Cultivating Awareness and Healing though Mindful Yoga Integration
Today’s blog comes to us from Des Wood. Des teaches at Spira Power Yoga Tuesday’s at 8:30 am and every third Sunday at 4:30 pm.
Des is also a critical care nurse. After eight years as a bedside nurse, Desiree went back to school to obtain her doctorate degree in nursing. As part of her thesis project, she conducted one of the first studies looking at helping to teach mindfulness through gentle yoga for patients and families in the hospital during critical illness. Her pilot study is currently being reviewed for publication. In addition, she serves as a member of the integrative and complimentary medicine group at the University of Washington Medical Center and holds quarterly trainings for medical staff on mindfulness-based stress reduction. Currently she works as a Nurse Practitioner caring for veterans, a career she is honored to have.
Last year, Desiree became a certified yoga instructor having completed the 200-hour Yoga Teacher Training at Spira Yoga in West Seattle.
Pain Knowledge and the Opioid Epidemic: Cultivating Awareness and Healing though Mindful Yoga Integration
In 2010, I undertook a medical mission with Project Medishare and the University of Miami, Global Institute for Community and Health Development to aid in the earthquake relief effort in Port-au-Prince, Haiti. I volunteered with an international team providing care for up to 200 patients in the only tertiary hospital within the city. We worked with local Haitian doctors and nurses to provide primary care, emergency treatments, critical care and preventive services. Through the vast devastation and heartache there was incredible love and a beautiful sense of community. I remember one night the entire ER breaking out in song at 2am; over 30 patients and staff harmonizing together in traditional hymn. What struck me in particular was the hesitancy toward narcotic administration. Like most countries, Haitian medical providers are trained to be tentative about opioid narcotic prescriptions and the hospital simply did not have supply with strict federal regulation and oversight.
As I reflect about my time in Haiti, I can’t help but think about the struggle American’s are facing with the current opioid crisis. Presently, the US consumes nearly 85% of the world hydrocodone supply although we make up a mere 4.5% of the world’s population. Pain is incredibly complex and personal: it is our bodies natural warning system, keeps us safe and is influenced not only by physiologic factors, but emotional, cultural, socio-economic and overall health status.
Please understand – opioids have a key role in certain medical areas and are crucial for indicated conditions. For example, I work as a Nurse Practitioner in an ICU where patients are critically ill and pain medications are vital for severe illness, metastatic cancers or traumatic injury. Opioids work by reducing the perception of pain, binding to the opioid receptors which are found on cells in the brain and in other organs of the body. The binding of these drugs to opioid receptors in the reward regions of the brain produces a sense of well-being, while stimulation of opioid receptors in deeper brain regions results in drowsiness and respiratory depression which can lead to overdose and death.
According to the National Institutes of Health (NIH) more than 25 million Americans suffer from daily chronic pain and misuse of opioid prescriptions has been increasing at an alarming rate. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse in the US exceeds $78.5 BILLION dollars a year, including the costs of healthcare, loss of productivity, addiction treatment and criminal justice involvement.
How did we get here?
In the late 1990’s a perfect storm occurred. Pharmaceutical companies assured the medical community that patients would not become addicted to prescription opioid pain killers, leading to a dramatic increase in the number of opioid prescriptions. This led to extensive misuse, evidence that narcotic medications were indeed addictive. In the year 2016 more than 63,000 people died from drug overdoses-more than 42,000 of these involved prescription or illicit opioids. Currently, over 2 million Americans suffer from substance use disorders related to prescription opioid pain relivers. People are dying, families are being torn apart – it is truly devastating.
What is next: Addiction Awareness, Improving access
One of the principal strategies is not just to provide education about the narcotic epidemic but to optimize holistic and integrative treatment options. Yoga and mindfulness are being studied extensively as a gold standard for non-pharmacological treatments addressing chronic pain issues. Yoga facilitates the mind- body connection assisting the healing process through movement, meditation, and breath. Yoga can reduce the perception of pain by helping to regulate the pain signaling mechanisms located within the brain and increases secretion of natural pain killers in the body. Breathing exercises used in yoga can also reduce pain and the associated anxiety by releasing tension and activating the parasympathetic nervous system leading to a reduction in the stress response. Yoga has consistently been shown to prevent and alleviate back pain by enhancing core strength and relieving muscle stiffness. The relaxation and meditation benefits of yoga are a physiologic antidote to the stress and depression that often accompany chronic pain. Other complimentary treatments for chronic pain that have shown to be effective include: massage therapy, acupuncture, physical therapy, tai chi, and mindfulness training.
Of course, access to these integrative treatment options is a recognized barrier. A major culture shift is necessary to help adopt these practices as a mainstay of treatment and insurance companies will need to partner in order to support engagement and cost reimbursement. In the meantime, we can all benefit from practicing yoga at responsible studios that teach mindfulness and breathing, not only exercise. We can spread the word on the benefits of mindfulness and thus increase awareness about this life changing practice.
References
1 .Substance Abuse and Mental Health Services Administration. Results from the 2014 National Survey on Drug Use and Health: Detailed Tables. (2015). http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs2014/NSDUH-DetTabs2014.pdf>
Williams, J. T. et al. Regulation of μ-opioid receptors: desensitization, phosphorylation, internalization, and tolerance. Pharmacol. Rev. 65, 223–254 (2013).
Jones, C. M., Paulozzi, L. J., Mack, K. A. & Centers for Disease Control and Prevention (CDC). Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths – United States, 2010. MMWR Morb. Mortal. Wkly. Rep. 63, 881–885 (2014).
Federation of State Medical Boards Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain. at http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/pain_policy_july2013.pdf>
Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths – United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016; 65:1445.
Office of Healthcare Inspections. Report No-14-00895-163 Healthcare Inspection-VA Patterns of Dispensing Take-Home Opioids and Monitoring Patients on Opioid Therapy. http://www.va.gov/oig/pubs/VAOIG-14-00895-163.pdf>
Cramer H, Lauche R, Klose P, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev 2017; 1:CD010802.
Pascoe MC, Crewther SG. A systematic review of randomised control trials on the effects of mindfulness on stress measures and anxiety. In: Anxiety Disorders, SMGroup, 2016.