The Ancient Practices of Yoga Meet Modern Pain Science (Part 1/4)

In this Noijam series, Martina Egan-Moog and Neil Pearson explore where ancient yoga philosophy intersects with contemporary pain science. Drawing on some of their work in the Embodiment in Pain Science Education course, they bring together philosophy, lived experience, and emerging evidence. They consider where current science offers support, as well as where ideas are still developing or not yet well understood. This creates space to explore different ways of thinking about pain, suffering, and care, while staying mindful of the evolving evidence base.

This ‘jam’ is the first in a series of four, intending to provide an overview of interconnected topics – yoga philosophy, techniques and practices, the lived experience of pain, neuroplasticity, and embodied pain education. Through the interconnectedness of these topics, we offer an introduction to how yoga can address common impacts of chronic pain across biopsychosocial and spiritual domains.

What does yoga say about pain?

In the Sanskrit language, which was contemporary to early written texts on yoga, the word ‘duhkha’ means pain and suffering and dis-ease. Sanskrit is a conceptual language, so context guides an understanding of meaning in any sentence. Clearly, though, within Sanskrit there is no language differentiating pain attributed to the physical body versus pain attributed to mental health concerns.

Yoga philosophy describes that there are five aspects to our existence – five ‘koshas’ – each potentially a source of and/or part of the solution to suffering.

The five koshas can be summarised as:

1. the physical body
2. the energetic body (think of the energy that animates us, and that energetic aspect of us that leaves the body after death)
3. the lower mind (think of all the autonomic functioning)
4. the higher mind (our ability to think about what we are thinking, feeling and doing)
5. the bliss body (the aspect of us that is connected to others, nature, beyond the world)

Yoga philosophy is also often interpreted as stating that suffering is related to afflictions of the mind. These afflictions are called the ‘kleshas’ in Sanskrit and can be summarised as the following:

• Ignorance (such as not knowing that we have some influence over chronic pain after injury)
• Attachment (such as a sense of entitlement to a pain-free life)
• Aversion (such as fighting to escape pain)
• Ego (such as believing that you should be able to overcome pain because you have always been competent)
• Fear (fear can be related to mortality, loss of identity or security due to pain)

Take a moment to consider each of the bulleted items in the koshas and the kleshas. Each is a meaning-making concept through which pain could be impacted based on yoga philosophy. If any of these seem outside of your scope or competence, yoga philosophy informs us that we can impact any aspect of our existence through any other. As such, we can use the physical practices of yoga to impact any of the koshas and the kleshas.

Before discussing how the experience of persisting pain commonly impacts us biopsychosocially and spiritually, and how we might use different techniques and practices of yoga to influence different realms, let’s review the research.

Yoga and chronic pain research

Based on available research, including systematic reviews and meta-analyses, when individuals with chronic pain complete an 8–12 week program of 1–2 yoga classes and 1–2 home practices each week there are mild to moderate effect size changes in pain, function, medication use, and both mental health and occupational outcomes.

Research gaps exist

Stating that yoga helps people in pain is much like stating that exercise is beneficial. At present, we do not know the dose and dosage, nor how to determine who will benefit. It is also uncertain whether certain styles of yoga practice lead to different outcomes or adverse effects, or if individualised yoga instruction might be different from group classes. The personal education, beliefs and language of the teacher might also impact outcomes.

Please see the reference Yogatherapy and Pain by Pearson et al. (2020) for more detailed information.

From a clinical perspective, it would be helpful to know whether adding yoga to a best practice care plan would improve outcomes. At least one research study is in the process of collecting data on this topic.

The lived experience of chronic pain: how yoga might help

People in pain commonly experience the following, and each of these can be addressed with yoga techniques and practices:

• Altered breath pattern and rate
• Muscle tension
• Muscle inhibition
• Decreased interoceptive accuracy
• Low energy
• Low confidence, self-efficacy and sense of competence
• Difficulty with focus and concentration
• Altered sympathetic nervous system activity
• Poor sleep
• Anxiety, depression, anger, fear
• Chronic heightened stress
• Relationship difficulties
• Loss of sense of purpose

Yoga is not a panacea. There is empirical evidence that yoga leads to significant changes in all of this, however, as the research evolves we will learn if yoga mediates the changes and how any changes compare to other interventions.

The next three ‘jams’ will dive deeper into understanding how yoga philosophy and techniques align with modern pain. Take a look at Part 2.

– Martina Egan-Moog and Neil Pearson

Martina and Neil teach the Embodiment in Pain Science Education (EPSE) course. Open to all healthcare providers, whether your background is specific to manual therapy, movement-based, psychological, wellness-focused, education or research. EPSE utilises body-based experiences to help individuals better understand and manage pain. It focuses on movement, interoception, and mind-body techniques like yoga to challenge misconceptions about pain through felt experience. This approach empowers both clinicians and patients by enhancing body awareness, reducing fear, and improving self-efficacy in pain care.

Complete References