Running Head: PAIN MANAGEMENT 1

Non-Opioid Pain Management Program for Osteoarthritis

Student’s Name

Institutional Affiliation
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Non-Opioid Pain Management Program for Osteoarthritis

Background of Study

Chronic pain is one of the main symptoms in multiple conditions and is the major reason

why people seek medical attention. Chronic pain can be defined as persisting pain that hinders

tissue healing process or one that last at least for three to six months. Several causes of chronic

pain have been identified in previous studies including underlying/previous medical conditions,

neuropathic pain, and inflammation of injured tissues (McDonagh et al., 2020). Chronic pain

interferes with a person’s general functioning and quality of life. Additionally, the pain goes

beyond physical functioning to cause impairments in working memory, attention control,

problem solving, mental flexibility, and information processing speed. Notably, chronic pain has

been linked to increased anxiety and depression in patients. As a result, patients often seek to

relieve their pain using treatment methods that have the least side effect on them while providing

maximum benefits. Opioid is one of the pain management method that has been used in the past

to control and manage chronic pain in patients.

Osteoarthritis (OA) is a common joint disorder that is affecting many individuals in the

United States and across the world. Approximately, 3.9 million (13.6%) of Canadians aged 20

years and above have been diagnosed with osteoarthritis. Consequently, in 2016 to 2017, about

219,000 (8.7 per 1,000 persons per year) were newly diagnosed for osteoarthritis. The statistics

show that osteoarthritis is a major medical condition that is affecting people across different age

groups. Epidemiological principles can be used to describe and understand the distribution of

osteoarthritis in the population as well as examining the risk factors associated with its

occurrence and progression. For the purpose of epidemiological investigations, osteoarthritis can

be defined clinically, radiographically, or pathologically. Radiographic osteoarthritis has been

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used as a standard reference point for understanding the condition. As a result, several

approaches of defining radiographic diseases have been devised.

The overall scoring system that is used to grade osteoarthritis is divided into five distinct

levels starting from 0 to 4. This scale is used in defining osteoarthritis based on the different

scores that a patient can attain from diagnosis. For example, for values starting from grade 2 and

above, the diagnosis shows that there is presence of definite osteophytes in the patients.

Moreover, for values within the extreme grades, it is presumed that there is successive

appearance of joint space narrowing, cysts, sclerosis, and deformity. Previous literature has

identified osteoarthritis to be a critical contributor of pain in the joints among different

populations which is also considered as the most prevalent type of degenerative arthritis. In most

cases, osteoarthritis is characterized by formation of completely new bones within the floor of

the cartilage lesions, progressive disintegration of the articular cartilage, and likely to lead to

chronic disability for older patients.

Clinical manifestation of osteoarthritis has been classified ranging from mild to severe

and is likely to affects the joints around the hands as well as weight bearing joints such as the

spine, hips, knees, and feet. As a clinical syndrome, osteoarthritis is characterized by tenderness,

joint pains, crepitus, limitation of movements, variable degrees of inflammation, and occasional

effusion. This makes the etiology of osteoarthritis to be multifactorial. According to professional

literature, biochemical and morphological changes that take place during osteoarthritis

consequently result into malfunctioning, softened and ulcerated articular cartilages. Findings

from some studies have identified risk factors such as gender, age, repetitive trauma, body

weight, and genetic factors as the main players in the manifestation of osteoarthritis in patients.

In this study, a unique approach to research will be taken where it will address pain management
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in knee joints which is partially associated with osteoarthritis using Santhigram product line and

regimen.

In the United States and Canada, opioid drugs have been administered for pain

management for patients suffering from musclo-skeletal pain. However, opium is explained as a

ahiphena according to Ayurveda which can be used for pain management. Opioid drugs have a

higher efficiency for relieving patients from pain compared to any viable painkillers that are

readily available in the market. Yet, continuous use of opioid drugs has been noted to potentially

lead to addiction when used in the long-term (Krebs et al., 2018). After using opioid-based drugs

for a long duration, it deranges the body by altering noradrenaline, thus, manifesting the side

effects associated with its usage. At the same time, when the patient tries to withdraw the opioid-

based drug, they are likely to suffer withdrawal symptoms which can have a detrimental impact

on the general health of the patient. Some of the withdrawal symptoms that the patients are likely

to suffer include vomiting, muscular pain, and when used for a prolonged period, opioid-based

drugs can cause death.

Ayurveda is considered as a conventional, ancient Indian system of health science.

