How Does Yoga Relieve Chronic Pain?

Chronic pain triggers changes in brain structure that are linked to depression, anxiety, and impaired cognitive function. New research shows that practicing yoga has the opposite effect on the brain and can relieve chronic pain.

Chronic pain alters brain structure. Brain imaging studies have shown that chronic pain leads to changes in gray matter volume and the integrity of white matter connectivity. Gray matter is home to the neurons in specific brain regions, while white matter creates communication lines between your various brain regions.

In a recent lecture, “Effect of Environment on the Long-Term Consequences of Chronic Pain,” at the American Pain Society's(link is external) annual May 2015 meeting in Palm Springs, M. Catherine Bushnell, presented findings from cutting edge research on the ability of yoga to counteract chronic pain that she's spearheading at NIH/NCCIH.

Catherine Bushnell(link is external), PhD, is scientific director of the National Center for Complementary and Integrative Health (NCCIH) at the U.S. National Institutes of Health (NIH) where she oversees a program on the brain’s role in perceiving, modifying, and managing pain. In a press release, Bushnell summed up the findings of her research by saying, "Practicing yoga has the opposite effect on the brain as does chronic pain." 

Bushnell and her colleagues are conducting research aimed at discovering non-pharmacological treatments for pain. They've found that chronic pain can be prevented or reversed through mind-body practices. Lifestyle choices—such as practicing yoga or meditation—have been shown to reduce pain perception and offset the effects of age-related decreases in gray matter volume while helping to maintain white matter integrity. 

Reduced gray matter volume can lead to memory impairment, emotional problems, and decreased cognitive functioning. Hyper-connectivity of white matter tracts between brain areas associated with negative emotions and pain perception can hardwire these corresponding states of mind.

The researchers used diffusion tensor brain imaging to analyze gray matter volume and the integrity of white matter tracts. Bushnell hypothesizes that increased size and connectivity of the insular cortex is probably the most important brain factor regarding changes in an individual's pain tolerance and thresholds.

Yoga appears to bulk up gray matter through neurogenesis and strengthen white matter connectivity through neuroplasticity. After assessing the impact of brain anatomy on pain reduction, Bushnell believes that gray matter changes in the insula or internal structures of the cerebral cortex are the most significant players involved in chronic pain.

"Insula gray matter size correlates with pain tolerance, and increases in insula gray matter can result from ongoing yoga practice," said Bushnell. Yoga practitioners have more gray matter than controls in multiple brain regions, including those involved in pain modulation. Bushnell stated, 

Brain anatomy changes may contribute to mood disorders and other affective and cognitive comorbidities of chronic pain. The encouraging news for people with chronic pain is mind-body practices seem to exert a protective effect on brain gray matter that counteracts the neuroanatomical effects of chronic pain. Some gray matter increases in yogis correspond to duration of yoga practice, which suggests there is a causative link between yoga and gray matter increases.

Rodent studies have shown that increased levels of stress alters pain behaviors, whereas socially and physically enriched environments reduce reduce pain-related brain changes. These findings in both humans and animals indicate that the adverse effects of chronic pain can be reduced, or prevented, by altering environmental factors and making lifestyle choices that improve the pain modulatory systems in the brain.

Yoga Increases Gray Matter Brain Volume and White Matter Connectivity

Bushnell has been working with Chantal Villemure to study the benefits of yoga on chronic pain. In their recent study, they focused on people who had been practicing yoga regularly for at least six years and compared the "yogis(link is external)" to healthy people who didn't practice yoga but were matched for age, sex, education, and other exercise.

Bushnell and Villemure found dramatic differences in gray and white matter between the general population and the yoga practitioners. As Bushnell explains,

We found from brain anatomy studies that the people practicing yoga had more gray matter in a number of regions; as we get older, we lose gray matter, but we didn’t see that decrease in the yoga practitioners, which suggests that yoga may have a neuroprotective effect. When we looked at pain perception, there was a significant increase in pain tolerance in the yoga practitioners, and there was a change in pain thresholds, too.

