According to the National Institutes of Health, more than 25 million Americans suffer from pain daily, yet less than half receive treatment. In the last decade, however, we've seen more emphasis and research placed on treating pain not with medications, but with mind-body therapies, such as yoga.

Yoga can be a great activity for people dealing with chronic pain. Think of it as therapeutic exercise. Not only can yoga's mind-body connection help students learn to control pain, but its gentle movements can help alleviate certain types of pain as well. Researchers have also found that meditation can help reduce chronic pain. And, when combined with yoga, it may be more effective than standard medical treatment alone.

The ancient yogis were just like us: They had aches and pains both acute and chronic that distracted them as they tried to rest or meditate. Thus, hatha yoga was created, to help people sit quietly and comfortably.

In addition, a regular yoga practice may lead to:

• Better management of osteoarthritis and rheumatoid arthritis. Patients suffering from rheumatoid arthritis reported significant improvements in their quality of life after starting a gentle yoga practice, according to a small study presented at the 2011 European League Against Rheumatism's Annual Congress. Participants in the 12-week yoga program, which also included breathing exercises, reported higher levels of physical activity and lower levels of pain. And a study published in the Journal of Alternative and Complementary Medicine found that hatha yoga was more effective than traditional therapeutic exercises when integrated into a treatment plan for those with osteoarthritis of the knee. 
   
• Less back pain. Back pain affects 31 million Americans, and the National Institutes of Health recommends yoga as a way to ease pain and stretch tight muscles that contribute to back pain. One 2009 study funded by the National Center for Complementary and Alternative Medicine, and published in the journal Spine, found that after six months of yoga, those suffering from lower back pain had significantly less pain, disability and depression. And another study, published in the Chiropractic Journal, found that just 12 weeks of yoga had a greater effect than standard medical care in those who suffered chronic or recurring back pain.
   
• Relief from carpal tunnel syndrome. A study published in the Journal of the American Medical Association found that an eight-week yoga program was more effective than splinting of the wrist in treating carpal tunnel symptoms. The group who practiced 11 yoga poses aimed at building strength, stretching the wrists, and improving balance saw significant improvement in grip strength and less pain.
   
• Migraine management. A study published in the journal Headache in 2007 found that yoga reduced pain, anxiety, and depression in those suffering from migraines, compared with those who used self-care. The group who practiced yoga reported fewer migraines during the three-month program.
   
• Less post-workout pain. A study published in the Journal of Strength and Conditioning Research in 2004 found that when practiced after exercise, yoga lessened the effects of DOMS (delayed-onset muscle soreness), which typically occurs in the days following an intense workout.<pagebreak>

But exactly how does yoga help?

Gentle yoga is low impact and helps to strengthen the muscles around joints, which can alleviate discomfort. It helps increase circulation, which can facilitate healing. And yoga's focus on deep breathing assists in delivering much-needed oxygen throughout the body, and helps relax tense muscles that can contribute to pain. Plus, because yoga links this deep breathing with movement, which requires concentration and focus "in the moment," it can take the mind's focus away from pain, helping diminish its affects.  So unlike other therapies that concentrate solely on the physical discomfort associated with pain, yoga can also ameliorate accompanying emotional distress, which at times can be equally debilitating.

When you're ready to give yoga a try, talk to your health-care provider, and keep these guidelines in mind:

• Choose your practice carefully. Seek out a yoga class in your area that caters to beginners or one called gentle or hatha yoga (rather than vinyasa, power, Bikram or Ashtanga yoga, which are flowing and generally more rigorous). Some studios even offer yoga classes specifically for back pain, osteoporosis, arthritis or injuries. You might also consider seeking out a certified yoga therapist or a teacher trained in viniyoga, which caters the yoga practice to a student's unique needs.
• Know your limitations. Ask your healthcare provider whether there are any types of movements or ranges of motion that you should avoid based on your pain. Your provider might not be a yoga expert or know what the poses are, but he or she should be able to tell you types of movement to avoid. For example, people with herniated discs should always avoid spinal flexion, which means modifying or avoiding forward folds, inversions and more.
• Speak up. Arrive a few minutes early to talk to theteacher. Tell him or her about your physical issues. Alerting your teacher ahead of time means you can focus on your practice and allow him or her to offer cues to suit your needs.
• Respect your body. Any form of yoga can be performed gently and with modifications, as long as you are mindful of your physical body and its limitations. Respecting your comfort zone and not pushing beyond your abilities are crucial.
• Take it easy. When you're in pain, focus on yoga as a form of therapy rather than a way to burn calories or build muscle. Choose poses that do not require much stamina or strength.
• Keep practicing. Tempting as it might be to skip your yoga practice altogether when you're in pain, the benefits extend far beyond a toe touch. Do what you can, take breaks when needed, and above all, focus on the breath.
• Use props. If pain limits your mobility or range of motion, turn to yoga props for assistance in a pose. Blankets, bolsters, blocks, and straps can help you get comfortable in a pose and avoid over-stretching or causing any additional pain.
• Find what feels good. Your practice is your own, and no one else has to live in your body. Do the poses that are within your reach, so to speak, and find the "place in the pose" that feels good to you.
• Focus intently on the breath. Breathing is the primary focus of any yoga practice. Use your yoga practice as time to develop mind-body techniques to help you cope with pain away from the mat.
• Use your core. If your body will allow it, focus on developing core strength, which will help keep you safe and stable throughout your yoga practice. A strong core takes over and helps stabilize you in most poses and makes the transition into and out of them easier as well.
• Rest when you need to. Listen to your body, and if you need a break, take one. Come to child's pose, mountain pose (standing tall), or even savasana (lying on your back) as needed. Do what your body needs in that moment, even when it isn't what others in a class might be doing.
• Let go of the ego. Your intentions for practicing yoga might be far different than the person on the mat next to you. You came to find relief from pain and learn techniques to cope with stiffness and limited mobility. Focus on what your body needs (not what it can't do or how it compares to the other students), and you'll leave each practice feeling like a million bucks!<pagebreak>

