Pain (Ruja) is a major clinical symptom of many diseases affecting quality of life.  Pain can be described as any physical or mental suffering or discomfort caused by illness or injury. No matter however mild the pain is anywhere in the body it lands person in state of discomfort and affects day to day activities. Pain can present in various ways as throbbing pain in toothache, colic pain which comes in spasm as in renal calculi, muscular pain as in sprain, sport injury and joint pain due to inflammatory condition and many more. According to modern review today’s era musculoskeletal and neuromuscular pain like pain of arthritis, sciatica, lumber spondylosis, migraine, etc are very common. Pain is also categorized as acute or chronic on the basis of duration. Our answer to pain is pain-killer medicines, which on frequent uses kills our resistance power.  Aims and objectives: To study the Ayurvedic basis of acute pain management and review the classical texts and synthesize the role of Agnikarma procedure in acute pain management. Materials and Methods: Relevant Ayurvedic and Modern literature is the material of the paper. Ayurveda explains the origin of pain due to vitiated Vata dosha and once Vata dosha is treated efficiently, the pain subsides automatically. Many people have a false belief that Ayurveda is not good in curing acute pain and Ayurvedic medicines should only be consumed in chronic pain and it always give very slow result but the thing is they are unaware of the wonderful management of Ayurveda. To relieve this pain every person seeks such a treatment which has minimum side effects and maximum benefits. Discussion: Ayurveda para surgical procedure Agnikarma can also be useful in acute pain conditions. Conclusion: Here it may be concluded that Agnikarma a para-surgical procedure involving therapeutic application of controlled heat, is described in Ayurveda as an effective modality for immediate pain relief.

Introduction:

Pain (Shoola/Ruja) is one of the most common reasons for seeking medical care. According to international Association for the Study of Pain (IASP), pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”[1] The word pain comes from the Latin word ‘Poena’, meaning punishment. Acute pain may result from trauma, inflammation, musculoskeletal disorders or nerve irritation. Conventional analgesics provide symptomatic relief but may produce adverse effects with long term use.

The word Agnikarma is combination of two words i.e., Agni and Karma, it means procedure done by the Agni to treat the disease. Application of heat directly or indirectly to the affected part of body. Sushruta mentioned the superiority of Agnikarma among all the para-surgical procedures and its importance explained in separate chapter in Sutrasthan. It has ability to cure the chronic diseases, which can’t be cured by the Bheshaja (medicine), Shastra (Surgical interventions) and Ksharakarma (alkaline cauterization). It is mainly indicated in the diseases caused by Vata and Kapha Doshas. Diseases of Twacha, Mamsa, Asthi & Sandhi with severe pain caused due to vitiation of Vata. Also, in Shiroroga, Netraroga, Vartmagata Vyadhi, Granthi, Arsha, Bhagandar, Arbuda, Shlipad, Charmakeela, Tilakalaka, Antravrana, Nadivrana, and in the diseases of the joints. [2] According to Sushruta, if Agnikarma is performed in above diseases, will be less chances of recurrence and successful in curing the diseases [3] Acharya Charak has not described details about Agnikarma but mentioned as one of the treatment measures in different Vatavyadhi such as Gridhrasi [4] In Sushruta Samhita different Dahanopakaranas and shapes are mentioned for Agnikarma as follows; Twakadagdha (gypsum), Shara (arrow), Shalaka  (metal rod) ,Mamsadagdha– Jambhavsta shalakla and other metals. For Sira, Snayu, Sandhi and Asthidagdha - Kshaudra (honey), Guda (jaggery) and Sneha (oil). [ 5] Shape of Agnikarma: According to Sushruta, Valaya: (round shaped), Bindu: (dotted), Vilekha: (linear cauterization) and Pratisarana: (irregular shape). [6] and according to Vagbhata three more types Ardha Chandra, Swastika and Astapada.

Aims:

To review the role of Agnikarma in acute pain management and evaluate available clinical and classical evidence.

Objectives:

1. To review the research work related to Agnikarma for acute pain management on different musculoskeletal disorders.
2. To analyse the collected data and study the efficacy of Agnikarma on acute pain management in various musculoskeletal disorders.

Materials and Methods:

This narrative review is based on:

1. Classical Ayurvedic texts:
   • Sushruta Samhita 
   • Ashtanga Hridaya
   • Charaka Samhita 
2. Peer-reviewed clinical studies evaluating Agnikarma in musculoskeletal disorders.
3. Modern medical literature explaining pain physiology and thermal therapy mechanisms.
4. Databases were screened using keywords including “Agnikarma,” “Ayurvedic cauterization,” “acute musculoskeletal pain,” and “thermal therapy.” Relevant English-language full-text publications, various dissertations, from search engines like Google Scholar, PubMed, etc were synthesized.

