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This month we had an opportunity to sit down with the Chopra Center’s Medical Director, Dr. Sheila Patel, to discuss chronic pain – a complex health issue that affects hundreds of millions of people through the world. As Dr. Patel describes, there is a lot of misunderstanding in both the mainstream medical community as well as the general public about what chronic pain is and the most effective ways for treating it. Read the interview to learn more about an integrative approach to chronic pain that addresses the mind, body, and spirit.
Let’s begin with the basics. What is chronic pain?
Dr. Patel: Pain is a complex topic and therefore the definition of chronic pain can vary quite a bit. It’s most commonly described as pain from an injury or illness that lasts longer than the expected time frame, whether that’s six weeks or six months. It can also be persistent pain from a primary medical condition, such as cancer, diabetes (as with neuropathy), autoimmune conditions, or other disorders. In addition, there are some pain conditions that we have given names to, such as fibromyalgia, that describe ongoing musculoskeletal pain that is not necessarily related to any injury. At its core, all pain consists of two main components: the unpleasant physical sensations that we experience in our body, and the emotional response that we have to those sensations. Our emotional response to pain may be the most important determinant as to how long we continue to experience pain. In the case of pain that did not originate with an injury, we may have learned patterns of movement or thinking that are contributing to ongoing pain sensations.
In short, all pain is a mind-body experience. In most cases of chronic pain, there are underlying emotional components that contribute to a person’s experience of chronic pain and these need to be addressed. In addition, when one is dealing with chronic pain, there are emotions that develop secondarily, as a result of the pain, that need to be addressed in order for healing to occur.
How do doctors diagnose chronic pain?
Dr. Patel: Since chronic pain is an internal experience with a strong emotional component, it can’t actually be diagnosed using conventional diagnostic tools such as MRIs, blood tests, or other technologies. There are a variety of pain scales that physicians can use to get a sense of how much pain a patient is experiencing, but pain is ultimately personal and therefore is impossible to measure objectively.
How does the conventional medical model for treating chronic pain differ from mind-body or integrative healing approaches?
Dr. Patel: In conventional Western medicine, very little attention is paid to the emotional component of chronic pain and to the role that the mind plays in the experience of chronic pain. To take a typical example, if someone suffers from recurring back pain following a car accident and goes to a conventional doctor, he or she will most likely be prescribed a strong narcotic such as hydrocodone or oxycodone. There are some serious limitations to this approach. First, a painkiller only addresses the physical components of pain and, as more and more medical research is finding, it doesn’t do it very well. Painkillers may temporarily mask the symptoms of pain but they don’t get to the root of the underlying issues that make chronic pain an ongoing problem. Furthermore, there is little scientific data showing that narcotic drugs are effective in relieving chronic musculoskeletal pain on a long-term basis. Unfortunately, many of the painkillers prescribed for chronic pain can cause more health problems for those taking them such as sedation and constipation. Narcotics are also highly addictive, and once someone has been taking them for any length of time, it can be very difficult to wean off of them due to physical tolerance. In certain situations, such as cancer-related pain, these issues may need to be balanced with the need to control severe pain. There are other medications that can be prescribed for pain, besides narcotics; however, they all have potential side effects that need to be considered. In addition, any medication used for pain is only addressing the physical component of pain and therefore isn’t a complete approach to pain management.
An integrative healing approach, on the other hand, looks at the whole person, including the mind, body, and spirit. The focus is on getting to the root cause contributing to chronic pain. The Perfect Health: Healing from Pain program that we’re offering at the Chopra Center in May, and again in September, is based on this holistic approach, encompassing the physical, emotional, and spiritual aspects of chronic pain.
Can you say more about each of these three elements and how they will be addressed at Perfect Health: Healing from Pain?
Dr. Patel: Yes, to begin with the physical component, we want to help people become more aware of their body and body mechanics, looking at the physical patterns that perpetuate pain, including how we move, sit, and do everything else in our daily lives. We will have experts in body mechanics and physical treatments who will share their knowledge and give experiential lectures on relieving pain. We will also teach a gentle form of yoga called the Seven Spiritual Laws of Yoga, which helps cultivate a state of body-centered restful awareness. As you practice yoga, you become more aware of habitual misalignments and movement patterns that contribute to ongoing pain. Even though there is a tendency for people with chronic pain stemming from issues such as arthritis to become sedentary, inactivity sets up a vicious cycle in which muscles become weaker and joints become tighter and there is a further decrease in range of motion. Gentle yoga is very effective in increasing the flow of energy and information in our physiology while inducing a state of relaxation.
