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.
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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.
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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.
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Congratulations and thank you! The value of the relationship with a yoga teacher or yoga therapist is an often overlooked factor. Having someone I know and trust tell me that, yes, I’ve been through alot and for now let’s focus on calming my nervous system is super valuable. No rushing, no impatience with me for *still* having pain, rather a calm presence and understanding/connection and a willingness to be there with me —> it all makes a big impact that I haven’t typically gotten from a standard medical doctor visit.
Beautiful Jean. Thank you for sharing and I’m glad that you have benefitted from yoga!
Wow what a glorious way to start the weekend- reading – reading about my passion and nodding and smiling at the truth in every sentence. This is absolutely truth. the need for this knowledge is enormous. The need for us to raise our voices together cannot be ignored. Thank you for your work on this and your wisdom
To listen to the voices of people in pain and the practitioners who serve them.
Thanks Neil – you of course have so much wisdom on this issue and have helped so many people. I’m so incredibly grateful for your knowledge and help!
Yoga provides an approach for those of us with chronic pain to meet ourselves with less aggression and demand. We learn to listen and care for our bodies, minds and spirits, to quiet judgement and practice self-compassion. With regularity, yoga helps us respect our personal rhythms, re-build self-reliance and feel a deeper connection to the world around us. After 30 years of living with chronic fatigue and arthritis, no modality or treatment has been as healing as yoga.
beautiful.
In July 2020 I suffered extreme orthopedic injury to arm and leg. Required 12 hours in trauma OR and an eight day hospital stay.
My first time ever on morphine, pain killer IVs in both appendages while in the hospital, and heavy duty pain killers when I left for home in a wheelchair van. I understand the comfort of the pain killers, but also the fog they produce that’s counterproductive to their exit.
Being a yoga teacher with a practice with my own instructors was invaluable. On my first full day home we started chair yoga and built from there with my recovery far exceeding the pace and level the surgeons expected. I firmly believe it was the daily yoga that made the difference; a journey we documented in 6 months of extensive notes and pictures.
I do also believe yoga helped with my decision to cease using painkillers before any doctor directive; yoga teaches an ability to incur discomfort for later benefit.
Unfortunately my recovery through yoga is a luxury that most could never enjoy due to financial and time restrictions. So they end up rushed back to work and activity, buttressed by pain killers. Ultimately that proves detrimental to them and society. Somehow we need to change that.
wow! what an experience Andy. Thank you for sharing and yes, I think you are right, healing takes time and in our production obsessed world, many people are not being giving the time, care, space, and financial resources they need to heal.
Namaste Kristine; i treasure your Divine presence at this interesting times where bringing awareness, mindfull education is truly very valuable despite other findings. Thak to so many scientist like Dr. Bruce Lipton, Gregg Braden Dr Joe Dispenza and so man Yoga Masters ha ve shower us so “scientific” information of how Yoga, meditation, mindfulness, breathing relaxation and even just a gentle restorative Yoga practice CAN…yes it CAN help to restore our health without pharmaceutical drugs that creates more imbalance in our whole System.
As a Yoga Master for over 50 years and Energy Medicine Therapist …I can say Yoga has been not only my but my student the medicine that supported so many dis-ease. I so much honor respect and treasure your great presence at this time. I have been writing a book for over 25 years (ha ha ha) Yoga your Medicine for life, it is in process to be printed, it has taken so long but now I feel its the perfect time.
As a yogini sister send you love and blessings your blessings.
OM SHANTI SHANTI SHANTI
that’s beautiful Emy, thank you for sharing.
Thank You Kaoverii, I respect your experience and review ability to draw the best outcome possible for this task. I’m glad I’ve not had an issue with my body that needed an intervention relative to pain, I have no personal experience to share.
Thank you Joe!
Thank you for this post. Not ALL yoga can help with chronic pain. Teachers much be knowledgeable and skilled, classes should have essential components, and pain relief doesn’t happen in 6, 8 or 12 weeks. The research is pretty clear…! When people have been in pain for years, the intervention may take years. But that is the beauty of an ongoing yoga PRACTICE.
of course you are correct. A lot of what’s popular and on IG will give you chronic pain unfortunately. The yoga world has much to do to properly train teachers to support those with chronic pain.
