Ayurvedic Pain Management

 Pain is one of the commonest symptoms which forces people to seek medical help; it is also one of the leading causes of chronic disability and adverse quality of life. It may arise from trauma, disease, inflammation or nerve damage. Pain can be classified in various ways. Duration wise, it can be classified as acute and chronic; it is termed chronic when lasting for more than three months. There are different known types of pain and these include breakthrough pain, bone pain, nerve pain, phantom pain, soft tissue pain and referred pain.

Pain perception is determined by a persons’ genetics, personality, emotional build, lifestyle and the memory of past experience. The need for pain control medications can be significantly reduced with the help of relaxation, meditation, deep breathing, music therapy, yoga and tai-chi, positive thinking and mind-body techniques which combine imagery with relaxation as well as biofeedback. These have been discussed in detail elsewhere.

Here, Ayurvedic pain management will be discussed in detail. This includes several treatment modalities which are outlined as follows:

Snehan: This is basically lubrication of the body using medicated oils. This can be either external or internal. Oil of sesame is considered the best oil for this purpose. Massage with oil has neuro-hormonal effects and may help release endorphins, thereby reducing pain sensation. Snehan therapy is useful for arthritis, insomnia, paralysis, tremors, nervous exhaustion, constipation, and other neurological derangements

Swedan: This implies hot fomentation which is meant to induce sweating. This procedure stimulates peripheral nerve endings which transmit heat and pain sensations, and is effective in relieving pain. Swedan is suggested for different pains like earache, headache, neurological pain, pain due to constipation, and absence or retention of urine. It is also indicated for stiffness, arthritis, muscle and tendon spasms and tremors.

Agnikarma: This procedure utilizes heat to bring about a burn in a small, preselected area; this is therefore a therapeutic cautery. This is probably one of the most effective techniques for pain control and is used for treating heel pain, osteoarthritis, and frozen shoulder. Several physiological hypotheses come into play here, including selective heat and pressure perception which competes with pain, counter nerve irritation, detoxification due to increased blood supply, and bringing about muscle relaxation.

Raktamoksan: This involves blood-letting, and includes removal of blood using a syringe (venesection), cupping, and the use of leeches. Blood-letting is useful for regional as well as generalized pain control. Severe and throbbing pain and burning sensation can be controlled quickly using this procedure.

Leech therapy: This reduces pain by counter pain and burning sensations, bringing about liquidification of blood, and treating inflammation. This procedure is usually used to treat migraine, intractable tension headache, painful clots, and gangrene wounds.

Viddhakarma: This procedure consists of piercing of specific vital points known as marmas; this causes release of endorphins, thereby controlling pain. In day-to-day clinical settings, a sterile insulin needle is usually used for this purpose. This procedure serves many purposes but is usually helpful in headache, eye-ache, tonsillitis, nasal blockage, renal colic, pain related to nerve defects, joint pain, radiated pain etc. A combination of piercing and cauterization can be used and is known as Viddhagni karma.

Lepankarma: This consists of application of medicated pastes on the skin to relieve inflammatory conditions as well as muscle and tendon spasm.

Bastikarma: This is the use of medicated enema wherein medicines are introduced into the rectum in liquid form. This procedure is known to affect the sympathetic nerves, which in turn act via the hypothalamus-pituitary-adrenal axis to release hormones to reduce pain and inflammation. Basti is useful for many disorders including chronic constipation, sciatica, lower back pain, arthritis, gout, and rheumatism. It also heals numerous neurological disorders like Parkinson’s disease, muscular dystrophy, paraplegia, hemiplegia, poliomyelitis, osteoporosis, and muscle and nerve atrophy. 

Miscellaneous modalities: These include Shirodhara (oil drip on the forehead), abhyang (massage), pichu (medicated cotton swab), anjan (medicated eyeliner), netratarpan (local basti over eyes), karnapuran (medicated oil for ears), karnadhupan (smoke therapy for ears), kawal-gandush (medicated gargles), hrudaya basti (localized oil dam procedure over heart area), Prushta basti and katibasti (localized oil dam procedures over upper and lower back). Each modality is designed to treat or cure some specific medical condition causing pain and other symptoms.

