Pain Management

What is Pain,

pain is an unpleasant sensory an emotional experience caused by actual or potential tissue damage.

Acute pain refers to the tissue injury

chronic pain is persistent refers to disease usually for more than 3 months.

Type of pain:

  • Nociceptive: usually somatic, like arthritis, post-surgical, endometrial or IBS
  • Neuropathic: peripheral ex: phantom limb
  • Mixed: inflammatory

Pain management is commonly done though medication physical therapy, psychological and interventional methods.

Physiology of pain: activation of nociceptors in the skin due to damage, these signals travels up to the spinal cord and cross at the spinal cord to other side then finally to cerebral cortex.

Endogenous mediators will be released with inflammation like prostaglandins, histamine, bradykinin, serotonin, acetylcholine, lactic acid etc.

Multimodal pain management: synaptic transmission and central sensitization the medications like – Anticonvulsants, Opioids, Alpha adrenergic agonists, NMDA blockers like Ketamine, morphine etc

Different medications at the different sites of the neuronal pathways to block the pain stimulation.

Opioid receptors: inhibit the neurons at the dorsal horn and stop the release of Substance P and reduces the pain.

Poor postoperative pain management which leads to the slower recovery times, patient satisfaction, poor rehabilitation participation and outcomes, compromised patient functional outcomes, physical pain and discomfort, psychological distress, increases post-operative complications, and poor sleep hygiene.

Postoperative pain management approaches may include pharmacological, physical and psychological therapies. It’s better to avoid the narcotic medication doses, hence reduced side effects.

Mc Donald’s et al study conducted in New York introduced multimodal pain management among study group and in comparison, with the control group mentioned that by using the multi model pain management protocol and significantly decreased number of IV opioids doses and pain better controlled, and patients are more mobile and quickly.

What Ayurveda can offer:

Ayurveda the pain means “SOOLA”, ayurvedic treatments are affective in the management of the chronic pain. Most of the conventional remedies are not successful in the management of chronic pain, moreover, leads to the dependency and long-term side effects.

In Ayurveda the management of pain is done through herbal combination medicines along with external rejuvenation therapies like shirodhara, kativasti, dhara, potali swedam etc.

If you want to know what suits to you, check with your practitioner or if you want to make an appointment with our practitioners, please email info@jeevahealth.com.au or ring us at 03 9939 9474.

Gastric Ulcers

Consider under Peptic Ulcer Disease (PUD). PUD mainly refers to the presence of one or more ulcerative lesion in the stomach or in the duodenum.

Causes: Chronic Helicobacter pylori infection, long term use of NSAIDS, excess acid secretions and stress.

Epidemiology;

More than 6 million cases per year in US, in Australia the annual ulcer incidence per 1000 population was 3.8 for duodenal ulcer and 0.7 for gastric ulcer. Approximately 70 000 Australians appear to receive initial treatment for a peptic ulcer each year.

It is estimated that more than 50% of the world’s population is infected with H. pylori, it increases with age. This infection invariably causes the active chronic gastritis. Pylori infection increases the risk of ulceration and bleeding in patients taking NSAIDS.

Classification: PUD is classified as

Gastric ulcers: Most often appears at the lesser curvature and gastric antrum
Duodenal ulcers: Occurs at the duodenal bulb.
Erosive gastritis: this is an acute mucosal inflammation of the stomach that does not extend beyond the muscualris mucosa.

Causes and risk factors: one of the major risk factors is Helicobacter pylori infection and second important one was chronic use of NSAIDS, glucocorticoids in combination with NSAIDS, other causes may include idiopathic, incompetent pylorus, lower oesophageal sphincter, impaired proximal duodenal bicarbonate secretion, gastrinoma. The common risk factors may include age, male sex, family history and smoking and alcohol consumption.

Diagnosis: the preliminary diagnosis is based on the history and examination which should be supported by the supper endoscopy – which remains the test of choice in this patient, which we did and confirmed that his presentation to ED due to upper GI bleeding is the ulcers in gastric antral region.

The standard care for PUD is to test for the H. pylori. However, we don’t have this facility at the hospital. Once the confirmation of the Pylori is done, which needs to be proceeded with standard treatment for Pylori infection.

Other diagnostic procedures along with upper GI endoscopy are:

  • Direct visualisation of the GI tract using video gastroscope (Contraindication if the acute perforation)
  • Biopsy of the tissue obtained during the procedure to exclude malignancy or identification of H. pylori infection

One of the differentials in this case is Upper GI carcinoma or Malignancy: which can be ruled our using this method.

