Yoga as a treatment for long-term pain

Can meditative yoga be a treatment option for long-term pain? A treatment study is currently investigating this. Elsa spoke with Joakim Lindqvist, a doctor and doctoral student at Stockholm’s Karolinska Institute, who is running the treatment study.

Many people live with long-term pain which usually cannot be treated with medication alone. Other forms of therapy are, therefore, an important part of treatment. There are some studies that show that meditative movement therapies such as yoga and tai chi can be good tools for managing long-term pain.

A treatment study is currently underway for people with rheumatoid arthritis or psoriatic arthritis who have persistent pain. Elsa spoke with doctoral student Joakim Lindqvist, who is responsible for the treatment study.

Who are you?

My name is Joakim Lindqvist and I am a doctor currently working on a doctorate on the theme of pain in rheumatic joint disease. I have long had an interest in what happens at the border between our psychological and physical senses and how these two things are interconnected. I have found that in healthcare we are largely focused on treating individual symptoms, while we are less active about taking care of the person experiencing the symptoms. I think there’s a lot of potential for this to improve.

We are currently in the middle of the first round of the treatment study, where we explore how yoga can be used as a tool for managing long-term pain. We have not yet analyzed results from the study, but we have received a very positive response from both patients and colleagues. There seems to be an interest and openness to this type of therapy, both in society at large and in the healthcare world. The skepticism I thought I would face when planning the study hasn’t materialized at all.

Why are you interested in pain problems?

I think it is interesting to work with pain problems precisely because it is an area where the question of the interaction between the body and the psyche is very central. It’s been very difficult to treat this type of long-term pain, which means the person living with it needs to find other ways to deal with it.

We know long-term pain is something that develops as a result of a local or acute pain, such as an inflamed joint. We also know that some people continue to suffer pain after the inflammation has receded.

Living with long-term pain can have consequences for the mental state. It seems that it works in the other direction too - mental feelings affect our pain system. If we feel bad mentally, it seems to affect the function of our pain system, including by lowering pain thresholds. The connection between our bodily and mental sensations and the mechanisms that operate in the boundary between them is an interesting phenomenon. It may have been a bit overlooked in health care, but I hope it will have a bigger role in the future.

How can yoga help with pain?

There are several reasons why yoga can be useful as a treatment method for long-term pain. We already know that physical exercise is good for long-term pain and that psychologically oriented therapies, such as CBT, can also be helpful in pain management. In yoga, and other similar forms of therapy, these two components are interwoven naturally. Yoga as a therapy contains both physical movements and cognitive, or psychologically oriented, exercise.

Yoga is also something that everyone can do for themselves. You can get instructions and then use it as part of your self-care. Yoga can also be adapted for different kinds of groups and purposes. When yoga is used as a therapy form, the treatment program needs to be designed according to the patient´s or group’s conditions and needs. Most of all, the instructor needs to know about the condition being treated.

In yoga, there are a plethora of different types of exercises such as body exercises, breathing exercises and meditation exercises that can be adapted as needed. I have been practicing yoga myself for about ten years and have found it has been beneficial on several different levels, both physically and mentally. I feel confident that it could be a form of therapy that can play a role even in conventional healthcare. It could be a complement to targeted symptom-relieving treatment. A compliment that can be part of active self-care: things we can do to optimize our own health.

How is the treatment study going?

The study is a randomized controlled trial, which means the study participants are allocated either to do yoga or to a control group receiving patient education in the form of a lecture series together with simple physical therapy. The lectures deal with current topics related to rheumatic joint disease and pain. The yoga session consists of adapted body movements, so-called "asanas", as well as breathing exercises, meditation exercises and relaxation exercises. The study lasts for 16 weeks where both groups meet once a week for about 90 minutes and complete home exercises between sessions.