UNDERSTANDING PAIN IN AYURVEDA & THE LOCAL EXTERNAL MANAGEMENT OF LOWER BACK PAIN
In Ayurveda, symptoms and illnesses arise when one or more of the three Doshas (biological intelligence principles) become disturbed.
- Vata Dosha is the intelligence behind all organised movement, communication and balance (homeostasis). It is most prominent in the pelvic area, all joints and the sense organs that afford hearing and touch (ears and skin). Vata, through the agents of “Space” and “Wind” facilitates all sorts of organised movements (peristalsis, circulation, absorption, elimination, respiration, emission etc.) In terms of metabolism, Vata enables and maintains the balance between catabolic and anabolic pathways. Vata is also responsible for the movement and direction of the other two Doshas which puts it at the “top of the table” so to speak. Hence, Vata is the most important Dosha in health and disease.
- Pitta Dosha is the intelligence behind digestion and heat production. It is most prominent in the navel area, blood, arteries, and the sense organs that afford the reception and digestion of light and heat (eyes and skin). Pitta, through the agents of “Fire” and “Water”, enables the reduction of matter from a gross to subtle state (a fewer number of larger complex entities are divided into an increased number of smaller simpler entities). In terms of metabolism, Pitta governs catabolic pathways.
- Kapha Dosha is the intelligence behind the organised manifestation of lubrication, cohesion, replication and structural abundance. It dominates in the chest area, plasma, lymph, muscles, tendons, ligaments, fat, marrow, nervous and reproductive tissue. Through the agents of “Water” and “Earth”, Kapha enables the synthesis of matter from a subtle to gross state (an increased number of small simple building blocks are combined into a reduced number of larger complex structures). So, in terms of metabolism, Kapha governs the anabolic pathways.
WHAT IS PAIN?
Your innate pain mechanism is part of Vata’s skillset and healthy physiology. Pain is a variety of sensory experience, and is primarily governed by Prana Vayu and Pranavaha Srotas. It operates within your physical and subtle bodies. Your causal body (comprising the Soul) cannot produce pain, but can witness it, though its doing so doesn’t influence the mechanism. Pain is part of your body’s natural self-defence messaging system. It informs us that something potentially harmful has happened or is happening to us. If you put your hand in fire, you feel intense burning pain which triggers the instinct to remove your hand from the fire. If you whack your foot on the corner of a piece of furniture, you feel intense pain, you might clench up and stop moving. This is designed to teach you that such an impact (and the behaviour that caused it) may have caused damage to your tissues. Life uses pain as a message that our Doshas and Dhatus are being severely challenged by some inappropriate or intolerable internal or external factor.
Before we explore the physical dimension of pain, it is worth mentioning that its subtle dimension, especially the mental aspect, accounts for a lot of additional suffering. If we don’t learn to accept pain, to allow it, to loosen and feel into it, to see it in context, to understand its origins; we create a “rejection response”: we recoil, tense up, close down, withdraw, try to escape from it. This behaviour tends to add more energy to the mix, increasing the degree of pain being felt. As a result, Vata undergoes additional aggravation. I believe that a large part of how we cope with pain has something to de with how we were “taught” as children. Young kids are like sponges, they soak everything up. So if every time clumsy little Bart whacks his head on the corner of the old dresser and mum, all flustered and overly dramatic, makes a big deal out of the thing, clenching up in fear or concern, then Bart will feel her energy and himself learn to hold tense with his pain, or to see pain as a big deal or dramatic event.
Instead of thinking of pain as a shitty life burden to be avoided at all costs, we need to practice accepting it, loosening up with it, breathing into it. We also need to learn to heed it’s inherently intelligent message designed to steer us from harm and suffering towards safety, comfort and inner growth. Our body, when being intelligent (which requires a balanced Prana Vayu), produces remedial aversion/desire messages: “aversion towards things that cause us pain and discomfort” as well as “attraction towards things that cause the pain and discomfort to subside”. This messaging process begins during the initial stage of the six-fold disease process (Kriya Kala). If, in response to these signs, we respond appropriately, our actions will bring us back to balance.
