Comparison Of Pain Pressure Threshold And Pain Tolerance In Yoga Practitioners And Age-Matched Sedentary Controls: A Cross-Sectional Study.

Pain is an unpleasant state experienced due to potential tissue damage. Pain is always influenced by psychological and biological factors. Pain threshold is a subjective sensation that can be measured with various assessment scales like visual analog scale, Verbal descriptive scale, numeric rating scale. It is the minimum intensity of stimulus that is required for a person to perceive the sensation of pain. Pain tolerance is the maximum intensity of painful stimuli that an individual can tolerate. It is also a subjective experience. The quantitative measurement of pain threshold can be done by various methods like pain pressure threshold using algometry which is one of the commonest quantitative sensory tests. Studies have shown that performing yoga asanas causes decreased physiological arousal and a calming effect due to relaxation of sympathetic nervous system and hypothalamic pituitary adrenal axis thus dysregulation of autonomic nervous system plays a key role in pain cognition and stress. Yoga has its roots in India where it has a holistic role in synchronizing mind, body and soul. The physical form of Yoga is done as postural and breathing exercises done in sequential flow (asanas) which has been found to increase pain threshold and pain tolerance in individuals practicing it. It is observed that there is an increased threshold for pain in people practicing regular yoga  Yoga instructors. Thus, Yoga plays a crucial role in cognitive perception of Pain, both in pain modulation and pain threshold. However, few studies have been done to correlate regular practice of yoga to pain perception, pain threshold and pain tolerance. In this study the investigators seek to find a correlation of yoga and pain perception. Our study involves a comparison of pain threshold and pain tolerance between individuals practicing regular yoga compared to individuals having sedentary lifestyles.

Aim: Comparison of pain pressure threshold and pain tolerance in yoga practitioners and age matched sedentary controls.

Objectives:

1.      To compare pain pressure threshold in yoga practitioners with age matched controls.

2.      To compare pain tolerance in yoga practitioners and age matched controls.

Review of Literature:

Yoga, an ancient mind-body discipline, has received heightened interest for its potential advantages in pain management and general well-being, leading to research on its impact on pain perception and tolerance (Boehnke et al., 2020). The therapeutic application of yoga, which commenced in the early 20th century, utilises the various psychophysiological benefits obtained from its constituent practices (Büssing et al., 2012). These include physical postures and exercises, breathing methods, deep relaxation, and contemplative activities designed to enhance awareness and, ultimately, achieve deeper levels of consciousness (Büssing et al., 2012). The physical exercises of yoga can improve flexibility, coordination, and strength, while breathing and meditation techniques can soothe and concentrate the mind, enhancing awareness and reducing anxiety, thus leading to a better quality of life (Büssing et al., 2012). In addition to these advantages, yoga may contribute to decreased distress and blood pressure, along with enhancements in resilience, mood, and metabolic control (Büssing et al., 2012). Studies demonstrate that yoga can effectively manage pain and enhance functionality, highlighting its potential as a therapeutic intervention (Boehnke et al., 2020). The investigation of pain perception and tolerance in yoga practitioners versus sedentary controls is based on the premise that yoga amalgamates physical, mental, and spiritual practices, which may influence pain processing mechanisms (Boehnke et al., 2020). A substantial body of research has established the therapeutic advantages of yoga in recent decades, including controlled studies with active control groups, for various mental health disorders such as depression, anxiety, and panic disorder (Vorkapic & Rangé, 2014). Research has shown the effectiveness of yoga practices in alleviating stress, anxiety, depression, and stress-related conditions such as hypertension and sleeplessness (Vorkapic & Rangé, 2014). Bibliometric analysis indicates that many published research have assessed yoga’s impact on mental health, consistently yielding favourable results. The multidimensional approach of yoga, which includes physical postures, breathing exercises, and mindfulness, may affect both the sensory and emotional dimensions of pain. The consistent practice of yoga may induce modifications in the neural system, thereby affecting pain sensitivity and enhancing pain tolerance (Phuphanich et al., 2020; Vorkapic & Rangé, 2014). Yoga has been linked to enhancements in emotional management and self-efficacy. Yoga exhibits substantial beneficial effects in alleviating psychiatric disorders such as schizophrenia, depression, and PTSD (Clark et al., 2014).

Yoga practitioners typically demonstrate elevated pain tolerance and pain pressure thresholds relative to inactive individuals. This disparity is ascribed to physiological and psychological adaptations stemming from consistent yoga practice.

