On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Neil Pearson on the show to discuss therapeutic yoga in pain care. Neil Pearson is a physiotherapist, and Clinical Assistant Professor at the University of British Columbia. He is a yoga teacher, a yoga therapist and creator of the Pain Care Yoga training programs for health professionals and yoga therapists.
In this episode, we discuss:
-The components of yoga practice that benefit people with persistent pain
-Yoga therapy as a pain education agent
-The Pancha Maya Kosha Model of yoga and the biopsychosocial model of healthcare
-Yoga and Science in Pain Care: Treating the Person in Pain
-And so much more!
Resources:
Yoga and Science in Pain Care: Treating the Person in Pain
For more information on Neil:
Neil Pearson, PT, MSc(RHBS), BA-BPHE, C-IAYT, ERYT500
Neil Pearson is a physiotherapist, and Clinical Assistant Professor at University of British Columbia. He is a yoga teacher, a yoga therapist and creator of the Pain Care Yoga training programs for health professionals and yoga therapists. Neil is founding chair of the Physiotherapy Pain Science Division in Canada, recipient of the Canadian Pain Society's Excellence in Interprofessional Pain Education award, faculty in yoga therapist training programs and an author. Neil develops innovative resources, collaborates in research and serves as a mentor for health professionals and yoga practitioners seeking to enhance their therapeutic expertise. He is co-editor of ‘Yoga and Science in Pain Care: Treating the Person in Pain,’ available Aug 2019.
Read the full transcript below:
Karen Litzy: 00:01 Hey Neil, welcome to the podcast. I'm happy to have you on to talk about yoga and science in pain care, which is a title of your new book. And we will talk about the book throughout the podcast, but I'm excited to learn more about yoga and how yoga can work with people in pain. So welcome back to the podcast.
Neil Pearson: 00:24 Thanks so much Karen. I can't remember how long it's been since we've been here but it’s wonderful to be back.
Karen Litzy: 00:29 Yeah, I think it's been awhile. I don't know either, but I think it's been a long time, but I'm excited today to talk about yoga and how yoga can be an agent for people in pain. So as a lot of the listeners know, I had a long history of chronic neck pain, so this is something that really interests me, but I will kind of pass it along to you. So how does yoga help as a pain education agent?
Neil Pearson: 01:00 Okay. So, maybe I'll start at a bit of a different place, but coming to there, so I guess part of my excitement around this, you know, we've got this new textbook out, it's called yoga and science in pain care. And really what it's trying to do is, is teach health care people about yoga and yoga research and how it can help but also some of the research behind that in terms of why it would work. And also it's sort of tried to go the other way as well as to teach yoga people about pain and about the lived experience of pain. So with the textbook, we're trying to hit both sides, right? Because we really see this as being something that needs to be integrated. And I think we sort of hit a really nice time with this because there's such interest in non-pharmacological pain management now.
Neil Pearson: 01:54 Everyone’s starting to recognize that the long-term management of pain or the care of people in pain has lots to do with what the individual does for themselves. Not completely as self-help kind of work, but more as what the person does for themselves under the guidance of people like us as physical therapists and under the guidance of people like the yoga therapists. So that sort of, the sort of broader where this is coming from. And then if we look at sort of how it can help, we can start by looking at some of the research and I guess probably in terms of pain management and pain care the simple thing to do to start with when we say we have now have formal analysis and systematic reviews that show that yoga therapy has been shown to be effective.
Neil Pearson: 02:45 That helping people to have less pain, to improve both perception of ability but also measured function and also improved quality of life. Those three things really are the three keys that people want. When we have ongoing pain, we want to have less pain, better ease of movement, and better quality of life. And the research is showing positive findings there. And it's showing positive findings in quite a varied group. So, there's a lot of research on low back pain. I mean, that's the one that has the most research. So much so that the, you know, the American medical association now has a yoga as one of the suggested treatments for people who have ongoing low back pain. But it also shows benefits for people who have rheumatoid arthritis, osteoarthritis, fibromyalgia, a whiplash associated disorder and a irritable bowel syndrome as well.
Neil Pearson: 03:43 So there's this growing body of evidence saying that when people have these conditions that they can find benefit from them. And of course, like any area of research, we'd have to say, you know, it doesn't say that it's gonna work for everyone. It just says that if you take a lot of people and you give it to them, there will be some benefit with using yogas. The therapy people always want to know, well, is the yoga therapy better than physical therapy or is it better than going to the gym? Is it better for other movement practices? And we don't have that research yet. The effects sizes of some of the research when people are going through using yoga therapy for pain management are higher than the effect sizes of movement on their own and comparable to the effect sizes. You see when you do research looking at cognitive behavioral therapy plus movement therapy for people with chronic pain, which makes a lot of sense because yoga therapy really does cover a lot of the aspects of the person. And so your listeners may be thinking yoga for people with pain. That sounds actually pretty ridiculous because whenever I see pictures of people doing yoga, there's no way that that's what people in pain are going to do,
Karen Litzy: 05:00 Right? Cause they're always in these positions where even if I don't have pain, I think to myself, how in the heck am I supposed to get into that position?
