Pain management in Ayurveda is a Big Gap of medical practice that demands research in this area â
Understanding the Pain intensity of patient is impossible
The highly unpleasant physical sensation caused by illness or injury i.e. PAIN can not be estimated by any measurable parameter
Pain developed by Mental suffering or distress that causes as a body protecting mechanism is not understood
What we do is just Block the pain perception or make the sufferer to sleep
2. Confession⢠Pain management in Ayurveda is a Big Gap
Panchakarma Practices in Pain Management
Confession⢠Pain management in Ayurveda is a Big GapÂ
of medical practice that demands researchÂ
in this area â
â Understanding the Pain intensity  ofÂ
patient is impossibleÂ
The highly unpleasant physical sensationâ The highly unpleasant physical sensationÂ
caused by illness or injury i.e. PAIN canÂ
not be estimated by any measurableÂ
parameterÂ
â Pain developed by Mental suffering orÂ
distress that causes as a body protectingdistress that causes as a body protectingÂ
mechanism is not understood
â What we do is just Block the painÂ
perception or make the sufferer to sleep
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
3. Panchakarma Practices in Pain Management
Why is othersâÂ
i i f ?pain is funny?
Acute Pain Chronic Pain
Causes specific injury -->
tissue damage
Acute episode
tissue damage
Self Limiting? Yes No
Duration Less than 6 months 6 + months
Responsive to pain killers? Yes Minimally
Pain ď â activity ď â mastery ď â control ď Depression
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Pain ď â activity ď â mastery ď â control ď Depression
4. P i
Panchakarma Practices in Pain Management
Pain
An unpleasant sensory and emotional experience associated
with actual or potential tissue damage, or described in terms of
such damage is Pain.
International Association for the Study of PainInternational Association for the Study of Pain
âDescribing pain only in terms of its intensity is like
d ibi i l i t f it l d âdescribing music only in terms of its loudnessâ â
von Baeyer CL; Pain Research and Management 11(3) 2006; p.157-162
Pain may not be directly proportional to amount of tissue
injury and there by it is highly subjective, leading to
under-treatmentunder treatment
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
5. Pain Prone Personality
Panchakarma Practices in Pain Management
Pain Prone Personality
Are some personalities more prone to experiencing, reporting
pain? YESpain? YES
1. Perfectionist: want all your tasks and projects to be complete to
the final detail, without flaws.
2. People-pleaser: tend to put others before yourself because it is
the good and nice thing to do.
3. Legalist: Just as you honor your commitments you expect3. Legalist: Just as you honor your commitments, you expect
others to honor theirs as well.
4. Stoic: uncomfortable with having or expressing strong
ti b di j i t l demotions-anger, abounding joy, passionate love, or deep sorrow.
Your feelings are not for the public.
5. Fear-prone: always anticipate that the worst will happen
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
6. Panchakarma Practices in Pain Management
Pain: A Complex PhenomenonPain: A Complex Phenomenon
⢠PainPain
â Sensory stimuli and/or neurologic injury modifiedÂ
by an individualâs memory expectations emotionsby an individual s memory, expectations, emotions
⢠Biocultural Model of Pain:
S i t l i fl i di id lâ iâ Society also influences an individualâs painÂ
experiences
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
7. Panchakarma Practices in Pain Management
Framework for Behavioral Pain Indicators
ď§ F i l i l h d t th f iď§ Facial expressions: clenched teeth, frowning,Â
grimacing, sad
ď§ Verbalizations/vocalizations: âouchâ cursingď§ Verbalizations/vocalizations: ouch , cursing
ď§ Nonâverbal: moans, groans, shouting, crying
ď§ B d t b i di iď§ Body movements: bracing, guarding, massagingÂ
affected area
ď§ Restlessness: agitation rockingď§ Restlessness: agitation, rocking
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
8. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
9. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
10. TYPES OF PAIN
Panchakarma Practices in Pain Management
TYPESÂ Â OFÂ Â PAIN
NEUROPATHICNOCICEPTIVE
Nociceptive pain (stimuli from Neuropathic pain (stimuli abnormallyÂ
S ti Visceral
p p (
somatic and visceral structures) processed by the nervous system)
Somatic
⢠bones, joints
⢠connective tissues
Visceral
⢠Organs â
heart, liver,
⢠muscles
heart, liver,
pancreas, gut,
etc.