Treatment:

The goal of the treatment should be to provide the symptom relief and encourage the ulcer healing.

Criteria for ICU admission: Patients who are hemodynamically unbale because of the uncontrolled GI bleeding.
Recommendation for the specialist referral such as Gastroenterologist and surgical consultation

Treatment options:

In our patient the main reason was suspected to be the use of NSAIDS, hence recommendation to stop the use of NASIDS and initiate the Proton Pump Inhibitors.

Standard care: For patients at high risk but require NSAIDS, better to use COX – 2 Selective NSAIDS and a proton pump inhibitor are recommended. They seem to reduce the incidence of NSAIDS induced peptic ulcers and subsequently the bleeding.

Misoprostol or sucralfate may be also useful in patients who must continue to take NSAIDS.

Standard treatment if of 2 antibiotics and a PPI for 10-14 days.

Triple therapy:

Most commonly used combination is: Amoxicillin + Clarithromycin + PPI (Omeprazole or lansoprazole).

Quadruple therapy: In case of triple therapy fails

  1. PPI+ Bismuth subsalicylate + Metronidazole+ Tetracycline
  2. PPI+ Bismuth sub citrate potassium + Metronidazole+ Tetracycline

PPI or H2 receptor antagonist can used before being referral to gastroenterologist.

Which needs to be followed by eradication therapy:

Combination therapy is recommended due to increased resistance of Pylori to antibiotics.

Which can be either triple or quadruple therapy plus PPI for 10-14 days as per NICE 2014 guidelines recommended for 7 days trice daily.
Prognosis

  • After adequate treatment, outcomes are typically excellent
  • Disease-associated mortality depends on general condition of patient; factors associated with increased mortality include significant blood loss, major medical comorbidities, advanced age, and endoscopic stigmata of recent haemorrhage

Prevention

  • Limit NSAID use; NSAIDs should be taken for brief courses at the lowest effective dose to control acute inflammation
    Patients anticipating long-term use may switch from a nonselective NSAID to a selective cyclooxygenase-2 inhibitor
  • Advise smoking cessation

What Ayurveda can Offer?

Ayurveda consider this condition under AMLA PITTA, one of the most common condition in the society affects all ages, classes and race. The main reason according to Ayurveda is predicted to me eating excess PITTA aggravating food such as spices, curries (CURRY) and worrying (WORRY) too much and eating too fast (HURRY).

Ayurveda recommendations:

Avoid eating excess spicy foods
Avoid eating late at night
Avoid eating deep fried foods
Avoid eating fast foods
Avoid eating fast
Take more water
Drink coconut water
Pomegranate juice
Do not skip meals
Avoid alcohol and smoking
Do not distract while eating such as watching TV or talking while eating or watching phone
Do not eat incompatible foods like fruit yoghurt at night times, pizza followed by milk shakes etc

Home remedies:

  • Use the pomegranate skin – dry powder mix it with buttermilk drink two times before food
  • Use Yasti madhu (Liquorice) powder – 1tsp with milk two times a day after food.

If symptoms persist consult your healthcare practitioner, the information provided in this article is strictly for education purpose only. If you are looking for a professional Ayurvedic practitioner to help with our health condition kindly contact us at info@jeevahealth.com.au or Ph: 03 9399474.

Drug combinations in Ayurveda

It’s been observed that the activity, the main action of the drug is activated or catalysed or accelerated by means of combination of herbs in Ayurveda, which is called as YOGA.

Explained as YOGA PRABHAVA means the formulation is getting a higher potency.

The main reason for the combination drugs or classical principle medicines is due to the combination of number of drugs commonly given  during the one episode of illness tends to increase the potency and its action, along with above mentioned reason the action of one drug combination is influences or modified or balanced with the other herbs in the combination.

Some of the uses of combinations formulas are:

  1. Increases the potency of the formula
  2. Avoid severe side effects or drug reactions
  3. To save time and money
  4. When single herb fail to meet the needs
  5. Double benefits
  6. Increases absorbability
  7. Sometimes useful in confused differential diagnosis or unidentified doshic imbalance.
  8. Useful in disease predominant in two doshas and three doshas.

Mostly the Ayurevdic formulations are named with the first ingredient mentioned in it. Other principles are main ingredient, method of preparation etc.

