Ayurvedic Treatment for Joint Pains includes internal and external medications. Joint pains are the most common problem doctors face in daily clinical practice. As joints and the musculoskeletal system does the important function of structure and movement of the human body, joint pains can affect a person’s daily life, resulting in the limitations of movement & activities. Although it can affect any gender or age, mostly old-aged women are most prone to this condition. The most prominent reason for loss of function & mobility of joints is chronic/episodic pain, which leads to psychological distress and impaired quality of life. Current therapies to help alleviate joint pain have limited effectiveness and certain drugs produce unwanted negative side effects, thereby precluding their long-term use. In short, millions of patients are suffering from the debilitating effects of joint pain for which there is no satisfactory treatment.
Signs & symptoms
Pain in the joints
Stiffness
Swelling
Painful movements/limited range of movements
Causes
Joint pains can develop due to numerous reasons. It can also present as an associated symptom of another main disease. The main causes of joint diseases in clinical practise are:
Injury
Wear and tear
Deficiency disorders mainly Calcium deficiency
Degeneration (Senile arthritis)
Osteoporosis
Rheumatoid arthritis
Osteoarthritis
Gout
Pathophysiology
As the term ‘joint pains’ is a term denoting a wide variety of diseases, single pathophysiology is not there for it. The pathophysiology is different and specific for each disease that causing joint pain. This review examines the sensory innervation of diarthrodial joints and discusses the neurophysiological processes that lead to the generation of painful sensations. During inflammation, joint nerves become sensitized to mechanical stimuli through the actions of neuropeptides, eicosanoids, proteinase-activated receptors, and ion channel ligands. The contribution of immunocytes to arthritis pain is also reviewed. Finally, the existence of an endogenous analgesic system in joints is considered and the reasons for its inability to control pain are postulated.
The neurobiological processes initiated in the joint give rise to neural signals and then decoded by the central nervous system into pain perception.
Joint innervation and nociception
Most of the weight-bearing joints are richly innervated by sensory and sympathetic nerves. Postganglionic sympathetic fibers terminate near articular blood vessels, where they regulate joint blood flow through varying degrees of vasoconstrictor tone. The primary function of sensory nerves is to detect and transmit mechanical information from the joint to the central nervous system. Large diameter myelinated nerve fibers encode and transmit proprioceptive signals, which can be interpreted as being either dynamic (movement sensations) or static (position sense). Pain-sensing nerve fibers are typically less than 5 μm in diameter and are either unmyelinated (type IV) or myelinated with an unmyelinated ‘free’ nerve ending (type III). These slowly conducting fibers typically have a high threshold and only respond to noxious mechanical stimuli, and as such are referred to as nociceptors. In the rat and cat, 80% of all knee joint afferent nerve fibers are nociceptive, suggesting that joints are astutely designed to sense abnormal and potentially destructive movement.
Nociceptors are located throughout the joint, having been identified in the capsule, ligaments, menisci, periosteum, and subchondral bone. The most distal segment of type III and type IV afferents is devoid of a myelin sheath and perineurium, and it is believed that this is the sensory region of the nociceptive nerve. Transmission electron microscopy revealed an hourglass shape repeating pattern along the length of type III and type IV nerve terminals, and the multiple bulbous areas exhibit the characteristic features of receptive sites. It is within these ‘bead-like structures on the terminals of ‘free’ nerve endings that joint pain originates.
The question of how a painful mechanical stimulus is converted into an electrical signal that can then be propagated along sensory nerves to the central nervous system is still unclear. The exposed nature of sensory ‘free’ nerve endings means that the axolemma of these fibers is probably subjected to significant stretch during joint movement. The recent identification of mechano-gated ion channels on type III and type IV knee joint afferents by electrophysiological means provided the first insight into the physiological mechanisms responsible for mechano-transduction in joints. The present theory is that movement of the joint generates shear stresses on the axolemma of the ‘free’ nerve endings, resulting in the opening of mechano-gated ion channels. This leads to a depolarization of the nerve terminal and the generation of action potentials, which are subsequently transmitted to the central nervous system where they are decoded into mechano-sensation. If a noxious movement is applied to the joint, the firing rate of the afferent nerve increases dramatically and the central nervous system interprets this nociceptive activity as pain. In addition to this cognitive aspect of arthritis pain, there is also an affective or emotional component to the disease. Patients who suffer from chronic arthritis pain exhibit clinical signs of depression and anxiety that appear to have a physiological basis. Some studies found that noxious mechanical stimuli applied to acutely inflamed joints had an excitatory effect on the firing rate of neurons in the central nucleus of the amygdala. These studies provide the first electrophysiological evidence that the amygdala is involved in transforming nociceptive information arising from arthritic joints into an emotional, painful experience.