Review Of Literature

 Pain in Ayurveda - In Ayurvedic texts various terms such as Ruk, Ruja, Vedana, and Shoola are commonly used for pain; however, ‘Shoola’ is the most commonly used and appropriate term amongst all. Sushruta mentions Shoola as a condition where the patient experiences the sharp intensity of pain as if pierced with Shanku. It has been further elaborated that out of Tridosha, vitiated ‘Vata’ is the main causative factor responsible for all painful conditions. This vitiation of Vata occurs in two ways, viz. Dhatukshyajanya Vata Prakop and Margavarodhjanya Vata Prakop (channel obstruction).[7] Furthermore, the ‘Ruksha’ and ‘Chala’ Guna of Vata are mainly involved in the manifestation of pain.

 Classification of Pain - [8] Pain is a protective body mechanism. Pain can be classified as per duration (acute, subacute, and chronic); nociceptive pain; neuropathic pain; psychogenic pain; breakthrough pain (ex., oncological pain); and pain asymbolia (ex., diabetic neuropathy). Nociceptive pain is caused when noxious stimuli are perceived by the free nerve endings of the afferent sensory nerve axon. From an anatomical point of view, nociceptive pain can be classified as per the axons involved in perception of pain as fast pain (mediated by A fibre), which is sharp, and slow pain (mediated by C fibre), which is diffuse, dull aching. Apart from Aδ and C fibres, Aẞ fibres carry non-noxious stimuli. From a locational point of view, nociceptive pain is classified as somatic (superficial and deep) and visceral. From the receptor point of view, nociceptive pain is classified as thermal (a transducer such as TRPV1), mechanical (receptors responding to excess pressure), chemical receptors responding to chemicals like capsaicin), silent (receptors responding only when inflammation sets in), and polymodal (many neurons performing a single function). Neuropathic pain is caused by damage or disease affecting any part of the nervous system involved in bodily feelings. Neuropathic pain may be divided into peripheral, central, or mixed (peripheral and central) neuropathic pain. Peripheral neuropathic pain is often described as burning, tingling, electrical, stabbing, or pins and needles. Some manifestations of neuropathic pain include traumatic neuropathy, painful diabetic neuropathy, and post herpetic neuralgia. Psychogenic pain, also called somatoform pain, is caused, increased, or prolonged by mental, emotional, or behavioural factors. Headache, back pain, and stomach pain are sometimes diagnosed as psychogenic. Breakthrough pain is transitory pain that comes on suddenly and is not alleviated by the patient's regular pain management. It is common in cancer patients. Pain asymbolia, such patients report that they have pain but are not bothered by it; they recognize the sensation of pain but suffer little, or not at all.[9]

Atyayika Chikitsa in Ayurveda encompasses the treatment and prevention of acute health conditions, focusing on emergency management. It involves immediate treatment procedures tailored for acute scenarios, ensuring effective handling of health emergencies. This approach highlights the importance of timely interventions and strategies designed to address urgent medical needs within the framework of Ayurveda, making it crucial for managing acute health situations effectively. [10]

In ayurveda Atyayik chikitsa (Acute Care) for pain is Agnikarma treatment.It is a para surgical procedure explained by Sushruta. [5]

Emergency Kit:

Emergency medicines available for Agnikarma Procedure- [11] For management of complications occur during and after Agnikarma procedure, following drugs are routinely used.

1. To subside (Daha) burning sensation and pain at Agnikarma site: Application Kalka of Kumara Patra (Aloevera pulp), Shatdhaut Ghrita.

2. For management of deep burn: Application of honey with plain Ghrita, Yashtimadhu Ghrita, Shatdhaut Ghrita, Jatyadi Ghrita, Madhuchisthaadi lepa ,Panchvalkal kwath and Triphala kwath are used.