Neil Pearson: 05:10 Well, exactly right. And, and it sort of the other question that often sounds ridiculous to the person who has ongoing pain is like, aren't you listening to me? I told you that movement hurts and you're telling me you want me to move as a way to get better. But movement is the problem. And so it's interesting that the practices of yoga can help people to find new ways to move with more ease. But also, the practice of yoga, we need to recognize really are so vast. We're talking about, if we sort of overviewed yoga, yoga is about learning how to relate to yourself in new ways, how to live in a world in new ways. It is about movement with the postures and it is about doing breathing techniques. And then there are awareness techniques which are akin to mindfulness, but they're a little different.
Neil Pearson: 06:10 And then there are also within yoga there are meditation techniques as well. So it really covers a broad, broad spectrum of interventions. And if we go to the literature again around chronic pain and chronic pain care, we see that mindfulness techniques and meditation are showing positive benefits. Movement is showing positive benefits. Gaining knowledge is showing positive benefits, acceptance, commitment therapy, cognitive behavioral therapy. All these things show benefit for people with chronic pain. And there are aspects of those all within yoga sort of as this package. And the idea would be that we could, with the person who has ongoing pain, the yoga therapist would be able to do an assessment to see how the pain has changed the person or influenced sort of all the aspects of their existence. And then try to find how we could use different techniques of yoga to help.
Neil Pearson: 07:08 So for instance, if a person was, let's take a common example, like the person who has chronic low back pain, but we know that with chronical back pain, often there's anxiety. Often there's grief. Well, there are aspects of yoga that we could use to address the grief or the anxiety. Often when we have ongoing pain, we have the sense of loss of self competence or self efficacy and we could use certain aspects of yoga to address those. Our body tends to get stiff or some muscles, you know, are gripping all the time. And within yoga we can do things to help to release muscles that are gripping or learn how to reengage muscles that seem to be inhibited. And so it's the practice of yoga would be to or yoga therapy would be to go through it and see how this individual is impacted and then see how we could use the different aspects within yoga to put together a plan to address a lot of the changes that are related to ongoing pain.
Karen Litzy: 08:12 Yeah. So I think what you're describing may be a little different than what a lot of, perhaps the listeners are seeing. Meaning yoga is more than just handstands on Instagram and you know, doing these impossible moves and making them look so easy because I think that's what a lot of people associate yoga with. And so what we're talking about here is not just going to a yoga class or not just putting something fun up on Instagram, but the yoga therapist being very intentional in their prescription, the type of yoga therapy they feel this person needs. So it's individualized based on a proper evaluation.
Neil Pearson: 09:02 Oh, exactly. Yeah. Although the one difference in yoga therapy is that yoga therapy is not diagnostic, right? So the yoga therapist isn't a trained health care professional. So what the yoga therapist is doing is it's actually applying yoga, getting the person to do different aspects of yoga, like meditation or awareness or breathing or movements. And then seeing how the person is limited in that and then working with them to find a way so that they can do that particular technique to help them to change ease of movement of life pain.
Karen Litzy: 09:40 Got it. Yeah. And there was, you know, something, we spoke about this a little bit before we went on the air, but there was a sentence within the book, the yoga and science and pain care that I had never heard of this saying before. I mean I'm not immersed in the yoga world, but it's the sentence is expanding our view and even altering our perspective to a Pancha Maya Kosha perspective enhances our understanding that pain physiology is studying the person as much as our biology. So can you talk about that for a little bit because I kind of liked that saying so you could expand on that.
Neil Pearson: 10:25 Yeah. So there's sort of the two parts of it is that that studying physiology is about starting the person, not just the biology, but then there's also this Pancha Maya Kosha which all start with that within healthcare we talked about the bio-psychosocial or bio-psychosocial spiritual model, which is intended to be an integrated view of the person that everything biological is going to affect everything psychological, it's going to affect everything social is going to affect the person who has spiritual manner and it's all working together as an integrated unit. So within yoga, the philosophy and the view of yoga is that there are different aspects of the individual, so the individual is integrated and whole, but we can look at the individual from different aspects to understand them better. And so I'm this pantry, my kosher view looks at the individual from a physical perspective, from a more energetic perspective, being Pancha is one of the things they're talking about, which really is life force.