Based on the first ingredient

  • Sitopaladi Churna
  • Talisadi Churna
  • Nisamalaki Churna
  • Chandraprabha Vati
  • Khadiradi Vati
  • Bilwadi Gutika

Based on the main ingredient

  • Dasamularista
  • Amrita Bhallataki Lehyam
  • Kanchanara Guggulu
  • Triphala Guggulu
  • Hingvashtaka Churna

Based on therapeutic efficacy

  • Arogyavardhini Vati
  • Arshogna Vati
  • Ashmaribheda Kwatha

Based on method of preparation

  • Satadhouta Ghrita
  • Sahasradhouta Ghrita
  • Vasapatra Putapaka Swarasa
  • Ksheerabala 101 Avarti

Based on dosage and quantity of drug used

  • Shadbindu Taila
  • Ashtakatvara Taila
  • Shatpala Ghrita

Based on name of Acharya who profound

  • Chavanaprasya Lehyam
  • Agastya Hareetaki Rasayanam

Interaction of herbs and synergism in the body

Two or more herbs given at same time for two different reasons, one is to counter the action or side effect of others- which is called as antagonism the other reason is to act on the same system or location – is denoted as synergism.

Synergism:

There are various ways the drugs act in concert

  • Summation or addition: Similar in action
  • Potentiating: enhance the activity
  • Stability: preservation

Pharmaceutical process of Ayurveda

Mainly works on

  1. Easy administration
  2. Tasteful
  3. Digestible and easy elimination and assimilation
  4. More tolerable
  5. More preservable

All the above mentioned process are mentioned under the Ausadha Kalapana (medicinal formulations)

Ayurvedic Dosage form:

  1. Solid dosage forms – tablets (Gutika and vatika)
  2. Semi solid form – Jams and Ghee (Avaleha and Gritham)
  3. Liquid form – Self fermented drinks (Asavam and Aristam ) in Oil form, drvakam, swarasam, panaka, phantam etc
  4. Powder form – Dry herbal powders

Most of the combinations are made from herbs but may also contain animal, mineral sources as well.

Any questions about your personal health will directed to info@jeevahealth.com.au, the contents covered in this article are for strictly educational purpose only, for the more comprehensive help, please contact our practitioners at 03 99399474

Fibromyalgia

Chronic wide spread pain for more than 3 months along with fatigue and disruption to the sleep with or without an association with a disease (Medical or neurological) condition is considered as fibromyalgia. Often associated with co-morbidities such as anxiety and depression.

Fibromyalgia is a diagnosed as diagnosis of exclusion, means rule out other conditions are co-existed or leading up to fibromyalgia. However, it can be diagnosed predominantly though clinical diagnosis only, one among the many criteria’s are 1990 American College of Rheumatology fibromyalgia Diagnostic Criteria, which states that having more than 11 tender points of 18 fibromyalgia associated localized areas of pain, pain- affected areas among all four regions of the body and the axial skeleton for more than 3 months duration can be diagnosed with fibromyalgia.

Exact cause for the fibromyalgia is still unknown, its been predicted that alterations in the pattern of sleep and changes in neuroendocrine transmitters such as serotonin, substance P, growth hormone and cortisol suggest the regulation of the autonomic, neuro-endocrine system appears to the basis of the syndrome.

It is divided in to two different types, primary and secondary. Primary is not associated with any identifiable underlying condition, secondary associated with an underlying condition may have triggered the disordered pain, which does not explain the patients symptoms.

Central disorder of pain sensation, increases with age, predominantly happens in women. Presented along with symptoms of TMJ and IBD, increase levels of substance P in CSF, gene alterations serotonin and catecholamine’s.

“Waste basket diagnosis” is the perfect term we can use in finding the diagnosis of fibromyalgia.

Clinical Symptoms:

  • Pain
  • Paraesthesias
  • Headache
  • Fatigue
  • Morning stiffness
  • Autonomic dysfunction
  • Foggy brain (Fibro fog)

The role of HPA axis (Hypothalamic pituitary axis) is critical in stress adoption, in fibromyalgia this response is disturbed and leads to increased stress and pain. Hence, it is presented with psychiatric co-morbidities.

Nevertheless, the approach to manage this condition needs a multidisciplinary approach.

What Ayurveda can offer?

Ayurveda is a traditional system of medicine that is bases eternal concepts of health and wellbeing. It advises to follow a healthy lifestyle, diet, herbs and regular cleansing process to maintain the healthy balanced state.