Ayurvedic herbs: These include herbs like turmeric, ginger, cinnamon, cloves, garlic, cardamom, tulsi, yashtimadhu, neem, ashwagandha, nirgundi, guggulu, and shallaki, which have anti-oxidant, digestive, detoxifying, stimulant, analgesic, and anti-inflammatory properties and thereby reduce pain.

Yogic procedures: These include asanas, purification procedures, meditation, and breathing techniques which bring about relaxation of muscles, tendons and ligaments, reduce stress, calm the mind, induce good sleep, and reduce inflammation on a long term basis. Different yogasanas can be prescribed for different types and locations of pain.

Satvavjay treatment: These include counselling and mind-body techniques to conquer pain.

In this way, people affected with both acute as well as chronic pain can use a combination of Ayurvedic pain management techniques to treat their pain on a long term basis. An accurate diagnosis by a qualified and experienced Ayurvedic practitioner is a must. Likewise, it is best to take professional help for handling acute pain and for planning long term treatment, and long term pain management. What works best for one person may not work for someone else; also, different stages of pain-causing diseases may require different management in the same individual.  However, it is an established fact that regular adherence to an effective pain management programme can significantly reduce and treat pain.

Dr A A Mundewadi is available as an Ayurvedic Consultant at https://www.mundewadiayurvedicclinic.com and http://www.ayurvedaphysician.com

Pain Management

Pain is one of the commonest symptoms which forces people to seek medical help; it is also one of the leading causes of chronic disability and adverse quality of life. It may arise from trauma, disease, inflammation or nerve damage. Pain can be classified in various ways. Duration wise, it can be classified as acute and chronic; it is termed chronic when lasting for more than three months. There are different known types of pain and these include breakthrough pain, bone pain, nerve pain, phantom pain, soft tissue pain and referred pain.

Pain perception is determined by a persons’ genetics, personality, emotional build, lifestyle and the memory of past experience. The need for pain control medications can be significantly reduced with the help of relaxation, meditation, deep breathing, music therapy, yoga and tai-chi, positive thinking and mind-body techniques which combine imagery with relaxation as well as biofeedback. Such mind-body techniques include altered focus, dissociation, sensory splitting, mental anesthesia, mental analgesia, pain transfer, time transfer, symbolic and positive imagery, and counting. These strategies can be used for about half an hour, thrice a week. It is best to take professional help to get started with such techniques.  

Physical therapy and occupational therapy can help with both acute and chronic pain. Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain and also by stretching and relaxing stiff and tense muscles, ligaments and joints. Hypnosis, joining pain counseling groups, sharing experiences, and meeting with family and friends also helps to reduce the burden of pain perception. Spiritual help may also help to cope up with chronic pain.

Diluted essential oils can be used for local application as well as for inhalation to relieve various pains such as headache, toothache, muscular sprain, arthritis and neuropathic pain. These oils include lavender, rosemary, peppermint, eucalyptus, cloves, and capsaicin. Ginger and turmeric powder can be used both orally as well as for local application. Fish oil taken orally has also demonstrated good pain control.

Therapeutic massage can be used for pain relief since it relaxes muscles, ligaments, tendons and joints and helps reduce inflammation. The application of cold press and ice, as well as heat application also helps in a similar manner. Cold applications are usually used within the first 48 -72 hours, after which heat application is more beneficial. Both are used for about 20-30 minutes 2 or 3 times daily. Neurostimulation can also be used for pain control; these include TENS, spinal cord stimulator, acupressure and acupuncture.

It may be necessary to use pain control medications to control and treat acute pain, and also in some instances of chronic pain. These medications include non-steroid anti-inflammatory drugs, muscle relaxants, analgesics, antidepressants and neuromodulators. The most commonly used over-the-counter drugs are NSAIDs such as paracetamol, aspirin, ibuprofen, etc. Drugs should be used preferably with professional medical advice. If these do not work, doctors may use more potent analgesics, steroids, local injections, or give surgical advice.

