Efficacy of multimodal approach in the management of chronic mechanical low back pain (katishoolaa) - A Randomized controlled trial

Millions of people worldwide suffer from the widespread and incapacitating ailment known as chronic mechanical low back pain. Because it causes severe pain, disability, and a decline in the quality of life for people who are affected, it presents as a serious worldwide health burden. There were 619 million LBP sufferers globally in 2020; by 2050, that figure is predicted to rise to 843 million.  As a complex symptom, LBP is linked to a lower quality of life for those who experience it. Among other symptoms, it causes negative social relationships, work absenteeism, functional impairment, fear of movement, stress, anxiety, and depression. The burden of low back pain  is greatly increased by lifestyle variables like smoking, being overweight, not exercising, and getting little sleep.  The main reason why a person with chronic LBP seek medical attention is because they have trouble carrying out everyday functioning tasks.  People with LBP are treated with a variety of therapies to address their range of motion limitations, pain symptoms, and perceptions of their disability. These therapies include pharmaceutical management, manual therapy, therapeutic exercise, patient education regarding lifestyle modifications, and modalities like electrical stimulation, ultrasound, heat, and cryotherapy.  Because of their affordability and effectiveness in managing chronic pain, medication-based treatments  are acknowledged as first-line treatments. The most effective therapeutic options are opioids and NSAIDs. Their long-term effectiveness and possible adverse effects, such as organ damage, ulcers, tiredness and dizziness, may raise questions, though. This method is only feasible and safe in the short term due to the possible adverse effects of medication and the possibility of opiate addiction. Over half of people with LBP experience a return of symptoms, necessitating expensive operations or a reliance on pain medication for symptom management. The long-term effects of current therapies are also variable. As a result, more successful interventions are required.  According to Ayurveda, low back pain is associated with cluster disorders of vata vyadhi, specifically Katigraha, Gridrasi, and Khalli, which have particular common symptoms including pain , stiffness , and suptata.  According to Vata vyadhi, pain is a common symptom. Sneha, Sveda, Samshodana, Agnikarma, Raktamokshana, Lepa, Basti and others are included in the Samanya Chikitsa Sutra for Vata Vyadhi.  When it comes to symptoms like Suptata, Kandu, Chimchimayana, Sthambha, and Grathita with ruja and avagadatara rakta dosha conditions, Alabu is especially recommended.  Because the principle of blood evacuation is comparable in cupping therapy and Alabu Chikitsa, the therapy is called Modified Alabu Chikitsa.  Cupping therapy is regarded as an alternate or additional form of treatment. Researchers have proposed the clinical value and acceptability of cupping therapy in the treatment of LBP, as interest in this pain management technique continues to grow.  Yoga has been shown in prior clinical trials to improve back-related impairment and self-efficacy in individuals with CLBP.  Traditional recommendations for the treatment of Vaat vyadhi include formulas such as Mahanaryana taila for local application and Trayodashang guggulu. Multimodal approach is necessary to provide a complete care for the patient and is the need of hour. Hence the integrative approach is planned to evaluate the efficacy of wet cupping therapy, yoga and medications in the management of chronic Low Back Pain.