Fibromyalgia is Vata Disorder, Aggrvated vata accumulates in the MAMSA (muscle, nervous and fibrous tissue) and cause the srotoavaraodha, (blockage of cannels) the information spread to central nervous system or over stimulation of CNS and leads increased secretions of Substance P in CSF, which indicated the aggravated VATA stimulation leads to the improper secretion of neuropeptides in central nervous system and causes the sensitivity and excess pain stimuli all over the body.

Available Ayurveda Treatments:

The best possible approach for the treatment of VATA disorders in Ayurvedic Medicines is: Medicated Enema (panchakarma ), five cleansing therapies need to be adopted based on the doshic imbalance and prakriti.

Following, a full spectrum of diet and lifestyle modifications along with herbs will be of great use to control the day-to-day symptoms

Finally, regular treatments from Authentic Ayurvedic Medical center- Jeeva health will offer the regular body- rejuvenating treatments like – Abhyngam, shirodhara, valuka swedam, navar khizi, podi khizi pinda swedam and kativati.

The ultimate treatment goal in fibromyalgia is chronic persistent pain and lethargy, unique Ayurvedic tretaments can provide a relief for both the chronic and acute pain and provide a natural approach for the elimination or balancing of the root cause.

For professional suggestions, please contact Jeeva health, one of our qualifies and registered Ayurveda practitioners will be able to help with diet, life style and therapeutics.

inflammation-bursa

Bursitis:

Inflammation of bursa,.

What is Bursa?

Bursa is a fluid filled sac that reduces the friction between two surfaces, such as bone and ligament or tendon and bone.

It is expected to have more than 160 bursas in the human body.

What causes the inflammation of bursa?

Most common cause for bursitis are local trauma (Direct Injury), fall on the joint, overuse injury, sports injury, excessive kneeling, leaning on the elbows for longer period of time while working at a desk.

Other systemic diseases such as RA, SLE and Gout will cause chronic and recurrent bursitis.

Infections are another important cause for the acute and chronic bursitis, can be from haematogenous spread infections from Staphylococcus aureus or other pathogens, most commonly happens due to puncture (transcutaneous) or micro trauma , less commonly due to haematogenous spread which is called as septic bursitis.

Crystalline deposits will cause bursitis in Gout.

Different types of bursitis

Most common type of bursitis is Sub acromion bursitis, which occurs at the shoulder joint, involves supra supinates muscle.

Other types of bursitis are:

Pre-patellar Bursitis (House maids knee) occurs just above the knee due to the inflammation of patellar bursa.

Infra-patellar Bursitis (clergyman’s knee) inflammation of one or more infra patellar tendons due to repetitive strain injuries

Trochanteric Bursitis causes pain on the lateral aspect of hip.

Olecranon Bursitis (Students Elbow) pain in the posterior aspect of elbow, due to constant kneeling on the joint, also happens in most computer bound sitting jobs.

Pes Anserine Bursitis happened between skin and patella, most often occurs in Obese people or in severe degenerative arthritis condition.

Most of the times the inflammation occurs due to recued subcutaneous fat and increased susceptible for direct injury.

Pathophysiology

Due to the above-mentioned reasons, there will be increased fluid secretions from synoviocytes or increased inflammation.

With the persistent inflammation there will be increase in the inflammatory cytokines, proteases, cyclooxygenases, or sodium or ureate crystals deposits may occur at the site.

Diagnosis:

Predominantly the diagnosis happens clinically by physical examination.

Physical examination may reveals that pain, swelling, local redness, aberrations, contusion, and reduced range of motion.

In septic bursitis is suspected with systemic issues such as fever or altered inflammatory markers, need for arthrocentesis / aspiration for the identification of specific bacteria is warranted most commonly performed in shoulder and knee joints.

Treatment:

Most common treatments include RICE

  • Rest
  • Ice application
  • Compression
  • Elevation
  • NSAIDS
  • Local Steroid Injections
  • Finally surgical correction may include bursectomy.

Ayurvedic Treatments:

Bursitis can be treated as generalized inflammation  by using some of the treatments such as valuka swedam or lepam or Dhara based on the presentation.

If there is reduction of subcutaneous fat; need for local Dhara treatment will be very effective.

If the Burs is intact with increased inflammation need for upanaha and lepa treatments.

Clinically best treatment for bursitis is valuka swedam., where we use herbs as such as rasandhi with sand- made in in to poultice, warm poultice will be applied gently on the joint for a period of time will give significant changes in pain and inflammation.