Certain lifestyle changes can relieve pain. For the obese or overweight people, the best recommendation is to reduce some weight. People who eat a balanced diet, drink plenty of water, get enough sleep and manage stress levels may be less likely to have chronic pain.

Ayurvedic pain management is a complete system which includes different modalities like medications, snehan, swedan, blood-letting, agnikarma, vedhan, basti, localized treatments, and mind control. These will be discussed elsewhere.

In this way, people affected with chronic pain can use a combination of relaxation, medicines, local applications, diet, exercises and mind-body techniques to treat their pain on a long term basis. An accurate diagnosis by a qualified and experienced medical practitioner is a must. Likewise, it is best to take professional help for handling acute pain and for planning long term treatment, and long term pain management. What works best for one person may not work for someone else; also, different stages of pain-causing diseases may require different management in the same individual.  However, it is an established fact that regular adherence to an effective pain management programme can significantly reduce and treat pain.

Dr A A Mundewadi is available as an Ayurvedic Consultant at https://www.mundewadiayurvedicclinic.com and http://www.ayurvedaphysician.com

How to Reduce and Treat Back Pain, Low Back Pain

 Back pain is a very common ailment which can seriously affect work performance and quality of life. Usually, eight out of every ten individuals will get back pain at some point of time in their lives. The back is a complex structure made up of vertebral bones, supporting discs, spinal cord and nerves, cartilages and muscles. This combination makes the backbone a remarkably strong but mobile structure.

Back pain can be acute, chronic or recurrent; it is labeled as chronic when it has lasted for more than three months. Back pain can be again divided into cervical or neck pain (upper back pain), thoracic or middle back pain, and lumbar or lower back pain. Lower back pain is the most common, and usually accounts for nearly 80 percent of back pains.

Over-the-counter pain management medicines can help to reduce acute back pain along with rest and cold or hot applications. If required, prescription drugs can be used after seeking medical advice. This usually includes the use of non-steroid ant-inflammatory drugs, muscle relaxants, and neuromodulators. For chronic or intractable pains, physicians may consider local injections, or rarely, surgery.

Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other nonsurgical spine treatments can make a difference for chronic back pain.

Ayurvedic medicines can be utilized for a few months to treat swelling, pain and stiffness, help rebuild cartilage and heal damaged bones. Depending upon the diagnosis and severity of back pain, Ayurvedic treatment may be required for about 4 to 8 months. Self-medication should be avoided at all costs.

It is absolutely necessary to take medical help if pain does not reduce, or there are additional symptoms like impaired sensation, severe or increasing pain, bowel incontinence, limb weakness or paralysis, fever and unexplained weight loss.

Having said this, we will now discuss some simple steps, precautions, lifestyle changes and home remedies which can both prevent as well as treat most back pains. These include the following:

1) Improve your posture: When sitting, make sure it is in a supportive chair, where your hips are higher than your knees. Avoid chairs that are too low or soft, such as sofas. Keep your neck in an upright position and don’t let it poke forward. When working at a desk, avoid twisting movements by keeping your keyboard, mouse and telephone within easy reach. Your elbows should be at desk height with your chair pulled right in underneath. Use a pillow or rolled up towel in the small of your back if it needs extra support. When driving, take frequent breaks and get out of the car and wander around. If time permits, you may even do a bit of stretching! Avoid remaining in the same position for long. When you lift something heavy, it's very easy to twist the wrong way. This can lead to muscle spasm and pain. Use proper body mechanics by engaging your leg muscles, not your back, when you pick up heavier items. Get help if the item is too much for you to lift alone

2) Foam rollers: Foam rollers are a popular choice for relieving pain in back muscles. The rollers effectively act like self-massage, with the user’s bodyweight providing the pressure.

3) Ice and heat treatment: Cold application like ice is usually used within the first 48-72 hours of a back sprain, after which heat can be used. Treatment time for both is usually 15-20 minutes 2 or 3 times a day, taking care not to harm the skin.