Neil Pearson: 11:31 And then it really relates a lot to breath as well. But then there's within yoga to SIM Phi, we could say we look at they often call it the lower mind, but it's really getting at the automatic aspects of the human, all that stuff that runs automatically. And then there's above that or you know, I guess above it. There's this other aspect of us that this about us thinking about what we're thinking and it's about us regulating thoughts and emotions and breath and all that stuff. And then the other aspect of us is more the aspect of his that has more to do with spirit and connectedness to the world and everything. And so yoga already looks at the person from that kind of perspective. And with the idea that any change in one aspect of the individual is going to have an effect on the other aspects of the individual.
Neil Pearson: 12:25 So if you have a little back pain, it's going to change the way you breathe. It's going to change the automatic functioning of the body. It's going to change the way you think and emote and it will change your connection with yourself, your community. And that then you'll also have as part of its core belief system is that if a person that had low back pain, you could help the person with low back pain by going through any one of those aspects of the person so that you could help the person by affecting the physical body, by working on breath, by working on the automatic system, by working on thoughts and emotions or community that all those, everything interacts. And so that you could, you know, work at it through any of those aspects of your existence.
Karen Litzy: 13:08 Got it. And as someone who has had chronic neck pain for many years, it is very true that the physical pain certainly affects so much else that is happening in your life. It affects your thoughts, it affects your emotions, it affects your relationships, it affects the way you hold your body, the way you relate to your body, the way you see your body. So now I feel like I have a much better idea as to what that sentence means and how yoga can help the individual relate to all of that and kind of put it all together. Cause sometimes when you're in it, you don't see it. Know what I mean? Like you don't see that you're not relating to your body, you don't see that you're moving differently, you don't see that you're breathing differently, you're clenching, you're holding, you just, you don't realize it because it's just the way you are as a result of the pain.
Neil Pearson: 14:10 It's so true. And I think one of the key things about what you just said is that the experience of pain often disconnects us from awareness of ourself even so much so that we know now from the science side that sometimes when there's ongoing pain that a person will have a hard time actually feeling the non pain sensations of their physical body. So you know, imagine a person with a low back pain and we asked them to take their attention to the rollback and tell us what they feel there. And typically what a person would do is tell us about their back pain. And then of course I get really sort of funny reaction to people when I say, okay, you told me about your pain. What I want you to do is take your attention back there and tell me the non pain sensations you can feel on your low back.
Neil Pearson: 15:02 Which a lot of people, you know, really don't get that. And I say, okay, well you know, just right now take your attention to the feeling of your hands. Your hands are resting. Can you feel your fingers? Can you feel the temperature of your skin in your hands? Can you feel the angle of the knuckles? You probably can feel a whole lot of non pins sensations there and say if you had low back pain, I'd probably say, okay, now take your attention to your upper back, your mid back and notice the non pain sensations. They're just sort of exploring. Scan around. Okay, now what I want you to do is go down to your low back. No, just the pain. Sort of acknowledge it. Now what I'd like you to do is see if you can feel non pain sensations in that same area.
Neil Pearson: 15:41 So maybe you need to try to look under the pain or around it or through it. I feel that and it's amazing that some people will say, you know, I really don't experience anything right now except the pain. All I feel there is pain. I can feel my mid back, I can feel my upper back, but my low back, it's pain. That's all there is. And then other people will say, I can sort of feel it, but it feels like it's murky or muddy or hard to feel. And then, you know, we don't often get it with low back pain, but say what was your hand where the pain was? Well often people when they start to do this say, you know, my hand doesn't feel this right shape or size. It feels like it's too big or it feels like it's too small. It feels distorted.
Neil Pearson: 16:24 And so it's really interesting is that the practices of yoga specifically get people to take their attention to their physical self to try to reconnect to those sensations. And this is always part of yoga, but in Western science we're finally understanding this. It's really only been in the last five or 10 years where we've paid attention to the distortions of body awareness and body image that are common when pain persists. And, of course this becomes really fascinating to me because the next part is, as a research guy, I get stuck in because I know clinically when a person tells me that, that when I get the person start to work on finding those subtle non pains and sensations of their physical body, that when the person starts to be able to feel those sensations, that there's an associated decrease in their pain.
Neil Pearson: 17:20 And then the more the person is able to feel the subtle non-painful sensations of self, the more the pain diminishes. But I can't give you any good scientific explanation for that. You know, we see it clinically, but we can't fully explain it in some sort of, you know, central nervous system or insular cortex or any of those things. We just can't explain it. But to me, that's part of the interesting thing about both the practice of yoga is that it's driven by experience. And yet what the science is now doing is showing is that there's science that says that, you know, the experience of yoga aren't just all in your head. They're actually real measurable changes in the humans biology and physiology.