Villemure has a theory that many of the benefits of yoga might be related to autonomic nervous system and stress reduction as it relates to chronic pain. The autonomic nervous system has two branches: the sympathetic nervous system(link is external) and the parasympathetic nervous system(link is external). Villemure is also examining how yoga practitioners might have a different method of coping with the anticipation of pain.

When most people are expecting pain, it triggers the “fight-or-flight" response of the sympathetic nervous system which causes cortisol levels to skyrocket. On the flip side, Villemure observed that when yogis anticipate pain, their parasympathetic nervous system activates. This creates a "tend-and-befriend" or "rest-and-digest" response, as opposed to a "fight-or-flight" response.

Conclusion: Yoga Is a Viable Drug-Free Treatment Option for Chronic Pain

Most of the pharmacological treatments for chronic pain are opioid based and are highly addictive. Luckily, the effectiveness of non-pharmacological interventions such as yoga and meditation have been shown to have potent pain-relieving effects on the brain. In the long run, alternative treatments for pain, such as yoga, could be more effective than pharmaceutical treatments for relieving chronic pain. 

This article originally appeared on psychologytoday.com and was written by Christopher Bergland.

Acupuncture and Migraine Management

How acupuncture can help

There have now been many controlled trials of acupuncture for migraine, with some large, high-quality ones in recent years. The results of the latest reviews are quite consistent: acupuncture is significantly better than no treatment/basic care for managingmigraine, and appears to be at least as effective as prophylactic drug therapy, with few contraindications or unpleasant side effects (Linde 2009, Wang 2008, Sun 2008, Scott 2008).  Acupuncture has a similar or slightly better effect than sham procedures, which themselves can perform as well as conventional drugs, indicating that sham acupuncture is not an inactive placebo but a contentious alternative intervention. Acupuncture has been found to be cost-effective (Witt 2008; Wonderling 2004). As well as prevention it may also be used to alleviate symptoms in acute attacks (Li 2009). There is preliminary qualitative evidence from patients that acupuncture can increase coping mechanisms as well as relieve migraine symptoms (Rutberg 2009).

Migraine is thought to begin as an electrical phenomenon in the cerebrum that then affects blood vessels, biochemistry, and causes neurogenic inflammation.

Acupuncture can help in the treatment of migraine by:

• Providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurochumoral factors and changes the processing of pain in the brain and spinal cord (Zhao 2008, Zijlstra 2003, Pomeranz, 1987)
• Reducing inflammation - by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijlstra 2003).
• Reducing the degree of cortical spreading depression (an electrical wave in the brain associated with migraine) and plasmalevels of calcitonin gene-related peptide and substance P (both implicated in the pathophysiology of migraine) (Shi 2010).
• Modulating extracranial and intracranial blood flow (Park 2009).
• Affecting serotonin (5-hydroxytriptamine) levels in the brain (Zhong 2007). (Serotonin may be linked to the initiation of migraines; 5-HT agonists (triptans) are used against acute attacks.)
  
  This article originally appeared on acupuncture.org.uk

Float Therapy: Mental and Physical Relief From Chronic Pain

Chronic pain (anytime) in the summertime can be a double whammy of discomfort. Those suffering from chronic pain find that relaxation and sleep is even harder to come by due to the heat, and lack of sleep can intensify pain. It’s a vicious circle. There are ways to beat the heat in the summer, including keeping a cool, dark bedroom for sleeping, exercising in the morning when it is coolest, and eating refreshing summer fruits and veggies to keep your internal fires cool.

In addition to those tips, many chronic pain sufferers find relief through meditation.

One way to get your zen on is by visiting a float tank, also known as a sensory deprivation tank. Flotation REST (reduced environmental stimuli therapy) was developed in the 1950s by John C. Lilly, M.D. and uses a water-filled tank that is approximately the size of a bed and heated to skin temperature. The water is saturated with Epsom salts so that the patient can float without any effort.