Yoga is like a homeopathic solution to pain. Treating like with like. I have pain, I use that pain to lead me to its source.
I was weeks away from spinal surgery in 2013. I’d been teaching yoga for 3 years and had been an avid gym goer. X-Ray, MRIs and lots of consultations with GPS, chiropractors, and sports physician’s resulted in diagnosis of severe spinal stenosis, and spondylolythesis L3-L4. Eight months of osteopathy hasn’t resulted in much improvement, I couldn’t walk far, Id stopped lifting weights at the gym, deep back bends(wheel) and extreme spinal twists and was living on pain killers. So I proceeded down the surgery track. I still have the pack of chemical wash I was to shower myself with the day of surgery- I was that close to getting a metal cage inserted in my lumbar spine. That ‘cage’ would forever prevent me from rotating my lumbar spine any more than 1%.
Something made me cancel. But I couldn’t cancel my yoga practice, I was managing a retreat and committed to teaching yoga five days a week. By necessity I had already altered my yoga practice and teaching to a much more restorative style incorporating yoga therapy wisdom I had gained from the beautiful Maria Kirstin.
And hallelujah my pain eventually dwindled to nothing. At the age of 63,I’m doing great. No aches or pains like many of my friends and peers. Or if I do I don’t audibly moan when I get up from sitting, because Maria told me not to!
Yesterday I worked in the garden and cleaned the house for 8-10 solid hours. I was tired and spent, but have suffered no pain. In fact I’m off to teach a YIN class now. Pain instructs they say. And I’m using those years of pain as the best teaching tools I’ve got.
That’s a beautiful analogy Donna. And I’m so happy that you knew Maria, a dear old friend of mine from college. And wow! You are a living example of the wisdom of yoga and how it can support those of us with chronic pain. THANK YOU for the beautiful work you are doing! xo
Thank you, Kristine, this is such an important subject. In two days I go to the “body shop” to have my second hip replacement due to generative arthritis. The first one was six weeks ago and it was literally like getting the car repaired. My husband dropped me off at 5:30 am and picked me up 13 hours later. Once I was home, I experienced a fever, chills and was probably in shock. Fortunately, I have a great internist who helped me that first week. Although, I believe I am going to have a good outcome it has not been easy. Our health care system needs an overhaul with less influence from insurance companies.
My hip issues were structural, but many who suffer from chronic don’t have structural issues. There are a number of pain programs that offer the mind/body approach like the Curable App and the work of Dr. John Sarno, Dr. David Hanscom, Alan Gordon and Alon Ziv. As I have learned in a number of your workshops, yoga offers therapeutic tools to ease chronic pain and are in alignment with the work of these individuals. We need a more holistic, accessible, expansive and patient-centered model for the health care industry.
thank you Susan. I so appreciate your comments and your knowledge – having experienced pain first hand. I wish you all the best with your hip surgery. I’m sure you will shine right through it! xoxo
I am so happy to hear all of this! In my experience as a private one on one yoga teacher, giving support, understanding, compassion & teaching specific tailored movement, has been so beneficial to my clients who are in some kind of pain. I feel like we definitely have a role in peoples recovery if they trust that we can help them and they are willing to weave us into their schedules. Thank you so much for everything that you do Kristine.
Thank you Vanessa! I agree. And I’m so glad you are doing the work that you are doing – very important and I think in the future we are going so see so much more demand for this work!
Thank you Kristine! I love reading your weekly article! This one particularly connected with me! I’m a retired elementary teacher and two years before I retired I enrolled in YTT 200 for my own self care! What has transpired since then is the the local school district allots a wellness grant to each school, elementary and high school! This is my second year where I have asked by a few schools to teach a yoga class to the staff once a week! I have taken many of your courses and implement some of your beautiful pearls of wisdom with poses and breath! The feedback from some of my participants has been overwhelming! You don’t have to convince about the benefits of yoga and the biopsychosocial and spiritual model! I’m all in!
wow! How exciting! I’m thrilled by the work you are doing Irena. Kudos!!
