Post By: Vishwanath Iyer Published on: December 15, 2016 Reading time: 15 minutes
Acknowledgement – School of Yoga is deeply grateful to late Dr. V. Sivaraman for his collaboration of pain management using Yoga therapy.
Pain is caused by an unpleasant stimulus. Consequently, it becomes a stressor which destabilises homeostasis. As a result, the body’s adoptive response mechanism initiates physiological responses to meet the threat. However, prolonged exposure to the lifesaving chemicals triggered by the response can result in harmful side effects.
Importantly, though pain is noxious and unpleasant, it is a powerful protective force. Pain sends a signal that the body needs protection and healing. But, if correction does not occur, or the pain persists, the pain may become chronic. Therefore, pain must be contained or relieved.
The body’s response to pain is centered around the Sympathetic Nervous System (SNS). The SNS reaction to pain is similar to fear and invokes a “fight or flight” response. To start with, the amygdala is activated by the pain. Immediately, the amygdala drives the hypothalamus to produce corticotrophin-releasing hormone (CRH). Next, this stimulus is transmitted to the pituitary gland which activates the Sympathetic Nervous System to release the production of adrenocorticotrophin (ACTH). Finally, the SNS also stimulates the adrenal medulla to release noradrenaline, serotonin and endogenous opioids into the dorsal horn.
As a result, there is stimulation of the heart and lungs, resulting in increased heart rate, blood pressure and respiratory rate. Consequently, there is increased blood supply to the musculo-skeletal system. This also results in reduced supply to the digestive system resulting in reduced secretion of digestive enzymes and peristaltic action. This results in a reduced ability to digest food, nausea, vomiting and constipation.
The level of cortisol in the blood provides a feedback mechanism to the hypothalamus, thereby preventing over-release.
Under normal circumstances, this mechanism is effective in reducing pain and preventing inflammatory response from getting out of control. However, long term stress and pain results in continuous production of cortisol which leads to resistance in the glucocorticoid receptors and impairs feedback to the hypothalamus. Consequently, cortisol slowly loses its ability to keep inflammation under control. Also, higher levels of inflammatory mediators can lead to depression, anxiety and sleeplessness.
Pain induces a variety of interrelated changes in several body systems. During the critical phase, these interventions are lifesaving and helpful in containing and relieving pain. However, over time, these responses result in potentially harmful side-effects, especially in patients whose reserves are already low.
Normally, a person in extreme pain will display elevated heart rate, blood pressure and respiratory rate. Also, they may shiver; have fever, goose bumps and pale skin. However, in case of chronic pain, these symptoms might not be exhibited unless the patient’s condition deteriorates. Hence, such indicators are often misleading and unreliable. So, it is important that the patient is constantly assessed for pain through various validated tools. This will help in effective pain management.
Very acute and chronic pain is called fibromyalgia.
All damage to tissue triggers the immune system which is based on the production of adrenocorticotrophin (ACTH). This results in blood vessel dilation and permeability to facilitate translocation of immune cells to the point of injury. Eventually, the quickened permeation also results in reduced oxygen content in the blood stream and this can have long term impact on the overall physiological health of the person.
Pain triggers an emotional response orchestrated by the various regions of the cortex – the amygdala, hypothalamus, brain stem and modulatory system.
Often, a high level of pain induces strong emotions such as fear or intense anxiety. Consequently, this leads to high state of arousal which can result in reduced sensitivity to pain. Similarly, a low or moderate state of arousal could lead to a lowered sensitivity to pain, making pain more easily felt.
Therefore, assessment of mood is very important for the right treatment and support to be given.
Cortisol is a steroid hormone that regulates many processes within the body, from metabolism to control of salt and water balance which affects blood pressure. Also, it plays an important role in the body’s response to pain. Pain induces the Sympathetic Nervous System to release the production of adrenocorticotrophin (ACTH). Unfortunately, chronic pain can lead to continuously elevated levels of cortisol and adrenal. Consequently, this can lead to adrenal fatigue. This includes, inability to get up in the morning, handle stress, craving for salty food, overuse of stimulants such as coffee and a weak immune system.
Growth Hormone is secreted by the anterior pituitary gland. This hormone affects cellular activity and metabolism of protein, carbohydrates and fat.
Additionally, pain prompts the pituitary gland to increase secretion of GH. Excessive GH results in increased blood glucose level and insulin resistance.
However, a deficiency of GH can cause muscle weakness and fatigue. Therefore, GH is an important element in pain management.
Cytokines are produced locally by peripheral cells local to the injury and by cells in the dorsal horn of the spinal cord and brain.
Immediately after an injury, sensory nerve endings get sensitised and stimulate production of noxious mediators. Similarly, they stimulate production of pain neurotransmitters. Finally, there is increased production of receptors on the neurons to increase sensitivity.
Simultaneously, cell activity is reduced. So, the increased sensitivity results in amplification of pain, triggering the HPA axis and causing fever.
Blocking the activity of pro-inflammatory cytokines can reduce pain. Application of cold compress locally may reduce production of cytokines.
This hormone like substance participates in a wide range of body functions such as contraction and relaxation of muscles, dilation and constriction of blood vessels, blood pressure and modulation of inflammation. Generally, prostaglandins are not secreted by any gland, but manufactured at the site where tissue is damaged or infected. Here, they cause inflammation, fever and pain as a part of the healing process.