Patients remove their clothes, enter the tank, turn off the lights, and relax. The idea is that this sensation of zero stimuli will help to focus inward, eliminating distractions and calming the mind and body. The Fibromyalgia Floatation Project (FFP) believes that spending an hour in a float tank will help sufferers reduce pain significantly.

Some of the potential benefits for fibromyalgia include:

• Eliminates stress, or improves ability to handle stress better, by lowering cortisol
• Promotes deep rest, eliminating fatigue
• Aids in combating insomnia
• Improves focus and concentration
• Increases dopamine production, the “feel good” hormone produced by the brain
• Reduces pain by relaxation and hormone production

When external stimuli are eliminated, the fight-or-flight response is deactivated. This response is the cornerstone of the stress response, and many chronic pain sufferers are constantly in this state of stress as their body reacts to pain. Chronic stress increases pain intensity. Eliminating or coping with stress better can help decrease sensitivity to pain.

• Manages arthritis, back pain, sports injuries, and pregnancy discomforts
• Improves chronic pain conditions
• Relieves pain and emotional stress for fibromyalgia patients
• Creates an ideal environment for pain relief with weightlessness and lack of effort
• Floating provides natural traction for a wide range of spine-related injuries

These claims are supported by research done by Thomas H. Fine, associate professor in the Department of Psychiatry of the Medical College of Ohio, and Roderick A Borrie, Ph.D., clinical psychologist at South Oaks Hospital, Amityville, New York. They found that:

“[F]lotation REST can have an important role at several stages of the pain management process. By reducing both muscle tension and pain in a relatively short time and without effort on the part of the patient, flotation provides a dramatic demonstration of the benefits of relaxation. Relief is immediate and, although temporary, offers promise of further relief from REST and other relaxation-based strategies. Symptom reduction gained from flotation can increase a patient’s motivation and interest in the remainder of the therapy plan. Pain patients generally come into treatment feeling suspicious and skeptical, requiring a clear demonstration that they can be helped.”

In their research, they found extraordinary benefits for chronic pain patients. Most of the patients that utilized flotation REST suffered from chronic pain for longer than six months and floated from one to 16 sessions. Overall, they reported a reduction in pain that averaged 31.3%, with the highest level of relief in the upper back at 63.6%, and the lowest in the legs at 15.3%. This seems to be a “clear demonstration” that float tanks help with chronic pain.

A small-scale 2012 study also showed the profound benefits of float tanks. 81 volunteers with fibromyalgia were given three free float sessions in exchange for feedback on a questionnaire.  Across the board, participants reported an immediate drop in pain and an increase in well-being. They also indicated a drop in pain over the course of the three sessions, so that their pain levels when they entered the tank were lower than they had been when they entered in the previous sessions.

This result speaks to the long-term potential for pain reduction.

In addition to chronic pain, advocates of flotation therapy also tout its benefits for creativity and excellence in sports. Researchers Oshin Vartanian of the University of Toronto and Peter Suedfeld of the University of British Columbia found that musicians who floated in the tank for one hour per week for four weeks showed better technical ability at the end of the research. The researchers compared two-minute recordings before and after from the study participants and the control group and found “a significant difference between the treatment and comparison groups on technical ability, but not on any other dimension.”

College athletes benefited from REST also. Multiple studies have found that when combined with imagery, athletes from gymnasts to professional tennis players to collegiate basketball players improved performance measurably over the long term.

This article originally appeared on paindoctor.com

A Must Read For People in Pain: 'Explain Pain'

If I could make only one recommendation to individuals living with chronic pain, it would be to read the book Explain Pain by David Butler and Lorimer Moseley.

Directed at both clinicians who work with chronic pain patients and patients who live with chronic pain, Explain Pain shows how the discoveries of modern pain science can be put to practical use. Written in understandable language with a touch of lighthearted humor, Butler and Moseley take a complex subject and make it possible for the average person to understand and use. One client remarked that she thought it would be hard to read and was delighted that she did not find it difficult at all. 