4. To relive burnig sensation: Triphala Guggulu, Godanti, Kaishor Guggulu.

Indications of Agnikarma:

A number of diseases and conditions have been explained in text where Agnikarma as therapeutic measure has been indicated as below: If there is excessive pain due to Vataprakopa in Twak (Skin), Mansa (Muscles), Sira (Veins), Snayu, Sandhi (Joints), Asthi (Bones), Granthi (Lymph nodes), Arsha (Piles), Bhagandara (Fistula in Ano ), Apache (lymphadenitis), Shlipad (Filariasis), Charmakil (Warts), Tilkalaka  (Pigmented moles), Antravrudhi (Inguinoscrotal Hernia), excessive bleeding from Sandhi (Joints), Sirachchheda (Cutting of veins), Nadivrana (Sinus ). [12]

Contra-indications for Agnikarma:

Agnikarma should not be done in the Pitta Prakriti, Bhinna Kostha, Daurbalya, Vriddha [13], Vrana of Snayu, Marma, Netra, Kushtha and Vrana with Visha and Shalya [14], who is contraindicated for it. Ksharkarma. [15].

Suitable Season for Agnikarma: Agnikarma can be done during all the seasons except Grishma and Sharada. 2.4.

Types of Agnikarma: [16] · Valaya- Circular, ring like. · Bindu - Dots done with Shalaka. · Vilekha - Straight lines. · Pratisarana - Wide spread, flat lines. · Ardhachandra - Semicircular. · Ashtapada- Having eight branches. · Swastika- Cross lined.

Poorvakarma : Patient is made aware of the procedure with written/ informed consent. Thereafter, patient is allowed to sit comfortably, and the most tender and painful point is marked with the marker. Before starting the procedure, the desired site where Agnikarma is to be done was properly cleaned with distilled water allowed to dry.

Pradhan Karma: After cleaning the site, Burn the candle and then with the help of probe holder Suvarna Shalaka applied on marked site.) the Samyak Dagdha Agnikarma is done intermittently on affected site as marked and thus, Bindu (dot) type of Agnikarma is performed. The Shalaka (tip of probe) is kept in contact of skin.

Pashchat Karma: (Post Agnikarma procedure):  Soothing Yastimadhu Ghrita is applied to the patient at the site of Agnikarma for relieving post burn discomfort as it has Vednasthapak (Analgesic) and Vranropak (healing) property as mentioned in classical text of Sushruta Samhita. The site of Agnikarma should be water-proofed to prevent wound infection.

Mode of action of Agnikarma: Agnikarma is considered as the method of choice to treat pain due to aggravated Vatadosha in Vatavyadhi samprapti as it relives pain and provides easy pain less movements of the related body part. The heat advocated via the medium of gold bar brings the aggravated Vata Dosha to normalcy and thus normalizes the equilibrium between dosha. The qualities of Agni being Ushna-hot, Laghu-light, Sukshma-penetrating, Ashukari- fast spreading, Aamapachaka- digestive to auto toxins and kriyakashtata- restricted movements of the joint which are strictly opposite to Vata & Kaphadosha qualities which are particularly vitiated in Vatavyadhi. Vata Dosha normalizes due to effect of heat produced by Agnikarma. Also Agni helps in digestion of Ama-auto toxins to remove the margavarodha pathway obstruction which also is a major event in the etiology of Vatavyadhi. The effect of Agni also reaches the deepest and smallest structures of the body system to improve Dhatvagni.

Effects of Agnikarma: It increases metabolism, blood circulation, decreases pain, stimulates nerves, relaxes muscles, decreases infection, decreases joint stiffness and inflammation.[17]

 Results and Observations:

Reviewed clinical studies demonstrate:

• Statistically significant reduction in Visual Analogue Scale (VAS) scores.
• Improvement in joint mobility and tenderness grading.
• Symptomatic relief commonly within 1–3 sittings.
• Low recurrence rates.
• Minimal adverse events.

Thermal stimulation may modulate nociceptive transmission through peripheral and central pathways. Increased blood flow and reduction in inflammatory mediators contribute to tissue healing. [18]

However, methodological constraints such as small sample sizes, absence of control groups, and limited blinding reduce the strength of available evidence.

Discussion:

Agnikarma acts through:

• Pacification of aggravated Vata Dosha
• Removal of Srotorodha (channel obstruction)
• Restoration of local metabolic activity

The Ushna and Tikshna properties directly oppose the pathophysiological qualities of Vata. [19]

