Sauna Therapy in Managing Chronic Pain – Insight into Endorphin and Circulatory Response
INTRODUCTION
Chronic pain is a serious issue for millions of people across the globe, in addition to suffering significant impairment to their quality of life, movement, and emotional status. Few medications exist to manage chronic pain but typically accompanied with side effects and concerns over growing borderline dependency with tolerance and faltering efficacy. One option gaining momentum as an option to alleviate chronic pain is sauna therapy. In practice, sauna therapy has been primarily used for relative relaxation and detoxification from harsh substances, but now may help alleviate chronically painful conditions due to its support of different therapeutic modalities, likely through physiological means that may include endorphin release and increased circulation.
This article provides an in-depth discussion of the physiological and neurochemical pathways by which sauna therapy may act upon chronic pain, including the roles of endorphins and circulation pathways.
Understanding Chronic Pain
Chronic pain is defined as pain that persists longer than 12 weeks, when the underlying cause or injury has already healed. Unlike acute pain, which should be viewed as a protective response to injury or illness, chronic pain often lasts long after that protective purpose no longer exists, sometimes being “own condition.”
Chronic pain could be a result of multiple health problems including: arthritis, fibromyalgia, chronic fatigue syndrome, neuropathy, back (lumbar spinal region) and neck (cervical spinal region) pain, and inflammatory diseases. These factors operating together may alter the way the brain dictates pain through disrupted nerve signals, imbalances in neurotransmitters (chemical messengers between neurons), and psychological drivers such as stress, anxiety, and depression.
What Is Sauna Therapy?
Sauna therapy involves spending time in a heated environment, usually between 70°C to 100°C (158°F to 212°F), to induce therapeutic sweating, and relaxation, and enhance wellbeing. There are many different types of sauna therapy; however, examples include: traditional Finnish saunas, which provide dry heat to the body from stoves, and also heated stones; infrared saunas, where heated light waves pass through the air to the body itself, rather than heating the environment; and steam rooms that provide moist heat using steam generators.
Regardless of how the heat is delivered, all sauna therapy will create passive heat exposure, inducing the same physiological responses with increased circulation, muscle relaxation, and detoxification. These beneficial body changes associated with sauna therapy are especially helpful for people suffering from chronic pain, by decreasing pain and enhancing physical function.
Sauna Therapy in Managing Chronic Pain
1. Natural Painkiller - Endorphins
Endorphins are naturally available neuropeptides that act as internal pain relievers by binding to opioid receptors in the lower brain and spinal cord and blocking pain signal transmission, promoting pleasure and feeling good.
- Sauna therapy can stimulate the release of endorphins from heat application, generally in a sauna at temperatures of 70°C to 100°C. High temperatures, while not causing harm (research supports this), induce a controllable stress response that stimulates the body’s stress response as well as the hypothalamic-pituitary-adrenal (HPA) axis to release neuropeptides associated with pain relief: beta-endorphins, dynorphins, and enkephalins.
- Study revealed, where the researchers reported “significant” increases in beta-endorphin levels that matched the pain reduction and mood elevation after sauna use. People with chronic pain diagnoses – fibromyalgia, rheumatoid arthritis, etc. – can obtain pain reduction and physical improvement with repeated sauna exposure. The increased endorphin activity may increase the placebo effect while decreasing inflammation, stress response factors, and difficulty sleeping (all of which are factors in the management of chronic pain).
2. Circulatory Response
The most immediate physiological benefit of sauna therapy is vasodilation (increased blood vessel size).
- Vasodilation in the body dramatically increased blood flow to muscles and joints. This increased blood flow helps deliver oxygen and nutrients to tissues better than when there is reduced blood flow. Moreover, vasodilation facilitates the removal of metabolic waste and inflammatory mediators. Improved circulation facilitates detoxification of the body but also helps relax muscles while releasing tension and pain.
- The deep penetrating heat of the sauna can soothe the stiffness and soreness associated with conditions such as osteoarthritis, fibromyalgia, and chronic back pain. In addition, improved blood flow helps flush lactic acid and various by-products built up in overused/injured tissue and supports recovery and decreased discomfort after physical activity.
- Infrared saunas can stimulate microcirculation, improving blood flow in all the smallest blood vessels. This is particularly useful for patients with troublesome neuropathic pain (eg, diabetic neuropathy) since peripheral circulation is often a source of chronic pain if compromised.