Pain education can help

Research has demonstrated that pain education can help to reduce chronic pain. For instance, a recent study by the army followed 4,325 soldiers over a two year period and found that one session of pain education could help lower the incidence of low back pain. Understanding how pain works is not a magic bullet that will make pain go away immediately, but it can help to take some of the fear and anxiety out of the experience which can then begin to help alter the experience. With time, thinking a little differently about pain can lead to more successful strategies for reducing, limiting, and eliminating pain.  

Pain is useful and should not be ignored. Pain is a protective mechanism generated by the brain in response to perceived threat. However, when pain is chronic and there is no direct or immediate threat to the body, understanding how the body can get "stuck" in pain can suggest ways to help it get "unstuck." 

Butler and Moseley provide some amazing stories to illustrate the surprising discovery that pain is not directly related to tissue damage. While this concept may, at first, seem odd and difficult to grasp, they produce convincing evidence to support this idea. Consider this: a paper cut produces very little tissue damage, yet can cause a lot of pain. A soldier can get shot in battle, yet not realize he is injured until he is off the battlefield. Amputees may experience phantom limb pain in tissue that no longer exists. How does that happen? The part of the brain that corresponded to the amputated limb can still generate the sensation of pain, even after the limb is gone.

Pain can be influenced by context. If everyone around us seems to be in pain, we may also expect to be in pain. Athletes involved in vigorous sports ignore impacts that would upset most of us because to them it's all part of the game. In that context, it is expected and not a threat. 

Butler and Moseley describe how pain is generated by the nervous system. Understanding that pain is generated by the brain, rather than by damaged tissues, does not mean that pain is "all in your head" and should be ignored or dismissed as imaginary. In fact, understanding that pain is the body's alarm system highlights the importance of treating pain so that the alarm system does not become oversensitive. 

The book describes what happens in different systems of the body and how they may be affected by pain. Normal responses to painful stimuli are contrasted with what happens when the responses become altered. The influence of our thoughts and beliefs is examined for the role it can play in chronic pain.

Practical suggestions

The last few chapters of Explain Pain suggest practical tools that can be used to manage chronic pain. Using "the virtual body" is explained, as is the use of graded exposure to break the association between particular movements and pain and to cultivate successful movement without pain. 

Pain education should be part of every client or patient's rehabilitation.Explain Pain provides an excellent model for pain education.

One of my clients suffered for many years with a painful chronic condition and found this book immensely helpful. Although she had seen many doctors and therapists, she had never been given any pain education. After reading this book, she asked, "Why didn't anyone tell me this?" My response was, "They didn't know." Although Explain Pain was first published in 2003, pain science is still only slowly finding its way to practitioners. 

Since I've begun studying pain science, I've incorporated information the information presented in Explain Pain into my practice. It has been a useful tool for helping clients get out of pain and feel in control of their lives once again.

Additional resources

I've posted a fifteen minute TED Talk by Lorimer Moseley on Why Pain Hurts in a previous post. There is also, in the same article, a forty-five minute lecture to a professional audience for those geeky folks who want to understand details about the biology of pain. Recently, I've found a twenty-five minute video by Moseleywhich has become a favorite because he addresses how we think about conditions like herniated discs and how our thinking can feed and perpetuate fear, anxiety, and pain. If you watch only one of these videos, this is the one I recommend. These videos are educational and entertaining. Moseley, who is both researcher and clinician, has a charming Australian accent and a great sense of humor. Imagine Crocodile Dundee giving an introduction to pain science and you'll get the picture.

For more information about understanding pain, I also suggest the following: 

Painful Yarns by Lorimer Moseley (stories to help understand the biology of pain)

Also, check out this article about understanding how pain works by Paul Ingraham of SaveYourself.ca. 

Cory Blickenstaff, PT, has put together some useful videos of "novel movements." Here are links to the ones on the low back, neck, and hand, wrist, forearm, and elbow. 

This article originally appeared massage-stloius.com and was written by 'Ask the Massage Therapist'.