Pain management in Ayurveda is a Big Gap of medical practice that demands research in this area –
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
Unit I herbs as raw materials, biodynamic agriculture.ppt
Ksr panchakarma in pain
1. Panchakarma Practices in Pain Management
PanchakarmaPanchakarma
Practices in Pain
Management
Prof KSR Prasad
author of … Technoayurveda’s Practical SOP Panchakarma
@ Regional Seminar on “Pain Management” dated 08‐09‐2018
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Bhausaheb Mulak Ayurved Mahavidyalaya Medical Science & Research Hospital , Nagpur
2. Confession• Pain management in Ayurveda is a Big Gap
Panchakarma Practices in Pain Management
Confession• Pain management in Ayurveda is a Big Gap
of medical practice that demands research
in this area –
– Understanding the Pain intensity of
patient is impossible
The highly unpleasant physical sensation– 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 protectingdistress 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
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
3. Panchakarma Practices in Pain Management
Why is others’
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 ↓ activity ↓ mastery ↓ control Depression
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
Pain ↓ activity ↓ mastery ↓ control 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
“Describing pain only in terms of its intensity is like
d ibi i l i t f it l d ”describing music only in terms of its loudness” –
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
– Sensory stimuli and/or neurologic injury modified
by an individual’s memory expectations emotionsby an individual s memory, expectations, emotions
• Biocultural Model of Pain:
S i t l i fl i di id l’ i– Society also influences an individual’s pain
experiences
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
7. Panchakarma Practices in Pain Management
Framework for Behavioral Pain Indicators
F i l i l h d t th f i Facial expressions: clenched teeth, frowning,
grimacing, sad
Verbalizations/vocalizations: ‘ouch’ cursing Verbalizations/vocalizations: ouch , cursing
Non‐verbal: moans, groans, shouting, crying
B d t b i di i Body movements: bracing, guarding, massaging
affected area
Restlessness: agitation rocking 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
TYPES OF PAIN
NEUROPATHICNOCICEPTIVE
Nociceptive pain (stimuli from Neuropathic pain (stimuli abnormally
S ti Visceral
p p (
somatic and visceral structures) processed by the nervous system)
Somatic
• bones, joints
• connective tissues
Visceral
• Organs –
heart, liver,
• muscles
heart, liver,
pancreas, gut,
etc.
Deafferentation
(nerve injury)
Sympathetic
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:
– Bone & soft tissue
– 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:
– Menstrual Pain
– Liver capsule distensionp
– CA pancreas
– 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
FEATURES OF NEUROPATHIC 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/
16. Pain Terminolo in A r eda
Panchakarma Practices in Pain Management
Pain Terminology in Ayurveda
• Vedana = pain, torture, agony
• Klesha = pain,
• Vyadha = piercing, hitting, striking, a stroke, wound
• Shoola = Pricking pain
• Ghosha = Sound produced in pain
• Duhkha = psychological pain
– Associated with any organ or place in the body and chitta
(psychological)
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 Treatment
• Different treatments for various pains are based on
V i h f i h i P iVata as without of it there is no Pain.
• The pain management in Ayurveda is based on
d h kh– Spasmodic Pain: Shankha
– Muscular Pain: Nirgundi
Bonny Pain: Asthisrunkhala– Bonny Pain: Asthisrunkhala
– Neurological Pain: Sahachara
• Apart from these types many pain types needs the management
accordingly
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 –
– Through Internal Medication for Visceral Pain
• Spasmodic – Shankhavati, etc
• Headache – Shirashooladivajra ras, etc
– The rest of Somatic (Nociceptive) , Neurological
(peripheral Nerve Injury) are with Panchakarma(peripheral, Nerve Injury) are with Panchakarma
– Chief route of applications are –
L l li ti (Abh Pi d d L t )• Local applications (Abhyanga, Pinda sweda, Lepa etc )
– Irritants –with Vatahara Herbs like Nirgundi, Shigru, etc.
– Counter irritants – like Gunja, Dattura, Arka , etc.
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 Pain
– It relieve pain because of rubrificient action applied
over the toxins accumulated in the neurolemma
Th b b d il t t ti d– The absorbed oil acts as neuro protective and
transports through the nerve pathways to reach even
higher centershigher centers
– The medicament (Vedanasthapaka) suppresses the
nerve impulses to reach the pain center p p
– Phizoelectricity produced during Abhyanga promotes
the nerve impulse restoration in uniform direction
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 – Patra Pinda, Jambeera
Pi d Ch Pi dPinda, Churna Pinda, etc.