Karen Litzy: 18:08 Yeah, it's really interesting. And I wonder now you have me wondering, well why do people experience that decrease of pain when they start, you know, looking at the painful areas more than just painful. I mean, are they making changes in the sensory cortex? Is it affecting that idea of smudging that maybe they have a clearer outline of what that body part is now in the brain? And that can lead to changes? I don't know, but it's really an interesting concept.
Neil Pearson: 18:45 Well, and the thing about that too is that as we start to study more our sense of our physiological state, we start to realize that body awareness and aspect of it is, or a big aspect of is happening, sort of outside the sensory cortex. It's happening more in the insular cortex. And so I know in the last year I saw one research study that was saying that they couldn't find any smudging and people who had altered body awareness, but they were looking at the sensory motor cortex and didn't look at the insular cortex. And so it's another area as the research goes on, is maybe that smudging is happening in a different place or that alteration of brain activity is happening in a different place than we thought, but certainly the person that is experiencing it and if the person is experiencing it, we hope we can be able to find, you know, the correlate in the brain activity.
Neil Pearson: 19:45 Of course our, you know, our sciences far beyond or far behind, the experience that the human has, which really gets back to that other aspect of what you're saying is that that statement is when we study physiology, we hope that by studying physiology and pain physiology, that what we start to do is understand the human more rather than, maybe I'll say it this way often when I go to pain society conferences, there's a lot of biochemistry people there and they're talking about their research and at the end of it, they nearly always say, so what the science says is that here's this target for pain care, for pain intervention. And what they're talking about is that, we could give a chemical to the person to target this thing, this gene or this ion channel or whatever it is to change the person's experience of pain. And of course, my question always when I'm there is, so is there anything that the human could do to change that
Karen Litzy: 20:48 Outside of something pharmacological?
Neil Pearson: 20:50 Well, exactly right. And it would make sense if, if we're getting good effects from different treatments. Like yoga therapy that obviously they must be affecting these same biochemical and genetic and epigenetic things within the human. But they're doing them through the person's own, you know, we can say through their own medicine cabinet.
Karen Litzy: 21:13 Right. That medicine cabinet in the brain that David Butler talks about.
Neil Pearson: 21:17 Yeah. Yeah. And I think we can expand it into the human right. Because there's a, you know, especially even with the endorphins, cause there seem to be receptors for those all over the body.
Karen Litzy: 21:29 Or even, you know, up and coming research into the microbiome and things like that. I think is also an interesting study in pain and how can we alter our diets or can we alter what we put in our system to change the pain experience?
Neil Pearson: 21:55 Oh, absolutely. And I think this, you know, when we get to nutrition, the book actually has a chapter on nutrition. And, one of the things that we find one scan clinically is that some people change their diet a lot and really have very little change in their pain or their quality of life. Other people change their diet even just a small amount and get a massive change. And this, once again is part of the thing that is the complexity of pain care is that, we, you know, as an organism, we are a whole bunch of systems together and sometimes you can change one system a little bit and it really, really changes the organism or the person and others times you change that system a ton and you get very, very little change in the human. And that's one scan, part of the trouble of pain care. But part of the advantage of approaches like yoga therapy is because they're sort of okay with that idea is that everyone's fully individual and we don't have everyone should change their diet this way, or everyone should move their back this way, or everyone should, you know, stand this way or, right, right. It's not a linear model at all.
Karen Litzy: 23:11 Yeah. No, definitely not. And then when you think about pain and you think about it as an experience, and if we're going off of all the different inputs that can be put into the body, that can have impact over one's pain experience, and you think of all the different ways you can alter those inputs, all of a sudden treating the person with persistent pain goes way beyond just movement. Right? It goes into all of those myriad of inputs that you have ability to alter, whether that be as the yoga therapist, a physical therapist, or let's not forget the person experiencing the pain themselves.
Neil Pearson: 23:54 Oh, it's so true. Yeah. And with that last comment, you made, the person experiencing pain, the one thing we were really happy that we did within this book was that's her first chapter. So Julietta Belton wrote the first chapter on the lived experience of pain because we wanted to bring it back to, you know, this is why we're doing this work. It's not, you know, it's not that we're all just trying to understand pain. We're trying to help people. But back to movement, one of the things I think is that physical therapists and yoga therapists, anyone who's doing movement therapy, I think one of the really important things that we can do is start to shift our view of movements as though we can use movement for more than helping a person to be flexible, helping the person to be stronger.
