Similar to the current biopsychosocial model used in the medical community when working with people suffering from chronic or persistent pain, yoga therapists utilize a comparable framework or philosophy, that being the panca maya kosha model.
The felted model above (by my colleague @meyogalune) beautifully illustrates how we might look at, explore and peel back the many layers of our existence when working with someone therapeutically. We are, after all, more than a body of tissue and matter.
What does this mean, exactly?
Let me provide a very general, simplistic idea of what each represents:
- Annamaya kosha. You can think of this generally, as the physical layer.
- Pranamaya kosha, or the energetic layer.
- Manomaya kosha, or the mental/emotional layer.
- Vijnanamaya kosha, or the mind. We might also refer to this as intellect or wisdom.
- Anandamaya kosha, or the spiritual, blissful layer. What I prefer to call the meaning and purpose of someone’s self, or life.
What happens sometimes in our current medical system is the person is looked at, evaluated by and treated in terms of the physical layer only or from a biomedical model, rather than a biopsychosocial model. This can be due to a multitude of reasons but I’ll highlight just a couple, below.
One, that may be surprising to you, is how many of our medical professionals are provided little training, specifically, in pain. (1) “In a review of 10 Canadian Universities across 7 provinces… 68% of programs were unable to specify any designated hours for pain education and veterinary students were shown to receive 2-5 times more pain education than that of health science students (Watt-Watson et.al., 2009). Educational content also typically lacks integration of biological aspects with the psychosocial factors that contribute to the experience of pain (Wideman et. al., 2019b).”
Another reason might also be lack of time that’s allocated to people given our over-burdened system and/or accessibility into “self-management programs that educate people about their condition and build their capacity to take action.” (2)
What is now understood about pain and as stated in the IASP definition, pain is “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. ” You might think of it as an ‘actual, or potential threat to the system’, that system or organism, being YOU. Your whole person.
And often these threats to the system are just under your level of awareness. Or as David Butler says “DIMs and SIMs can hide in hard to find places”. Referencing DIMs as being the Danger in Me, while SIMs as being the Safety in Me. (If you want a brief explanation of this concept, here’s a link.)
We will experience pain when our credible evidence of danger related to our body is greater than our credible evidence of safety related to our body. Equally we won’t have pain when our credible evidence of safety is greater than our credible evidence of danger (Moseley and Butler 2015, pp14).
People sometimes think that their pain problem is, or must be, something physical. Or, sadly, they think or are told, that its all in their head. Pain is complex and by bringing a sense of curiosity to explore many areas, layers or koshas and how they might be affecting you either positively (perhaps a SIM) or negatively (maybe a DIM) we might just change this human experience, we call pain. Your experience of pain.
If you’re interested in exploring this further, I offer both private sessions or group classes utilizing this approach. Along with awareness, exploratory and gentle movement practices, I always add in an educational aspect or some yoga philosophy in line with what we know about pain and how you can learn to be your own best resource. Click here, to see my current schedule.
References above are from ‘A Report by the Canadian Pain Task Force, June 2019’. You can read the full report here, if interested.
(1) “…the current state of pain education in Canada remains inadequate across disciplines, with significant knowledge gaps in both pre- and post-licensure contexts (NASME, 2019; Thompson et. al., 2018).” On page 21 of the report.
(2) “Research in 2005-2006 indicated the median wait time for a first appointment at a MPTC was 6 months….. In a recent update to this work, researchers found little change in the wait times, noting in 2017-2018 the median wait time still hovered around 5.5 months, with some people waiting up to 4 years to access to multidisciplinary pain care (Choinière et. al., 2019).” On page 18 of the report.