Different types of metal and non-metal materials i.e., Dahanopkarana were used for Agnikarma procedure, Shalakas (metal rod) like Suvarna Shalaka (gold rod), Rajat Shalaka (silver rod), and Tamra Shalaka (copper rod), Lauha Shalaka (iron rod) and Panchadhatu Shalaka (rod made of five types of metal). Non-metal materials like Pippali (Piper Longum), Ajashakrut (goat excreta), Kshaudra (honey), Guda (jaggery) and Sneha were used in various painful disorders. Agnikarma were done in Multiple (Twakadagdha) which is important in Agnikarma. Non-metals material like Pippali found less effective because of its low temperature retention capacity and it burns only superficial layer of skin. Different Shalakas were used in various musculoskeletal disorders but result was statistically same in different articles. Sushruta has described Agnikarma ineffective when there is Atyugraruja (intense pain) in Snayu Sandhi-Ashti immediate i.e., musculoskeletal disorders.[20] Agnikarma was useful for pain relief and same was observed in above different research papers. Probable mode of action of Agnikarma - Agnikarma acts on a multi-factorial level in the body and its importance lies in its action. Exact mechanism action of Agnikarma still remains unsolved. Some theories can be adopted to explain these mechanisms but their action varies according to the condition. According to Ayurveda it acts against Vata and Kapha Dosha by its Ushna (hot), Tikshna (penetrating), Sukshma (minute), Laghu (small), Vyavayi (quick acting), and Vikasi (quickly spreading) Guna and it breaks Srotoavarodha, produced due to Vata and Kapha, results in relieving pain and inflammation at that site. [19] The heat therapy, which is given at the local or affected area, increases the local blood circulation by vasodilatation, local metabolic process speed up, waste products get excreted, reduce edema, accelerate repair, and which resulting in decreased intensity of pain. Agnikarma may stimulates the sensory receptor lying in the muscle, by sending a message to the brain which stimulates the pituitary gland to release endorphin which in turn binds with opiate receptors in the pain cells to block the pain stimuli. Endorphin is a naturally occurring neuro peptide and like morphine and other opiates it has a marked propensity for binding on to the “opiate receptors” of the pain cell in the brain. [21]

The pain receptors in the skin and other tissues are all having free nerve endings, due to hot Shalaka there is destruction of the free nerve endings and it causes, closing the “gate” and prevent the sensory transmission of pain. [21]

Biomedical Correlation:

Thermal micro-cauterization may exert its analgesic effect through:

• Vasodilation and improved microcirculation [22]
• Reduction of inflammatory mediators
• Disruption of the pain–spasm–pain cycle
• Neuromodulation consistent with the Gate Control Theory [23]

Modulation of central sensitization processes [24]

Compared to long-term NSAID therapy, Agnikarma provides localized intervention with minimal systemic involvement.

Nevertheless, future multicentric randomized controlled trials with standardized protocols are essential for stronger evidence generation.

Conclusion:

Agnikarma is a procedure frequently indicated in many Vata and Kapha predominant conditions. It is very effective procedure for acute pain management by inhibiting the pain pathways.

For knee joint pain, painful heel like plantar fasciitis, calcaneal spur, tennis elbow, sciatica, frozen shoulder, corn etc. Agnikarma is most simple and fast effective procedure which can easily administered on O.P.D. level.

 From this review can be concluded that Agnikarma with different kind of Shalakas is found significantly effective in pain management in musculoskeletal disorders in almost all the studies. It can be performed in combination with other supportive oral medications.

  It is simple, cost effective, convenient and non troublesome procedure which relieves pain instantly from the affected sites.

No wound, bleeding, scar or after marks of the procedure is visible on the body.

 More scientific and Molecular studies are required to know the exact action and its applicability on the large scale.

Agnikarma is a classical Ayurvedic para-surgical intervention with promising therapeutic potential in acute musculoskeletal pain management.

 It offers rapid analgesic effect, improved functional outcomes, and low recurrence rates.

Although preliminary evidence is encouraging, rigorous scientific validation through well-designed clinical trials is necessary before broader integration into mainstream pain management strategies.

 Acknowledgment :

The author expresses sincere gratitude to the management and faculty of Smt. Shalinitai Meghe Ayurved College, Hospital and Research Centre, Bhilewada, Bhandara, Maharashtra, India for providing academic support and an encouraging research environment. The author also acknowledges the classical Ayurvedic scholars whose foundational texts have guided this work.

The author appreciates the contribution of researchers and clinicians whose published studies on Agnikarma and pain management have contributed to the conceptual development of this review.

No technical, financial, or editorial assistance was received in the preparation of this manuscript.

Conflict of Interest:

The author declares that there are no financial, commercial, legal, or professional relationships that could be construed as a potential conflict of interest in relation to this manuscript. The research was conducted independently without influence from any funding agency, pharmaceutical company, or institutional body.

Funding Statement:

No external funding was received for the preparation of this manuscript.

Ethical Statement:

This article is a narrative review based exclusively on previously published literature. No human participants or animals were directly involved; therefore, institutional ethical clearance was not required.

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