Neil Pearson: 24:39 And within yoga therapy, we often do this. We'll say, you know, when you're in this yoga posture, it's not just affecting you on the physical level. It's affecting you on every level. And so we can actually use some of the yoga postures to help with other issues related to pain such as, so I was thinking about, so,one when we do a seated forward bend. So maybe if you have back pain, it's really hard to do it, but you still can get in that kind of position where you're sitting on the floor. Legs were straight or bent in front of you and your trying to reach down towards your knees, your shins, your feet, wherever you get to. The metaphor here is of learning how to let go so you can move forward.
Neil Pearson: 25:29 And so, we can use a lot of the different yoga postures like that is that we're thinking. So here's a person who is stuck, right? The person is, you know, maybe it's letting go of the need to have a definitive diagnosis because a lot of times that happens and sometimes to be able to, we see the person clinically that, you know, when we're in this multidisciplinary pain management setting, we say, you know, it seems to be this, one of the big things that stuck for this person, they're stuck believing that they need that to be able to move forward. And so we can use movement or postures to try to address other issues like that. Or as maybe another one that makes a little bit more, is more clear. Often we feel a sense of fragility when we have especially low back pain, pelvic pain.
Neil Pearson: 26:19 So if we can get you to come into one of the standing warrior postures, when people, the majority of people in a warrior posture, I'm standing with your arms reaching up or out to the sides. There is a sense of strength and stability and connectedness when you do this. And the really nice thing is we could do those postures from a seated position and people still feel that same kind of thing. And so the idea is could we use movement to effect the person on a psycho-emotional level as well? Could we make that out? One of our goals is this person who doesn't feel strong, feels unstable, feels fragile. Could we use movements not just create physical strength, but to address the other changes that are happening to the person? I think so.
Karen Litzy: Yeah. I think so too. And I love that yoga has got that part and I hope that other movement practitioners start to think, well, you don't need yoga to do that.
Neil Pearson: 27:16 Right? You can use any, you know, think of any movement that we do and how it makes us feel. Could we address it that way. And then the one other thing that movement has tried to address in one of the chapters in the book is the idea of using movements or yoga therapy as an educational agent. So I know your listeners all know about explain pain and that wonderful work there. And what we're doing with explained pain really is it starts with a cognitive behavioral therapy, right? We're changing auditions to change their behavior. And so for a lot of the people that we work with, they may not have learned how to learn by sitting and listening or reading a book. They may have learned how to learn by doing. And so one of the things we're playing around with is the idea of when a person has ongoing pain, could we get the person to move in a way that could sort of, when the person moves that way they feel an increased sense of ease or they get some increased movements. And then you use that change from the movement as the educational agent.
Karen Litzy: 28:21 Saying like, look at what your body can do. Yeah, same thing.
Neil Pearson: 28:26 Yeah. Well you can start with, wow, that's awesome. Your pain changed, right? Because that's one of the core messages of explained pain is that right? Changeable. So instead of telling the person that pain is changeable and explaining it to them, if you can get the person to do something and at the end of it, they have less pain or more ease of movement to say, look, it changed. And of course the next step is, and you did it. And so I would then jump into, let's look for all the other things that you could do to actually change this, which is saying to the person your pain is changeable. And you have some influence in it, which is part of what we're trying to do with pain.
Karen Litzy: 29:09 Yup. Yeah. It's like giving them the keys to the car.
Neil Pearson: 29:13 Exactly.
Karen Litzy: 29:13 Right. And having them be in the driver's seat versus feeling like they're the passenger and the pain is in the driver's seat.
Neil Pearson: 29:24 Oh yeah. That's a really great way of saying it. And I think clinically what we want to do is both with people we, you know, we want to find a way to integrate these things, but I really, really believe that there's a lot of the people we work with would understand pain better if we got them to experience it. Experience what we're trying to tell them.
Karen Litzy: 29:47 Yeah. And we know experiential learning for a lot of people is something that sticks.
Neil Pearson: 29:54 Exactly. Yeah. And I think that's the thing is that there were a whole bunch of people that when we explained pain, it changes their cognition, but it immediately they get it, they understand it. It's powerful enough to change their behavior. But then there's other people then some of the research shows this now is that some people have this sort of partial reconceptualization of pain. They understand everything you told them, but they don't apply it to themselves. And so what you're going to need to do at that point is get the person to have the physical experience that matches up with the cognitive experience. And I guess what I'm saying is that what we could do is use the movement practices of yoga or any kind of moving practice for some individuals as the educational agent first and then, I think we need to start to play with that because some people just don't learn well when we talked to them, at least not as well as they do with the physical experience of it.