Some of the anti-inflammatory herbs such as Turmeric,  Boswellia, Moringa and aswgandha and Pippali (Piper Longum) will be useful in reducing some of the symptoms.

For further information please contact your healthcare practitioner or logon to jeevahealth.com.au to consult one of our practitioners based in Melbourne or Canberra.

Netra tarpana treatment

Importance:

The Head (Siraha or Uttamanga) is one among the prime organ of the body, where brain is seated along with all the sense organs (Indriyas), which perceives all the sensory information and interpreted. Among them eyes (NAYANA) considered to be most vital and useful for the perception of visual information, as per AYURVEDIC MEDICINE it is predominated by alochaka Pitta (A sub type of pitta), often subjected to strained due the increased screen times like watching computer, televisions and phones. Due to which the burden on the vision is greatly increased and caused enormous amount of the damage.

Certain conditions associated along with aging, repetitive eye strain through years of work and so forth can irritate or strain the eye/s to the extent they need further intervention to be able to maintain the healthy function.

Netra Tarpana is the Ayurvedic treatment in such cases.

It is used in cases where the patient is:

  • Suffering eye strain
  • There is a stiffness/rigidity within the eye movements
  • The eyes are excessively dry
  • Suffering eye injury
  • Certain Vata Pittaja diseases are causing problems within the eyes
  • Has abnormal deviations of the eye
  • Eye lashes falling often into the eyes
  • Cellulitis
  • Conjunctivitis
  • Dirtiness within the eyes, possibly from work conditions
  • Glaucoma
  • Hyperaemia of the conjunctiva
  • Atrophy of the cranial nerves
  • To pacify irritation, soreness, redness or tearing within the eyes themselves.

What is Netra Tarpana?

Netra (eye) and Tarpana (nourishment) is directly treating the eye with nourishing therapy. A dough is made that is appropriate (sticky enough but gentle enough) for the face and gently made into a bowl like shape around the eye. Ghrita (medicated Ghee) is then warmed and then placed over the eyes contained within the dough bowl and the patient is to preform eye movements and blinking.

Contraindications of Netra Tarpana:

  • On cloudy, excessively hot or cool days
  • A patient who is excessively worrying
  • A patient who is physically exhausted
  • A patient experiencing vertigo or dizziness
  • If the patient’s symptoms worsen or do not improve with the treatment

How was Netra Tarpana performed on the day?

Items Required:

  • A bowl to make the special dough, it needed to be stickier and looked smoother than a standard type of Vasti for the body. The flour of wheat flour/black gram and hot water.
  • Heating device, a double boiler (with water bath in the bottom) and Triphala Ghrita (Ghee medicated with Triphala) to prepare and heat the Ghrita as required.
  • Cloths, towels, tissues: for patient modesty and cleaning as is required
  • Cotton balls: to put the Ghrita into the Basti.
  • A clean spoon: for distribution of the Ghrita.
  • The dough needed special preparations compared with the basti/vasti of the body. It is made from a grain mixture of whole wheat/black gram/pulses and hot water is used to construct the dough. It is then carefully molded around both eyes and across the nose bridge. Water is then used to make a seal on both inner and outer walls by gently bringing down a small amount of the dough onto the patient.
  • When the eye basti are complete, and Ghrita is sufficiently warmed (it is not made too warm/hot) the patient was asked to test with his little finger the temperature. Then a cotton bud was used to wipe a layer of the Ghrita over the patient’s eyes and then slowly, gently cotton balls were used to gently drip the warm Ghrita across the eyes. When a sufficient amount was administered (covering the eyes enough so when the patient’s eyes were opened they were immersed in the Ghrita), the patient was asked to slowly blink, and then move his eyes up and down and side to side. (It was necessary at times to push the Basti towards the patient’s eyes at the top of the bowl to ensure complete immersion at times). When the Ghrita had lost its warmth, the Ghrita was removed slowly by daubing gently with cotton balls and returning it to the upper bowl above the water bath. It was reheated and re-administered the same way three times at 10-minute intervals.
  • After the last of the Ghrita was removed, and cloths and towels were used to help clean the skin of the upper face, the patient was instructed in his own time to sit up. Practitioner then examined the patient and decided to have him lie back down and used saline to flush his eyes as it brought out quite a lot of redness and inflammation. After about 10 minutes the patient was fine to sit up and move around again.

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