By Dr. Hiruni Poornima 
Understanding pain is very essential, as it is an universally understood signal of a disease, and the most common symptom that will bring a patient to a doctor. We can define pain as a disagreeable sensory and emotional experience, linked with substantial or possible tissue damage, or expressed in terms of such damage. It allows the body to react and prevent further tissue damage.
In medical diagnosis, pain is a symptom that is subjective in nature. Pain can be categorised into two groups; the first category is acute pain, which may be severe but short-standing, while the second category is chronic pain, which usually lasts for more than three months.
Ayurveda mentions pain, but ascribes different names to specify its nature; pricking pain (toda), splitting pain (bheda), piercing pain (vyadha), binding pain (veshtana), pain during joint movement(prasaranaakunchanavedana), severe pain (maharuja), and other than these terms “ruja”, and “vedana” also describe pain in Ayurveda.
According to these descriptions, we can say that Ayurveda has deeply elaborated the concept of pain. Ayurveda explains that the aggravation or vitiation of “vaata dosha” is the main cause of pain, but the other two body humors “pitta dosha” and “kapha dosha” also play an important role.
In the assessment of pain, “trividhapareeksha” (the patient examination method) consists of inspection (darshana), palpation (sparshan), and interrogation (prashna), and are very relevant in understanding the causes, symptoms, and etiopathogenesis of disease in the Ayurvedic point of view.
They are almost similar to the current clinical methods like history-taking, and general and systemic examinations. In Ayurveda pain management, there are three stages, which are: determination of causative factors (hethu), analysis of the etiopathogenesis (samprapthi), and selection of the suitable treatment. There are analgesic drugs in Ayurveda called “vedanasthapak”; this name is given because these medications have the ability to relieve pain and bring back the body to rest.
The analgesics defined in Ayurveda are categorised into many groups such as “angamardaprasmana”, “nidrakar”, and “madak”. Acharya Sushruta describes “madya” (liquors) and “bhanga” (cannabis sativa) as pain relief medications. During pain management, pharmacological treatments such as drug therapy using various single drugs and formulations, external therapies like oil massage (abhyanga), hot fomentation (swedana), application of paste of drug on affected areas (pradeha, pralepa), medical leech therapy (jalookavacharana), or bloodletting (rakta moksha) can be used.
There are a huge variety of medications in various dosage forms that are available in the Ayurvedic pharmacopeia and formulary for pain management. They are single herbs and poly-herbal formulations like decoctions, powders, tablets, medicated oils and hydro alcoholics, and herbo-mineral preparations. The goal of pain management is to relieve pain whenever possible, for which the identification of the root cause is essential.
(The writer possesses a BAMS [Hons] from the University of Colombo, an Msc in Food and Nutrition from the University of Peradeniya [Reading], and a Diploma in Panchakarma)