Karen Litzy: 30:58 Yeah. And I think as the therapist that you can kind of get a sense of this after one or two visits that okay. It seems like they understood, but yet they're not able to apply this to themselves or are they kind of come back to you with the same, I don't want to say the same complaints cause that's not right. But with the same maybe problem solving outlook that they did before when you know, you've kind of spoken about pain and maybe how pain works, let's say from explaining pain and they're still coming back to you with this same idea. The same. I did this so I must have done something wrong. And that's why it hurts because I keep doing this to myself.
Neil Pearson: 31:55 Exactly right. There was something in what you said too that made me think that it's possible that that person coming back, doesn't have the coping strategies that match up with the new information that they learned. So the person's, you know, coped by being saved, being tough and just sucking up and gritting your teeth and pushing through it or coped by fear avoidance. And so we've given them this new information, but the person that hasn't, when the pain worsens, they go back to the coping strategies that don't match up with the new paradigm.
Karen Litzy: 32:29 Right. Yeah. And that was really hard for me to do as well. So what would happen, and I'll give an example of what that means. I think you correct me if I'm wrong, but I used to get a lot of neck pain in my sleep so I'd wake up and kind of feel a pop and then wouldn't be able to move. And what my original coping strategy was hi, I have to call off work today because I need to stay in bed. So I would stay in bed. I used ice, I would use heat but I wouldn't move and that did not do well for me cause like it would help in the short term maybe that day. And then I'd be able to get back into things the next day. But I was still in an awful lot of pain. I mean, maybe I was a nine out of 10 and then I was at seven out of 10 but the seven out of 10 I could function. You know what I mean?
Neil Pearson: 33:24 Yeah, absolutely.
Karen Litzy: 33:25 Until I started going through explain pain and moving more. So now if I wake up and I feel that pain, my first thought is not, Oh, I better lay in bed. It's okay, let me get up, let me start stretching, let me start moving, let me go to the gym and at least get on a bike. And now, because that's sort of my new shift in thinking that maybe the pain will last only one or two days and not forever. Because before it was this high level of pain with a higher spike. And now it's just little to no pain with a spike or a flare up, if you will, a couple times a year. But knowing the moment I feel that, that I get my butt to the gym and I realized that movement is the thing that helps and that I shouldn't be fearful of that. So for me, that was the input into my system that helped and everyone is different of course, but I think that's a real life example of what you just said.
Neil Pearson: 34:27 Yeah. And I think it's great one because what you've said is that what you've found is that you can change the pain and the ease of movement through movements, but also I think what you're saying as well is there's somehow there's a different relationship with your different perspective on it. You're understanding it in a different way.
Karen Litzy: 34:48 Yeah. It's less as this sort of monstrous threat that's going to take over my life for the next couple of weeks, days, months versus now. It's like a little annoyance that I know I have the coping skills and the mechanisms at my disposal that I can make a change for myself versus going to a doctor for a quick fix of a pain medication or something, which is what I used to do.
Neil Pearson: 35:22 Yeah. Well and what I'd say is, well as within yoga and yoga therapy is that a yoga therapy will offer you more on expanding a number of coping strategies or alternatives. We often think of as making people more flexible in their body, but it actually makes us more flexible in how we adapt or modify things when pain persists. So, you know, you wake up in the middle of the night, maybe one of the things is that I'm laying there and actually taking your attention to the pain and exploring the pain. Actually spending some time doing that or the practice of noticing what's happening to your breath. So now or changing your breath or noticing what's happening in your body tension or changing your body tension too. Within yoga there's many, many different ways that you can try to impact things. We often say we want to do practices that have to do with awareness because awareness practices in and of themselves can be a beneficial when we have ongoing pain.
Neil Pearson: 36:28 And then there are other practices that are about regulation. So, you know, getting you to breathe in a certain way or hold your body in a certain way or move your body in a certain way or think a certain way. So with the awareness you can have awareness of your breath or your body or your thoughts or your emotions or your energy or the pain. And the same thing with regulation. You can regulate any of those and start to see what happens when you do either of these things. But then the one other bit you said too was about discernment is what you've learned. You've, you know, you've changed your view of you. You're now when you feel the pain, you can discern more about when the pain is like this, I need to do this. And when the pain’s like this, I need to do this. And, I think that's another positive that people can get or the practices of yoga therapy is that you start to actually understand your pain better, right? Be able to discern different aspects of it or different strategies that you need to do at different times where often when we have chronic pain, it's almost like we lose coping, right?