Pain Tolerance and Pressure Sensitivity in Yoga Practitioners

·        Enhanced Pain Tolerance: Yoga practitioners exhibit a much greater capacity to endure pain compared to inactive individuals. This correlates with augmented grey matter in cerebral regions like the insular cortex, which is implicated in pain processing and interoceptive awareness. The practice of yoga improves cognitive strategies associated with parasympathetic activation, leading to increased pain tolerance. (C. Villemure et al, 2014)

·        Neuroanatomical Alterations: Consistent yoga practice correlates with structural modifications in the brain, notably inside the insular cortex. These modifications are thought to improve the integration of sensory inputs and emotional regulation, essential for pain management. C. Villemure et al, 2014)

Comparison with Sedentary Controls

·        Sedentary Controls: Individuals who do not participate in regular physical activity, such as yoga, typically exhibit diminished pain tolerance and pressure thresholds. This is frequently associated with less physical activity, which correlates with increased pain sensitivity and diminished pain tolerance thresholds.(O. Skogberg et al, 2022)

·        Physical Activity and Pain Sensitivity: A notable correlation exists between elevated physical activity levels and enhanced pain tolerance. This indicates that participating in regular physical activities, such as yoga, can enhance pain sensitivity and tolerance.(O. Skogberg et al, 2022)

Examining the influence of yoga on pain perception and tolerance could have substantial ramifications for the formulation of alternative pain management approaches. By comprehending how yoga influences pain processing, healthcare practitioners can customise interventions to meet the distinct requirements of patients with chronic pain disorders. The investigation of pain perception and tolerance in yoga practitioners versus sedentary controls offers potential for enhancing our comprehension of yoga’s analgesic properties and its prospective contribution to holistic pain management strategies (Boehnke et al., 2020; Büssing et al., 2012; Clark et al., 2014; Vorkapic & Rangé, 2014).

The comparison of pain pressure threshold and pain tolerance between yoga practitioners and sedentary controls seeks to clarify the probable processes behind yoga’s analgesic effects. The pain pressure threshold denotes the least pressure necessary to elicit pain, whereas pain tolerance signifies the highest degree of discomfort an individual can endure. By evaluating these measures, researchers can discern the disparities in pain sensitivity and coping mechanisms between persons who practise yoga regularly and those who do not. Clinical research including yoga for the elderly indicate its ability to alleviate pain-related symptoms by decreasing falls and enhancing overall quality of life, balance, mobility, osteoarthritis symptoms, and sleep (Boehnke et al., 2020).

The comparison of pain pressure threshold and pain tolerance between yoga practitioners and sedentary controls seeks to clarify the probable processes behind yoga’s analgesic effects. Pain pressure threshold is the least amount of pressure necessary to elicit pain, whereas pain tolerance signifies the highest level of pain an individual can endure. By evaluating these measures, researchers can discern the variations in pain sensitivity and coping mechanisms between those who regularly practise yoga and those who do not.

Methodology:

Study type: Descriptive, cross-sectional study

Study settings: Study will be conducted in Department of Physiology in  AIIMS Bathinda.

Study Duration: 1 Year

Study Population: The study will include healthy adult yoga practitioners and their aged matched sedentary controls.

Sample Population: 60 (30 in each group)

From the study conducted by Villemure. C et al, and with the above assumptions the sample size for 95% confidence level and 80% power works out 24 in each group. This number has been increased to 30 per group (a total of 60) to allow for a predicted dropout from treatment.

Inclusion criteria: Yoga practitioners practicing yoga for more than 2 hours per day for 5 days a week. Consenting age matched control population with no comorbidity and having sedentary lifestyle.

Exclusion criteria: Yoga practitioner having any comorbidity as well as non-consenting practitioners will be excluded

Study Method: In this study comparison of three parameters will be done. Pain pressure threshold , pain tolerance and pain perception. The quantitative assessment of pain pressure threshold and pain tolerance will be measured by using an instrument known as Dolorimeter.  The qualitative assessment of pain perception will be done by Pain Assessment Scales (Numerical Rating Scale and Visual Analog Scale). The result of quantitative and qualitative assessment will be compared in yoga practitioner and age matched healthy controls.

Quantitative assessment of Pain: Pain threshold and pain tolerance will be measured in Yoga Practitioners by using Dolorimeter. Dolorimeter is a device that measures pain by applying pressure or electrical stimulus. Dolorimeter will be first used on yoga practitioners. Steady pressure will be applied using the dolorimeter over the body surface. The pressure at which the individual first feels pain is recorded and is marked as pain threshold. The duration of time the subject will tolerate the enforced painful pressure is pain tolerance of the subject. The quantitative data will be compared to healthy age matched controls in which the pain pressure threshold and pain tolerance be measured similarly.

Qualitative assessment of Pain: When pressure is applied by the dolorimeter the subject will be asked to indicate how much pain they feel using pain assessment scales. This reading will be providing the pain perception at pain threshold.

Pain perception is again recorded by pain assessment scales during the recording of pain tolerance. The pain perception of yoga practitioners will be compared to the aged matched controls.