Chronic Pain and Meditative Movement

Chronic pain is generally defined as “any pain that lasts longer than three to six months”, or pain “that lasts beyond the time normally required for bodily tissues to heal”. It can be debilitating, even immobilizing, often turning simple tasks into ordeals, thereby impacting most aspects of daily living, and significantly interfering with an individual’s quality of life.

Chronic pain may result in decreased productivity, social issues, and/or relationship problems. Chronic pain also takes a psychological, cognitive, and emotional, toll; patients often experience concurrent depression, anxiety, loss of confidence, and, even, guilt.

In 2012, Health economists from Johns Hopkins University gauged the economic burden of pain in the United States by assessing the incremental costs of health care due to pain, and the indirect costs of pain from decreased productivity. They estimated that the annual cost of chronic pain ranged from $560 to $635 billion; and discovered that, compared to other major disease conditions, the per-person cost of pain is lower, yet, the total cost of pain is higher.

Pain triggers the fight-or-flight survival mechanism, which initiates physical and chemical changes in the brain, and induces bodily stress responses such as increased heart rate and blood pressure, release of stress hormones, and prioritization of blood to the muscles. Chronic pain effectuates the prolongation of these brain and bodily changes, which can result in actual psychological changes that can significantly impact certain brain functions, and lead to behavioural change. For example, by influencing sensory input, thought, experience, and understanding, chronic pain potentially causes changes in these brain systems that compose cognitive function; and, thereby, negatively affects cognitive function. Over time, this may lead to a patient’s self modification of their own behaviour. These prolonged brain and bodily changes can also result in actual physiological changes that can significantly affect certain bodily functions, leading to complications such as heart, and gastrointestinal, issues. Further, physical pain signals and emotional pain signals travel along almost identical pathways through the nervous system; as a result, chronic pain often correlates with, and is exaggerated by, an increase in emotional pain (and vice-versa).

Chronic pain is also often accompanied by psychiatric disorders; such as anxiety, depression, and pain medication addiction.

Anxiety develops because the patient (often) possesses no way to flee, or find a lasting solution for, the pain, and no way to predict when the pain will return; with the resultant heightened sensitivity possibly developing into a hyper-vigilance of other, unrelated, “threat” cues. Depression develops from the patient’s perceived loss of control, their loss of self-agency, because the threat perceived by the body and the mind (i.e. the cause of the pain) is internal. When chronic pain and depression are simultaneously present in a patient (i.e. are co-morbidities), and are not under control, there is often exacerbation of all associated symptoms, resulting in greater pain, increased depression, and loss of functional ability.

Chronic pain is not merely sensorial. It is dependent on how the brain processes pain signals. As such, many treatment regiments depend upon opioid medications that suppress the body’s perception of pain by inhibiting pain signals between the brain and the nervous system. These medications are often extremely addictive, especially because prolonged use can lead to tolerance, wherein, over time, qualitatively similar relief requires ever-increasing dosage quantities. Many of these medications also feature side effects such as drowsiness, fatigue, and decreased motivation. Further, chronic pain is often accompanied by significantly increased guilt. Chronic pain patients often experience guilt for being unable to participate in social activities, for being unable to manage their pain better, for disappointing family and friends, and, even, for legitimizing their pain without concrete evidence and diagnosis.

Guilt affects self-identity, self-perception, and self-value; and the guilt that accompanies prolonged exposure to chronic pain can potentially result in a self that is defeated and despondent.

The complexity of chronic pain diagnoses and treatments, its high prevalence in modern society, and the negative consequences of pain medication dependence, have led to interest in more holistic treatment programs that often include adjunctive therapy and alternatives to medication.

One movement modality that has some proven efficacy in the treatment of chronic pain is meditative movement.

Meditative movement and meditation have been found to correlate with positive improvements in stress levels, depressive symptoms, pain acceptance, coping, substance abuse, quality of life, and functional status.

Meditative movement practices which focus on using slow bodily movements, and combine awareness of breath and awareness of bodily movements, facilitate a detached, observational stance. They refocus the mind on the present, and increase a patient’s awareness of their external surroundings, bodily movements and sensations, breath, and thoughts. This allows the patient a dispassionate perspective that, potentially, enables them to reframe the movement experience, and, accordingly, their experience of their chronic pain symptoms, which can possibly extend beyond the meditative movement practice, into other facets of their life.

Several small studies, specifically regarding pain patients and meditative movement practices, show some promising outcomes on physiological symptoms, such as chronic low back pain, musculoskeletal pain, and fibromyalgia; psychological symptoms, such as somatization disorder, mood disturbance, anxiety, and depression; as well as pain-related drug use. The relief from chronic pain, and the invigoration, that a meditative movement practice can provide, can serve as excellent motivation for a patient to integrate movement and exercise into their lifestyle; this, in turn, may have the additional benefit of empowering the patient with some sense of self-agency.

Justin is a Sculpt, Barre, and Yoga teacher based in New York City. Various nerve injuries, debilitating chronic pains, and postural problems, led him to yoga and pilates; which profoundly impacted his body and mind. Cognizant of the relation between the physical, psychological, and emotional, Justin has a deep love for creative yet sound movement patterns that nurture proprioception and mobility, cultivate strength and balance, and instill fluidity and adaptability.