“Pain is an experience produced by a body and mind trying to interpret sensation and determine whether a threat is present.”
Neil Pearson, MSc (RHBS) BscPT, BA, BPHE
International Journal of Yoga Therapy, Vol 18 (2008)
“Yoga for People in Pain”
As a warning signal, pain is helpful. It usually indicates injury and encourages change to promote healing and prevent further harm. Unfortunately, pain messages can outlive their useful purpose and take on a life of their own.
Fifty million Americans live with chronic pain and an additional 25 million have acute pain from an illness or injury according to Kathryn Weiner, PhD, the Director of the American Academy of Pain Management. More important than statistics is the fact that hurting prevents people from enjoying life. If not stopped in its early phases, pain can create a cycle that lingers and eventually becomes chronic. Therefore, it’s important to relieve pain as soon as possible.
Pain may be alerting you to one of the following five cycles, which can be resolved.
Pain Cycle Scenario #1 – Inflammation Gone Wild
Inflammation is a natural part of the acute healing process. Blood flow increases to injured areas of the body in order to bring nutrition and carry away damaged cells. When the inflammatory process doesn’t turn off, internal swelling puts pressure on sensitive tissues and creates more pain and prolonged injury.
You can control inflammation naturally with RICE: Rest, Ice, Compression, and Elevation. Notice the first criterion is rest, which means the body needs a break from all stressful activities. Ice, compression and elevation take time, but it’s worth it to spend 15 minutes icing with the body part elevated three to four times a day.
Diet is also a factor. Marcelle Pick, Ob/Gyn, NP identifies foods that help and hurt in an article about joint pain and inflammation for Women to Women. Hydrogenated oils, saturated fats, and sugar contribute to inflammation. Omega-3 oils and dark, leafy, green vegetables counteract those effects.
If natural remedies aren’t enough, there are always over-the-counter anti-inflammatories such as ibuprofen and naproxen. Note that acetaminophen does not reduce inflammation. Some people resist taking any pills. However, if you are caught in an inflammatory pain cycle, you will be tempted to take even stronger and more harmful pain relievers unless you get inflammation under control.
If all else fails, cortisone injections can be used to dramatically reduce swelling in a particular area. However, this option is used after others have failed, according to Robert Leach, MD, editor of the American Journal of Sports Medicine.
Pain Cycle Scenario #2 – Unconscious Repetitive Injury
Sometimes pain tells us that we have a bad habit which causes internal injury. The habits are so ingrained that we aren’t conscious of ourselves or the negative effects. It may start with tension in the neck and shoulders and then send pain into the arms and hands. Poor posture in front of a computer or in a car is often the culprit. Other posture habits create different injuries. Low back pain is commonly the result of sitting back on the pelvis.
This isn't a one-time injury, but instead small injuries that recur faster than the body can heal.
An assessment of your posture and movement patterns can determine if your pain is the result of an ineffective movement pattern. Structural integration practitioners are trained to spot these patterns as are physiatrists and physical therapists who treat the body holistically. Once diagnosed, the challenge is to stop the behaviors that create injury and develop new, better habits for movement. But you can’t even start the process without becoming aware of the harmful patterns.
Pain Cycle Scenario #3 – Cascade of Trigger Points
Tension is a natural reaction to pain. Muscular tension adds strain to already overloaded or weakened muscles, which increases pain. Trigger points are small sections muscles that are stuck in contraction and send pain to the surrounding or a distant area. If trigger points persist, new pain points will develop in surrounding muscles which can become a web of agony that is hard to unravel – not to mention the tension that increases every step of the way.
One solution is to decrease tension with relaxation techniques and reduce stress in the muscles. Progressive relaxation is one of the easiest techniques to try on your own and can be done in as little as 15 minutes. Lie in a quiet place and tune into your breath. Tighten the muscles in your toes as you inhale and as you exhale relax them as much as possible. Work up the muscle groups in your body (calves, thighs, buttocks, etc.) squeezing the muscles on inhale and letting go as much as possible on exhale. By the time you tighten and release your jaw and eyelids, your whole body will be much calmer.
Relieving the entire pattern of trigger points is also necessary, which requires a combination of warming the muscles, pressing the points, and stretching according to Hal Blatman, MD author of Winner’s Guide to Pain Relief. Many times you can do this yourself. The Trigger Point Therapy Workbook is also an excellent resource. It’s important, however, to get every point or the pattern can return. Massage therapists who specialize in trigger point therapy can help. The most extreme cases might need trigger point injections (usually injected with an analgesic called lidocaine), which can be administered by a physician or physical therapist.
Pain Cycle Scenario #4 – Pain and Depression or Anxiety
People with chronic pain are at higher risk of developing mood and anxiety disorders according to Harvard Health Publications, and people who are depressed are more sensitive to pain sensations, as the brain pathways that process pain and mood are related. Depression or anxiety and pain can become a vicious cycle as stress increases pain and pain increases stress.
The Mayo Clinic website recommends autogenic relaxation, progressive muscle relaxation and visualization to decrease wear and tear on the body and mind. The progressive relaxation exercise noted above can be used, as well as other activities you find to be restful. Mindfulness Based Stress Reduction, a form of meditation, has been found to be extremely effective in increasing the ability to relax and the ability for patients to cope with their symptoms including pain.
Exercise produces endorphins which reduce the perception of pain and increases the feeling of well being according to WebMD. Walking is one of the most common and helpful, but any enjoyable exercise such as biking or dancing will help combat a pain and anxiety/depression cycle.
Slow breathing is also effective. Researchers at the Barrow Neurological Institute in Arizona found that study participants who tried to slow the breath rate to half could diminish pain and improve their mood pain as reported in hc2d, a global healthcare news site. One way to slow your breath is to exhale through pursed lips, like a whisper. Another technique is to count the inhale and exhale and increase the count of each (especially the exhale) slowly and incrementally.
Medication is another option if natural remedies aren’t successful enough. Certain pain conditions respond to anti-depressants or a combination of anti-depressants and analgesics. Physicians who are experienced in treating patients with chronic pain, such as physiatrists or rheumatologists, have the best knowledge to determine if this will work for you.
Pain Cycle Scenario #5 – Amplified Pain Messages
Some of the latest research is finding that pain receptors can become oversensitive and produce pain signals out of proportion to the actual condition of the body. In this case, the message is a bit like Peter crying wolf.
Neal Pearson in the article noted in the opening paragraph puts it so well. “The body and nervous system may amplify the signals to get attention. Pain could then intensify without further tissue damage, the experience of pain could spread to new areas, previously non-painful movement might become painful.”
“New Culprits in Chronic Pain” in the November 2009 issue of Scientific American details how the sensing neurons can become overly excited and create pain without a stimulus. In this case the body–mind is misinterpreting sensation, but that doesn’t change the amount of pain felt. In some cases the pain gets worse and worse.
Researchers are developing new medicines to affect the sensing neurons and combat pain in a different way. That doesn’t mean that current natural methods won’t work. Alternative health care like acupuncture and yoga therapy can affect the nervous system to restore a more accurate internal sense of sensation, called proprioception.
Finding the Right Solution
It’s also possible that pain cycles are the result of more than one cause, for example inflammation and depression or unconscious habits and tension. As a result it can take a bit of trial and error to find a combination of approaches that work for your particular situation.
A journal can help you recognize and track your cycles and document what techniques that are most helpful. With practice, you can decode the incomprehensive messages of your pain and find some relief.