At the physical level, we will also offer a group acupuncture experience, administered by a Doctor of Acupuncture and Oriental Medicine. As many studies have found, acupuncture is a powerful healing modality in treating both acute and chronic pain. By manipulating the fascial layer overlying the muscles, we are manipulating electrical energy in the body that can affect pain locally or at distant sites. This can also be accomplished using massage and acupressure. When we manipulate the sensory receptors on the skin and muscle, we can change the sensations that the brain is receiving, and even bypass sensations of pain. Each day at the Perfect Health program, guests will also receive a therapeutic Ayurvedic massage tailored to their individual mind-body type. Healing touch is a wonderful way to calm the nervous system and enliven the body’s innate healing response through the release of endorphins (natural pain relieving chemicals). Guests are also taught a self-massage technique that they can use at home to engage in the healing process.
At the level of the emotions and the mind, we teach a variety of tools and techniques that have the potential to transform a person’s experience of chronic pain. As I mentioned, pain has both a physical aspect and an emotional aspect, and through meditation, yoga, breathing techniques, and other mindfulness practices, it is possible to find relief from chronic pain, decreasing its intensity and sometimes even healing it. Both meditation and yoga decrease the body’s “fight or flight” response – that state of heightened stress that tends to be overactivated in people suffering from chronic pain. Meditation and yoga induce relaxation in the body, slowing heart rate and breathing. In this state, the body decreases the production of cortisol and adrenalin, and it increases the production of natural “feel-good” hormones such as oxytocin, serotonin, and dopamine.
There is a growing body of research showing the benefits of meditation and yoga for chronic pain. For instance, Dr. Jon Kabat-Zinn, studied a ten-week program that offered instruction in mindfulness meditation and hatha yoga to a group of fifty-one participants with chronic pain who had received conventional medical treatment and not improved. As Dr. Kabat-Zinn found, half of the participants reported a 50 percent reduction in pain, and the pain scores of 65 percent decreased by one-third. In addition, the participants reported great improvement in mood and other symptoms. We also know that meditation and yoga are effective in relieving insomnia, which tends to be a problem for people with chronic pain. When people are not experiencing restful sleep, pain perception is increased. Ironically, some of the prescription medications used for pain can actually interfere with restful sleep, thereby counteracting what we are trying to accomplish.
Another effective healing approach in treating chronic pain is hypnotherapy, which is a way to rewire the brain’s internal message of pain, disrupting patterns of thinking and reacting that tie into the emotional component of chronic pain. When someone has suffered from recurrent pain for quite some time, there is a tendency to get stuck in a story of pain. Hypnotherapy works at the level of the subconscious, allowing us to let go of conditioned patterns that aren’t serving us – including our story of pain. We will have a certified hypnotherapist at Perfect Health: Healing from Pain so that participants will have the opportunity to explore this mind-body modality. We will also include some guided journaling activities that will tap into the subconscious and the healing power of the mind. One of these writing activities will ask participants to interview their pain, entering a dialogue that may reveal underlying sources of the pain and the physical and emotional habits that may need to be addressed. In an interesting study conducted at the University of Wisconsin-Madison, researchers showed that anticipation of pain can actually lead to higher pain scores, underscoring the importance of the mind’s activities in the perception of pain. The results also support the hypothesis that training of specific cognitive strategies, specifically meditation, can affect the subjective unpleasantness of a sensory experience separately from the intensity.
Finally, a truly integrative approach encompasses not only the body and mind but also the spirit. Of course, the word spirit means different things to different people, but we can define it simply as that aspect of our being where we experience meaning and purpose. It is our connection to that part of ourselves that is eternal and unbounded. It is also that part of us that is constantly at work in a self-repair and self-regulatory capacity, without our conscious awareness. It is our “inner healer” and we activate our internal healing abilities when we connect to that part of ourselves. Practices such as meditation and yoga are not only mind-body practices – they are also spiritual practices that help us return to our natural state of wholeness and wellbeing. When we detach from what is happening in our mind and body with these practices, we place our attention on that part of us that is whole, pain-free, and timeless. In doing this, we start to bring that sense of wholeness more and more into our conscious, day-to-day mind-body existence.
