Neurology Now:
doi: 10.1097/01.NNN.0000300609.58938.1a
Feature: Mind/Body Medicine

Mindful Of Pain

HAUPT, JENNIFER

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Jennifer Haupt writes health and lifestyle articles for Woman's Day, AARP: The Magazine, Cure, and Reader's Digest.

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Abstract

Yoga and tai chi can help you harness the power of the mind-body connection to ease the pain of multiple sclerosis, neuropathy, and other conditions.

When Eric Small was diagnosed with multiple sclerosis (MS) at age 21, his case was so severe that doctors thought he wouldn't live past age 40. “It got to the point where I had to use a breathing machine, and my legs were so weak that I used two walking canes to get around,” says Small, now age 75. “And, yet, I never gave in to the disease. I was determined to find a way to beat it, and I did.”

Though Small suffers from the blurred vision, fatigue, and occasional numbness that are common among MS patients, he is a vibrant man who says he hasn't had a serious relapse in more than 20 years. He walks without a cane and takes no regular medications. In large part, he credits his unexpected good health to his dedication to Iyengar yoga, which he practices from 5:30 a.m. to 7:30 a.m. six days a week. Iyengar is a type of yoga that emphasizes the correct alignment of the body and incorporates supportive props such as cushions and straps, which allows physically limited students to more easily and safely experience the postures.

Small is such a strong believer in the physical and spiritual benefits of yoga in battling MS symptoms that he became a certified Iyengar yoga instructor. For the past 25 years, he has taught modified yoga poses to students with MS and other chronic pain conditions, such as lupus, arthritis, and fibromyalgia, at his studio in Beverly Hills, CA.

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YOGA FOR MS

According to a 2004 study from the Oregon Health and Science University, just six months of yoga significantly reduced fatigue in people with MS. The study found that yoga is as good as a traditional aerobic exercise program in improving measures of fatigue, a common and potentially disabling symptom of MS. Yoga was studied because an earlier survey at the university of nearly 2,000 MS patients in Oregon and southwest Washington found about 30 percent of respondents had tried yoga. Of those, 57 percent reported it to be “very beneficial.”

According to Dennis Bourdette, M.D., chairman of the School of Medicine's department of neurology, the goal was to see whether or not yoga was beneficial when studied scientifically, and how it compared with a type of exercise that physicians more commonly recommend: exercise on a stationary bicycle supervised by a physical therapist.

The study examined 69 MS patients in three groups: one taking weekly Iyengar yoga classes along with home practice; another taking a weekly exercise class using a stationary bicycle along with home exercise; and a third group placed on a waiting list to serve as a control. While the yoga and aerobic exercise programs produced no significant changes in alertness, attention, or other measures of cognitive function in MS patients compared with the waiting-list group, both of these exercise programs showed significant improvements in two fatigue-measurement tests.

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RELEASING TENSION

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While the physical benefits of yoga and tai chi can be observed and measured, many experts believe there are other benefits that go even further.

“We look at yoga as a technology to reduce both physical and mental turbulence, to quiet the mind and reduce stress,” says David Simon, M.D., a board-certified neurologist and CEO and medical director of the Chopra Center for Wellbeing in Carlsbad, CA. “Our focus is on reducing the symptoms of neurological diseases by changing the patient's relationship to them. When people with chronic pain reduce their stress using yoga and meditation, they find their ability to modulate their pain and suffering.”

The Chopra Center works with many people who have MS and other conditions that cause musculo-skeletal pain. According to Dr. Simon, people with chronic pain usually hold tension where they have discomfort, as a way to control it. Part of their limitation is due to the physiological pain, but this muscle tightness is another contributing factor, says Dr. Simon. Yoga teaches them to identify where they are holding pain, breathe into those areas, and expand their flexibility so that they can begin to release the tension.

“Yoga is excellent for reducing fatigue and controlling spasms because it energizes your entire system—mind and body,” explains Loren Fishman, M.D., a certified Iyengar yoga instructor and assistant clinical professor in rehabilitation at Columbia College of Physicians and Surgeons in New York City. Dr. Fishman co-wrote the instructional manual Yoga and Multiple Sclerosis: A Journey to Health and Healing (Demos Medical Publishing, 2007) with Small. “The goal of medicine is usually to take you from being sick to being at some measurable level of good physical health. But the benefits of yoga just keep growing the more you do it.”

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MINDFULNESS

The roots of therapeutic yoga go back thousands of years in India; and the Chinese practice of breathing, form, and meditation known as tai chi dates to 14th-century China. The mainstream medical community in the U.S. has been slow to embrace these Eastern arts, favoring conventional low-stress exercise such as walking and bicycling for people with conditions such as neuropathic pain. However, there is a growing movement of doctors and physical therapists who are incorporating yoga, tai chi, and other meditative disciplines that combine balance and flexibility training with what is know as “mindfulness” into treatment programs for MS, Parkinson's disease, neuropathy, and other neurological illnesses.

Mindfulness is nothing more than paying calm, moment-by-moment attention to what you are thinking and feeling. Ideal for cultivating greater awareness of the connection between mind and body, mindfulness has been shown to positively effect a range of autonomic physiological processes, such as lowering blood pressure and reducing overall arousal and emotional reactivity. Yoga and tai chi combine the stress-reducing effects of mindfulness with low-impact movement, which is especially helpful for people who have chronic pain or physical limitations that make them relatively sedentary.