4) Think about your diet: Eating a balanced diet ensures that your body gets all the nutrients it needs to strengthen and repair itself. Anti-inflammatory foods may help reduce pain. These include wholegrain foods, fruit and vegetables including leafy green vegetables, fiber foods, yogurt, some spices, including turmeric, ginger, green tea and black pepper. Foods that may make inflammation worse include highly refined flour or gluten, refined sugars, trans-fats and saturated fats, and red meat. Turmeric milk, tart cherry juice, and ginger green tea can reduce inflammation. Vitamin D can strengthen bone and reduce back pain and other body pains.

5) Quit smoking: Smoking restricts blood flow to the discs that cushion your vertebrae. This could lead to quicker disc degeneration. Smoking also reduces calcium absorption and new bone growth. This increases the risk of a fracture due to osteoporosis.

6) Lose weight: It is also worth noting that if you are carrying excess weight, it can put added strain on your back. Losing those extra pounds is a great way to give your back a break and rediscover the joy of movement.

7) Get enough sleep: Try to get about 6-7 hours of sleep at night. Sleep relaxes mind and muscle, reduces muscle strain and spasm as well as reduces pain perception. Vitamin C, vitamin B6, melatonin, L-theamine, and valerian can help bring about sleep easily. Mindful meditation can also help.

8) Adjust your sleep position: Getting the right support from your mattress is crucial in helping with back pain at night. Finding the appropriate firmness to provide relief while keeping your body supported is important, no matter what position you like to sleep in. You should then try and keep your spine in a straight position, so avoid using too many pillows, which can push your head out of line, and consider putting a pillow between your knees if sleeping on your side, or under them if you sleep on your back.

9) Stretching: Regularly stretching the muscles, tendons, and ligaments that support the spine is an important element of all back exercise programs. Benefits of stretching include (i) reducing tension in muscles supporting the spine - tension in these muscles can worsen pain from any number of back pain conditions (ii) improving range of motion and overall mobility and (iii) reducing risk of disability caused by back pain.

Back pain can be easily reduced or prevented using the following exercises: knee to chest stretch, modified cobra, standing hip stretch, seated spinal twist, pelvic tilt and glute bridges. Hot tub bath, and swimming or water exercises can also help with back pain.

10) Manage stress: Stress can cause or aggravate back pain, so it is necessary to manage or reduce stress using relaxation techniques like meditation, deep breathing, stretching exercises, and yoga.

11) Yogic Asanas: Yogasanas which can help with the reduction and prevention of back pain include Bhujangasana, Paschimottanasana, Ushtrasana, Dhanurasana, and Setubandhasana. Details and images of these are available online, or one can enroll for yoga classes.  

12) Back pain associated with pregnancy: During pregnancy, the ligaments in your body naturally become softer and stretch to prepare you for labour. This can put a strain on the joints of your lower back and pelvis, which can cause back pain. The same methods as described so far can help relieve back pain with this condition too.

In this way, people affected with back pain pain can use a combination of rest, medicines, diet, and exercises to treat their pain on a long term basis. An accurate diagnosis by a qualified and experienced medical practitioner is a must. Likewise, it is best to take professional help for handling acute back pain and for planning long term treatment, and management with exercises. What works best for one person may not work for someone else; also different stages of back pain causing diseases may require different management in the same individual.  However, it is an established fact that regular adherence to an effective exercise programme can definitely preserve structure and function of the back on a long term basis.

Dr A A Mundewadi is available as an Ayurvedic Consultant at https://www.mundewadiayurvedicclinic.com and http://www.ayurvedaphysician.com

How to Reduce Knee Joint Pain

The knee is the largest and probably the most complex joint in the human body. Diseases of this joint can seriously hamper movement as well as quality of life. The joint is made up of the thigh bone, the shin bones, knee cap, and muscles and cartilages. Common diseases of the joints include osteoarthritis, rheumatoid arthritis, and traumatic arthritis. Any disease of this joint will normally cause the following symptoms: pain, redness, inflammation, heat, swelling, stiffness, immobility or limited mobility.

Most of these symptoms are normally treated with rest, ice or heat applications, compression, elevation, over-the-counter medications, non-steroid-anti-inflammatory drugs, physiotherapy, intra-articular injections, and surgery. Most diseases of the knee joint last for long periods, and cause symptoms, of which pain is probably the one symptom which requires immediate attention. Measures and ways to prevent or treat this pain of the knee joint will be discussed at length here.