Healthcare professionals will sometimes recommend yoga, but they need to know what kind of yoga to recommend. When I had persistent bladder pain (no infection or injury) and pelvic pain, a dr recommended yoga (but no specifics given). I had just taken a yoga teacher training so I was able to navigate that better than someone brand new to yoga. What helped me most was gentle, yin, and restorative yoga. (I’m sure nidra would have helped, too). Now I teach clients with pelvic pain and see firsthand how when the nervous system is downregulated, it quiets the pain signals. People will finally feel the pain ease in longer held supported poses. Then it’s about developing a home practice – I tell my students it’s not a “one and done” deal, but an ongoing practice with slow and gradual changes over time. Be patient with yourself and kind to your body. And yoga needs to be covered by insurance.
You are spot on Megan. Not all yoga is the same and health care professionals desperately need guidance in their referral process – and helping people understand that it takes time to undo pain wiring is huge too. thank you!
Thankfully, you are in a position to help at a level that could take yoga from a luxury to the serious healing modality that it is.
In my long- time work as a yoga teacher in a small town, I’ve seen people transformed from debilitated to enjoying their bodies and aging gracefully. I wish that I could offer it to those who cannot rationalize spending their hard- earned money on what doesn’t seem
“necessary”. Many people cannot see spending even my quite low rates in an economy that already has them feeling financially strapped. I am in the same boat! I’m grateful that I know how to take care of myself at home on my mat and when I come home from my grocery store job I can undo the tensions that have bound me up.
Thank you, Kristine, for doing this work in the political arena. Maybe change is coming!
Thank you Karen! Yes this is a barrier. Some folks will spend $20 a week on coffee, but not on yoga. Others don’t have money for either. We need to find many different ways to offer yoga so that it’s available to all people and so that people like you can make a living teaching it if they want to.
Hi Christine thankyou ! … the chair practice was wonderful …we have just gone thru major floods here on East coast of Australia and I have been thinking to offer a little chair yoga practice for our community . People have been thru so much and lost so much .. nervous systems maxed , tired and anxious about the future . The practice you shared was very self nurturing . Much Gratitude , Celena
Thank you Celena. Sending you lots of love – I heard about the floods from some of my friends there and on the news. I’m so sorry for the loss and the suffering. Glad the chair class was helpful for you andI hope it helps you help others.
Thank you so much for your insight and wisdom, Kristine. I’m am working my way through one of your courses and have found it to be very helpful in filling in the knowledge gaps for me. I agree with the comments above in relation to the importance of the type/style of yoga that is recommended. I did my 200hr intensive over 1 month and although I was pleased with the standard of the teaching, I was sent off with a script and a sequence and encouraged to jump in and start teaching, however, I knew 30 days of training wasn’t sufficient. I am now in the middle of a year-long training that is giving me time to dive deep into yoga philosophy as well anatomy & physiology. I think this YTT model needs to be reviewed if we want people to safely practice yoga for chronic pain. A functional approach is necessary to ensure it is sustainable and accessible. The excessive range of motion demands for many traditional poses can put people at risk. Exploiting hypermobility is a real issue in the yoga world and even long-held yin poses can exploit HM as well. The yoga world has a lot of reflection to do, and its work like yours that makes me feel hopeful that it can change for the better. Best of luck with your report.
As a licensed clinical addictions specialist, I have spent most of my career serving people who are experiencing Opioid Use Disorder and have seen first hand how shaming our nation is towards people experiencing addiction. Yoga can help heal the collective shame imposed by Thor epidemic. Yoga helps us feel good about our bodies and all of the wonderful things they can do. We will never get past this until we look at the ways we shame people experiencing addiction and stop it.
I too, agree with all you have written. ‘The nuerons that wire together fire together.’ I have truly benefitted from your teachings. I have been practicing for over 26 years and recently earned my 500 hour advanced teacher certification. Like many others, personal pain and multiple crisis’ brought me to yoga. My time on the mat is essential to my healing on all levels.
