The practice of Ayurveda is based on managing pain, it is the art of staying within the confines of comfort and safety between two polarities such as sweltering heat and freezing cold, prickly dryness and liquid congestion, stagnated heaviness and unbearable lightness.
Yet, despite efforts to maintain equilibrium, accidents and illnesses occur. Poor health decisions, exposure to harsh environments, or unexpected injuries can lead to pain and disease requiring medical intervention, hospitalisation, surgery and the use of strong and fast acting analgesics.
In acute pain, rational cognitive abilities suffer, shifting blood circulation away from the prefrontal cortex (responsible for reasoning) toward the primitive reptilian brain, which governs survival instincts. This shift impairs decision-making and can amplify pain perception. While Ayurveda effectively manages mild pain, moderate to severe pain necessitates, in my view, pharmaceutical intervention. Once pain subsides, muscle tension eases, circulation normalises, and most importantly, the mind perceives safety, enabling the body’s natural self-regulation and healing. As stress dissipates, rational thought returns, making recovery and Ayurvedic interventions more effective.
Acute pain experiences
Acute pain is a slightly more complicated an issue than it seems. Caused by injury, illness, surgery or other unknown factor, the latter constitutes a clear issue: there is no biological verifiable origin for the pain. The injured tissues are already healed or have never been injured in the first place. Yet, this pain exists and it tends to flare up. This type of pain often resists conventional analgesics, making management more complex and a perfect client for ayurvedic practitioners specialising in chronic cases.
Pain signals travel through nerve pathways, similar to trains moving along tracks. The “pain train” carries information from the site of injury to the brain, making several stops where neurotransmitters relay messages between neurons. Common painkillers interrupt these signals by preventing the transmission of pain impulses.
However, in some cases, the pain train never departs from the injury site. Instead, it originates in the brainstem and higher centres, delivering pain without trauma. This type of centrally driven pain requires systemically acting pharmacotherapy such as opioids, but these medications come with risks, including dependency, increased tolerance and potential pain amplification over time.
Fibromyalgia
One example of centrally driven pain is fibromyalgia, a condition characterised by diffused pain without identifiable tissue damage. Pain often flares up in response to stress, pointing to a maladaptive nervous system response rather than localised injury.
This phenomenon is driven by neuroplasticity, the nervous system’s ability to reorganise itself based on experience. When exposed to chronic stress, the nervous system learns pain, leading to heightened sensitivity even in the absence of injury. The interaction between an individual and their environment, along with their lived experiences within it, becomes the central focus in defining the objectives of care. One way to describe ayurveda is adaptation to the environment.
Addressing neuroplasticity
Neuroplasticity can be harnessed for both healing and harm. The nervous system adapts through synaptic changes, neurotransmitter release, and receptor activity, which are strongly influenced by psychological states.
Maladaptive changes happen under stress. Adaptive changes take place when we feel safe and comfortable. Healing-focused interventions retrain the nervous system in the absence of fear, helping it to unlearn pain
Neuroplasticity presents a challenge for pharmacotherapy. Medications that address top-down control such as opioids, tramadol and other serotonin reuptake inhibitors (SSRI) often have side effects, are only symptomatic and can slow down or prevent rehabilitation of the nervous function.
Post surgical pain
One of the risk factors for development of chronic pain is surgery. Elective or emergency, small or extensive, short or long, surgical intervention is a frightening event for many. Particularly vulnerable are those with a negative mindset, anxiety and stress. Catastrophisers, those with difficult home environment, socially isolated or have doubts about safety and efficacy of interventions are also at risk. The best approach to prevent post-surgical pain becoming chronic is pre-operative education, pain control and managing expectations. The goal of per-operative care is safety, proven to have direct consequences on post-operative pain intensity, recovery and rehabilitation times.
My dual approach
While Ayurveda is classified as complementary and alternative medicine (CAM) in Western healthcare, I am now considering biomedicine be complementary to Ayurveda. A dual approach allows patients to benefit from the best of both systems, balancing immediate symptom relief with long-term solution-based healing approaches.
The studies about acute pain management have reinforced my confidence in the transdisciplinary approach for relieving suffering. Within the Ayurvedic healing protocols for increasing resilience, systemically lowering down inflammation and improving top-down nervous system control, acute pain management techniques can have a significant role to play in managing pain in community setting. As a result of multimodal integrative approach, I create comprehensive symptomatically effective and holistically restorative healing plans.
Anu Paavola, UCL student number 24250504
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