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Ksr panchakarma in pain

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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

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Ksr panchakarma in pain

  1. 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. 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. 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. 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. 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. 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. 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. 8. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  9. 9. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  10. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 30. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  31. 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. 32. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  33. 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. 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. 35. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  36. 36. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  37. 37. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  38. 38. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  39. 39. Panchakarma Practices in Pain Management Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/
  40. 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. 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/

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