For example, if Vata Dosha becomes disturbed (leading to unintelligent, disorganised styles of movement in our channels) we will usually experience aversion towards things which are dry, cold, light, agitated etc. At the same time, we will feel desire to experience unctuous, warm, grounding, stable things. It is worth noting that as the Kriya Kala progresses, the reliability of this messaging system becomes compromised. In fact, much chronic pain is actually a sign of aggravated Prana Vayu (which means our most subtle forms of messaging systems become disturbed). Even if there is no immediate or obvious threat or problem with the physical flows, or no major damage happening to our tissues and organs, disturbed Doshas and accumulation of Ama (toxins) can trigger the experience of pain and discomfort. It is for this reason that much success can be had when resorting to “energy” treatments such as acupuncture, Marma therapy, yogic breathing, Pranic healing (including Reiki), because all these modalities impact directly on our “energy or vital body” (Prana Maya Kosha in Yogic terms) and its functional aspects (Prana Vayu / Prana Vaha Srotas in Ayurvedic anatomy and physiology).
Most pain is a sign of wrong flow in the Srotas (deficient, excess, blocked and deviated flows). Most often, it is the deficient or blocked flows that are to blame for chronic pain. Since Vata controls flow, all pain is associated with a degree of aggravated Vata. Vata moves through channels (nerve, blood, etc.) and supports the function of the two other Doshas. As a result, Pitta (burning / inflammation) and or Kapha (congestion / accumulation) are often included in the localised Vikriti of pain. When Vata fails to produce healthy flow, the question must be asked “what has caused the flow to become modified in the first place? What is restricting the flow? What is forcing excessive flow, what has cause flow to move out of its normal channel or in the wrong direction?” Most of the time, aggravated Vata itself is responsible (excessive qualities like dry, cold, light, rough, mobile-agitated have interfered with the functionality of the channels). The cold (constricting) and dry (restricting) nature of Vata Dosha means that when aggravated by like qualities experienced through diet and lifestyle, the flow of Vata can get blocked in places. This sort of pain will be sensitive to movement and the cold. Sometimes however, the flow of Vata becomes restricted or blocked due to an underlying aggravation of Pitta or Kapha. A third and final flow blocking factor is the presence of Ama (non-digested, non-eliminated food derivatives and toxins). No matter what type of Ama: Sama Vata, Sama Pitta or Sama Kapha, they all have a sticky quality that tends to restrict flow in the channels.
So with Vata at the top of the “pain table”, it will usually be of benefit to use Vata balancing treatments. But when pain is being caused by an underlying aggravation of Pitta or Kapha (with or without Ama), our therapeutic attention must also turn towards managing these factors as well. Needless to say, the situation can get a bit complicated on paper. For example, while all pain is somewhat relieved by application of heat (Vata is relieved), a true Pitta-caused pain Vikriti will only respond adequately when careful use of cooling therapies are used.
IN SEARCH OF THE CAUSAL DOSHA
No matter what chronic disease condition we are trying to understand and treat, our quest must begin with a progressive but thorough evaluation of the Doshas, Jathara Agni (digestive fire), Dhatus (tissues), Srotas (channels), Malas (wastes) and Ama (toxins). The classical Ayurvedic method for this includes use of the Rogi Pariksha and Roga Pariksha protocols. Complex cases often require that we incorporate an initial phase of exploratory treatment. In this early phase of the Ayurvedic process, we must focus our attention on these questions:
- What Dosha or Doshas are locally aggravated in the pathology?
- Where are they situated (in what Dhatu, Srotas, organ)?
- What is the causal Dosha, the one responsible for the localised aggravation?
Honing in on the causal Dosha makes the difference between failure or success, and finding it requires skill and plenty of practice. A solid theoretical understanding of Ayurvedic anatomy, physiology and pathogenesis are essential. Once we have studied the intellectual framework, we need clinical practice for integration. Ideally, every hour spent studying should be balanced with the same time in consultation. For example, for a 1 year foundation in Ayurveda (say 150 hours contact + 300 hours self-study), we would ideally need 450 hours of consultations. This might equate to 225 consultations. If you work for 1 day a week and give 4 consultations that day, you will need 56 weeks of consultations. So be patient with yourself. Practice will make perfect !