Literally, the name “Ayurveda” means ‘life knowledge.’ The system uses holistic approaches

that emphasize on balancing the mind, body, and spirit when treating and preventing diseases in

patients. The 5,000 years old system of health focuses on harmonizing the body through nature

using herbal remedies, diet, exercise, yoga, and meditation, changes in lifestyle, and

panchakarma. when using Ayurveda, both Vihara and Ahara are given much importance when

treating diseases. It is believed that food itself can cause and treat diseases at the same time.

Ayurveda proposes the use of daily and seasonal regimens which can be used in enhancing the

wellbeing of an individual.
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Some of the common non-opioid pain management strategies that are used in Ayurveda

include panchakarma and yoga. According to the explanation offered in Ayurveda,

panchakarma is understood as five procedures obtained from the words Pancha meaning five

and karma meaning procedure. Basically, the process involves five procedures which are used in

the treatment process. On the other hand, Ayurveda defines Yoga as a stress-relief and posture-

based physical fitness technique which is used for enhancing the mental and physical health of

people across all ages. In Ayurveda, the Yoga used is different from the traditional Yoga that has

been used which mainly focuses on meditation as an individual releases themselves from worldly

attachments. In Ayurveda, Yoga largely consists of the asanas, which is an additional concept

from the conventional methods used.

Rationale for the Study

Several studies have been conducted in the past which aim at understanding the relevance

of using non-opioid and opioid strategies in chronic pain management. Similarly, studies have

been conducted to investigate the influence that non-opioid treatment and intervention on

osteoarthritis. Through such studies, there are several benefits as well as downfalls that have

been identified through research. However, a limited literature exists on the use of Santhigram

Ayurvedic wellness program in the management of pain for osteoarthritic patients. As a result,

there exists a gap that needs to be filled in understanding the impact that Ayurveda in treating

osteoarthritis. The current research will add insight on the existing literature on the effectiveness

of Ayurveda in pain management. Also, the study takes a unique approach by focusing on

different aspects that are implemented when managing pain using Ayurveda. Thus, the research

will be beneficial for proposing the best intervention and strategies from Ayurveda that can be

used for mitigating pain for osteoarthritic patients. Furthermore, since the research undertakes a
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non-opioid based intervention, it is needed due to the increase in adverse impacts that opioid

interventions have on patients.

Aims of the Study

Generally, the aim of the study is to investigate the use of Ayurveda as a pain

management method for patients with joint pains. However, the individual aims of the study can

be grouped into:

1. Investigate the relevance of Panchakarma or Yoga in the management of osteoarthritic

pain

2. Investigate whether the prakriti of an individual plays any roe in pain management of

osteoarthritis

3. Investigate if prakriti is one of the predisposing effects of using Ayurveda in

osteoarthritic pain management

4. Investigate the relevance of Ayurvedic herbs in the management of osteoarthritic pain

5. Investigate the relevance of Dinacharya and Ritucharya mentioned in Ayurveda in the

management of osteoarthritis

6. Investigate the importance of Ahara and Vihara in the management of osteoarthritis

Literature Review

McDonagh et al. (2020) defines chronic pain as pain that persists past the normal period

for tissues healing and can las for at least three to six months. The diverse origins of pain add to

the complexity of chronic pain and previous studies have identified causes of pain including

underlying medical conditions, inflammation of injured tissues, as well as neuropathic pain

which is associated with a lesion of the somatosensory nervous system. The experience of pain

has been considered to be more than a biological output, and factors such as belief systems,
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emotional disposition, and attitude can determine how an individual experiences pain. According

to the findings of (McDonagh et al., 2020), the physical deficits linked to chronic pain can lead

to disabilities and a poor quality of life as well as increase medication costs. The Centers for

Disease Control and Prevention reported that about 20.4% of adults in the United States

experienced chronic pain the 2016 alone, which significantly contributed to population mortality

and morbidity while also adding to the economic burden on the healthcare system. Such adverse

impacts have been recognized to negatively influence the quality of care as well as the quality of

life for the patients.

As a result, most patients use different pain management strategies which focus on

relieving the patients from the extreme pain they experience. Pain management is a dynamic and

multifaceted process that is used for alleviating dysfunctions and pain in individuals. Before

seeking pain management strategies, it is advised that patients should try self-management which

is often considered as the initial stage for managing chronic pain. There are several

nonpharmacological and pharmacological interventions that can be used for managing and

treating chronic pains. Opioid prescription is one of the main pharmacological interventions that

is used for moderating pain during pain management. However, there has been a growing

concern for the misuse and appropriate use of opioid treatment for pain management which has

been linked to addiction and other related side effects. Increasing use of opioid prescription has

led to a rise in opposition of the intervention when alleviating pain for chronic pain patients.

