Pain management

Rheumatoid arthritis, commonly known in Hindi as "Gatiya", is a disease of our own dysfunctional immune system. When I say dysfunctional immune system, it means that our own body and immune system which is meant to protect us from other infections and foreign invaders, starts attacking us back. One percent of India's population has rheumatoid arthritis. Considering the large number of population we have, if we calculate almost 10 lac people are affected by it. People often have this conception that it is the disease of the elderly and we as a young individual should not be having it. To broadly identify it, we have two types of arthritis. One is the age related one known as Osteoarthritis where there is more of wear and tear of cartilage. Osteoarthritis is a disease of the elderly. The other arthritis is the inflammatory arthritis, which has fifty different variants with Rheumatoid arthritis being one of them. Rheumatoid arthritis affects most of the people in the younger age group between 20-40 and is more common in the girls. Arthritis in itself can affect the children as young as 6 months of age, known as Juvenile Idiopathic arthritis. So it doesn't really spare any age group. But it is very important to be aware of the signs and symptoms of the disease. Only then you can approach your Rheumatologist early and help in arresting the disease at an early stage. One of the first signs is pain and stiffness in the hand joints (wrist, knuckles) and foot joints. One very peculiar feature of this arthritis is the early morning stiffness. You feel the hands and body are stiff in the mornings and takes you more than 30-45 minutes to get back to daily routine. The stiffness goes down as day passes only to worsen at night again. And this is the exact time we should intervene and halt the disease . Eventually within 4-6 weeks of these symptoms you will start experiencing the swelling of the joints and progression to the large joints like knees, shoulders, elbows. Those are the early signs that the disease has progressed. All the new data points towards early control of disease, within six months of onset. People who start treatment late have more intake of pain killers and higher chances of joint damage. Rheumatoid arthritis does not limit to the joints only. It can affect lungs, kidneys, eyes as well. Coming to the most important aspect is the treatment. There have been a lot of advances in the recent years but we still havnt been able to find the ultimate cure for it. One of the main goals which has changed over years is to use almost negligible pain killers and minimum steroids. We prefer avoiding steroids in our prescription. The drugs are divided into DMARDS and Biological DMARDS. 90 percent will respond to the traditional old DMARD Drugs (Methotrexate, LEflunomide, Hydroxychloroquine and Sulphasalzine) while 10 percent with aggressive disease may need the help of the Biological drugs. As with alternative medicines, I will not comment much but to my experience it doesn't really help patients with moderate to severe disease and we end up losing crucial time to control the disease. Patients with mild disease may benefit a little from it. Ultimate goal remains to minimize the damage caused to the joints, provide good quality of life and avoidance of pain killers and steroids. Apart from the medications, lifestyle modifications are very much needed to keep the disease at bay. Make sure you exercise daily for 20-30 minutes, avoid smoking and eathygienic food which should be well cooked. stress has been found to be a major culprit in triggering autoimmune diseases. We should learn the art of stress coping strategies to lead a well nurtured balanced life. (Dr Naval Mendiratta, Consultant, Rheumatology, Fortis Memorial Research Institute, Gurugram)

- Prof. K.R. Kohli, M.D. [Ay] Ph. D Migraine is a neurological condition that can cause multiple symptoms. It’s frequently characterized by intense, throbbing pain or a pulsating sensation debilitating usually on one side of the head. Pain present in migraine can be so severe that it interferes with daily activities. Migraines often run in families and affect all ages. The diagnosis of migraine headaches is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headache are those without aura (previously known as common migraines) and those with aura (previously known as classic migraines). Signs & Symptoms- Prodrome Phase-Migraine symptoms may begin one to two days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include: fatigue or low energy, frequent yawning, hyperactivity, irritability, neck stiffness etc. Aura- In migraine with aura, the aura occurs after the prodrome stage. During an aura, person may have problems with your vision, sensation, movement, and speech. Examples of these problems include: difficulty speaking clearly, feeling a prickling or tingling sensation in the face, arms, or legs, seeing shapes, light flashes, or bright spots. Actual Migraine attack-The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine pain occurs. In some people, this can overlap or occur during an aura. Attack phase symptoms can last anywhere from hours to