Pain Processing, the Pain Neuromatrix and Where Yoga Fits In

Niamh outlines pain as a protective output of the brain and body systems. Nociceptive input is modulated in the dorsal horn, many brain areas such as the prefrontal cortex, amygdala, hypothalamus, hippocampus and insula take part, and the periaqueductal gray and rostroventral medulla act as the brain's pharmacy for descending modulation. Sensitization can be driven by prolonged input, inflammation, low mood, stress, poor sleep, too much or too little activity and early life trauma. Melzack's 2001 neuromatrix links cognitive, sensory and emotional inputs to outputs such as pain, protective actions and stress responses, which then feed back as inputs. Yoga fits contemporary pain care because it is active, adaptable and builds self-efficacy, as long as it is not taught with rigid rules about correct alignment. Physically, it can provide graded loading, exercise-induced pain relief and a way to try out helpful movement. For thoughts and beliefs, principles such as non-harming support healthier body beliefs. For emotions, slow breathing lowers stress markers, and meditation can engage opioid-mediated descending inhibition and improve emotional regulation.