• The selection of medicine is usually based on the basic
di th t d th “PAIN”disease that produces the “PAIN”
• In this the transmission of the heat is the most
important factor works as counter irritantimportant factor – works as counter irritant
• Heat makes the local area inflamed, so the blood rush
to the local area supplies more nutrition to recoverto the local area supplies more nutrition to recover
• Heat in local area makes vasodilatation to facilitate
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 the
i fl i i i / i i dinflammatory signs as irritant / counter irritant and
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 Pain
• The advantages of lepa are• The advantages of lepa are –
– It is a passive method
– Last for long timeLast for long time
– Easy to apply
– 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 counter
irritant
Y k h– Yavakshara
– Apamarga kshara
l d k h– 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 by
damaging the local pain receptors g g p p
• Mean while the body will take its healing mechanism
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
26. Vasti Karma
Panchakarma Practices in Pain Management
Vasti Karma
• Vasti is Vata hara ‐ There is no pain without Vata
• Thus the Vasti with disease specific and VedanaharaThus the Vasti with disease specific and Vedanahara
medicines makes the pain relief
• The Vasti is again neuro (Vata) protective and corrective
• This can be safely used for Nociceptive Pain (Visceral
/musculoskeletal) and Neurological (Nerve Injury
/ i h l)/peripheral)
• For short acting we can consider Niruha (Vaitarana Vasti) and
long acting (Nirgundi taila matravasti)long acting (Nirgundi taila matravasti)
• The Low molecular weight (Niruha) Vasti reaches upper part
of the body and High molecular weight (Sneha) Vasti goes to
lower part
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
27. Rakta Mokshana Karma
Panchakarma Practices in Pain Management
Rakta Mokshana Karma
• Sira vedha and Alabu are commonly practiced
• Avoiding Marma in Siravedha is necessary
• Alabu replaced with Cupping therapy – either with bleed or
withoutwithout
• Without bleed cup application makes the counter irritation
and muscle relaxationand muscle relaxation
• Application of series of cups at nerve root and course makes
temporary pain relief even though under laying pathology is
not rectified in total
• Cupping is applied either Vacuum creation by heat or
pressure creation through suckingpressure creation through sucking
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
28. Shirodhara
Panchakarma Practices in Pain Management
Shirodhara
• The impact of shirodhara on Pain acts as Hypnotic and
d i l i h i isedative along with pain center suppression
• Especially psychological pain or Pain prone people
i krequire as a package
• Dashamoola or any Vedana hara taila impact is
remarkableremarkable
• Using Karpura (volatile) substance makes the irritatnt
action to support the treatmentaction to support the treatment
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
29. Anal esic Herbs
Panchakarma Practices in Pain Management
Analgesic Herbs
• Chamomile: Aroma therapists use chamomile essential oil to
promote relaxation and pain reliefpromote relaxation and pain relief.
• Clove: Essential oil from cloves is an age‐old remedy for
toothaches. ...
• Lavender: Lavender essential oil has antispasmodic and anti‐
inflammatory chemicals; it can soothe the soul and alleviate pain.
il’ l ( h b )• Devil’s claw (Harpagophytum procumbens),
• Capsaicin from hot chiles (Capsicum spp.),
• Gamma linolenic acid (GLA) from seed oils• Gamma‐linolenic acid (GLA) from seed oils
• White willow (Salix spp.) and
• Peppermint (Mentha piperita).eppe ( p p )
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): 32‐44
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),
• Hibiscus rosasinensis (Malvdceae),
• Unum usitatissimum (Linaceae) Big problem is these are best a Unum usitatissimum (Linaceae)
• Pluchea lanceolata (Compositae)
• white willow Bark ‐ nonselective inhibitor of COX‐1 and COX‐2
g p
1000 mg/Kg Body weight
• Curcumin ‐ suppressing NF‐kB, restricting various activators of NF‐kB
• Green tea –antioxidant, suppresses IL‐1b and attenuates
ti ti f th t i ti f t NF kBactivation of the transcription factor NF‐kB
• Boswellia serrata resin (Frankincense) ‐ inhibit the
• leukotriene biosynthesis in neutrophilic granulocytes by• leukotriene biosynthesis in neutrophilic granulocytes by
inhibiting 5‐LOX,
• A combination of Boswellia and curcumin showed superior
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 ANTI‐INFLAMMATORY PLANTS: AN UPDATED
REVIEW, International Journal of Pharmaceutical Sciences Review and
ResearchVolume 12, Issue 2, January – February 2012; Article‐022
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
Conclusion
• We may discuss much on Tridosha – Saptadhatu –
T i l d D h D h h i K i k lTrimala and Dosha Dushya sammurchana in Kriyakala
base to treat
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 pain
reliever, which is not available
• Santapanashaka Vati or Guggulu works as Placebo till• Santapanashaka Vati or Guggulu works as Placebo till
the time we prove its analgesic effect
• Many analgesic herbs are listed but we are not able to• Many analgesic herbs are listed but we are not able to
prepare a single “Pain Killer” for “Common
Ayurveda Practitioner”Ayurveda 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 Complication
• Thank You
Prof KSR Prasad
h fauthor of …
Technoayurveda’s
Practical SOP PanchakarmaPractical SOP Panchakarma
If you wish to purchase the Book
– please send a Whatsapp
t 9503227966 ithmessage to 9503227966 with
your details and request
Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/