Diagnosis
Case taking to confirm any history of trauma
Physical examination to locate the site of tenderness etc.
X ray
USG
MRI
Blood tests to rule out inflammatory diseases or medical conditions like gout
Arthrocentesis
Treatments
Treatments for joint pain are as varied as the conditions that can cause the pain.
- Medications
Analgesics
NSAID’s
Anti-inflammatory
Steroids in severe autoimmune conditions
- Physical therapy
Sometimes physical therapy sessions to strengthen the muscles around the joint will make it more stable and ensure the best mechanical movements. Working with a physical therapist can help avoid injuries or further worsening of the condition.
- Injections
Injecting medications directly into the joint might help in certain situations where not many joints are involved. The two most common injections are corticosteroids and lubricants. Corticosteroid injections can help arthritis and other inflammations of the joints, mainly weight-bearing ones. They usually need to be repeated every few months. Lubricants that are similar to the synovial fluid.
- Surgery
Arthroscopic joint surgery:
It allows the surgeon looks inside the joint through a few small holes and an optic fiber camera. The surgeon can repair many of the injuries and remove small pieces of loose bones or cartilage. This is a common outpatient procedure.
Partial joint replacement:
The surgeon replaces the damaged portions of the joint with artificial parts. Only part of the joint is replaced in this procedure.
Total joint replacement:
In this procedure, the knee is replaced with an artificial joint.
Prognosis
The prognosis of the joint pain depends upon many factors like age of the patient, disease-causing the joint pain, any associated illness like diabetes, etc. Usually, acute inflammatory joint pains have a good prognosis with proper treatment. Chronic arthritic pains may need long-term treatment and recurrence is common.
Complications
Increase in pain, joint damage, and disability
Chance of having injuries in the future
Joint instability
Deformity of joint
Gait problems
Disease & Ayurveda
Sandhigatavaata
Nidana- Causes of Joint Pain
Dhaatukshaya(degeneration)
Aavarana(obstruction to channels in the body)
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors Vaata gets vitiated and gets lodged in the joints causing pain and swelling.
Lakshana
Vaatapoornadrutisparsam – Feel of an air-filled bag on touch
Sopham – Swelling
Prasaaranaakunchanayo: savedanaam pravrthim- Painful movements of joints like flexion and extension
Divisions
Not mentioned
Prognosis
Yaapya.
It is saadhya/krichrasadhya if it is new and involves only singe joint.
Chikithsa
Samana
Lepana with soolaharadravyas
Parisheka with soolaha-sothahara dravyas
Upanaha with Vaataharadravyas
Sodhana
Sneha (Anhyanga)
Sweda (Potalisweda)
Vasti
Virechana
Raktamokshana
Commonly used medicines
Rasnasaptakam Kashayam
Pachanamrutham Kashayam
Nirgundayadi Kashayam
Sahacharadi Kashayam
Maharasnadi kashayam
Amruthotharam kashayam
Rasnerandadi kashayam
Amruthaguggulu
Kaisoraguggulu
Yogaraja Guggulu
Simhanada Guggulu
Vatagajankush Ras
Yogendra Ras
Rasaraj Ras
Guggulutiktakaghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Dabur India
Home remedies
Over-the-counter pain medications can frequently alleviate the pain.
The RICE mnemonic is often helpful, especially when the pain is because of minor injuries:
Rest: Rest the joint, and take a break from your usual activities involving the affected joint.
Ice: Applying ice can help with pain and inflammation.
Compress: A compression bandage can help prevent swelling and help alignment. It should not be tight and should be removed at night.
Elevate: Elevation can help with swelling and the resting of the joint.
Diet
- To be avoided
Heavy meals and difficult-to-digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause obstruction in channels
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid climbing stairs.
Yoga
Vigorous exercises are not allowed in painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised. Also, specific yogacharya including bhujangaasana, salabhasana, vajrasana is recommended. Caution must be there to consider the range of movement and flexibility.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Salabhasana
vajrasana
Bhujangasana
exercises for leg pain
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206347/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232340/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1794504/
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