Jon Kabat-Zinn, Ph.D., professor of medicine emeritus at the University of Massachusetts Medical School, developed the Mindfulness Based Stress Reduction program at the University of Massachusetts Medical Center in 1979. The program is now offered in over 200 medical centers, hospitals, and clinics around the world. Two decades of published research—much of it supported by the National Institutes of Health—indicates that the majority of people who complete the mindfulness program report lasting decreases in physical and psychological symptoms. Completed studies have found dramatic reductions in pain levels, an enhanced ability to cope with pain that may not go away, and decreased use of pain-relieving drugs for a majority of participants.

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TAI CHI FOR NEUROPATHY

The Eastern art of tai chi combines relaxation and balance techniques in a way that seems to be particularly beneficial to people with neuropathic pain. Li Li, Ph.D., professor of kinesiology at Louisiana State University, is conducting a study into the benefits of tai chi for peripheral neuropathy patients. Since the program began in 2004, hundreds of students practicing tai chi in a modified form that accommodates peripheral neuropathy have shown consistent, far greater levels of improvement than those who use walking alone or low-impact weight training for exercise.

A primary symptom of peripheral neuropathy is a loss of sensation on the soles of the feet, which is vital to maintaining balance. The continued practice of tai chi helps in regaining one's balance and preventing falls, according to Dr. Li, who says that he sees improvements in sensation, flexibility, and overall health in his patients in anywhere from a few weeks to a few months. So far, says Dr. Li, most of the patients in his study have reported a significant decrease in falls and increased confidence walking and standing; in addition, many have been able to stop using walkers or canes.

Olivia Whitten, 64, has been in Dr. Li's program since October 2006 and participates in three one-hour classes each week (more than the average participant). “Within a month, I began to feel an improvement in my circulation and had more feeling in my extremities,” says Whitten, who has numbness in her feet and fingers. “My family notices that my balance is better. I used to be afraid to take long walks with them because I couldn't keep up. That's not a problem anymore.”

Today, the program is maxed out, with 75 participants who attend weekly classes and another 200 on the waiting list. “We're seeing great things happening,” says Dr. Li, who is currently working on publishing the study results. “Some people started the program unable to stand, even with assistance, for more than five minutes. Today, these same people have no trouble standing independently in the shower or doing other routine things most of us take for granted.”

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START SLOW

Whichever discipline you undertake—as with all exercise—consult with your doctor first. Depending on the progression of your condition, certain forms of exercise may be too taxing. Start out slow, let your body be your guide, and for MS patients, be careful about overheating. “For students who have MS or any physically limiting condition, moderation is important,” says Karen O'Donnell Clarke, 51, a yoga therapist in Ledyard, CT, who has MS. “Too much, too soon can overwhelm the system, causing fatigue and increasing the risk of injury.”

Kevin McShea, 28, was diagnosed with MS 10 years ago, and spent part of 2002 bed-ridden. When he decided to try yoga in late 2004, he started with private lessons. “I wasn't very confident of what my body could do,” says McShea, who took eight to 10 private lessons with Clarke, then joined her weekly classes. “After just a few sessions, I began noticing changes—I wasn't as stiff when I walked up stairs, and even moving my leg from the accelerator to the brake when I drove was easier.”

Clarke recommends starting with a weekly yoga class, and practicing breathing and stretching for five to 10 minutes each day and building up as you feel comfortable. The bottom line is that the more you do it, the better you feel.

“Once people begin a routine practice, they find they have more flexibility and movement in their daily lives,” Dr. Simon explains. “The more they move, the more chemicals are released in their body that makes them feel psychologically better—which also makes them feel more able to physically move more. It's a mind-body cycle that feeds itself.”

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INNOVATIVE THERAPIES

This is the fourth in a series of regular articles covering complementary therapies. Also known as alternative therapies, they are now being accepted by doctors to augment standard medical treatments.

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Om Away From Home: How to find a yoga or tai chi class

There are a growing number of different kinds of yoga classes available, and it's important to note that the proper method and teacher is critical for people with chronic pain or physical limitations. The same goes for tai chi or any other type of exercise program.

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BE CAREFUL “You can hurt yourself, even with simple yoga classes, so doing the exercises properly is important,” says Small, who teaches yoga instructors nationwide and has designed dozens of classic yoga poses for people with limited mobility, including variations for those in wheelchairs. “The use of the appropriate supportive props and the progressive sequences in the Iyengar method make it perfect for people who are not very flexible and suffer from chronic pain.”

GOOD GUIDANCE The right teacher is also a key element to success. “Find a yoga teacher who recognizes that it's less about the external model of the poses,” Dr. Simon says, “and more about the awareness of the mind-body connection—helping to breathe, relax, and release.”

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Om at Home: Instructional Books and Videos

Lilias! Yoga 101 Workout for Beginners by Lilias Folan contains four mild, 30-minute sessions culled from her popular PBS series. Folan has a down-to-earth delivery that makes yoga feel natural and intuitive. To order, call 406-443-7630 or go to liliasyoga.com/store/dvd.htm.

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Yoga and Multiple Sclerosis: A Journey to Health and Healing by Loren Martin Fishman, M.D., and Eric Small is a guide to applying the principles of yoga to the management of MS. Poses that work toward a common goal, such as combating fatigue or reducing spasticity are included and illustrated. Go to demospub.com.

Tai Chi for Diabetes by physician and tai chi expert Paul Lam, M.D., includes a 77-minute tai chi workout with movements specifically chosen for people with both Type I and Type II diabetes. To order, call 901-388-3253 or go to taichiproductions.com.

©2007 American Academy of Neurology

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