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.

It's Official: Yoga Helps Depression

Evidence keeps stacking up that yoga is a boon for both physical and mental health conditions. Now, a small new study from Boston University finds that taking yoga classes twice a week may help ease depression, thanks in part to deep breathing.

The study, which was published in the Journal of Alternative and Complementary Medicine, included 30 people from ages 18 to 64 with clinical depression, who either were not taking antidepressants or had been on a steady dose for at least three months. Half of the participants were assigned to take a 90-minute Iyengar yoga class three times per week, as well as four 30-minute sessions at home each week. People in the other group took two group classes and three at-home sessions every week.

Iyengar yoga classes emphasize alignment, precise postures and controlled breathing. The classes taught in the study also included 20 minutes of slow, gentle breathing, at a rate of five inhales exhales through the nose per minute.

After about three months, most of the people in both groups had lowered their scores on a depression-screening questionnaire by at least 50%. Not surprisingly, more yoga was better; those who took three classes per week had lower depression scores than those who took two per week.

But since many participants mentioned that the larger time commitment was challenging, the researchers actually recommend two classes per week, saying that the regimen still comes with meaningful benefits.

That yoga seems to be effective is good news for people struggling with depression. Lead author Dr. Chris Streeter, associate professor of psychiatry and neurology at Boston University School of Medicine, says that the practice has far fewer side effects and potential drug interactions than mood-altering medications. The most common complaint reported in the study was a small one—temporary muscle soreness—and one participant experienced distressing thoughts while practicing breathing exercises at home.

Some people who haven’t responded to traditional treatments might do well with yoga, because unlike antidepressant drugs, yoga and deep breathing target the autonomic nervous system, Streeter says. “If your autonomic nervous system is balanced out, then the rest of the brain works better,” she says. Research shows that 40% of people on antidepressants do not recover fully from depression, says Streeter, which puts them at increased risk for a relapse. “Getting that 40% all the way better is a really important goal. Instead of adding another drug, I would argue that yoga is another thing you can add to the treatment regimen that might help.”

More research is needed to determine how yoga stacks up against other treatments. (A larger trial comparing yoga to walking is underway, the study notes.)

While Iyengar yoga is generally considered to be a safe practice for people of all levels, it’s not the only type with health benefits, Streeter adds. “It depends on who the person is and what they’re looking for,” she says. For now, what’s clear is that the type with the most health benefits will be whichever kind you stick with.

This article originally appeared on time.com and was written by AMANDA MACMILLAN.

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Getting the Right Massage for Low Back Pain

Massage therapy can provide substantial healing and pain relief for people suffering from low back pain caused by muscle tension and strain, if the correct muscles are targeted.

I asked certified massage therapist Kate Fish, who works at in a chiropractor's office, to explain how she helps heal her clients' pain with massage.

See Chiropractic Treatments for Lower Back Pain

She explained that isolating and rejuvenating the main back muscles that can have the biggest effect on low back pain caused by stressed muscles.

See Pulled Back Muscle and Lower Back Strain

Kate stresses that two important muscles, the quadratus lumborum (QL) and the gluteus medius, may play a bigger role in causing pain than most people realize, saying, "If you strain either of these muscles, the pain can be severe and debilitating.

Dysfunction in these muscles (the QL and the gluteus medius) can lead to severe and debilitating low back pain." Tweet this to share on Twitter.

Kate recommends that you specifically ask your massage therapist to spend 60 minutes on these two muscles.

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1. Quadratus lumborum (QL) muscle massage

Ask your therapist to massage the QL muscle while you lie on your side for 20 minutes on each side (40 minutes total).

The QL muscle, which connects the last rib to the pelvis, is responsible for pelvic stability and structural alignment. It is a common source of low back pain.

See Back Muscles and Low Back Pain

The muscle can become irritated when the lower body is engaged while the upper body is still. For example, activities that could irritate the QL muscle are:

See Office Chair, Posture, and Driving Ergonomics

See Running and Lower Back Pain

• Lifting that requires leaning over something (such as getting groceries out of a trunk)
• Leaning over a sink while doing dishes
• Sitting slumped in a chair
• Running on uneven pavement

Sharp, stabbing pain, urgent pain in the low back is a symptom of a hypertonic (tight) QL.

This muscle must be stretched and massaged simultaneously by your therapist in order to reduce lower back pain. Typically, clients can get relief by combining treatment of the QL muscle with 20 minutes of massage on the gluteus medias.

Back Strains and Sprains Video

2. Gluteus medius massage

After working on the QL muscle, ask your therapist to focus on the gluteus medius for 20 minutes.

The gluteus medius is a posterior hip (or buttocks) muscle that frequently causes pain when the QL muscle is irritated. The gluteus medius becomes inflamed as it tries to compensate for the QL’s dysfunction. Your massage therapist should focus on simultaneously stretching and massaging the gluteus medius as you lie on your stomach.

Kate has been able to provide significant pain relief to numerous clients by using these massage techniques in only one session. She recalls,

"One of my clients had experienced severe low back pain for 3 months. After his doctor ordered an MRI, he was worried he would have to have surgery. He visited the chiropractor where I worked as a massage therapist, and I assessed that his QL was ischemic (so tight that the blood supply got cut off). Working on these specific muscles, I loosened them and increased their blood flow, and the client was pain-free after one session."

