Psychiatric Aspects in Chronic Pain and Utility of Yoga and Mindfulness-Based Cognitive Behavioral Therapy for Pain (Y-MBCT Pain) as a Translational Model

One may agree that under-treated pain is an epidemic and over-treated pain is a nightmare for clinicians. It is a major public health problem. Chronic pain in the United States has a national economic cost of approximately $600 billion per year [57]; pain costs society $2000 per year for every individual living in the United States [113]. Chronic pain involves many complex aspects including persistent pain, anxiety, depression, difficulty moving, muscle weakness due to lack of use, and, of course, reduced quality of life—requiring further healthcare resources [3]. Pain is necessary to handle the danger signal that invoked it; however, due to the unpleasantness of pain, it is something that is consciously avoided: this adds to its complexity. In addition, the fear of pain in these patients more often than not leads to the avoidance of important activities such as exercises and thus creates a vicious cycle of avoidance, disability, depression, and more enduring pain. Prolonged pain, through the various feedback mechanisms, may lead to changes in the structure of the body and functions of the nerves that perpetuate these symptoms even after the tissue has had adequate time to heal [21]. It is not only the cost of health care or disability that is impacted by chronic pain; actually, the type of care that a patient receives and responds to is greatly impacted by chronic pain as well. No wonder that chronic pain is a leading cause for absence from work, reducing labor productivity, patient's income and insurance coverage, and increasing the need for workers' disability [71]. Also important to note that although many therapies are available for chronic pain, up to two-thirds of patients are inadequately treated [92].