Deafferentation
(nerve injury)
SympatheticÂ
Maintained
Peripheral
( j y)
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
11. S i P i
Panchakarma Practices in Pain Management
Somatic Pain
⢠Aching, often constant (Vedana)
⢠May be dull (Manda) or sharp (Teevra)
⢠Often worse with movement (Vyanavata)
⢠Well localized (Sthaneeya)⢠Well localized (Sthaneeya)
Example:Example:Â
â Bone & soft tissue
â chest wall
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
12. Visceral Pain
Panchakarma Practices in Pain Management
Visceral Pain
⢠Constant or cramping (Shoola)p g ( )
⢠Aching (klesha)
⢠Poorly localized
⢠Referred
Example:Example:Â
â Menstrual PainÂ
â Liver capsule distensionp
â CAÂ pancreas
â Bowel obstruction, etc
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
13. FEATURES OF NEUROPATHIC PAIN
Panchakarma Practices in Pain Management
COMPONENT DESCRIPTORS EXAMPLES
St d B i Ti li Di b ti th
FEATURESÂ OFÂ NEUROPATHICÂ PAIN
Steady,
Dysesthetic
⢠Burning, Tingling
⢠Constant, Aching
⢠Squeezing, Itching
⢠Diabetic neuropathy
⢠Post-herpetic
neuropathyq g, g
⢠Allodynia
⢠Hypersthesia
neuropathy
Paroxysmal,
Neuralgic
⢠Stabbing
⢠Shock-like, electric
⢠trigeminal neuralgia
⢠may be a component
f thi⢠Shooting
⢠Lancinating
of any neuropathic
pain
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
14. T pes of Chronic Pain
Panchakarma Practices in Pain Management
Types of Chronic Pain
⢠a. Benign pain
⢠1 Lasts for at least 6 mos⢠1. Lasts for at least 6 mos.
⢠2. Non-responsive to Tx
⢠3. Example: lower back pain
⢠b. Recurrent acute pain
⢠1. Repeated episodes of sharp, acute pain, with pain free periods in between.
⢠2. Last for at least 6 mos.
⢠3. Example: Migraine headaches.
⢠c. Chronic progressive pain
⢠1 Duration: at least 6 mos⢠1. Duration: at least 6 mos.
⢠2. Increases in severity over time
⢠3. Example: Cancer, degenerate diseases
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
15. Pain Path a s
Panchakarma Practices in Pain Management
Pain Pathways
Pranavata
Vyanavata
Shat Chakra
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
17. Panchakarma Practices in Pain Management
Use a standard scale to track the course of pain
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
18. 1 Evaluation Pain Management Programs
Panchakarma Practices in Pain Management
1. Evaluation
a. Pain evaluation
b. Understanding life style changes, limitations
c Knowing Emotional and Mental functioning
Pain Management Programs
c. Knowing Emotional and Mental functioning
2. Treatment plan
a. Definitive / In definitive
b S tti S ifi l d T tb. Setting Specific goals and Targets
3. Program
a. Education
1 K i N t f i h i h l i l1. Knowing Nature of pain: physio, psychological
2. Evaluating Pain reduction techniques
3. Prevention measures
b. Therapy
1. Psycho therapy
2. Cognitive therapy:
3. Family therapy
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
19. Palliati e Treatment
Panchakarma Practices in Pain Management
Palliative TreatmentÂ
⢠Different treatments for various pains are based onÂ
V i h f i h i P iVata as without of it there is no Pain.Â
⢠The pain management in Ayurveda is based onÂ
d h khâ Spasmodic Pain: Shankha
â Muscular Pain: Nirgundi
Bonny Pain: Asthisrunkhalaâ Bonny Pain: Asthisrunkhala
â Neurological Pain: Sahachara
⢠Apart from these types many pain types needs the managementÂ
accordinglyÂ
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
20. A r eda
Panchakarma Practices in Pain Management
Ayurveda
⢠Treatments in Ayurveda is undertaken â
â Through Internal Medication for Visceral PainÂ
⢠Spasmodic â Shankhavati, etc
⢠Headache â Shirashooladivajra ras, etc
â The rest of Somatic (Nociceptive) , NeurologicalÂ
(peripheral Nerve Injury) are with Panchakarma(peripheral, Nerve Injury) are with Panchakarma
â Chief route of applications are â
L l li ti (Abh Pi d d L t )⢠Local applications (Abhyanga, Pinda sweda, Lepa etc )
â Irritants âwith Vatahara Herbs like Nirgundi, Shigru, etc.
