How to work with chronic pain on the level of physiology (part 1)

Some days, when I begin my yoga practice, I can feel the entire physical history of my body: here is that neck tension from staring at the computer all day yesterday, and here is that old hamstring injury from an unfortunate split, and here is that wonky sacrum… Every body carries a history of past injuries and hurts, but most of the time, your brain chooses not to get alarmed about it, and those experiences of past pain do not rise to the level of a full-blown pain episode.

Other times, your brain decides to be alarmed about a certain sensation based both on your past experience of similar sensations and current context. The situation gets exacerbated by other unrelated factors and can lead to a full-blown emergency pain-and-stress response.

The emergency stress response initiates a cascade of physiological changes in the body; it consists of:

1. Endocrine response (release of adrenaline to initiate and amplify sympathetic activation)
2. Sympathetic system activation (a branch of an autonomic nervous system responsible for fight-or-flight or freeze response in emergency situations);
3. Immune response (increased inflammation to heal wounds and fight toxic invaders).

Having recurring emergency responses for every suspicious sensation in the body is very taxing on the entire system (and, needless to say, generally unpleasant). What can we do about it? We certainly cannot control how much adrenaline gets dumped into our bloodstream, but we can control one aspect of our physiology that gives us access to sympathetic/parasympathetic balance. It’s the breath.

Your breath both REFLECTS the inner state of your body and AFFECTS it. When your sympathetic system gets activated, you might experience a classic fight-or-flight response, with the body mobilizing all resources to fight or flee. As a result, your breathing becomes fast, it happens mostly in your chest, and you can even hyperventilate. Or you might experience sympathetic activation as a “freeze” response when the body withdraws to protect itself from the painful experience, which can show up as holding the breath, breathing in a shallow or incomplete way, and overall difficulty with breathing.

It becomes a vicious cycle where the emergency response breathing pattern persists even after the emergency has passed and continues to send signals to the brain that the danger is still present. To get out of this cycle, we need to change the breathing pattern to promote parasympathetic activation (rest-and-digest mode) and reassure the brain that all is well and healing is underway.

The starting points of working with breath for chronic pain management are:

Step 1. Become aware of your breathing pattern. You cannot consciously change something that you are not aware of. The first step is to notice your habitual breathing patterns, especially during a pain episode. Do you tend to breathe fast, do you tend to hold your breath or does your breath become shallow? At any point of the day, bring your attention to your breath and observe it for a few cycles. Simply bringing your attention to your breath might help calm your system down.

Step 2. Work on deepening and relaxing the breath. Deepening the breath has all sorts of physiological benefits for the entire system. In terms of sympathetic/parasympathetic balance, “when your breathing is relaxed, your nervous system receives the message that you are safe and well. This message ignites a cascade of changes in your body and mind that can prevent or interrupt a full emergency pain-and-stress response. The result is that you immediately feel better while teaching the mind and body a healthier way to respond to pain and stress.”(1)

Step 3. Introduce “belly breathing”. When the sympathetic system is activated, you are more likely to take shallow breaths that happen mostly in the chest. Intentionally expanding your belly out on the inhale AS IF you were breathing into your belly has a grounding and calming effect on the entire system.

Step 4. Emphasize exhalation. Every time you inhale, you activate your sympathetic system a bit, and every time you exhale, you activate your parasympathetic system. That is why emphasizing long, flowing exhalations helps facilitate the “rest-and-digest” response and turns off the alarms in your brain.

For any breathing technique to have an effect, it is recommended to do it for at least 12 breath cycles. Not all practices will work for all people. The breath should never be forced.

In the short run, simple breathing practices can effectively calm down the nervous system and help lessen the pain; in the long run, healthy breathing patterns help make the brain less reactive to minor instances of pain. Breath work becomes more impactful with consistent practice over time.

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Resources

1. Yoga for Pain Relief by Kelly McGonigal, Ph.D.