Karen Litzy: 37:37 Oh, there's no question. You lose everything. You lose all perspective on yourself as a human being, you know? I mean, even as someone like me who is, I was a physical therapist when I first had all of this pain and you just completely, everything I learned as a PT flew out my brain. It was gone because all you want is for the pain not to be there. And the reason you want the pain not to be there is because you want to have a life with more choices and more possibilities. Whereas when people are in pain, their choices are you get up, you go to work and you come home. If you can even make it to work, those are your choices. That's all you have. You know, have kids, maybe it's struggled to take care of your kids or suffer through taking care of X, Y, Z. Right? Versus when you don't have pain, your options are, I can get up, I can go to the gym, but I can go to work or I can go to the gym, meet up with friends, go on vacation, you know, clean my apartment, go play sports. So all of a sudden you have a life of very little choice and possibilities to an opening of your choices and possibilities. And it's just because you don't have that pain anymore.
Neil Pearson: 38:53 Right. And I think that's one of the beauties of the practices that allow us to start to explore are there things that we actually can do for ourselves to try to change this? Or are there things that people can help guide us to be able to do that? Because I think when we're in that huge pain, what we're looking for is, you know, the thing that will just stop it, of course. And you know, we're living in society where the approach mostly is to look externally. And then one of the troubles that people have sometimes when they start to hear about yoga therapy and sort of the self care part is just this idea that it's almost like it's all up to me, right? You're telling me it's all up to me and what we want to say is no, that that doesn't really work well or we want to do is say, what you need is the expertise of a PT or a yoga therapist or an OT who can help to guide you and be there and you know, cheerlead you and coach you and help you through this.
Neil Pearson: 39:53 Because this is really, really hard stuff. You know, learning the techniques of yoga, if people really immerse themselves in it, they'll typically say, this is hard to do. Well, it's way harder to do when you're in pain. Right?
Karen Litzy: 40:09 Right. And you don't want to think like, Oh, I have one more thing I need to do now. I need to do this. I've got all this pain, now I need to do this.
Neil Pearson: 40:17 Yeah, yeah, true.
Karen Litzy: 40:19 But yeah, when you position yourself as the guide, you know, I've been reading this book by Donald Miller called the StoryBrand. And in it he talks about the guide who would be, in this case, the yoga therapists and physical therapists and thinking of them as like the Yoda and the student or the hero, he calls them the hero of the story, which would be our patients would be the heroes of our stories are like the Luke Skywalker's. So they're coming to you for guidance, you're helping them, you're giving them the tools, the confidence, in this case, the movement, the education that they need to go out and be the hero of their lives.
Karen Litzy: 41:00 So it's not like, Oh, one more thing I have to do. If we can reframe that for those people in pain, it's more like let us guide you so that you have so much to do.
Neil Pearson: 41:13 Absolutely. And you know, there's one other piece that I just want to tack on the end because I'm sure you have some people here listening who have ongoing pain is that one of the really difficult things, and I know some, there's been some blogs talking about this recently that has importance is when we work with an individual who has ongoing pain, actually don't know what the outcome is going to be. I think we can be pretty certain that we can help people to be able to move with more ease and to have some less pain and to, you know, get quality of life. But somehow we need to say to people that, you know, when you do these things, you might be the person who says, you know, the pain is mostly gone and I really can do most of what I could do before.
Neil Pearson: 41:56 Or he might be the person who says, well, you know, the pain is better, but it's still there. But what you've been able to do is show me how to get back to allowing my life. You know, the pain is less, but I'd be able to get back. And then there's this other group that will say, you know, it doesn't seem like the pain really is changed at all, but you know, if we've been successful with them, the person will say that, you know, even though the pain is there, you've helped me figure out how to live and have pain. Right. And I think that's one of the struggles that people have when they hear us talking about pain management, is the struggle between you're looking for wanting so much the thing that will stop all the pain. But then not really recognize where maybe recognizing the ideas that for some people that's not the outcome.
Karen Litzy: 42:50 Right. Yeah. And I try and, you know, and that comes, I think as the therapist, I think that comes, that's something that I think experience helps a lot. The experience of the therapist helps a lot because you kind of have a little more confidence to say to the patient, Hey listen, the goal here is to get you doing the things you want to be doing. You may still have pain doing them, but you can do everything you need to do. Would you be okay if you had a small amount of pain and were still able to do everything you want to do? Cause our goal here is not complete elimination of pain or, I mean, yeah, I guess that is the ultimate goal, but being realistic, we have to tell the patient, Hey listen, this may not happen. What if I told you you could do everything you wanted to do and the pain might be there if doesn't really, you're not suffering. It doesn't bother you that much. Would you be okay with that? And that's a hard conversation to have.
