Jacket Cover: Dean Nicastro. Photo: Harold Brown, Getty Images
Real Life is Real Yoga
Melanie Thernstrom on the field of pain medicine
BY MAGAZINE EDITOR SUSAN MAIER-MOUL
Ordinarily pain is protective – a finely wired system warning the body of tissue damage or disease and enforcing rest for the bone to knit or the fever to run its course.
This is known as acute pain; when the tissue heals, the pain disappears.
When the pain persists long after it has served its function, however, it transforms into the pathology of chronic pain.
The Pain Chronicles is an introduction to both the science and the experience of pain that ought to be read by every yoga teacher on the planet.
Why? Medical science and alternative therapies agree: appropriate movement is key to pain prevention and pain management. And yoga teachers are on the front lines in an epidemic.
Chronic pain, writes Melanie Thernstrom “is a specter of our time: a serious, widespread, misunderstood, misdiagnosed, and undertreated disease.”
The gender of pain
The spread of this disease is one of the reasons so many more women than men practice yoga: an extraordinary number of chronic pain sufferers are women.
According to the US government, women are more than 4 times as likely to suffer from chronic fatigue syndrome as men. CNN reports women are more than 7 times as likely as men to be afflicted with fibromyalgia. According to the American Autoimmune and Related Diseases organization, more than 75% of those with autoimmune disorders are women.
Not since Laura Hillenbrand’s “A Sudden Illness,” a narrative of the onset of chronic fatigue syndrome in the The New Yorker, (July 7, 2003), have we had so accessible an account of inexplicable disease and the numbing journey from doctor to doctor caused by the arrival of an incapacity no one understands.
What is pain?
The core of Thernstrom’s book is her own path to diagnosis. Underscoring this personal story is a capsule study of how pain has been understood throughout Western history.
The Pain Chronicles really comes into its own, however, when Thernstrom turns her attention from the past to current neurological research. Studies of neuroplasticity demonstrate the body’s “pain system [can be] molded by pain to increase its pain sensitivity.”
The nerves in the spinal cord become hyperexcitable and begin spontaneously firing and recruiting other nerves in their service and the whole system revs up to be increasingly responsive to pain.
This “revved up” state of alert is called sensitization. When this hypersensitivity occurs in the body it’s known as peripheral sensitization. When it occurs in the brain and spinal cord it’s called central sensitization.
Chronic pain sufferers can also suffer from heightened sensitivity to painful stimuli in a process known as hyperalgesia that involves an amplification of pain signals (in the periphery, or in the spinal cord, or in the brain itself).
In other words, chronic pain sufferers feel pain more intensely because their nervous systems – brain, spinal cord, nerves – amplify sensations of pain. Sensitization can cause a nervous system to increasingly process neutral sensations as pain as well.
The pain of fibromyalgia
Thernstrom describes fibromyalgia as “baffling,” listing its symptoms, “chronic muscular pain, fatigue, depression, and heightened sensitivity to touch.”
The disturbance appears to reside not in their muscles, but in their nervous systems. Fibromyalgia patients have been shown to have lower pain thresholds and altered chemistry in their spinal cords and in the parts of their brains involved in regulating pain.
They also suffer from a dysregulation of the neurotransmitter dopamine (which is intimately involved in feelings of well-being) and a dysregulation of the transmitters serotonin and norepinephrine (which are involved in both depression and pain modulation).
As for all those who suffer chronic pain, the longer the pain continues, the more dominant its transmission within the nervous system becomes.
“Pain begets pain.”
Potentially the most important message Thernstrom delivers is the simple truth that it’s wrong to ignore ongoing pain.
The longer that pain pathways relay pain messages, the more efficient those pathways become, causing greater pain to be transmitted, the way a stream carves a path through land, so that over time, it flows more quickly and turns into a river.
We learn from Thernstrom’s research, “Central and peripheral sensitization routinely happen in a mild way after any injury to protect the area.”
In 1975, endocrinologist Hans Selye documented the body’s response to an overwhelming stressor such as an injury. The body’s general adaptation syndrome is physiologically designed to conserve energy. In the case of acute pain, conservation is a response that promotes healing.
Thernstrom describes how chronic pain can alter the natural course of conservation.
Normally, the wound begins to heal and the sensitization disappears. But in some chronic pain syndromes the sensitivity endures. Harmless stimuli – pressure or light touch – become painful, in a phenomenon known as allodynia.
Ordinarily, light touch is transmitted by different nerves from those that register pain. In allodynia, however, the light-touch nerves change so that they function as pain nerves.
Thus, the very nerves by which we sense pleasure are co opted into amplifying pain.
New ideas in pain management
“Pain can kill” is a motto of the new field of pain medicine – a motto that is not hyperbole.
Far from being merely an unpleasant experience that people should endure with a stiff upper lip, prolonged pain turns out to actually harm the body by unleashing a cascade of neurochemical and hormonal changes that can adversely affect healing, immunity and kidney function.
Whatever systems of meaning we subscribe to, pain should never be romanticized, metaphorized or condescended to by the language or practices of care providers. Whether we have students with pain or we suffer pain ourselves, educating ourselves about pain is ultimately our best path. Books like The Pain Chronicles serve us by guiding us in our search for care and evaluation of the competency of the care we receive.
Physicians say those who suffer chronic pain need to move. Without movement, chronic pain becomes worse.
Many pain syndromes cause deconditioning and guarding behavior of the afflicted area, which can lead to muscle atrophy, which further impairs mobility and causes greater pain.
“Patients,” says Thernstrom, “become literally afraid to move.”
We can encourage our students with pain to seek qualified, compassionate help; we can assure them they are not the cause of their suffering; as yoga teachers we can offer complementary breathing techniques, gentle range of motion classes, restorative yoga that supports the medical protocols designed to back the nervous system down from hyper-vigilance and amplification.
Thanks to the clarity of The Pain Chronicles we can understand the challenge of those whom we serve, and release the self judgment we experience with our own suffering.
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© 2011, The Magazine of Yoga, LLC.