Wisteria Buds by Melina Meza
“You don’t have to be afraid of pain. If it’s going to be there, you can let it be there—but don’t let the mind be in pain with it.” —Upasika Kee Nanayon, from Tricycle Magazine’s Daily DharmaAt the recent MISTY yoga therapy conference in Montreal, Quebec, Canada, physiotherapist and YFHA contributor Shelly Prosko and I talked about yoga and chronic pain, which she has been teaching for some time with Neil Pearson, who is also a physiotherapist. I was so happy to get to pick Shelly’s brain on this topic, which I get so many questions about from our YFHA readers! So today it’s me asking the questions and Shelly answering them. —Baxter
Baxter: Can you start by talking about the problem of chronic or persistent pain—how you define it?
Shelly: To put it simply, chronic pain or persistent pain (we use the terms interchangeably) is different than acute pain in that it lasts longer than three to six months or longer than one would expect for normal tissue healing to last. Persistent pain can be a symptom of an underlying condition or it can be a diagnosis on its own. And many other symptoms can accompany persistent pain that may contribute to the overall pain experience, such as fatigue, sleeplessness, altered breathing pattern, protective postures, and guarded movement. There are also psychosocial and emotional issues that can be associated with persistent pain, such as anxiety, depression, feelings of social isolation, loneliness, hopelessness, as well as cognitive changes, such as reduced memory and learning ability, and altered thought patterns, such as pain “catastrophization” and rumination.
Persistent pain is a serious and widespread health concern that affects approximately 1.5 billion people worldwide. According to the Institute of Medicine of The National Academies, at least 100 million Americans suffer from chronic pain, which is more than from heart disease, stroke, diabetes, and cancer combined. But because persistent pain is a very complex phenomenon involving all aspects of your existence, people who suffer from it need to be treated, managed, and guided in a way that supports a holistic approach. Unfortunately, this type of treatment is not often provided, and the result is staggering rates of disability, depression, prescription painkiller drug abuse and overdose, suicide, and inability to successfully control or manage pain.
There are many possible reasons why this epidemic is poorly managed—which I won’t go into here—but whatever the reason(s), I believe there is hope! I’m convinced we can significantly improve the care and support of those with persistent pain with ongoing education about pain and pain management strategies that includes enthusiastic participation of the person who is suffering.
Baxter: Can you tell with our readers a bit about the new information you shared with me earlier regarding the Centers for Disease Control and Prevention’s recommendations for healthcare providers in US regarding the use of narcotic meds and the gap you see that is creating so many problems for those suffering with chronic pain?
Shelly: On March 15, 2016, the US Centers for Disease Control and Prevention (CDC) released guidelines for healthcare providers who prescribe painkillers (narcotics/opioids) for patients with persistent pain. These guidelines were a response to the rising rates of opioid abuse and overdose and a parallel increase in opioid prescriptions. They were also a response to solid evidence that showed opioids are not very effective in alleviating persistent pain or helping people improve function (and in some cases, long-term opioid use even appears to be correlated with hyperalgesia, or increased pain sensitivity). The CDC states that these guidelines are intended to:
“ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function, and reduce the number of persons who develop opioid use disorder, overdose, or experience other adverse events related to these drugs.”
Although these guidelines were established with the best of intentions, there has been some backlash and gaps in treatment guidelines have surfaced. One year after the guidelines were released, a follow-up survey was conducted by the Pain News Network and the International Pain Foundation. The survey was divided into sections for healthcare providers and people in pain. The results were disheartening, to say the least. They showed that both healthcare providers and people in pain believed that the guidelines have resulted in more harm than good. And a whopping 90% agreed that the guidelines have not improved the management of pain. The Pain News Network reports that the guidelines have failed, saying there was:
“a failure to stop abuse and overdoses, hoarding behaviors by well-intentioned patients, increased use of illegal drugs and, worst of all, suicides increase.”
(In Canada, there are similar opioid prescription guidelines that organizations such as Pain BC have responded to by their outlining valid concerns in a formal document.)
So there now appears to be a huge gap in education, guidance, and training for healthcare providers on what to do either in lieu of prescribing or in conjunction with changing opioid prescriptions. We can't just implement the new guidelines without providing other evidence-based, safe, and effective options that are accessible and feasible to deliver. In my opinion, this is a crisis! There is so much work to be done.
The good news is that there are many people and organizations out there doing phenomenal work to help improve overall pain management that uses an evidence-based, holistic approach and empowers the person in pain to be involved in a successful way.
