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Cognition
Context
Mood
Individual factors
Centres for
sensation, memory,
association, emotion
and behaviours
Pain impulses
Chronic Pain is when a person experiences pain on most days of the week, for > 3 months
Result:
Worsening pain in intensity, severity and extent.
Acute Pain
Short duration Nervous system is normal
Chronic Pain
> 3 months to years Neuro - plastic changes in the CNS Vegetative changes Unremitting, progressive Intensity does not reduce, reminder of advancing disease Chronic pain takes on characteristics of a disease
Autonomic responses
Self limiting with healing Intensity subsides over time with
healing
Acute pain is a symptom ; it is protective
If there is lack of clarity and meaning, non curability, unfamiliar, sense of hopelessness, helplessness
spreads to the other dimensions energy, emotional, intellectual and
behavioural spheres
Cognitive evaluative
Motivational affective
She has no appetite, vomits and food consumed does not get digested Her recent scan shows increase of her disease She has persistent severe pain in the abdomen spreading in currents to back Her daily activities are affected; she does not sleep well This is Shikha during her 1st visit to my consulting room in Bangalore
Physical
Persistent pain Unreliable pain relief Deep ms. tension, other symptoms
Social Loss of role family /society Loss of income Helplessness/abandonment Relationships - sense of isolation Body image related
Spiritual
Why has this happened to me? What is lifes purpose? Is this a punishment?
Guilt / anger
What is the point of this all?
why?
Can it impinge on self efficacy / self esteem? Can it lead to questioning on belief systems?
Physical Sheath
Energy Sheath
Emotion Sheath
Wisdom Sheath
Bliss Sheath
Wind Up of NS Vital rhythms Gland secretions Metabolic activity Endocrine flow Immune activity ANS function
Shallow breathing Loss of appetite Sustained deep muscle tension Disturbed sleep Impotence Fatigue
Anderson R U J Urol. 2008 Mar;179(3):956-60. Epub 2008 Jan 22 Spring J -Plucne Bolesti. 1991 Jan-Jun;43(1-2):5-12 Jensen Headache 2003;38[1] 10-17 Michael J -Headache: volume 18, issue 4: 189 - 196
Jnana Yoga
Bhakthi Yoga
Karma Yoga
Raja Yoga
Sahaja Yoga
Kriya Yoga
Power Yoga
Self awareness .. Be informed illness, person, environment and ongoing inputs Acquire communication skills
Active listening, understand concerns, personality, expectations
Shared goals of care Respect for body & emphasise awareness of body and breath Facilitate efficient body mechanics, optimal energy expense Gradual pace, individualised process Profound interaction body breath mind
Submissive, suppressed
Impact of Iyengar Yoga on Quality of Life in Young Women with Rheumatoid Arthritis 6-week twice/week Iyengar yoga program
Phylogenetic tendency for protection reflected in breath Restricted, Shallow, chest breathing - inefficient Mind interprets Ongoing stress
Physiological stabilization
Physiology is unable to differentiate hypothetical / retrospective thought
State of mind
Breath
It is both ways + positive or negative
Take next gulp of food before the previous has been chewed and
swallowed?
At traffic signals, start honking when the light turns from red to yellow?
When walking with another with slower pace, ending up waiting for the other to catch up?
Darting glances, jerky movements Irregular breath, broken flow of speech Difficulty in counting slowly till 5 during exhalation Hypertonic shoulder and neck muscles incomplete exhalation Irregular breath during asanas need help / slowing / pause
Allow the body to breathe on its own OR watch inhalation happen spontaneously
The slowing of the flow of thoughts and allowing a thought to finish before rushing to the next one is a natural consequence of breathing in this manner.
Filter, humidification Efficient absorption of O2 from lung through vacuum created Absorption of prana Allows cyclic alterations of predominance between nostrils Mouth breathing urgency / perception of threat
breathing techniques do offer rapid relief from excess emotionality, poor concentration, a scattered mind, and other disturbances they can be taught to be used on demand Cramer, General Med 2013, 1:2
Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors
Pranayama (breathing exercises), 16 Gentle Hatha and Restorative
Addresses Life STANCE - Yama, niyama Preferable after establishing a therapeutic relationship Give scientific perspectives to emphasise thoughts body
lie detector
Mana [mind]
Budhi [intellect]
Ahamkara [individualised self]
required
Relaxation Response
Subtle notional corrections Change in the context of the disease, pain and meaning of life
Subject Pain
Associations with experience and memory victim, no hope, fear of dependence, chitha helplessness, death Response / reaction Anthahkarana Oh . this is unbearable, why me? this is unfair, I am doomed, am I being punished?
Subject
Pain
Experience
Sensation of pain
victim, no hope, fear of dependence, helplessness, death Oh . this is unbearable, why me? this is unfair, I am doomed, am I being punished?
Awareness, pratyahara, sakshi bhava, venting fears, misconceptions, caring team, CBT, sense of control
Factors that lower pain threshold Anxiety Depression, Grief Insomnia Isolation Lack of control on pain Doubts, unresolved conflict
Factors that raise pain threshold Calm outlook Optimism, Joy Adequate sleep Support family, community Perceived control over pain Clarity, communication
Incorrect training of the trainer Premature introduction of mobilisation before adequate relaxation and stretch
Competitiveness in asanas
Aggressive Pranayama
Relaxation asanas Breath awareness and DPH breathing Deep relaxation techniques in range of movement Individualised asanas and Pranayama practices according to capacity and need Focus on awareness and Pre meditation practices if patient chooses
Chronic Pain is a multidimensional disease Shared decision- as active participation is expected Incorporating Yogic discipline influences the different realms positively Specific individualised approach enhance results
Awareness of body, breath and thoughts Aim for gradual improvement Emphasise relaxation and optimal energy expense Practices based on knowledge, tailored to suit the person Therapist open to learning
aanandini@hotmail.com