days. Symptoms of a migraine can vary from person to person. Some symptoms may include: increased sensitivity to light and sound, nausea, dizziness or feeling faint, pain on one side of your head, either on the left side, right side, front, or back, or in your temples, pulsing and throbbing head pain, vomiting. Postdrome Phase-After the attack phase, a person will often experience the postdrome phase. During this phase, there are usually changes in mood and feelings. These can range from feeling euphoric and extremely happy, to feeling very fatigued and apathetic. A mild, dull headache may persist. Migraine attacks last for hours to days. Migraine treatment is aimed at reducing symptoms and preventing future attacks. Initial treatment includes avoidance of triggers, pain medication such as Paracetamol (acetaminophen), ibuprofen and medication for the nausea. When simple pain medications fail, specific medications such as triptans or ergotamines may be used. Ayurveda lays emphasis on ‘’Head” (Shira) by terming it as the Uttamanga - The most vital part of the body because all the indriyas (Sense organs) are located in the head along with the Prana (life) of the individual. Shira being seat of Prana and Indriyas is considered under Dashvidha Pranayatanas and Pradhan Marma in Ayurveda. Various Ayurvedic Scholars have elaborated Shiro Roga with Shira Shoola as the chief symptom (Headache Disorders) which describes the prevalence of the diseases from ever since and need of requiring their proper management. Shirashula is collectively used for all the aches and discomfort in the region of cranial vault .Many dietetics, personal, environmental and behavioural factors are responsible for causing headache. It may manifest a disease as whole or it may be a symptom of other disease. Acharya Shushruta has explained 11 types of Shiro Rogas, namely - 1. Vatika, 2. Pittaja, 3. Kaphaja, 4.Raktaja, 5. Sannipataja, 6. Kshayaja, 7.Krimija, 8. Suryavarta, 9. Anantavata, 10. Ardhavabhedaka, 11. Shankhaka. Migraine can be correlated to Ardhavbhedaka disease mentioned under Shirogat Vyadhi in Ayurvedic system of medicine. According to Acharya Shushruta the Shiro Roga in which intense pain occurs in half part of head for a period of multiple days days has been termed as Ardhavabhedaka. The nature of the pain in this type of Shiro Roga has been described of pricking nature - like that of a piercing needle and tearing pain and the pain is mainly present in forehead, eyebrow, ear, eye and temporal region. The severe pain is associated with mental confusion. Vitiation of all the three Doshas is chiefly responsible for Ardhavabhedaka Ayurvedic Treatment of Migraine: Avoidance of precipitating factors whenever possible, consuming compatible diet and modification in lifestyle are recommended. Panchakarma treatments include Snehana (Oleation) with Balaguduchyadi Taila, Swedana (Nadissweda and Upanaha Sweda), Virechana (medically induced purgation), Anuvasana Basti (Medicated enema), Shirovirechana / Nasya (instillation of medicines in nostrils) with Kshira and Ghrita or Anutaila or shunthi with milk, Raktamokshana (Bloodletting), Shiroabhyanga (head massage) and Shiro Lepa (application of medicine on scalp, head). Shunthi, Yashthimadhu, Godanti Bhasma, Pravala Pisthi are useful in migraine. Ayurvedic preparations like Swarna Sutashekhara Rasa, Laghusutashekhara Rasa and Kalyanaka Ghrita are useful. Many patients suffering from migraine benefitted and most of them have got full cure from customized Ayurvedic treatment coined by Dr. Kohli. Migraine episodes and their severity have been found to be significantly reduced in the first month of treatment. It takes around 3-4 months for a complete cure. ( Courtesy - http://www.kohliayurveda.com)

Pain associated with different body parts is not something quite uncommon. From headaches to body aches, there are all sorts of pains that people experience from time. Some of these troubles could be easy to manage while others might prove to be too excruciating for you. Some pain issues are very critical for the health and life as well, for example, the chest pain. Chest pain can occur due to various reasons and sometimes it may be an early symptom of stroke or some cardiac condition like angina pectoris. If you experience chest pain, it is highly suggested that you do not take it lightly. Besides consulting an experienced practitioner, here are some of the precautions you can follow to prevent chest pain or manage it better when you undergo an episode of chest pain. Usually, the chest pain affects the front of the body and neck and spreads to the upper abdomen. Chest pain is the greatest indication of a heart attack but it is not compulsory every chest pain cause the same. There are other reasons for chest pain such as a contraction in organs and tissues around the heart that can cause pain. Moreover, issues with lungs, muscles, nerves, food pipe or ribs are other reasons for pain and this may spread from back to abdomen. ------------------------------------------------------------------- Reason For Chest Pain ------------------------------------------------------------------- The common reason behind chest