1) Walking or running on a soft ground or mud-filled ground is safer than on hard surfaces like concrete, which can damage knee and ankle joints in the long run.

2) Gait alignment and correction is important to treat or prevent knee joint pain; professional advice may be required for this.

3) Weight reduction is another important method to reduce pressure on painful knee joints. The stress on knee joints on level ground is about 1.5 times the body weight, while on stair-cases, it may increase from 2 to 3 times the body weight.

4) Regular exercise is important in maintaining strength of the joint muscles. Some good choices include walking, swimming, water aerobics, stationary cycling, and elliptical machines. Tai chi may also help ease stiffness and improve balance.

5) Painful or unstable joints may induce falls, which can further damage an already diseased joint. Falls can be prevented by using good lighting, fitting handles on staircases and in bathrooms, using a cane for support, and using a sturdy ladder or stool when climbing up. Knee splints and braces can also stabilize joints.

6) Cold application like ice is usually used within the first 48-72 hours of a joint injury, after which heat can be used. Treatment time for both is usually 15-20 minutes 2 or 3 times a day, taking care not to harm the skin.

7) High impact activities and exercises like running, jumping, kickboxing, lunges and deep squats, that put a lot of stress on the knees, should be avoided.

8) A diet which has anti-inflammatory properties should be adopted since it helps in reducing joint inflammation, swelling, and long term damage. These include fruits and vegetables that are high in phytonutrients like vitamins C, D, and E, and selenium, as well as cold water fish which contain omega-3-fatty acids.

9) Acupuncture, or acupressure, sometimes combined with moxibustion, can help relieve the pain of osteoarthritis.

10) Stress should be avoided or reduced since it can increase muscular pain and also increase pain perception. Stress can be reduced effectively by deep breathing, relaxation techniques, meditation and yoga. Massage can also relieve stress and bring about a feeling of well being.

11) Supplements and herbs like ginger, curcumin (from turmeric), glucosamine and chondroitin sulphate, may reduce pain, inflammation, and help rebuild cartilage tissue. Likewise, Ayurvedic medicines can be utilized for a few months to treat swelling, pain and stiffness, help rebuild cartilage and heal damaged bones. Depending upon the diagnosis and severity of joint disease, Ayurvedic treatment may be required for about 4 to 8 months. Self-medication should be avoided at all costs.

12) As mentioned earlier, exercises are best for reducing and preventing knee joint pain on a long term basis, and keeping the joints and associated muscles in good physical condition. These include warm up, heel cord stretch, quadriceps stretch (standing and supine), hamstring stretch, half squats, hamstring curls, calf raises, leg extensions, straight leg raises (prone and supine), hip abduction and adduction, and leg presses. Details and images of these exercises are all available online. These exercises can be adopted as a joint conditioning programme lasting from 4 to 6 weeks, after which these can be continued with lesser frequency life-long, on a maintenance basis.

13) Yoga exercises are also very useful in preventing and relieving knee joint pain. These can be performed everyday for about 5-20 minutes, depending upon the severity of the condition. Included here is a list of asanas which are quite simple and can be done by almost anyone. These include Santulasana, Natrajasana, Vrikshasana, Trikonasana and Veerabhadrasana. These asanas involve movement of all the components of the knee joint and lower limbs, and help in improving blood flow, strengthening muscles, bones and cartilage, and reducing long term pain and inflammation.

In this way, people affected with knee joint pain can use a combination of medicines, diet, and exercises to treat their pain on a long term basis. An accurate diagnosis by a qualified and experienced medical practitioner is a must. Likewise, it is best to take professional help for handling acute joint conditions and for planning long term treatment, and management with exercises. What works best for one person may not work for someone else; also different stages of knee joint diseases may require different management in the same individual.  However, it is an established fact that regular adherence to an effective exercise programme can definitely preserve joint structure and function on a long term basis.

Dr A A Mundewadi is available as an Ayurvedic Consultant at  https://www.mundewadiayurvedicclinic.com and http://www.ayurvedaphysician.com