According to Krebs et al. (2018), long-term opioid therapy has been used as a

standardized approach for managing chronic pain in patients despite lacking substantial and

high-quality data addressing the benefits and harms of this intervention. Rising opioid overdose

related deaths have raise questions relating to the risks associated with prescription of opioids for
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pain management. However, some studies that argued that using opioid for pain management in

osteoarthritis does not have a significant pain relief difference from using nonopioid

prescriptions. While nonopioid treatment was linked to greater pain intensity, opioid

prescriptions have been described to cause medication-related adverse symptoms which have

negative consequences on the users (Krebs et al., 2018). Majority of the observational studies

that have been conducted in the past have shown that long-term use of opioid therapy has been

associated with great functional impairment, poor pain outcome, and lower return to work rates.

This shows that despite opioid prescriptions being used for pain management in osteoarthritis,

they are connected to some negative effects that it has on the patients.

In the multimodal treatment of osteoarthritis using Ayurveda, Dinacharya is regarded as

the daily regimen administered to the patient while Ritucharya is the seasonal regimen. It is

perceived that change in an inevitable concept that we cannot ignore as human beings. This

includes changes in seasons as well as the environment in which we live in. The human body is

significantly influenced by changes in the environment which alter the functioning of the body.

As a result, we need to adopt to the changes since it is considered as a key to survival. Thus,

Ritucharya provides knowledge that is important in understanding the seasonal changes and how

we can overcome the challenges that individuals face. Both Dinacharya and Ritucharya dictate

the lifestyle of patients when undertaking treatment using Ayurvedic pain management. The

regimens are administered to ensure that individuals undertaking this type of treatment continue

to participate in self-care approaches in minimizing pain experiences.

According to Sharma, Yalgachin and Bhagat (2019) Ahara which means diet in

Ayurvedic pain management and Vihara which means lifestyles have been identified as the main

modalities for the management and prevention of diseases in Ayurveda. According to the
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provisions of Ayurveda, individuals need to consume food when considering several elements of

their stomachs. For instance, according to Ayurveda, one section of the human stomach should

be filled using solid foods, the second portion should be full of liquids whereas the third part

should empty at all times to allow for the proper action of Doshas (Sharma, Yalgachin & Bhagat,

2019). However, the consumption of this diet is not necessarily taking randomly. There are

factors according to Ahara that needs to be considered to determine the utility of the food

consumed, thus, bringing out the intended benefits to patients diagnosed with osteoarthritis.

Consequently, Ayurveda considers lifestyle as an important part of treating and managing pain in

patients suffering from chronic pain. Based on the treatment approaches adopted in this

traditional method, patients experiencing chronic pain are supposed to have adequate exposure to

sunrays (Atapa Sevana), bath in warm water (Ushnodaka Snana), and sleep on soft beds

(Mridushayya) (Sharma, Yalgachin & Bhagat, 2019). This shows that both Ahara and Vihara

play a vital role during pain management of patients diagnosed with osteoarthritis.

Lindler et al. (2020) postulates that Ayurvedic herbs have been used for a long time for

the management of osteoarthritic pain. Due to the increasing concerns for the costs and safety

associated with conventional arthritis therapies used in the treatment of osteoarthritis, there has

been growing need for the use of natural remedies in pain management. In the process, the

complexity of using herbal remedies for osteoarthritic have led to extensive investigation of the

effectiveness of herbal remedies. Ayurvedic herbs have been used in the past for pain

management for osteoarthritic patients and studies have indicated that it has a positive impact in

pain management. According to Lindler et al. (2020), Ayurvedic herbs have been found to be

efficient in managing pain for OA patients while at the same time having minimal adverse

impact on the patients. However, despite the positive impact, studies have revealed that using
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herbal remedies have some associated side effects such as gastrointestinal upsets, hepatoxicity,

fatigue, serum aminotransferase elevation, dizziness, cutaneous reactions, and toxicity of the

male reproductive system (Lindler et al., 2020). Thus, although using Ayurvedic herbs have been

found to be effective in managing pain for osteoarthritic patients, its use should be controlled to

avoid the adverse side effects that it can have on the users.