Additional Mechanism that Support Chronic Pain Management
Sauna therapy includes many other physiological mechanisms in addition to endorphin release action and improved circulation patterns that aid in chronic pain treatment.
- One example is the reduction of inflammatory markers, because persistent low-grade inflammation is a common feature of chronic pain, sauna exposure is associated with reductions in all are pro-inflammatory cytokines.
- Sauna therapy is also involved with the control of stress hormones; although cortisol has the potential to rise during heat exposure, subsequent exposure helps lower cortisol and provides a state of calmness and relaxation.
- Sauna therapy improves sleep quality, more exposure can help enhance circadian rhythm, and subsequent exposure promotes melatonin production which is important for sleep’s quality and depth. Enhanced quality of sleep is especially important because poor sleep has been found to increase pain perception.
- Lastly, sauna therapy promotes mental health through elevating dopamine and serotonin levels to enhance mood and reduce anxiety and depression – mental states that usually exacerbate chronic pain conditions.
Clinical Application of Sauna Therapy on Chronic Pain Management
Sauna therapy is getting attention as an adjunct therapy for chronic pain disorders across many disciplines, particularly in integrative and functional medicine.
- Fibromyalgia is among the most receptive conditions; patients have experiences of widespread musculoskeletal pain and fatigue. Infrared saunas are noted to decrease muscle stiffness, pain intensity and fatigue through increased blood circulation and release of endorphins.
- Patients with rheumatoid arthritis and osteoarthritis also can benefit from sauna therapy, sauna use increases circulation of synovial fluid, decreases joint stiffness and decreases inflammatory cytokines leading to greater mobility.
- Chronic lower back pain is one of the most common medical problems globally, and heat therapy dedication is well reported, sauna therapy reduces tension in paraspinal muscle and increases flexibility.
- With patients that experience neuropathic pain, pain often is a result of nerve dysfunction and sauna therapy intervention may have some benefits due to the resulting increased peripheral circulation and pain transmission reduction through neurochemical modulation.
- In addition, for patients with migraine headaches may be substantially reduced and tension headaches may also contribute to relief through sauna sessions and stabilizing vascular flow as well decreasing the frequency of headaches. Together these therapeutic effects lend support to sauna therapy as a viable adjunct in chronic pain control.
Final Thought
Sauna therapy is a safe, noninvasive strategy for treatment of chronic pain and may work through multiple overall physiological and neurochemical mechanisms. Sauna sessions stimulate the release of endorphins, promote blood flow and circulation, decrease inflammatory profiles, balance hormones related to stress and provide health benefits associated with sleep and mood to lessen symptoms and improve quality of life significantly. Patients with chronic pain disorders, such as fibromyalgia, arthritis, back pain, neuropathy, and chronic headache, have found sauna therapy to be especially helpful, socially and physically, and sauna therapy is becoming a legitimate and rejuvenating contribution to pain management treatment paradigms.
Reference
- Cho, H., Kim, H., Kim, C., Yang, H., Kim, J., & Hwang, B. (2019). Dry sauna therapy is beneficial for patients with low back pain. Anesthesia and Pain Medicine, 14(4), 474. https://doi.org/10.17085/apm.2019.14.4.474
- O’Hara, E., & Babione, J. (2017). Sauna as a rehabilitative component in chronic pain: A Systematic review. Archives of Physical Medicine and Rehabilitation, 98(10), e107. https://doi.org/10.1016/j.apmr.2017.08.344
- Hussain, J., & Cohen, M. (2018). Clinical Effects of Regular Dry Sauna Bathing: A Systematic Review. Evidence-Based Complementary and Alternative Medicine : ECAM, 2018, 1857413. https://doi.org/10.1155/2018/1857413
- Nance, M., Stetsiv, K., McNamara, I. A., Carpenter, R. W., & Hepp, J. (2024). Acute, Chronic, and Everyday Physical Pain in Borderline Personality Disorder. Current Psychiatry Reports, 26(5), 240. https://doi.org/10.1007/s11920-024-01498-0
- Tsagkaris, C., Papazoglou, A. S., Eleftheriades, A., Tsakopoulos, S., Alexiou, A., Găman, A., & Moysidis, D. V. (2022). Infrared Radiation in the Management of Musculoskeletal Conditions and Chronic Pain: A Systematic Review. European Journal of Investigation in Health, Psychology and Education, 12(3), 334. https://doi.org/10.3390/ejihpe12030024