Neil Pearson: 43:51 Yeah. Well, you know, in the yoga world is it's somewhat easier because anyone who's a yoga therapist has, I mean that's what we've learned. That's really what yoga says is that we will have pain, we will have suffering in life. And the whole practice of yoga and yoga therapy is to actually learn how to live with it and decrease it. But it's not, you know, it doesn't have the goal of saying there's going to be none.
Karen Litzy: 44:21 Yeah. And I think that that's important. It's important to tell patients. And that's the one thing, this is a total rant on my part, so apologize ahead of time. But you know, when you see websites and they're like eliminate your back pain by reading this free resource, well, that drives me bananas and it drives me crazy as a person who did have chronic pain for many years, you're searching for that thing and if someone puts it out there and then you read it and you're like, my pain is the same, I would be like, screw you. It didn't help my pain. It's like a crappy thing to do to someone because I feel like you're praying on very vulnerable people by doing that. And I think that's why.
Neil Pearson: 45:08 Yeah, I agree all the way. I mean, it's just not truth. It's a marketing stick.
Karen Litzy: 45:14 Right.
Neil Pearson: 45:15 I'm like you, it enrages me. It's hard not to be the police though, right? You want to jump on and say, what are you saying then? And we know that, you know, within our professions, really within all the healing professionals or helping professions, there are people who unfortunately use language like that. Hopefully at some point we will be more compassionate.
Karen Litzy: 45:40 Yes. Yes. I hope so because, Oh man, that is something that just drives me crazy. But I digress. Let's get back to the book. What do you hope people take away from the book after reading it?
Neil Pearson: 46:05 Well, I guess the biggest thing that I want people to take away with is this idea that yoga therapy is something we should consider as a one of the paths when people have ongoing pain. Overall, that's what I want people to do. You know, we don't think that yoga therapy is the answer. But we see it as something that can be integrated within our Western medical world with people with chronic pain and so integrated into that system. But also it allows more access because people usually can get to yoga therapy for less of a cost than they could to medical practitioners. So it's more just to see it as you know, as we've talked about, there's this view of what yoga is. Well, yoga is something different from that. And it actually does make sense as one path to consider when we're working towards recovery when pain persists.
Karen Litzy: 47:01 Absolutely. And now before we end, I have one more question for you. And that's knowing where you are now in your life and in your career. What advice would you give to your younger self?
Neil Pearson: 47:16 Oh, wow. You know, after I graduated as a physical therapist, I spent the first four and a half years working in hospitals and worked, trauma, ICU. And I worked in a neonatal ICU and cardiac care and all these things. And, the thing that if I were to go back to that spot, I would say, Hey, you're doing the right thing. It's funny because a lot of my colleagues were working, you know, we're stepping right into private practices. And by being in that situation, what I not only did I started working as a physical therapist with this umbrella of protection because there were all these other people who are also working with the same patients in the hospital. But I learned such a humanistic view of what I was doing.
Neil Pearson: 48:10 I guess that's because a lot of the stuff we were doing in the hospital had to do with life and death. Now when you're working in a trauma ICU with neonates and so I think you know, cause I know there was a lot of pressure I wanted to work in, you know, sports medicine and in private practice. There was pressure not to be in the hospital. So I guess I'd go back and say you're doing the right thing cause it really helped me to see the person more than the low back or the shoulder or the knee.
Karen Litzy: 48:50 Yeah. You know, I worked in a hospital first as well when I first graduated from PT school.
Neil Pearson: 49:00 There are some advantages to that.
Karen Litzy: 49:04 Yeah. Oh yeah, absolutely. I think it like really increases your empathy and your communication skills. Cause you're like you said you're dealing with pretty sick people. And I wouldn't have traded that for the world. All right, so now where can people find the book?
Neil Pearson: 49:28 Well the books on Amazon. Awesome. So that's probably the easiest place to find it.
Karen Litzy: 49:34 Yes. So we'll put the link in the show notes. So if people want to go to podcast.healthywealthysmart.com, they can just click on this episode and go straight to the book.
Neil Pearson: 49:47 Great. And if people want to learn anything more about the other things that I work on. My website is paincareu.com I'll share that as well with you on there. You can learn about the pain care yoga training that I do and I have a distance professional mentorship that I do for health care professionals as well.
Karen Litzy: 50:11 Nice. That's awesome. And because you're up in Canada, right?
Neil Pearson: 50:16 Yeah, that's right. If you're in Vancouver and you drove East of it four and a half hours over a couple of mountain ranges, I'm in the Okanogan Valley of British Columbia.
Karen Litzy: 50:26 Got it. Kind of. It is so big. Well Neil, thank you so much for coming on. This was a great conversation. I think it's going to give people a lot to think about when they're working with those patients in pain. So thank you so much. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
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