To sum up, our hope and expectation for the Perfect Health program is that within a week, we will address pain from all angles and people will experience some immediate relief as well as learn tools that they can continue to use to heal and shift their experience of pain when they return home.
Many people with long-term conditions such as arthritis or fibromyalgia say that they have learned to “live with their pain.” Do you think that too many people have resigned themselves to living with pain that could be relieved?
Dr. Patel: The short answer to this question is yes. Since chronic pain has such a large mental and emotional component, there are no doubt many people who have received conventional medical care, found little relief from their pain, and have done their best to adapt to a life in which daily pain is an ongoing experience. Human beings are incredibly adaptable, and we can find ways to tolerate ongoing discomfort and pain even as it limits our mobility and pleasure in life.
With an integrative approach to chronic pain, I believe that many people who have resigned themselves to living with daily pain could experience significant improvements and minimize if not eliminate the source of their pain. That said, there are some situations in which chronic pain may never be completely eliminated, such as in the case of someone who has been severely injured or undergone massive trauma. However, even in these cases, the potential to feel better is still immense because even when there is great physical trauma, we can still tap into the infinite power of the mind. Through meditation and other awareness-expanding practices, we can learn how to direct our attention in a way that decreases stress and anxiety and increases calm and wellbeing.
What role does diet play in chronic pain? Are there specific foods that can help relieve chronic pain and are there some that exacerbate pain?
Dr. Patel: Yes, the role of diet is vital. The food that we eat can promote health and wellbeing or contribute to toxicity, so in treating chronic pain or any disorder, we want to choose foods that nourish our body and mind. In general, the recommended diet is fresh, whole foods, emphasizing vegetables, whole grains and some fruits while eating meat and dairy in moderation (if you’re not a vegetarian). Chronic pain is linked to inflammation in the body, so it’s important to eliminate foods that create inflammation – namely “unnatural” foods (including refined, processed, and manufactured foods, as well as artificial sweeteners). The Ayurvedic recommendation for including the six tastes in every meal is beneficial for overall wellbeing as well as for cultivating the balance and healing for those coping with chronic pain. The six tastes are sweet, sour, salty, bitter, pungent, and astringent. Including all six tastes in every meal ensures that you are getting the variety of nutrients that your body needs to heal. It is also important to balance the amount of each taste in the diet, depending on an individual’s mind-body type. We teach people during our Perfect Health week to understand their mind-body types and choose appropriate foods accordingly.
Dr. Patel: The first and most important thing is to show empathy and compassion for the person experiencing pain. This is healing to them in and of itself. Next, one could consider helping a loved one with chronic pain explore integrative and holistic practitioners in their area that may assist them in learning about and using therapies that they haven’t yet tried. Often, physicians in a typical medical practice are not aware themselves of all of the healing modalities out there, so patients and their friends and family need to be proactive in seeking out these practitioners. Approaching pain from a mind-body-spirit approach gives a person the best chance of maximizing their potential to relieve or even end chronic pain.
Perlman, D, et al. (2010). “Differential effects on pain intensity and unpleasantness of two meditation practices.” Emotion, 10(1): 65–71.
Rosenblatt,RA and Catlin, M. (2012). “Opioids for chronic pain: First do no harm.” Annals of Family Medicine. Vol. 10, No. 4: 300–301.
Vickers, A; Cronin, A; Maschino, A; Lewith, G; MacPherson, H; Foster, N; Sherman, K; Witt, C; Linde, K. (2012). “Acupuncture for chronic pain: Individual patient data meta-analysis.” Archives of Internal Medicine, 172(19): 1444–1453.
*Note: The information in this article is intended for your educational use only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition and before undertaking any diet, fitness, or other health program.
If you are interested in mind-body healing and have been diagnosed with pain disorder, suffer from chronic pain, or want to learn more about holistic approaches to treating pain, the Chopra Center’s Perfect Health: Healing from Pain program is designed specifically for you.
If physical and emotional roadblocks are preventing you from fully enjoying your life, it's time to experience Perfect Health.
Sheila Patel, M.D. is a board-certified family physician who is passionate about bringing holistic healing practices into the Western medical system. Before coming to the Chopra Center, she practiced full-spectrum family medicine, from prenatal care and deliveries to ER coverage and primary care for all ages. As the Chopra Center’s Medical Director, she offers integrative medical consultations that combine the best in conventional medicine with the wisdom of Ayurveda. Her special interests include preventive medicine and mind-body medicine, with an emphasis on Ayurveda.