I wonder if the bridge to CDC and yoga can be built with creating a ‘prescription for yoga’. Languaging is powerful for systems. Yoga has been proven with ‘research and clinical trials’ like the University at Massechusettes and others. I sense it is healthy and wise for the true soul and long term economy of health care to expand our big pharma to address humans not isolated conditions.
Thank you for this.
I think it matters too that not all yoga is created equal, Someone looking for wellness and ending up in the wrong class could actually injure themselves. I am sure there will be some legislation around what yoga for this issue needs to look like and people who specialize in it will need certifications or something. I hope you write the courses to teach the certifications needed to be a health care working yoga teacher!! 😀
Something that might be important to point out is the systemic nature of yoga as a complementary form of healing. We, as long time practitioners and teachers know that the healing benefits of a practice are only deepened and spread throughout the body’s systems with repeated, consistent practice. So helping to illustrate that in addition to short-term pain relief, for example, a regular practice will also begin to help rewire neural pathways and grow a practitioner’s ability to better self-regulate balancing of the ANS and increase HRV, etc.
Another reader commented on medical professionals knowing WHAT type of yoga could be helpful and I think that’s also a key point to detail in any explanation of the HOW and WHY yoga is a powerful healing tool. More specifically, being able to articulate the multifaceted approach that yoga represents through the interrelated benefits of pranayama, meditation, mantra, etc. as well as asana is going to go a long way in helping health care providers to understand that it’s less about which ‘poses’ are practiced and more about how the entire system of yoga and all its limbs are integrated into a patient’s life as a means of facilitating recovery through the mental, emotional and energetic bodies versus simply viewing yoga as a way to move and stretch the physical body.
I’m incredibly grateful that YOU are part if the team drafting these responses as your strong ability to empower us to learn to heal ourselves is matched by your deep understanding of the science and ability to speak the language of the medical professionals who will hopefully begin prescribing yoga as a method of healing to aid in recovery of both chronic pain and addiction.
So accurate. Oh, that people didn’t just want the damn pill. Right now in my own family, I’m trying to help thread 3 people away from
what I’ve seen to be poor medication and surgical options (there are good ones ,too) and toward ways of finding stability and pain relief
through the holistic model. This is well put, as usual, and will be shared. Thank you!
thank you Beth! xoxo
Thank you, Kristine. What I would like to share with the CDC is the ever expanding body of randomized control trials research that supports holistic practice. The list of acknowledged evidenced based practices within the federal agency “Substance Abuse and Mental Health Services Administration (SAMHSA) – has been on hold for over three years. Trauma Center Trauma Sensitive Yoga (TCTSY) – for just one example – is on that list. We need research to identify objective outcome measures, and additional research to clarify exactly the practice components that “work” for varied concerns. We need clarity as to the path to insurance reimbursement – insurance of all kinds, not just boutique but that which is Medicaid based. We need Universal Coverage. Thank you for your important service to this committee. Blessings on it
Thank you so much Anne. This is a really important point. One of the things that is glaringly underemphasized in the CDCs opioid prescription guidelines draft is the importance of behavioral health. Yes and we need CMS to lead the way on reimbursing integrative care for all chronic diseases. It’s a juggernaut for sure, but that doesn’t mean we shouldn’t keep fighting to make these important changes that are the ethical thing to do.
It certainly is a breath of fresh air when medical insurance provides at least an allowance for preventive or alternative measures. I am in the age group where I prioritize some coverage of same as a requirement for my Medicare supplement of choice. I have been able to find yoga practice, for instance, covered through Silver Sneakers. Younger folks have access to Flexible Spending Accounts that might be an opportunity to look at to offset yoga or exercise expenses. I just completed training, “Yoga for Addiction” and the book by Dr. Gabor Mate, “Hungry Ghosts …” and your discussion is spot on! I am so glad to hear you may have influence with CDC. Pharma may have its place, but never should have filled up the entire space!