Apart from the aforementioned pain management strategies in Ayurveda, Yoga and

Panchakarma are also considered as some of the most effective treatment interventions in pain

management. In the study conducted by Rathod and Dattani (2017) which investigated the

effectiveness of using Yoga in pain management for osteoarthritic patients, the findings indicated

that Yoga as a strategy used in Ayurveda significantly contributed to the alleviation of pain and

improvement of other symptoms linked to the condition. According to the findings, it was

concluded that Yoga helped in reducing deformity, restricted movement, relieving fatigue,

stiffness, and pain. The Yoga implemented in pain management using Ayurveda uses eight basti

which help in improving the health outcome of the patient (Rathod & Dattani, 2017).

Implications from previous studies suggest that when Yoga is administered in the right method, it

can yield the best positive results in managing pain for osteoarthritic patients. This shows that

Yoga is a relevant approach that can be used as a pain management strategy in eliminating pain

and related adverse effects in osteoarthritis.

On the other hand, Panchakarma has been used in diverse therapeutic measures to

provide several benefits to patients undergoing pain management programs for osteoarthritis.

Mehta et al. (2021), using Panchakarma in pain management provide several therapeutic

benefits to patients including improved blood circulation, detoxification, pain relief, and spasm.

Thus, this strategy of pain management in Ayurveda has been found to have a high efficacy in
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facilitating the mitigation and alleviation of pain for osteoarthritic patients. As mentioned earlier,

there are multiple modes of actions that are classified as Panchakarma. One of the first line

treatment options for this intervention is Snehana (Oleation therapy). Abhyanga which is used as

one of the methods in Panchakarma involve the use of herbal oil massage in managing pain for

chronic pain patients. This method included as an element of Panchakarma has been found to

contained some therapeutic benefits such as increased blood circulation and enhancing the

elimination of waste products from the body. When Abhyanga is used for osteoarthritis, it

provides benefits such as improved joint movement and reduced joint swelling.

Another method under Panchakarma that is used in the management of pain is Janibasti.

In this intervention, lubrication is used to improve the local blood circulation around the knee

joint area, therefore, enhancing the mobility of the knee joint (Mehta et al., 2021). Other methods

used under this intervention include Sandhi Lepa and Sandipichu. Sandhi Lepa helps in reducing

stiffness as well as effusion around the knee joint area for osteoarthritic patients. In Sandipichu,

nourishing of the connective tissue and the bone around the knee joint area is done which

prevents inflammation and degeneration which are a major challenge that most osteoarthritic

patients experience. The efficacy of using Panchakarma for pain management has been

attributed to its rejuvenating, promotive, preventive, and prophylactic properties as it provides a

radical cure for the management of pain for osteoarthritic patients.

Nonopioid interventions and treatments have been preferred since they have minimal

adverse impacts that they have on the health of the patient. Specifically, Ayurveda has been used

for chronic pain management due to the additional benefits that it adds apart from alleviating

pain. Slowly, healthcare organizations and professions are shifting their focus from opioid

treatments to nonopioid treatments for pain management programs. Although Ayurveda has an
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Indian origin, it is extensively being adopted across the world, making it a common intervention

that is currently being used for pain management in osteoarthritis. This makes it an effective

approach for pain management for chronic pain. The proposed research focuses on the benefits

gained from Ayurveda as well as the different elements of Ayurveda that should be understood.

Methodology

Research Design

The proposed study will implement a mixed research design where both quantitative and

qualitative data will be collected. A mixed research design will be adopted since it will provide

effective outcomes regarding the variables that will be investigated in the current research. Both

qualitative and quantitative data will be collected concurrently within an estimated period of one

month.

1. Quantitative Approach

Population Characteristics

Females will be selected as the primary target population in this study since females have

a higher risk of being diagnosed with osteoarthritis as compared to males. Thus, females, with an

age range between 35 years and 50 years will be randomly picked across different locations in

the United States. This is because the findings of the research need to be diverse and not

confined within a specific locality/region. Additionally, for participants to be considered

qualified for inclusion in the study, they need to be married. These characteristics will aid in

picking the best participants to be included in the research.

Data Collection/Research Instrument

The research will use the survey approach for collecting data from the target population.

Questionnaires will be administered to the participants via email. Volunteers will be recruited
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and briefed on the rationale for the research before engagement (Fletcher, 2016). Those that will

chose to continue with the research will be emailed the questionnaire containing a total of 15

questions. They will then be given two weeks to respond to the questions and send the response

back after which the survey will be considered completed.

Ethical Considerations

Since the research will be dealing with human participants, there will be need for

upholding the privacy and confidentiality of the participants. Before participating in the study,

participants will be required to sign an informed consent which abides by the stipulated IRB and

APA guidelines. The informed consent will include a detailed explanation of the anticipated

risks, the procedures, and the benefits and implications of the study. Furthermore, the consent

form will indicate the rights of the participants to withdraw from the study at any given time they

deem appropriate. Also, the form will explain to the participants the data protection approaches

that will be used in the study.