pain is reduced blood flow to and from the heart and technically, it is known as angina. People who have experienced this pain describe it as the feeling of heaviness, tightness, burning, squeezing, and nausea, shortness of breath, fatigue, dizziness, sweating, and pressure behind the ribs. Women may feel this experience these indications even without chest pain or discomfort. The major cause of this pain is cigarette smoking, high cholesterol, diabetes, high blood pressure, or a family history of heart disease. Hence, people suspect chest pain arising because of such reasons as heart attack and angina owing to their similar symptoms. The only difference in both the pain is angina lasts for 5 to 10 minutes. ------------------------------------------------------------------- Chest Pain Prevention ------------------------------------------------------------------- More often, this pain occurs during exercise and alleviates after you rest. It also goes away after taking medicine but there are other preventive measures that you must keep in mind so, that this pain does not occur again. • Avoid tiring exercise that brings angina or chest pain • Eat a non-oily balanced and nutritious meal • Do not take fast food and soda drinks • Try to cut the excess fat from food • Maintain body mass index • Limit alcoholic drink and smoke • Reduce stress by taking stress management session or yoga • Control blood pressure and take fiber diet • Avoid extreme hot and cold environment • Take medicine prescribed by a doctor and perform the exercise in the presence of an expert ------------------------------------------------------------------- Do’s While Pain Occurs ------------------------------------------------------------------- • Take adequate water • Include fenugreek seeds, garlic, basil leaves, lemon, turmeric, and ginger in food. • Take food rich in natural carbohydrates like potato, cereals, and wheat • Consume at least a day fermented food such as yogurt • Grapes and amla are beneficial for heart These are the do’s and don'ts for the chest pain. moreover, while you apply this prevention daily if the chest pain becomes frequent or severe or your heart rate increases suddenly too often, you must consult a doctor. Image Credit: bruceblaus

So many times, due to a hectic schedule, sedentary work habits, or sleeping in the wrong posture you have to experience the neck pain. It can indeed be quite bothersome as the pain can further spread to head, forehead, shoulders or arms. There can be various reasons for neck pain but mainly it is due to wrong posture, unhealthy habits, strenuous lifestyle, some injury or any chronic diseases. An injury or chronic disease is not in our control but the other reasons which comprise about the maximum cases of neck pain can surely be checked. As it is said that prevention is better than cure, it is better to take follow some best practices to avoid the possibility of neck pain. Here are some health safeguards which can be very effective in preventing neck pain: a) In maximum cases of neck pain, the cause of the pain is the wrong posture. Hence the most important measure to prevent neck pain is to maintain the right posture. Some of the things you can implement in your daily practices are: When you sit or stand, the shoulders must be in a straight line with the hips and ears should be directly above the shoulders. This ensures that your neck remains straight. It is obvious that due to the demand for work, sitting for long hours in front of a computer is normal practice, but it should be ensured that the monitor is at eye level so that there is no requirement of a bending neck for a longer duration. It must be also taken care that a break is taken between the long sitting hours to relax and stretch the neck and shoulders. The bending of the neck in between ear and shoulder to speak on the phone while driving or for any other reason should be strictly avoided. Maintaining the right posture while sleeping is very important, try using a soft small pillow which supports and maintains the natural curve of the neck. Avoid the strain in the neck, doing anything which makes your head bend for longer duration should be avoided. b) Lifestyle exercises are a good way to avoid neck pain. The exercise should include neck exercise, stretching, and walking or jogging. c) Healthy eating-eating right is very important for a healthy body. to prevent the neck pain one must avoid the food which can cause an inflammation. For example, something too cold, too spicy, too bitter, or too astringent should be avoided. drinking a lot of water to stay hydrated is always recommended. the foods which have calcium, vitamin d, and fibers should be consumed more. Role of Ayurveda - Ayurveda has not only cure for any pain or disease but ayurveda also helps in the prevention of the pain .for prevention of neck pain, in addition to the right posture, vyayama and eating healthy, Ayurveda has various therapies. the therapies such as Nithya Abhyanga, Greeva Vasti, Pinda Sweda and Dhara help in relaxing our body, lubricate the tissues and muscles as well as rejuvenate the body. An individual can avail of these therapies to prevent pain.