Applying Ancient Insights to Modern Pain Management (Part 4/4)

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 fourth 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. (Read part one, part two and part three.)

Meeting Patients Where They Are and Validating Current Practice

Patanjali teaches that we can only interpret and do things according to our current state of consciousness. This aligns remarkably well with concepts explained in “Pain and Perception” (Harvie & Moseley, 2012), as well as stages of change and readiness to adopt self-management approaches (Kerns & Rosenberg 2000). We need to be ready to change. Those who outwardly appear similar in their pain presentation may be at vastly different levels of readiness to “let it be, let it come, and let it go.”

The ancient masters recognised that each person will go through their own process of transformation—it’s just a matter of when. This understanding can be liberating for clinicians. It reminds us to accept patients for where they are, recognising that their journey toward deeper understanding might take longer, but they’re doing the best they can with the wisdom they’ve currently acquired.

This realisation also protects us from burnout when progress is slower than our ego allows.

The Power of Language and Conceptual Shift

Knowledge and education are keys to transformation (Moseley et al 2024; Moseley et al 2025). According to the sutras, it’s easier to provide someone with new information than to change an existing idea—this aligns with our understanding of the importance and challenges of conceptual change in pain education. Filling minds with wisdom (whether from pain science masters or ancient philosophers) while avoiding threatening information (sensationalised news or “Dr. Google” or unhelpful terminology) is a crucial first step.

Consider the revolution happening around terminology: shifting from “chronic pain” to “persistent pain” and actually telling people that pain can be changed. The consistent use of less judgmental, more descriptive language helps reduce stigmatisation of the lived experience. The language of yoga and of neuroplasticity support that pain can be changed and helps remove the belief that pain cannot be changed without fixing the tissues.

Changing conceptions about pain—for both clinicians and patients—is a valuable first step, though it still requires neuroplasticity to create biological effects.

The Connection Between Mind and Body: Breath

Breath can be used to increase the connection between mind and body. For people in pain, it can be difficult to use the mind to change the body or to use the body to change the mind. Breath can be the bridge. By bringing focus to breathing, we use interoception as a grounding anchor. This increases activity in the right dorsolateral prefrontal cortex, creating top-down influence on nociception and pain. With less pain and less sympathetic nervous arousal, it can be easier to learn how to decrease muscle tension, and easier to gain some influence over racing or catastrophic thoughts. Breath is one of the most accessible ways to reconnect to the body, and to regain regulation of body and mind.

Breath practices might have any or all of the following goals: to increase sense of control, to be more present and calm the mind, to help sleep, to reduce muscle tension, to decrease hypervigilance, to teach a person to be able to focus on what they want to focus on rather than only on the pain.

Today, research addressing proposed mechanisms of breathing exercises is sparse.

Addressing the Afflictions (Kleshas)

In part 1 of this series, it was mentioned that Patanjali’s sutras identify kleshas (afflictions or obstacles) that can be minimised through the practices of yoga. This process can be considered as reprogramming ourselves – learning to decrease our attachments and aversions and releasing what we’ve learned in error (ignorance). We have the ability to retrain ourselves over time. Guiding individuals with low back pain to nudge up against the edge of their sweet zone, and to do this daily without leaving the pain provoked, is one example of reprogramming. In yoga, the first steps to addressing the kleshas include gaining more control of the breath and the body and specifically learning to find more calm in both. From this place of greater calmness, one can then observe attachments, aversions, ignorance, ego, and fear with some ability to maintain homeostasis – at least without it being knocked completely off balance.

From I-ness to We-ness

Perhaps one of the most profound applications of yoga philosophy is the shift from “I-ness” (my patient, my therapist) to “we-ness.” If we truly believe we’re all interconnected, this helps maintain an empathetic, non-judgmental attitude. It recognises that we’re all part of the same field, with access to the same energy source when we activate our available resources.

In yoga, when we let go of I-ness we take a step closer to an understanding of our true nature, and thus suffering diminishes further. Patanjali states that the truth is that we are spirit. Our physical self and our mind-self are not who we truly are, and gaining this understanding can set us free from our suffering.

In modern pain management language, we discuss utilising the individual’s “SIMs” (Safety In Me factors from the Protectometer model) (Moseley & Butler 2015). For some, the philosophy of yoga will be a powerful SIM. For others, increasing awareness of breath, body and mind will be powerful SIMs. And for others powerful evidence of safety will arise while gaining influence over breath, and muscle tension, and motor control, and thoughts and emotions – or simply being with other people in a yoga class can help to co-regulate.

The Ultimate Goal: Mastery

Pain management, viewed through this lens, aims for a sense of control—mastery over the senses so that we as humans run our lives rather than having pain run us. This is Patanjali’s Sutra 2.55: achieving mastery that allows us to live fully despite persistent sensations.

We can all be guides for this transformation, using our energy to influence the energy in our patients. But we don’t do it for personal gain or to keep patients dependent. We do it to foster independence, control, and the deep realization that transformation is possible.

Conclusion: A Novel Framework for Person-Centered Care

Yoga philosophy offers a novel, holistic framework for understanding person-centered pain management. It provides language for the complexity of human suffering while offering a path forward that honours both ancient wisdom and modern neuroscience.

Yoga philosophy states that consciousness can evolve, that suffering is influenced by the body and by perception, and that we all have innate wisdom waiting to be accessed, we create space for genuine transformation. We meet patients where they are, provide them with tools they haven’t even considered for their journey, and trust in their capacity to find their own path to healing.

Kriya yoga states this in another way. Its focus is on disciplined action, self-study and surrender to the mysteries of life as the path to less pain and suffering. Like pain care, the path of Kriya yoga includes the recognition that the person in pain requires enthusiasm and energy to change, requires increased knowledge through others and of self, and requires connection to a higher power.

In the end, perhaps the greatest gift of this ancient wisdom of yoga is permission—permission to be patient with ourselves and our patients, permission to acknowledge that healing isn’t linear, and permission to trust that transformation happens in its own time, when consciousness is ready to shift.

The sutras remind us: enlightenment is not a question of if, but when. And in that compassionate waiting lies the art of true healing.

– 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.

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