Yoga for Chronic Pain - Movement as Medicine
“Movement is a medicine for creating change in a person’s physical, emotional, and mental states.”
Today’s post is the fourth and final in a series of four blog posts discussing chronic pain. Below is a brief discussion on how movement is medicine and can and should be prescribed as such. I hope you have learned a few things and enjoyed this important journey.
Movement as Medicine
I recently read a very interesting article (linked below) that I feel is a huge step in the right direction but I am concerned about HOW this information may get used. The article discusses to use of movement as medicine in treating individuals with chronic pain.
The National Institute for Health and Care Excellence (Nice) in the UK recently released recommendations for patients with chronic primary pain (defined as “pain with no identified cause that has persisted for at least three months”) to be treated with physical and mental therapies instead of pain medications. The study does, however, continue to recommend pain medication for those living with chronic secondary pain (defined as “pain caused by a known underlying health condition such as osteoarthritis, rheumatoid arthritis, ulcerative colitis or endometriosis“).
In my experience as a physical therapist assistant, movement is not just medicine, it is also diagnostic. Subjective information from patients is huge in pain diagnostics but watching, assessing, and adapting how someone moves and reacts to these movements can also give someone with a trained-eye, like a physical therapist, significant insights into possible reasons for pain when other diagnostic testing comes up empty or inconclusive.
Research for Movement as Medicine
First, my excitement. This is the type of research that can inspire further research into physical therapy and yoga techniques to address individuals with chronic pain. This is where my passion lies - using yoga and my knowledge as a physical therapist assistant to help clients and patients takes steps toward living beyond pain, maybe not without pain completely, but being able to function and live the lives they desire without pain controlling every move and decision.
The empowerment that clients and patients can gain from taking an active role in their care plan can greatly impact both physical and mental outcomes related to their pain. The more research that is done the more we all will continue to learn and benefit from the applications of these techniques to address the limitations that many deal with daily.
Now for my biggest concerns - access and implementation.
Access to Movement as Medicine
Let’s start with access. The issue of access is two-fold, in my opinion - access for patients and access for physicians.
First is patient access to these other options like yoga, physical therapy, talk therapies, and acupuncture. Location, transportation, daily pain levels, and cost are just a few of the potential hurdles to access.
In the US, insurance runs the show, so many patients will not be able to afford the out-of-pocket costs associated with the options not “approved” by insurance. This is already a limiting factor for many due to co-pays and high deductibles even when insurance agrees that the treatment is appropriate and medically necessary. Relating back to research, this specific limit in access can be minimized by continued research and further development of treatment techniques that can translate to clinical practice and improved patient outcomes as insurance requires the treatment techniques be evidence-based.
Location and transportation are also significant hurdles. Most of the US, outside of major cities, does not have consistent public transportation. Some insurance companies will provide transportation services but that is again likely limited by what treatments/interventions insurance deems medically necessary. Unlike medication that can now be delivered to a person’s home more easily, movement and talk therapies are not always as easy to make mobile and again insurance can limit access to those services that are mobile.
These recommendations also seem to ignore that a patient’s daily pain level may be the ultimate hurdle to access due to not being able to move enough some days, tolerate the ride to/from their appointments, tolerate the treatment, or be able to absorb the education generally provided due to being understandably consumed with dealing with their pain. Continued use of medication may be required, especially early on, to maintain patient engagement and motivation as they also need to feel listened to.
Now for the second issue of access - the physician or clinician who prescribes these options. This is a much clearer concern. Have they had access to the appropriate training needed to be able to safely and effectively guide their patients down this path? In the US, until the insurance companies accept these as medically necessary options, the answer is likely no or if they had access to learning opportunities they chose or were encouraged to choose learning more about something that is reimbursable by insurance instead.
Education for both the physician/clinician AND patient are critical. Many patients may feel insulted that they are told to move more instead of receiving pain medication. Education provided to the patient from multiple sources (physician, nurse, therapists) will be crucial to the success of this transition. If a patient does not feel like they are being taken seriously then the probability of patient compliance with the recommendation decreases significantly. These types of recommendations should only be given to patients who are appropriate for such interventions and then have a proper evaluation done to determine the type of routine to start to develop.
Implementation of Movement as Medicine
Implementation is another big concern of mine.
Having been not only the receiver but also the deliverer of such recommendations as - “you should try yoga” or “you should exercise more regularly,” I realize how empty these recommendations can be. When my doctor recommended yoga, I was like ‘oh, okay’ but he gave me no other information. I found myself doing the same thing with my patients in physical therapy initially. If these options are to be truly impactful to clients and patients then the patients (and prescribers for that matter) need clear, simple, and actionable steps to take to make these changes effectively for all involved. This means having connections to other clinicians, therapists, acupuncturists, and yoga instructors to be able to give patients a specific next step to take.
Additionally, would antidepressants become to new pain medication? As this seems an easy way out, it is not, I fear the rise in their use without patients being properly informed of their use in addition to physical and/or mental therapies.
Patients need to feel listened to and an active part in their pain care. When a patient has agency and feels empowered on the pain care journey, they are more likely to try new options and benefit from coordinated multidisciplinary care.
Yoga as Medicine
Yoga can be an amazing part of this continuum of care. As part of your care management plan, yoga can help get you moving and deepen you connection to your body allowing you to become more in tune with the signals it sends. In my opinion, this is best achieved through private sessions, much like physical therapy is done. This will allow the client and instructor to build a relationship and specifically tailor each session to address the client’s needs and goals.
Through breathing exercises and meditation (as discussed in two previous blogs), you can learn to self-regulate your nervous system and decrease reactivity to stress and pain. The addition of movement brings this full circle and truly allows for a whole person mind-body treatment specifically designed for each person.
Interested in learning more about how private yoga sessions can be the next step on your journey beyond pain? Schedule a Free Intro Call with me today and we can discuss your specific needs and concerns and develop a routine to best address what you need.
