to stay on this road of learning our tendencies and recognizing moments to create meaningful shifts.


3. Asana – a posture or position that is comfortable and steady – Asana is the physical practice, or mindful movement.

This one may be obvious and yet difficult for many to put into practice in pain care. The key is ‘mindful movement', meaning creating movements, positions or shapes with the body with observation. It is here that we can learn to identify adaptive and maladaptive (helpful or unhelpful) patterns in response to pain. We can also learn to separate physical sensations from pain.


4. Pranayama – meaning life force. This is a breath practice.

In pain care sometimes, this is the best place to start and return to again and again. When we can’t quite seem to shift anything else we can lean into the comfort of softening our own breath.


5. Pratyahara – a practice of drawing inward and letting go of our focus on the outside environment. This directly connects to interoception or how we perceive our physical self.

In pain, the perception of our body may shift. Pratyahara, could act as a vehicle to gain awareness of what is true in our physical self and what we have begun to perceive as true.


6. Dharana – concentration. The ability to choose how and where we place our focused attention, mindfulness.

This limb can be combined with the five above in pain care. Choose a place of focused concentration, like the breath during a painful flare may help to soften the experience.


7. Dhyana – meditation. Dhyana is where we practice and gain the ability to maintain a chosen focus or concentration.Taking a few moments each day, or each week, to perform a specific mindful practice can help us gain the skill of focused attention.

In pain care meditation can soften the sometimes strong emotions or negative narratives. It can also stimulate our natural pain relieving system. In the example given above, we can use the breath as a focus to soften a painful flare. This will be easier to do if it has been practiced during neutral or less painful times.


8. Samadhi – A higher state of consciousness, bliss. This state of consciousness is reached when we can see the reality in front of us, with equality.

In regards to pain, samadhi may be the path of life beyond suffering.

Out of the head, onto the mat, and into life:

Can you be your own medicine? Choose one limb and think about how you might use it to begin to shift an experience with something painful or difficult in your life. Use the wisdom Lucy offered Charlie Brown and try to identify the “You” that is limiting your contentment in life.

See here for the evidence supporting the use of Yoga in Pain Care.

References

1. Moloney, N., & M. Hartman. PAIN SCIENCE - YOGA - LIFE. 2020, United Kingdom: HANDSPRING Publishing LIM

2. Saraswati, S.S., Asana Pranayama Mudra Bandha. 2013, Ganga Darshan, Mungar, Bihar, India: Yoga Publications Trust.

3. Iyengar, B.K.S., Light on Yoga. 1979, New York: Schocken Books.

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