Article by Dr Manasa S, B.A.M.S & Dr Raghuram Y.S. MD (Ay)
Pain is our body’s way of sounding the alarm—a signal from the nervous system that something needs attention. It can feel like a sharp stab, a dull ache, or even a burning, stinging, or throbbing sensation. Whether it’s a fleeting discomfort or a persistent challenge, pain is as varied as the people who experience it.
Sometimes, pain comes and goes or appears only under specific conditions. It can be acute, like the sudden sting of a paper cut, or chronic, with recurring sensations lasting months or years. Pain may stay in one place, like a sore knee, or spread throughout the body, as with flu-related aches.
What makes pain truly unique is its personal nature. Some people barely notice it, while others feel overwhelmed by even mild discomfort. Regardless of tolerance, pain serves an important purpose: it helps us understand our bodies and often points to underlying issues that may need attention.
From manageable aches to signs of serious conditions, pain isn’t just a symptom—it’s a guide. Recognizing its signals helps us take the right steps toward relief and healing.
From an Ayurveda perspective, there is no separate chapter or context to describe what pain is. Pain is a part and parcel of a big picture. It appears in various forms in different diseases and they are contextually touched upon in Ayurveda treatises. There are different names which describe pains of various nature, like ruja, ruk, Vedana, shula etc. Ruk, which explains pain, is also a synonym of Vyadhi – which means disease. So, pain according to Ayurveda is a synonym of disease. On the flip side it can be understood that ‘all diseases are associated with one or the other kind of pain’. Every disease is painful in its own way.
Describing Pain: Common Terms
When describing pain, using precise language can help healthcare providers better understand its nature, cause, and severity. Below are commonly used terms to articulate pain sensations:
– Burning – often associated with nerve pain of inflammation
– Sharp: A sudden, piercing sensation typically linked to injuries or acute conditions.
– Dull: Persistent, less intense discomfort that might indicate chronic conditions.
– Intense: Severe pain that demands immediate attention.
– Aching: A continuous, throbbing sensation commonly felt in muscles or joints.
– Cramping: Pain with a squeezing or tightening quality, often linked to muscle spasms or gastrointestinal issues.
– Shooting: Pain that radiates or travels along a path, often tied to nerve involvement.
– Stabbing: Sudden, pinpointed pain resembling a sharp jab.
– Gnawing: Deep, persistent discomfort with a “nagging” quality.
– Gripping: A constrictive sensation, often linked to conditions like angina.
– Pressure: A heavy or compressive feeling, frequently described in cardiac or vascular conditions.
– Heavy: A sensation of weight or burden in the affected area.
– Tender: Sensitivity or discomfort upon touch or pressure.
– Prickly: A tingling or needle-like sensation, often associated with nerve irritation.
– Stinging: A sharp, tingling pain resembling a bee sting or burning sensation.
Accurately describing pain helps clinicians tailor assessments and develop effective treatment strategies.
Ayurveda too has explained different kinds and patterns of pain. Many of the above said pains fit into one or more of doshic patterns of pain.
– For example, sharp, intense, cramping, shooting, aching stabbing, pricking and stinging types of pain are those which are caused by aggravated vata.
– Burning, sharp, intense types of pain and tenderness are generally pitta types of pain. The same pains and some of the vataja types of pain like sharp, stinging etc are pain patterns of aggravated rakta also.
– Dull, Gnawing, Pressure and Heavy pains are due to Kapha.
– Ama is yet another entity which will produce severe pain wherever it is located in the body. The pain will be of mixed nature moreover like a vata pattern along with signs of ama.
Causes of Pain
Pain arises when specialized nerve endings, called nociceptors, detect damage or potential harm to tissues and transmit this information to the brain via the spinal cord. The process is a critical defence mechanism, prompting immediate protective actions, such as pulling away from a hot surface to prevent further injury.
The severity and nature of pain depend on the brain’s interpretation of these signals and the efficiency of communication between the nociceptors and the brain. Additionally, the brain may counteract the unpleasant sensation by releasing chemicals like dopamine, which provide temporary relief.
According to Ayurveda, pain cannot manifest without the involvement of Vata. So, by default, vata aggravation is the chief culprit in causation of pain, as main or associated dosha. But it is not ‘only vata’ which causes pain. Pitta, Kapha and Ama too would cause pains of patterns particular only to them but we can consider Vata to be associated in small proportions in each of these patterns.