2. Qualitative Approach

Search Strategy

A broad literature search will be conducted across credible sources for evidence-based

journals. Several medical and nursing databases and journals will be searched to identify studies

that will be incorporated in the research. Some of the databases that will be searched include

CIHANL, Google Scholar, PubMed, Elsevier, EMBASE, and Cochrane Library. From these

databases, retrospective studies, pharmacological studies, systematic literature reviews, case

reports, and any subject-related articles reporting on both opioid and non-opioid pain

management strategies will be selected. A combination of search words will be used in locating

the appropriate studies to include in the research. Some of the phrases that will be used in the
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search engines include “non opioid treatment for pain,” “non-narcotic pain relief,” “non opioid

therapy,” “controlling pain without medication,” and “pain management without drugs.”

Consequently, phrases relating to Ayurveda such as “Ayurveda therapy,” “Santhigram

Ayurvedic wellness program,” and “Ayurveda for pain management will be used in locating

more resources.

Inclusion and Exclusion Criteria

Since several studies are likely to be identified during the search of literature, a unique

inclusion and exclusion criteria will be adopted to eliminate studies that do not add value to the

current research. To qualify for inclusion, studies must be published between 2014 to present so

that the research reports on current and contemporary trends. Also, only peer-reviewed articles

and resources from reputable journals and publications such as government and organizational

website will be included in the study. Additionally, all studies included must at least report on

opioid pain management, non-opioid pain management, or Ayurveda approaches of pain

management. As a result, studies published before 2014, do not come from reputable journals

and websites, are not peer-reviewed, and do not report on the research topic will be excluded

from the research.

Data Analysis

For analysis, several data analysis methods will be implemented to ensure that the

findings and conclusion of the research and comprehensive enough. Analysis of Variance

(ANOVA) will be used in analyzing the quantitative data that will be collected from the survey.

For qualitative data, thematic analysis will be used in identifying the recurring themes that are

significant across the different studies that will be included in the research.

Conclusion
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The main objective of the proposed research is to investigate the effectiveness of using

Ayurveda and its associated interventions as an appropriate treatment for chronic pain, especially

for osteoarthritic patients. Diverse pain management treatments have been used in the past,

including both opioid and nonopioid treatments, yet there is need for more research to be

conducted on the effectiveness of most nonopioid interventions. The literature existing on the use

of Santhigram Ayurvedic wellness program is limited, prompting for the need of more research

on the area to be conducted. Also, opioid based treatment has been used for therapeutic pain

management for chronic pain although the adverse effects are many. From the diverse review of

literature that has been conducted, it can be concluded that Ayurveda is an effective approach for

pain management for osteoarthritis. The method uses several interventions such as Yoga,

Panchakarma, herbal remedies, Ahara, and Vihara. The Ayurvedic wellness program

encourages the patients to live a good lifestyle and watch their diet as part of managing pain, as

well as consistently engaging in exercise. The study will implement a mixed research design

where both quantitative and qualitative data will be collected concurrently. Quantitative data will

be collected through survey questionnaire while qualitative data will be gathered from previous

peer-reviewed studies. This data will be analyzed using ANOVA and thematic analysis.
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References

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Noorbaloochi, S. (2018). Effect of opioid vs nonopioid medications on pain-related

function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE

randomized clinical trial. Jama, 319(9), 872-882.

Lindler, B. N., Long, K. E., Taylor, N. A., & Lei, W. (2020). Use of herbal medications for

treatment of osteoarthritis and rheumatoid arthritis. Medicines, 7(11), 67.

McDonagh, M. S., Selph, S. S., Buckley, D. I., Holmes, R. S., Mauer, K., Ramirez, S., ... &

Chou, R. (2020). Nonopioid Pharmacologic Treatments for Chronic Pain [Internet].

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IN SANDHIVATA WSR TO KNEE ARTHRITIS. International Ayurvedic Medical

Journal,

Rathod, D., & Dattani, K. (2017). Effect of Yoga Basti in Sandhivata wsr to osteoarthritis of

knee joint. Int J Ayur Med, 8, 73-9.

Sharma, S., Yalgachin, G., & Bhagat, S. (2019). Pathya & Apathya in Sandhigata Vata: A Bird’s

Eye View. International Journal of Health Science and Research, 9(6), 309-314.