Chronic pain is not only a physical problem; it also includes sensory and emotional factors that impact both the body and mind. It is classified as chronic pain when it lasts for more than three months, regardless of whether it is continuous or intermittent. This condition s characterized by a complex dysregulation of the nervous, endocrine, and immune systems, and can lead to disability. Most painkillers are available over the counter, but there are multiple adverse effects associated with their use, which implies a need to find alternative pain management treatments. These days, yoga is recognized not just as an exercise but as a neurobiologically active intervention that balances central pain processing, autonomic function, and stress pathways, thereby helping the patient with chronic pain.
Downregulating the Stress-Pain Cascade
Yoga reduces the overactive hypothalamus–pituitary–adrenal (HPA) axis by downregulating the pain pathways, which decreases the vagal tone. Regular practice of yoga reduces levels of cortisol and catecholamines, which in turn lowers allostatic load and sympathetic hyperarousal- the two factors that can intensify pain perception. Improved parasympathetic activity helps to stabilize autonomic balance, which is most often disrupted in chronic pain conditions such as osteoarthritis and mechanical low back pain.
Modulating Central Pain Pathways
Yoga has a protective effect on the immune response triggered by stress and helps maintain cardio-vagal tone. It promotes autonomic balance by regulating the activity between the parasympathetic and sympathetic systems, thereby reducing the stress response. The physical postures, breathing techniques, and meditation associated with yoga stimulate the release of endorphins, which reduce the perception of pain. This helps modulate descending inhibitory pathways and reduce central sensitization. Multiple neuroimaging studies show that experienced yoga practitioners have increased grey matter volume and white matter integrity in regions like the insula and prefrontal cortex, which are critical for interoception and pain tolerance.
Reducing Pain Sensitization and Catastrophizing
Yoga reduces pain sensitization by decreasing pro-inflammatory signalling and normalizing nociceptive processing. It also targets the affective dimension of pain: mindfulness and acceptance-based components of yoga lower pain catastrophizing, anxiety, and depression, which are strong predictors of pain severity and disability. A study of patients with knee osteoarthritis found that yoga reduced pain and stiffness, resulting in clinical improvement and improved quality of life.3 Yoga improves awareness and increases the pain tolerance threshold.
Clinical Implications for Integrative Pain Care
Yoga offers a low-risk, multimodal adjunct to conventional pain management. There is evidence supporting the use of yoga to improve chronic low back pain, osteoarthritis, and rheumatoid arthritis, where it not only reduces pain but also improves joint function and quality of life, thereby reducing disability and the burden on health care. 4,5A neurobiological framework helps explain why yoga works: it simultaneously targets peripheral inflammation, central sensitization, autonomic imbalance, and maladaptive pain pathways.1,6
References
- Bakshi K, Balkrishna A, Varshney A. Traditional and Complementary Approaches in Combating Central Sensitisation of Pain in Osteoarthritis: Trends and Advances. Ann Neurosci. 2025;0(0):09727531251357658. doi:10.1177/09727531251357658
- Gautam S, Kumar U, Dada R. Yoga and its impact on chronic inflammatory autoimmune arthritis Department of Anatomy , All India Institute of Medical Sciences , New Delhi , India , 2 Department of Rheumatology , All India Institute of Medical Sciences , New Delhi , India TABLE OF CONT. Published online 2021:77-116.
- Bennell KL, Schwartz S, Teo PL, et al. Effectiveness of an Unsupervised Online Yoga Program on Pain and Function in People With Knee Osteoarthritis A Randomized Clinical Trial. Ann Intern Med. 2022;175(10):1345-1355. doi:10.7326/M22-1761
- Wang Y, Lu S, Wang R, et al. Integrative effect of yoga practice in patients with knee arthritis A PRISMA-compliant meta-analysis. Med (United States). 2018;97(31). doi:10.1097/MD.0000000000011742
- Hochman JR, Davis AM, Elkayam J, Gagliese L, Hawker GA. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthr Cartil. 2013;21(9):1236-1242. doi:10.1016/j.joca.2013.06.023
- Nijs J, Meeus M, Van Oosterwijck J, et al. Treatment of central sensitization in patients with “unexplained” chronic pain: what options do we have? Expert Opin Pharmacother. 2011;12(7):1087-1098. doi:10.1517/14656566.2011.547475