So, any food or activity or habit which can cause or trigger aggravation of vata mainly and also pitta, kapha or ama as the case may be, shall be considered as causative factors of pain. Avoiding those causative factors along with dosha specific treatments will help in relieving and cure of pain.
Common Causes of Pain
Pain can stem from a wide variety of sources, including:
– Injuries: Cuts, burns, bruises, and fractures.
– Musculoskeletal Issues: Muscle strains, cramps, or joint damage.
– Infections: Sore throats or flu.
– Chronic Conditions: Arthritis, endometriosis, and fibromyalgia.
– Neurological Triggers: Headaches and migraines.
– Gastrointestinal Issues: Stomach aches or cramps.
From Ayurveda perspective, injuries of all kinds would definitely aggravate vata, and some times rakta too. Strains, cramps and joint damage – all these would aggravate vata while infections can imbalance any of the doshas or all three of them. Conditions like arthritis and fibromyalgia presenting with severe pain will have vata as causal dosha in the backdrop, pointing towards vata aggravating causes being responsible for the same, but in different patterns of arthritis we can see involvement of other doshas, rakta and ama too. The causative factors can be tracked back after identifying the pain causing dosha or doshas in the pathogenesis.
It is important not only to identify the doshic pattern by analysing the nature and presentation of pain, but also from a therapeutic perspective since ‘Nidana Parivarjana’ i.e. avoidance of causative factors is an important strategy in pain management, like in other diseases.
Unless proved otherwise, vata aggravating causes can be credited to be the neurological triggers causing aches and cramps in the gastrointestinal tract.
Types of Pain Triggers
Acute Physical Trauma: External injuries like burns and fractures.
Internal Damage: Inflammation or organ dysfunction.
Chronic Diseases: Long-term conditions that consistently activate nociceptors.
Unknown Causes: Pain with less apparent origins, requiring detailed medical investigation.
Pain serves as a signal that prompts individuals to seek medical attention, ensuring proper treatment and management. Its economic impact is significant; in the U.S. alone, pain contributes to substantial healthcare costs and loss of productivity, underscoring the need for effective management and preventive measures.
Looking from Ayurveda lens,
Acute physical trauma leads to vata aggravation or rakta aggravation and the pattern of pain too will be similar to that of vata or rakta or involvement of both.
Inflammation behind any kind of pain points out towards pitta aggravating causative factors and involvement of pitta in the causation of pain.
Unknown causes of pain would involve any dosha or dosha aggravating etiological factors and may also have Tridosha pattern also. They too shall be identified on the lines of predominant dosha symptoms and addressed accordingly.
Types of pain
Pain is broadly classified based on its underlying causes, mechanisms, and characteristics. Here’s a compilation for a clear understanding, drawing insights from trusted sources:
Nociceptive Pain
This kind of pain results from actual or potential tissue damage activating nociceptors.
Subtypes:
– Somatic Pain: Localized pain affecting skin, muscles, bones, or joints. It is often sharp, throbbing, or aching.
– Visceral Pain: Diffuse pain arising from internal organs, often described as cramping or squeezing.
– Examples: Post-surgical pain, bone fractures, arthritis.
Management: Typically, responsive to nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol.
Vata aggravation leads to tissue damage and tissue damage or depletion leads to vata aggravation. In both patterns pain is the main feature. Nociceptive pain is a vata type of pain. Sharp, throbbing or aching type of pain found in somatic subtype of pain and cramping or squeezing type of pain found in visceral subtype of pain are also Vata nature of pains.
Neuropathic Pain
Definition: Caused by nerve damage or dysfunction, leading to abnormal sensory processing.
Characteristics: Burning, shooting, or electric-shock sensations; heightened sensitivity (allodynia) to stimuli.
Examples: Diabetic neuropathy, sciatica, shingles, trigeminal neuralgia.
Management: Often treated with medications such as antidepressants, anticonvulsants, or nerve-specific pain relievers.
Neuropathic pains are a vata type of pain. Vata is either a cause or effect of nerve damage. Sensory processing is also under the control of vata. The pain pattern too belongs to the vata type of presentation. Pitta and Rakta may be involved along with vata and they need to be identified for planning the treatment in a better way.
Nociplastic Pain / Functional pain
Definition: Pain arising from altered nociception without clear evidence of tissue damage or nerve injury.
Associated Conditions: Fibromyalgia, chronic pelvic pain, irritable bowel syndrome.
Characteristics: Diffuse, amplified pain that may coexist with fatigue, poor sleep, and mood disturbances.
Management: Requires a multidisciplinary approach, including cognitive-behavioral therapy, physical therapy, and lifestyle changes.