Gratitude Practice
When pain takes over, loving and appreciating your body can be a difficult task. Find a comfortable position, either seated or reclined, supported with props as needed. Close your eyes and focus on your breath. Take long, slow breaths, aiming to match the length of the inhalation to the length of the exhalation. After a few breaths, shift your focus to a specific area of the body, such as the one causing you pain. Send healing thoughts and offer gratitude for that body part. Maybe it's the back that has carried so much proverbial weight through life and now suffers from a herniated disc. Maybe it's the ankle that allowed you to walk your first 5K but is now plagued by osteoarthritis. Rather than fall into a pattern of resentment with the areas of that body where you feel physical pain, offer gratitude and healing energy instead.

Guided Savasana
Lie down, either on the floor (if possible) or in bed. Use props as needed to make yourself feel comfortable. Close your eyes and focus on your breath. After 10 breaths, start to focus on your toes. Imagine them relaxing as you exhale and receiving fresh, new energy as you inhale. Move your way up your body, stopping on every body part and breathing as long as necessary. With each inhale, send healing energy and breath to that body part, and with each exhale, send the pain and negative energy away from your body. Once you've reached your head, remain in savasana for as long as desired, keeping the eyes closed and focusing on the breath. You can also do this practice sitting up or with a focus on a specific area of the body

Alternate Nostril Breathing
Use alternate nostril breathing to divert attention from pain and create a feeling of calmness in the body. Find a comfortable seated position. Place your left hand in your lap and take your right hand and bend in your index and middle fingers, keeping your pinkie, ring finger and thumb extended. Place your thumb on the right side of your nose, pressing to close off the nostril. Close your eyes. Take a long, slow inhale through your left nostril. Pause, holding that inhale, as you use your pinkie and ring fingers to close the left nostril and exhale slowly through the right nostril. Next, take a long, slow inhale on the right side, then close off the right side and slowly exhale through your left nostril. Switch: Inhale on the left, closing the right. Exhale on the right and then inhale on the right, keeping the left side closed. Then switch sides and exhale on the left. Repeat for 10 breaths, focusing on the rhythm of your breath. Keeping your eyes closed, place your hands in your lap and continue to breathe slowly, evenly and deeply for another 5-10 breaths. Slowly open your eyes.

Whether you choose to focus on the physical poses or the breathing exercises of yoga, integrating the practice into your pain treatment plan can yield real results. Be sure to talk to your healthcare provider before starting any exercise program, and always respect your body's limits.
 
This article has been reviewed and approved by SparkPeople fitness expert Nicole Nichols, certified personal trainer.

Sources
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Duke Integrative Medicine. "Optimizing Health with Effective Pain Management," accessed on April 5, 2013. www.dukeintegrativemedicine.org
  
John PJ, Sharma N, Sharma CM, Kankane A. "Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial." Headache, 2007 May;47(5):654-61.
 
Journal of the American Medical Association. "Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia." 1996 Jul 24-31;276(4):313-8.

Science Daily. "Siginificant Benefits of Yoga in People With Rheumatoid Arthritis, Study Shows," accessed on April 2013. www.sciencedaily.com

Williams K, Abildso C, Steinberg L, Doyle E, Epstein B, Smith D, Hobbs G, Gross R, Kelley G, Cooper L. "Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain." Spine, 2009 Sep 1;34(19):2066-76.