â Counter irritants â like Gunja, Dattura, Arka , etc.Â
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
21. Abh an a
Panchakarma Practices in Pain Management
Abhyanga
⢠Abhyanga is common method of Nociceptive PainÂ
â It relieve pain because of rubrificient action appliedÂ
over the toxins accumulated in the neurolemma
Th b b d il t t ti dâ The absorbed oil acts as neuro protective andÂ
transports through the nerve pathways to reach evenÂ
higher centershigher centersÂ
â The medicament (Vedanasthapaka) suppresses theÂ
nerve impulses to reach the pain center p p
â Phizoelectricity produced during Abhyanga promotesÂ
the nerve impulse restoration in uniform directionÂ
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
22. Pinda S eda
Panchakarma Practices in Pain Management
Pinda Sweda
⢠Pinda Sweda are many types â Patra Pinda, Jambeera
Pi d Ch Pi dPinda, Churna Pinda, etc.Â
⢠The selection of medicine is usually based on the basicÂ
di th t d th âPAINâdisease that produces the âPAINâ
⢠In this the transmission of the heat is the mostÂ
important factor works as counter irritantimportant factor â works as counter irritant Â
⢠Heat makes the local area inflamed, so the blood rushÂ
to the local area supplies more nutrition to recoverto the local area supplies more nutrition  to recoverÂ
⢠Heat in local area makes vasodilatation to  facilitateÂ
the toxins transfer from Shakha to Koshtathe toxins transfer from Shakha to Koshta
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
23. Lepa
Panchakarma Practices in Pain Management
Lepa
⢠The lepa is an external application that induces theÂ
i fl i i i / i i dinflammatory signs  as irritant / counter irritant andÂ
works as like Pinda sweda
M L lik D h l K k l G j⢠Many Lepa like Dashanga lepa, Kanaka lepa, Gunja
lepa are used for PainÂ
⢠The advantages of lepa are⢠The advantages  of  lepa are â
â It is a passive methodÂ
â Last for long timeLast for long time
â Easy to applyÂ
â Drug action is expected with powder particle size g p p p
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
24. Ksharakarma
Panchakarma Practices in Pain Management
Ksharakarma
⢠Even though Ksharakarma comes under Shalya Tantra
li i f k h l ll i dan application of kshara locally is done as counterÂ
irritantÂ
Y k hâ Yavakshara
â Apamarga kshara
l d k hâ are commonly used kshara
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
25. A nikarma
Panchakarma Practices in Pain Management
Agnikarma
⢠Agnikarma is widely practiced in old Bombay province g y p y p
i.e. Maharshtra and Gujarat
⢠The main purpose of this is to induce nerve block byÂ
damaging the local pain receptors g g p p
⢠Mean while the body will take its healing mechanismÂ
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
30. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
31. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Sen et al., IJPSR, 2010; Vol. 1 (11): 32â44Â
30/36
32. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
33. ⢠Achillea millejolium(Compositae)
Panchakarma Practices in Pain Management
⢠Achillea millejolium(Compositae),Â
⢠Hibiscus rosasinensis (Malvdceae),Â
⢠Unum usitatissimum (Linaceae) Big problem is these are best a Unum usitatissimum (Linaceae)Â
⢠Pluchea lanceolata (Compositae)
⢠white willow Bark â nonselective inhibitor of COXâ1 and COXâ2
g p
1000 mg/Kg Body weight
⢠Curcumin â suppressing NFâkB, restricting various activators of NFâkB
⢠Green tea âantioxidant, suppresses ILâ1b and attenuatesÂ
ti ti f th t i ti f t NF kBactivation of the transcription factor NFâkB
⢠Boswellia serrata resin (Frankincense) â inhibit the
⢠leukotriene biosynthesis in neutrophilic granulocytes by⢠leukotriene biosynthesis in neutrophilic granulocytes byÂ
inhibiting 5âLOX,
⢠A combination of Boswellia and curcumin showed superiorÂ
efficacy and tolerability
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
34. Rupa Sengupta ANALGESIC AND ANTI INFLAMMATORY PLANTS: AN UPDATED
Panchakarma Practices in Pain Management
Rupa Sengupta, ANALGESIC AND ANTIâINFLAMMATORY PLANTS: AN UPDATEDÂ
REVIEW, International Journal of Pharmaceutical Sciences Review andÂ
ResearchVolume 12, Issue 2, January â February 2012; Articleâ022
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
35. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
36. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
37. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
38. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
39. Panchakarma Practices in Pain Management
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
40. Concl sion
Panchakarma Practices in Pain Management
ConclusionÂ
⢠We may discuss much on Tridosha â Saptadhatu â
T i l d D h D h h i K i k lTrimala and Dosha Dushya sammurchana in Kriyakala
base to treatÂ
B t th t d t d i t k f di t i⢠But the present day tendency is to ask for a direct painÂ
reliever, which is not availableÂ
⢠Santapanashaka Vati or Guggulu works as Placebo till⢠Santapanashaka Vati or Guggulu works as Placebo tillÂ
the time we prove its analgesic effectÂ
⢠Many analgesic herbs are listed but we are not able to⢠Many analgesic herbs are listed but we are not able toÂ
prepare a single âPain Killerâ for âCommonÂ
Ayurveda PractitionerâAyurveda Practitioner .
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
41. E l U d t di t A id C li ti
Panchakarma Practices in Pain Management
Early Understanding to Avoid ComplicationÂ
⢠Thank You
Prof KSR PrasadÂ
h fauthor of âŚ
Technoayurvedaâs
Practical SOP PanchakarmaPractical SOP Panchakarma
If you wish to purchase the BookÂ
â please send a Whatsapp
t 9503227966 ithmessage to 9503227966 withÂ
your details and requestÂ
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/