Vata type of pain is unpredictable owing to the unpredictable nature of vata. Hence, we cannot find evidence of tissue or nerve damage many times. The diffuse nature of pain associated with fatigue, poor sleep and mood imbalances is definitely due to vata aggravation.
Chronic Pain
Definition: Pain persisting for more than three months, beyond the usual healing time.
Subcategories:
– Chronic Primary Pain: A disease in its own right (e.g., fibromyalgia).
– Chronic Secondary Pain: Linked to conditions like cancer, arthritis, or nerve damage.
Management: Involves a combination of pharmacological (painkillers, antidepressants) and non-pharmacological (exercise, psychotherapy) strategies.
Chronic pain is generally due to vata. It may also involve other doshas. Vatarakta, Amavata and Sandhigatavata which has involvement of vata run a chronic course and are associated with chronic and repeated pain patterns. Long standing pain shows the progression of pathology and progression of ‘vata aggravation’ and consequent tissue damage, immaterial of the pain being primary or secondary to some other disease.
Acute Pain
Definition: Short-term pain signalling an injury or illness, acting as a protective mechanism.
Characteristics: Sudden onset and resolves with appropriate treatment.
Examples: Surgical pain, burns, fractures.
Management: Often treated effectively with analgesics.
Just like chronic pain, acute pain also has a vata pattern unless proven otherwise. The nature of the pain and causative factors involved will be a pointer to decide the dosha or doshas involved in the causation of pain.
Psychogenic Pain
Definition: Pain influenced by psychological factors such as stress, anxiety, or depression.
Characteristics: Can occur in the absence of clear physical causes but is very real to the individual.
Examples: Stress-related headaches, somatoform disorders.
Management: Focus on addressing psychological contributors through therapy and holistic care.
Vata governs the functions of the mind. Vata imbalances has severe impact on the nervous system and mind. Similarly stress and anxiety causes vata aggravation and the converse is also true. Vata calming medicines and therapies are seen to calm stress related pains. Shirodhara with vata calming oils can get rid of stress headaches or stress related muscle pains and fatigue. Oil therapies done on the head and body will calm vata, induce good sleep, calm stress and anxiety and are effective remedies for many kinds of psychosomatic diseases and pains. A simple abhyanga can be a gamechanger in many of these conditions. Depression may have a kapha component and need to be addressed. Anger and aggression are known to cause pitta aggravation and can cause or trigger pains of inflammatory origin and nature.
Types of Pain: Additional Subcategories
Allodynia
Allodynia refers to pain caused by typically harmless stimuli, such as a gentle touch or light breeze. This pain is thought to arise due to heightened skin sensitivity (reducing the activation threshold of nociceptors) or structural changes in the nervous system caused by peripheral nerve damage. These changes may cause touch-sensitive fibres to reroute and send signals to spinal areas typically reserved for pain processing.
Hyperalgesia
Hyperalgesia occurs when a painful stimulus generates an exaggerated response. This heightened pain sensitivity may share mechanisms with allodynia, including nervous system sensitization, resulting in amplified and prolonged pain.
Referred Pain
Referred pain is perceived in a location different from its source. For example, pain from a heart attack may be felt in the neck, shoulders, or back. This phenomenon may occur when sensory nerve fibres from visceral organs and somatic tissues converge at the same spinal level, causing the brain to misinterpret the origin of the pain. Referred pain can be visceral (from internal organs) or somatic (from deep tissues such as muscles or joints).
These subcategories underscore the complexity of pain perception, emphasizing the importance of identifying pain mechanisms for effective diagnosis and management.
The pain due to heightened sensitivity or changes occurring in nervous system structure due to peripheral nerve damage as occurring in Allodynia or exaggerated pain response and prolonged pain as in hyperalgesia are vata patterns of pain presentation. Referral of pain is also caused by vata.
Measuring Pain: Tools and Indicators
Pain assessment is an essential aspect of medical care, enabling healthcare providers to gauge the severity, nature, and impact of pain on an individual’s life. Several standardized tools and observational methods are used to ensure accurate evaluation:
Pain Measurement Tools
Numerical Rating Scales (NRS):
This scale rates pain from 0 to 10, where 0 indicates no pain and 10 represents the worst imaginable pain. It is particularly useful for tracking pain progression or evaluating treatment effectiveness.
Verbal Descriptor Scale (VDS):
Designed for individuals who may struggle with numerical scales, such as children with cognitive impairments, older adults, autistic individuals, and those with dyslexia. This method involves descriptive questions to help classify the pain’s nature and intensity.