High levels of prostaglandins can cause pain, cramps, and muscle distress. So, this hormone needs to be controlled and managed.
Methadone is a synthetic analgesic that causes sedation and relaxation. Additionally, methadone is also used in treating narcotic addiction. Slowly, it is being accepted as a drug for treating cancer pain.
However, it is possible to supplement methadone by making the dietary changes as given in the solution section below.
The quartet of happiness: Dopamine, serotonin, oxytocin and endorphins are responsible for our happiness and the best part is that we can control their secretion. So, increasing the production of these hormones in the body, it is possible to improve our ability to manage pain.
Oxytocin is secreted by the hypothalamus. It is released when people bond socially or get physically intimate with each other. In fact, oxytocin plays a critical role in managing cardiac and kidney homeostasis. Also, oxytocin induces sleep and has a tranquilising and calming effect on us. Consequently, this counters the effect of steroids which are secreted as a side effect of pain.
Endorphins are chemicals produced naturally by the body to fight pain. They are released when we get hurt or in any stress situation, but also during exercise, laughter or sex. Additionally, endorphins, while reducing the sensation of pain, increase the feeling of euphoria. Also, these chemicals boost the immune system when activated.
In fact, endorphins are released after any aerobic exercise and last for up to 24 hours. Importantly, endorphins are also released by acupuncture, massage, hot bath etc.
Dopamine and Serotonin are neurotransmitters. Neurotransmitters are chemical messengers that transmit signals between to other nerve cells and regulate the countless functions performed by the body, from sleep to metabolism.
Dopamine helps control the brain’s reward and pleasure centers. Thus, dopamine drives motivation and helps regulate movement and emotional responses. Consequently, it is released during pleasure seeking situations such as food, sex etc. The pleasure we experience after successful conclusion of any activity is the rush of dopamine. Conversely, deficiency of dopamine in the brain can result in movements becoming delayed and uncoordinated. In fact, the loss of motivation, stress and trauma could be on account of low levels of dopamine.
Serotonin is also a neurotransmitter. It triggers moods such as anxiety in all areas, including OCD (obsessive compulsive disorder).
The difference between dopamine and serotonin is that dopamine affects motivation while serotonin affects mood. Also, both dopamine and serotonin affect digestion. Dopamine affects the release of insulin from our pancreas and peristalsis. Additionally, dopamine has a protective effect on the mucosal layer in the gastrointestinal tract.
95% of our body’s serotonin is found in our gut. In fact, serotonin is released when food enters the small intestine where it helps in creating peristalsis. So, low serotonin can result in constipation.
Sleep – Sleep is controlled by the pineal gland which produces melatonin. Dopamine induces wakefulness and reduces production of melatonin. However, serotonin has a deeper impact. Firstly, induces the pineal gland to produce melatonin. Also, it affects wakefulness and prevents REM (rapid eye movement). Consequently, this affects management of pain.
So, dopamine and serotonin are two neurotransmitters which impact the management of pain by affecting the brain and gut. Consequently, an imbalance will affect mental health, digestion and sleep.
Importantly, seeds such as sunflower or pumpkin, nuts such as almonds and walnuts and herbs such as ginseng, fenugreek or peppermint increase dopamine levels.
GABA is a chemical in the brain which helps regulate nerve activity. So, it is found to be reduced in people with mood and anxiety issues.
Asana and pranayama such as kapalabhati can fire up the thalamus and increase levels of GABA. Also, magnesium, which iis found in bananas, increases GABA and reduces stress and anxiety.
Importantly, a diet which includes grains, leafy vegetables, dark chocolate etc can increase levels of GABA.
While it is obvious that chronic pain management requires lifestyle change, natural pain management cannot replace medical intervention.
Importantly, while natural remedies may not reduce pain, they will increase the body’s ability to manage pain. Also, natural remedies will increase the body’s resilience and increase the person’s stamina or reserves to overcome the ailment. Additionally, these remedies will help in purging the body of the toxins created by pain and pain management drugs.
Before starting any of these remedies, it is recommended that the practitioner discusses the remedy with his or her physician.
It is assumed that a person in chronic pain will be suffering from a debilitating illness. So, the ability to perform exercise may be limited.
|No||Time frame||3 months||3 months||thereafter|
|1||Padmāsana||3 minutes||3 minutes||3 minutes|
|2||Sukhāsana||3 minutes||3 minutes||3 minutes|
|12||Sundara-viparītakaraṇi (essential)||3 x 2 mts||5 x 2 mts||15 minutes|
|13||Sarvāngāsana (if possible)||3 minutes||5 minutes||10 minutes|
|14||Matsyāsana (if possible)||–||–||1 x 10 counts|
|15||Arda-matsyendrāsana||1 x 10 counts||2 x 10 counts||2 x 10 counts|
|16||Nāḍī-śuddhi– prāṇāyāma (important)||5 x 2 cycles||5 x 2 cycles||5 x 2 cycles|
|17||Śavāsana||5 minutes||5 minutes||5 minutes|
|18||Meditation – dhyāna (sit in silence and focus on the breath – very important)||10 minutes||15 minutes||20 minutes|