Baxter: What you just said—that chronic pain is quite complex and that the use of narcotic/opiod medicines is not proving very effective in treatment—is so important because it opens the door to using yoga to address the whole person as well as the underlying causes of a person’s ongoing pain. You yourself are part of a training program that teaches people how to more effectively address pain using yoga tools. Can you give us a brief overview on how that looks and some of the key tenants of your approach?
Shelly: Yes, I have the privilege of learning from and training and teaching with Neil Pearson, the founder and creator of Life is Now Pain Care. The Pain Care Yoga (PCY) training program is for yoga teachers/therapists, healthcare professionals or any movement or bodywork practitioners who work with people suffering from persistent pain. It also includes courses and resources for people in pain. The Pain are Yoga program is an educational and practical program that enhances the ability of people to manage pain, move with more ease, and live well again by integrating pain science education, yoga philosophy and techniques, and the lived experience of pain. It allows people in pain to access a variety of self-care practices that provide a more self-empowered approach to pain care, in addition to their current medical care.
The self-care practices include breath and body awareness practices, self-regulation practices, movement guidelines to follow when moving during pain, and unique daily planning strategies that have been shown to be successful with people in pain. A good description of how a program like this can help someone suffering from persistent pain is this testimonial from a patient of mine:
“What helped me the most was learning how to breathe and paying attention to it more often. I realized I was almost always holding my breath when I moved because I thought that would actually protect me, but it didn't, it actually made my pain worse. The other thing that really helped me was to trust myself and my spine and know that my body wasn't going to break. Yoga helps me practice letting go and move more freely and I can feel that immediately helps my pain. It's amazing how much more in tune I am with my body. Now I am more aware and know when I'm tense, and I can change it and then my pain changes. Shelly (yoga) has taught me how I can help myself, and not just rely on others to fix my pain. The pain doesn't control me anymore. I feel like I'm more myself again. It feels really good, and hopeful."
Baxter: Can you tell us about one practical yoga tool or technique for addressing persistent or chronic pain?
Shelly: If we want to take advantage of the capacity of our nervous system to change pain, we first need to practice awareness! And research suggests that mindfulness methods that focus on awareness of subtle non-pain sensations show a reduction in persistent pain. A breath awareness practice means paying attention to a variety of characteristics of the breath, without trying to change anything, and without getting caught up in elaborative stories or thoughts. In other words, simply notice the breath.
The technique includes paying attention to the rate, pace, depth, sound, length of inhale and exhale, temperature of the breath, how the breath moves in the body, or other qualities like if the breath feels rigid or smooth or if you feel like you are breathing more through one side of the nostril than the other. The next step is to then learn a breath regulation practice (pranayama). Neil Pearson has an example of a guided breath regulation and awareness practice here.
Baxter: You and Neil do workshops and trainings in many locations. Where can our readers find out about opportunities to study and learn with you?
Shelly: Readers can find Neil’s schedule and calendar of events at www.lifeisnow.ca and can follow Life is Now Pain Care on Facebook and Twitter. My schedule and calendar of events is at www.physioyoga.ca. You can also follow me at Prosko PhysioYoga Therapy on Facebook and Twitter or sign up for my newsletter to keep up to date with what I am offering.
For people who cannot travel to study with us, we have a short introductory online webinar accessible through Yoga U Online: Yoga, Neuroplasticity and Pain: New Hope for Self Empowerment and Healing. And Neil has a phenomenal online Pain Care for Life curriculum with the first 5 steps for free, as well as many other resources on his site.
We also have Overcome Pain with Gentle Yoga video practices as a complement to (not to replace) one’s pain care program. They are available for download on vimeo or order as DVD. The four-minute trailerhttps://vimeo.com/ondemand/overcomepaingentleyoga2 outlines the seven practices of different themes. And I have a series of Creating Pelvic Floor Health PhysioYoga videos that can be useful for people suffering from chronic pelvic pain (as a complement to their existing treatment).
Thank you, Baxter, for this opportunity to share all this. There are others out there doing very valuable work to help people in pain improve pain management, movement, function and quality of life. Together I believe we can all make a difference!
Shelly has been integrating yoga into her physical therapy treatments since 1998, addressing a wide variety of conditions including persistent pain. Currently, she travels globally offering specialty PhysioYoga and Life is Now PCY courses, lecturing at medical college programs, instructing at numerous therapeutic yoga programs, and presenting at international conferences. She is dedicated to actively promoting the integration of yoga into healthcare by inspiring, empowering, and educating health professionals, yoga practitioners, students, and people in pain about ways yoga can be used safely and effectively to address a variety of health issues and improve quality of life. Please visit www.physioyoga.ca for more information.
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