See Pulled Back Muscle Treatment

Most likely, your massage therapist is well-versed in the muscles that cause back pain, but don’t hesitate to speak up and specifically request this type of massage if you suspect your pain is due to muscle dysfunction.

This article originally appeared on Spine-Health.com and was written by Allison Walsh.

What is Pain and What is Happening When We feel It?

What is pain? It might seem like an easy question. The answer, however, depends on who you ask.

Pain doesn’t originate at the site as most think, it’s created by the brain so we protect the area that’s in danger.

Some say pain is a warning signal that something is damaged, but what about pain-free major trauma? Some say pain is the body’s way of telling you something is wrong, but what about phantom limb pain, where the painful body part is not even there?

Pain scientists are reasonably agreed that pain is an unpleasant feeling in our body that makes us want to stop and change our behaviour. We no longer think of pain as a measure of tissue damage – it doesn’t actually work that way even in highly controlled experiments. We now think of pain as a complex and highly sophisticated protective mechanism.

How does pain work?

Our body contains specialised nerves that detect potentially dangerous changes in temperature, chemical balance or pressure. These “danger detectors” (or “nociceptors”) send alerts to the brain, but they cannot send pain to the brain because all pain is made by the brain.

When you’re injured, the brain makes an educated guess which part of the body is in danger and produces the pain there.

Pain is not actually coming from the wrist you broke, or the ankle you sprained. Pain is the result of the brain evaluating information, including danger data from the danger detection system, cognitive data such as expectations, previous exposure, cultural and social norms and beliefs, and other sensory data such as what you see, hear and otherwise sense.

The brain produces pain. Where in the body the brain produces the pain is a “best guess scenario”, based on all the incoming data and stored information. Usually the brain gets it right, but sometimes it doesn’t. An example is referred pain in your leg when it is your back that might need the protecting.

It is pain that tells us not to do things – for example, not to lift with an injured hand, or not to walk with an injured foot. It is pain, too, that tells us to do things – see a physio, visit a GP, sit still and rest.

We now know that pain can be “turned on” or “turned up” by anything that provides the brain with credible evidence that the body is in danger and needs protecting.

All in your head?

So is pain all about the brain and not at all about the body? No, these “danger detectors” are distributed across almost all of our body tissues and act as the eyes of the brain.

When there is a sudden change in tissue environment – for example, it heats up, gets acidic (cyclists, imagine the lactic acid burn at the end of a sprint), is squashed, squeezed, pulled or pinched – these danger detectors are our first line of defence.

They alert the brain and mobilise inflammatory mechanisms that increase blood flow and cause the release of healing molecules from nearby tissue, thus triggering the repair process.

Local anaesthetic renders these danger detectors useless, so danger messages are not triggered. As such, we can be pain-free despite major tissue trauma, such as being cut into for an operation.

Just because pain comes from the brain, it doesn’t mean it’s all in your head. 

Inflammation, on the other hand, renders these danger detectors more sensitive, so they respond to situations that are not actually dangerous. For example, when you move an inflamed joint, it hurts a long way before the tissues of the joint are actually stressed.

Danger messages travel to the brain and are highly processed along the way, with the brain itself taking part in the processing. The danger transmission neurones that run up the spinal cord to the brain are under real-time control from the brain, increasing and decreasing their sensitivity according to what the brain suggests would be helpful.

So, if the brain’s evaluation of all available information leads it to conclude that things are truly dangerous, then the danger transmission system becomes more sensitive (called descending facilitation). If the brain concludes things are not truly dangerous, then the danger transmission system becomes less sensitive (called descending inhibition).

Danger evaluation in the brain is mindbogglingly complex. Many brain regions are involved, some more commonly that others, but the exact mix of brain regions varies between individuals and, in fact, between moments within individuals.

To understand how pain emerges into consciousness requires us to understand how consciousness itself emerges, and that is proving to be very tricky.

To understand how pain works in real-life people with real-life pain, we can apply a reasonably easy principle: any credible evidence that the body is in danger and protective behaviour would be helpful will increase the likelihood and intensity of pain. Any credible evidence that the body is safe will decrease the likelihood and intensity of pain. It is as simple and as difficult as that.

Implications

To reduce pain, we need to reduce credible evidence of danger and increase credible evidence of safety. Danger detectors can be turned off by local anaesthetic, and we can also stimulate the body’s own danger-reduction pathways and mechanisms. This can be done by anything that is associated with safety – most obviously accurate understanding of how pain really works, exercise, active coping strategies, safe people and places.

A very effective way to reduce pain is to make something else seem more important to the brain – this is called distraction. Only being unconscious or dead provide greater pain relief than distraction.

In chronic pain the sensitivity of the hardware (the biological structures) increases so the relationship between pain and the true need for protection becomes distorted: we become over-protected by pain.

This is one significant reason there is no quick fix for nearly all persistent pains. Recovery requires a journey of patience, persistence, courage and good coaching. The best interventions focus on slowly training our body and brain to be less protective.

This article was originally posted on https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040

For more information and audio recordings discussing pain, follow this link.