Pain, Yoga, and the CDC’s Pickle
By Kristine Kaoverii Weber | March 19, 2022
A Bold Statement
About 10 years ago I spent a weekend with my husband at a conference for addiction recovery professionals. I attended a few chronic pain workshops because I wanted to understand the intersection of chronic pain and addiction more deeply and think about how yoga could support folks dealing with either or both.
Not many people were talking about yoga for chronic pain at that time. How could moving more lessen pain? How could ethical inquiry, mindfulness, or meditation help what was understood as a nerve problem? At that time the medical community was hyperfocused on pharmaceutical solutions and were inadvertently contributing a growing opioid epidemic.
The workshop lecturer (who’s super famous in the science of recovery world BTW) came out with a flourishing statement – “The gold standard for treating chronic pain,” he said, “is the biopsychosocial model.” And then he paused. Mic drop.
I admit my pitta was provoked.
Of course the gold standard for chronic pain is the same as the gold standard for other chronic health problems – diabetes, addiction, depression, autoimmune conditions, COPD, heart disease, etc. – because people need to be seen, heard and helped in their entirety, not just in parts.
The biopsychosocial model (now widely understood as the biopsychosocial spiritual model) is a way of approaching a health problem from a whole-person perspective, as opposed to the hugely inadequate 20th century biomedical model, which basically says, “You’re a car that needs to have parts or fluids replaced.”
The problem is – we’re not cars, we’re people.
As opposed to what the lecturer thought was a powerful epiphany, he was simply stating the overlooked obvious. But the way the medical community has been trained, and the way the medical system is set up, have both been woefully inadequate for addressing chronic pain (or any chronic health problem).
His statement reflected how the medical community was beginning to wake up to the reality that chronic pain can’t be treated exclusively with medication. The source of chronic pain is something much more complex and systemic – because human beings are not cars, not even Teslas.
We are much more complicated. But until we have major shifts in the way we approach health, and until we have a major overhaul of our health care systems, we will continue to default to reductionism – which means pills and/or expensive procedures. Yoga and yoga therapy are holistic and person-centered. They also have a growing evidence base for supporting the treatment of chronic pain, particularly low back pain. You can read more about that here.
The CDC’s pickle
Today the CDC (Center for Disease Control) is in a pickle.
Chronic pain is a growing public health disaster. It’s been well known for years that opioids are not a silver bullet – in fact, they can make chronic pain worse. Opioids work well for acute pain – accidents, broken bones, post-surgery pain, but they are woefully inadequate for treating chronic pain, because it’s not an exclusively biomedical issue.
Chronic pain involves not only pain signals from the brain, but also a person’s social determinants of health, mental health status, whether or not they have a good support system and feel loved and valued, if they’ve had adverse childhood experiences, as well as their sense of spirituality, meaning, and purpose. Isolation, depression, disconnection, heartache, grief and loss can all contribute to chronic pain.
In response to the understandable outrage over the opioid epidemic, the CDC is trying to do something about it. Last month they released new guidelines for doctors who prescribe opioids for chronic pain. In this 211 page document, they suggest that complementary and integrative modalities (like yoga) may be useful.
The CDC is currently asking for feedback from organizations and the public (if you want to provide comments, you are encouraged to do so!). You can find out more about commenting here.
Of Course It’s Political
There’s certainly some butt-saving going on here in regards to how the medical community is being blamed for overprescribing opioids – which has led to massive increases in addiction, death, and diversion (medications finding their way to people and places they weren’t meant to go). Additionally, the guidelines that the CDC released in 2016 about opioid prescribing has led many states to put caps on prescriptions which has prevented folks (particularly people of color) from receiving the medication that they actually need.
Like COVID, the opioid epidemic is removing the veils of illusion that have shrouded the massive dysfunction of the health care system which is ill equipped to treat chronic pain effectively. Very few insurance companies reimburse for yoga (or other effective complementary modalities), many patients don’t have the time or money to find appropriate complementary care, and most doctors have no idea how to get these important (and evidence-based) services to their patients – and so, the solution remains a highly addiction substance.
Yes, opioids are an important piece of the pain puzzle – but with a growing body of research around mind-body modalities like yoga, it’s essential that the health care system pivot to include more sustainable, less risky, more person centered, less life-threatening solutions to pain.
In my new role as the yoga therapy representative on the Integrative Health Policy Consortium, I am involved in drafting two different responses for the CDC – one from IHPC, and one from IAYT (the International Association of Yoga Therapists). I have some great support but always appreciate more input. What do YOU think the CDC needs to understand about how yoga can support chronic pain? Please comment below. Thank you.