The following braches of enquiry help us find the causal Dosha of the Roga in question:
- LAKSHANA – nature of the symptoms in terms of the Gurvadhi Gunas
Time must be taken to accurately and unhurriedly explore the nature of the symptoms for each Roga. First, we must map the language of symptoms onto the language of the 20 Gunas (hot, cold, dry, unctuous, light, heavy etc). Then, in a second step, we can map these symptom Gunas onto one or more Doshas. In practice, this often shows us that two or even three Doshas are somewhat aggravated locally. By locally, I mean in a specific Dhatu/Srota location. For example, with lower back pain, the Dhatus concerned are mainly Mamsa and Asthi Dhatus as well as their respective Srotas.
- Vataja pain is sharp, throbbing, migrating in location and variable in intensity and tends to be localized more on the surface of the body.
- Pittaja pain is burning, lancing, intense and stays in one place. It tends to be at a middle level of depth in the body.
- Kaphaja pain is dull, aching and stays localized in one place. It tends to be located deep in the body.
- SAMPRAPTI – evolution of symptoms over time
- Vataja pain comes and goes very quickly.
- Pittaja pain comes on with increasing force during 1 or 2 hours and reaches peak periods around midday or midnight.
- Kaphaja pain takes 6 to 24 hours to reach full intensity and can last for several days at a time.
ABHYANTARI-KARANA – insights into the nature of triggering factors
While this point might seem obvious, it is worth remembering to enquire as to whether the Rogi has any information about what events might have severed as a trigger for their condition. This point has some overlap with the others, but needs to be taken as separate so as to remain open to the unknown or less obvious. If any potential “triggering factors” are found, we must apply symptom mapping exercise to them in the same way that we did for the Lakshana enquiry.
KALA PRAKOPA – at what times are symptoms worse?
- Vataja pain peaks in the hours prior to sunrise and sunset (typically, the last part of the night and the late afternoon). It is generally worse during the autumn and early winter, just before ovulation, and just before and during menstruation.
- Pittaja pain reaches a peak around midday or midnight, is worse during the spring and summer months, as well as during menstruation.
- Kaphaja pain peaks in the evening and morning, and is worse during ovulation, the winter and early spring.
KALA ZERO – When did the condition start?
It can be useful to know when the symptoms first started to manifest. This can often be clue as to the causal Dosha. Same rules as for Kala Prakopa.
ANUPASHAYA & UPASHAYA – activities, substances or therapies found to aggravate or relieve the condition?
- Vataja pain is aggravated with excessive movement and cold; it is relieved by unctuous warmth, gentle movement, relaxation, eating warm unctuous grounding foods, and massage with light to moderate pressure.
- Pittaja pain is aggravated with heat, movement and palpation with mild to moderate pressure; it is relieved with relaxation and cooling therapies.
- Kaphaja pain is aggravated with immobility, coldness and food; it is relieved with moderate to dynamic movement, deep firm stimulating massage, dry heat and fasting.
In order to treat lower back pain correctly the therapist should treat the Dosha that is causing the problem. Since Vata is implicated in all forms of lower back pain oil & heat treatments as oil has the opposite qualities of Vata. The oil is either mixed with cooling herbs for the treatment of Pitta (inflammation) or heating herbs for the treatment of Kapha (congestive).
EXTERNAL TREATMENT OF LOWER BACK PAIN ACCORDING TO THE DOSHA THAT IS CAUSING THE PROBLEM
For Vataja back pain – warm oil massage with application of heat for 20 mins daily. Use heating and nousishing oils such as sesame oil or Vatashamana oil, Mahanarayana oil, Bala or Ashwagandha medicated oils. Slow, soft massage with light to moderate level of pressure is needed.
For Pittaja back pain – room temperature oil massage. Use cooling, anti-inflammatory oils such as olive oil, coconut oil, Pittashamana oil, or other oils prepared with Pitta reducing herbs or oils such as Manjistha, Bala, etc. Vigorous massage followed by soft massage with moderate level of pressure is needed.
For Kaphaja back pain – hot oil massage with application of heat for 20 mins followed by dry powder massage with heating herbs such as Calamus, Ginger, etc. Sesame and mustard oil blends can be used, or olive / sesame oil blends if mustard oil is not available. Vigorous massage with pressure is need.
If symptoms do not improve within seven days, consult an Ayurvedic practitioner.
Combined with internal treatments (nutritional and supplements), good results can be expected in most cases.