AN OPEN LABEL CONTROLLED CLINICAL STUDY TO EVALUATE THE EFFECT OF VIDDHAGNI KARMA IN PAIN MANAGEMENT IN SCIATICA VIS-À-VIS GRIDHRASI.

Gridhrasi (Sciatica) is one of the Vatavyadhi caused by aggravated Vatadosha. Included under 80 types of Vataj Nanatmaja Vyadhi. Gridhrasi consist of features like Ruk (continuous pain), Toda (intermittent pricking pain), Stambha (stiffness), Spandana (twitching sensation) over Sphik, Kati, Prishta, Uru, Janu, Jangha extending up to Pada. On the basis of symptoms,Gridhrasi can be clinically correlated with Sciatica.

Sciatica occurs due to spinal nerve irritation and characterized by pain in the distribution of sciatic nerve. The lifetime incidence varying from 13-40% while the annual incidence of an episode of sciatica ranges between 1-5%. Peak incidence occurs in patient in their fourth decade

Sciatica is a condition which incapacitates the patient to perform his daily routine activity due to continuous and stretching type of pain. Conservative management of sciatica încludes administration of NSAIDS, analgesics, muscle relaxant and corticosteroids which gives temporary relief. In some cases, if nerve compression is more, surgical procedure like Laminectomy, discectomy is indicated but this surgical procedure which are quite expensive with their limitations.

Keeping in view about the adverse effects of the modern sciences, there is a need for review our science for an effective, economical, and simple short-term therapy with no side effects and non-recurrence in the management of Sciatica.

In our Ayurvedic Science various modalities of treatment are explained for the management of Gridhrasi are Bheshaj, Snehana, Swedana, Siravyadhana, Agnikarma and Basti. Agni karma chikitsa is even indicated in various painful conditions like joint pain, headache, abdominal cramps/discomfort & few convulsive disorders like epilepsy, schizophrenia & phychosomatic disorders can be treated with this intentional heat burn therapy.

In charkadatta & yogaratnakara we find direct reference of Agnikarma indicated for Gridhrasi. Agnikarma is the most important para surgical procedure. It is said to be better by virtue of its action. It is known to render quick relief. Moreover, Acharya Sushruta appreciates Apunarbhavarva as its prime quality, that means there is no recurrence of diseases treated by agnikarma. Thus it could be a potential area to explore in ayurvedic pain management.

In classics, there are different types of agnikarma have been narrated. Among them Twak dagda & mamsa dagda are of therapeutic significance. The Mamsa dagda can be used for pathologies situated in deeper tissues such as asthi, snayu and sandhi. Based on the targeted area, different materials known as Dalhanopakarana are used to render the heat on effected tissue.For Mamsa dagda, Jambavoshta, loha shalaka, madhu, Sneha, guda and Suchi are advised as choice of material by Vagbhata.

Acharya Vangasena has specified agnikarma with suchi as the treatment modality of Gridhrasi. Compared the classical agnikarma using shalaka, suchi renders deeper penetration and minimal scar. Moreover, its easy availability, inexpensiveness, early heating and better cosmetic outcomes makes it better choice..

To make the method user friendly by avoiding repeated heating, procedure is modified with the support of advanced technology. Viddha karma is one of the eight Shashtra karma mentioned by Acharya Sushruta

Here Suchi in the form of hollow needle will be heated using a cautery machine, which is practiced as Viddhagni. This procedure ensures the heat delivery to the targeted deeper tissue with better cosmetic outcomes. Hence this innovative, improved and user-friendly procedure is adopted for the study.

Hence, the current work is intended to manage Sciatica, a condition which causes significant clinical and public health burdens by exploring effective, safe and cost-effective method of treatment using principles of agnikarma. Also adopting the agnikarma with suchi and modifying it as viddhagni appears to be the best line of intervention in pain management.

Thus, the present study is intended to evaluate the effect of viddhagni karma in subjects fulfilling the criteria of Sciatica vis a vis Gridhrasi.