Pain and Fear in the Ayurvedic Perspective

"No Fear, No Hate, No Pain" was one of the Eurythmics songs, wasn't it. Fear and pain obviously are in large part related to the pains we go through in life and although that might sound true, we still tend to have the need to dissect and differentiate the pain and the current moment to then move on to proper treatment

Let us discuss pain as it is defined by the International Association for the Study of Pain - An unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential damage.

While that definition might probably be a bit confusing, the definition itself is expanded (see the direct link below). It is important to note out that pain is always an experience of an individual, it depends on psychological, biological, and social factors. Also, the pain needs to be different from nociception which is the process by which unpleasant stimulation is communicated through the peripheral and central nervous system. While nociception often participates in the process of feeling the pain, sometimes we can feel the pain without any stimuli and vice versa.

The Ayurvedic View of Pain

Pain is mostly discussed in Ayurveda through vitiated Vata dosha. In many cases, Vata-derived pain can also cause accumulation of Pitta and Kapha and eventually cause a myriad of different symptoms. So, to paraphrase, pain always carries a component of Vata aggravation, but it can also eventually be a Pitta or Kapha-related disorder as Vata imbalance might reflect on aggravation of other doshas.

Similarly the modern medicine, the pain can and should be classified according to the site, duration, severity, nature of the pain, and also the doshic predominance in pain.

For example, in the description we should differentiate between the pricking pain (toda), splitting pain (beda), piercing type pain (vyadha), binding pain (veshtana), severe pain (maharuja) or pain during joint movements (prasaraanaakunchanavedana).

As readers might have already derived, more colicky, irregular, pricking types of pains are mainly Vata doshic. Burning and sharp pains usually have a Pitta component as well. Heavy and often dull pains might be associated with Kapha dosha.

Ayurveda also describes the sensation or feeling of severe sorrows related to pain as vedana (in Sanskrit, it carries the meaning of pain, agony, but also feeling, knowledge, sensation). Severe pains are described as ruja (in Sanskrit, pain, fracture, breaking, sickness). Shula means colic and this term is specified under 8 subterms to describe the pain.

Fear in Relation to Pain

Interestingly, Vata dosha is not only the main mediator of pain but also of fear and anxiety. In understanding this doshic accumulation, we are able to resolve the underlying current between the intertwining aspects of pain and fear.

Travis and Wallace published in 2015 (the link to the article) the neural model of the dosha types:

While strongly suggesting to read the article, it is important to note that the limbic system is responsible for the fear-responses, appetite, and spatial awareness. While the limbic system from the perspective of modern psychiatry and neurology is a very vague term, we can still differentiate between the different areas of the limbic system and their functions. Loosely translating, the amygdala of a Vata-person is very active, providing a rich spectrum of emotions, while in accumulation, it can be a source of fear and even developed phobias. The hippocampus, being responsible for anger and spatial awareness, is more related to a Pitta person. While giving powerful dynamics and a good spatial vision, overactivity can lead to irritability and angry. In Kapha person, possibly the insula is more active which ties bodily states to emotions. In balance, it creates happiness and calmness, but overactivity is possibly related to seeking sensual pleasures and overeating.

Going further, it is known that the amygdala is an important brain center for the emotional-affective dimension of pain and pain modulation. In case we have an opinion of the amygdala being more active in a Vata person, we also become aware that this energy communicates to us the emotional dimension of pain and the way we modulate the pain over time. One of the emotional responses to pain is the fear response. Interestingly, in a 2010 article (link here) it is pointed out how the view we look at the pain, especially the fear response, might lead us into the cycles of chronic pains.

Fear Management Options

While directly making any specific recommendations would be unethical because we should assess the severity, type, and general condition of fear, it needs to be addressed that the fear response or fear-avoidance response can be soothed out with the activities, therapies, and behaviors that balance Vata.

This means introducing regular qualities to daily life, possibly keeping a fear (and pain) diary, 8 hours of sleep or more. Also, introducing sweet, soft, and warm qualities in terms of nutrition. Improving psychological aspects such as possible insecurity and shyness that comes from aggravated Vata dosha.

Oleation therapies such as Abhyanga might soothe the underlying anxiety and the tense body while allowing enough relaxation to process through fear. Trying out different types of emotional healing practices (breath therapy, walking meditation, color therapy, etc)

Also, oftentimes we don't realize that the fear might be related to hidden, chronic, or subtle pains so taking a proactive stance in managing pain would be the way to go in these cases.

Stay tuned for Pain Management in Ayurveda :)

References

1. International Association for the Study of Pain

https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=10475

2. Amarprakash Dwivedi & Pradny, Chaugue &in, O. (2018). Pain Management Through Ayurveda

https://www.researchgate.net/publication/331672467_PAIN_MANAGEMENT_THROUGH_AYURVEDA_A

3. S, Mahesh & Wele, Asmita & Patgiri, B & Pórszász, Róbert. (2019). REVIEW OF PAIN: AN AYURVEDIC APPROACH. International Research Journal of Pharmacy. 10. 20-34. 10.7897/2230-8407.1009256.

https://www.researchgate.net/publication/336375394_REVIEW_OF_PAIN_AN_AYURVEDIC_APPROACH

4. Pain Management In Ayurveda Dr. Manisha Rani, Dr. Ankur Sinha, Dr Anil Kumar Dev

5. Travis, F. T., & Wallace, R. K. (2015). Dosha brain-types: A neural model of individual differences. Journal of Ayurveda and integrative medicine, 6(4), 280–285. https://doi.org/10.4103/0975-9476.172385

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719489/

6. Turk, D. C., & Wilson, H. D. (2010). Fear of pain as a prognostic factor in chronic pain: conceptual models, assessment, and treatment implications. Current pain and headache reports, 14(2), 88–95. https://doi.org/10.1007/s11916-010-0094-x

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872063/

7. Neugebauer V. Amygdala pain mechanisms. Handb Exp Pharmacol. 2015;227:261-84. doi: 10.1007/978-3-662-46450-2_13. PMID: 25846623; PMCID: PMC4701385

https://pubmed.ncbi.nlm.nih.gov/25846623/