Faces Pain Scale:
This visual tool depicts a series of facial expressions ranging from distressed to content. It is commonly used with children and has also proven effective for autistic individuals.
Brief Pain Inventory (BPI):
A comprehensive written questionnaire that evaluates the impact of pain on mood, daily activities, sleep, and interpersonal relationships. It also identifies patterns by charting the pain timeline.
McGill Pain Questionnaire (MPQ):
The MPQ allows individuals to select words from 20 descriptive groups to articulate their pain. For example, group 6 includes terms like “tugging” and “wrenching,” while group 9 features “dull” and “aching.” This in-depth approach provides valuable insights into the pain’s characteristics.
Indicators of Pain in Cognitive Impairments
For individuals unable to verbally communicate their pain, such as those with cognitive impairments, specific behavioural and physiological signs can indicate distress:
– Restlessness
– Crying or vocal expressions like moaning and groaning
– Facial grimacing
– Resistance to care
– Decreased social engagement
– Increased wandering
– Changes in eating habits
– Sleep disturbances
Recognizing When to Seek Medical Care for Pain
Understanding when pain warrants medical attention is crucial for addressing potential health concerns. Seek professional help if your pain involves:
Severe Injuries or Trauma
Pain resulting from accidents or injuries, such as severe bleeding, broken bones, or head trauma, requires immediate evaluation to rule out significant physical damage.
Acute and Sharp Internal Pain
Sudden, intense internal pain could signal serious conditions like a ruptured appendix or bowel perforation, both of which demand urgent medical intervention.
Pain with Cardiac Symptoms
Discomfort in areas such as the chest, back, shoulders, neck, or jaw, particularly when paired with symptoms of a heart attack (e.g., chest pressure, shortness of breath, dizziness, cold sweats, nausea, or vomiting), should prompt immediate emergency care.
Pain Impacting Daily Life
Persistent pain that disrupts routine activities, including sleep, work, or hobbies, may require medical evaluation to identify the cause and develop an effective management plan.
Seeking timely medical attention can help address the underlying cause of pain and improve overall well-being.
Takeaway
Pain is a complex, multifaceted experience that serves as a vital signal of injury, illness, or dysfunction in the body. It can range from acute and easily identifiable to chronic and challenging to manage, impacting physical, emotional, and social well-being. Understanding the types and causes of pain is essential for effective diagnosis and treatment. While pain may be a natural and protective response, persistent or debilitating pain requires medical attention to prevent further complications and improve quality of life. Comprehensive management strategies, including medical interventions and lifestyle adjustments, are critical in addressing pain holistically.
In an upcoming discussion, we will explore the management of pain, focusing on practical approaches to alleviate discomfort and improve overall health and functionality.
Related Article – Pain Management
To sum up from Ayurveda Perspective
Since pain is the main feature of all the diseases, Ayurveda has also classified all diseases as being of a single type. Pain and disease are mentioned as being synonymous.
Pain is often due to Vata.
Pain may also be caused by pitta, kapha, ama or rakta.
Pain is also caused due to blocks occurring in different srotas of the body.
Pattern of pain and also its intensity depends on which dosha is involved in causation and trigger of pain.
Pain is a symptom of many systemic diseases and are generally caused by one or the other dosha / doshas.
Nature of pain helps in identifying the causal dosha. Example – toda and bheda are patterns of pain caused by vata, daha and davathu type of pains are caused by aggravated pitta etc.
Specific pain patterns are explained in some diseases which help in diagnosing those conditions. Example – ‘Vrischikadamshavata Vedana’ pain mimicking ‘scorpion sting’ in Amavata. ‘Akhu visha iva’ – spreading pain as if bitten by a rat – typical of vatarakta.
Pain is also tagged with tissues and organs, which help us in understanding the location of pain. Example – shirashula – indicates headache, dantashula – indicates tooth pain, janu shula – indicates pain in the knee joint etc.
The severity scale of pain is emphasized by words like maha, tivra etc.
In non-healing and non-responding pains, damage to Marma needs to be understood.
Usually neurological and degenerative pains are of vata nature. Inflammatory pains are of pitta nature. They can also be of vata-rakta or vata-pitta nature. Pain caused due to accumulation of fluids and pressure imparted on the nerves and tissues due to different growths and accumulations can be designated to be of kapha nature.
Treatment for pain should be dosha specific or disease specific. Diagnosis of pain and pain patterns in relation to dosha and dhatu is the key for successful management of pain.
