Abstract: Osteoarthritis commonly referred to as OA is the most common joint disease and one of the most widespread of all chronic conditions managed in General Practice. Whilst its prevalence increases with age, a significant number of adults experience symptoms of OA earlier in life. Most cases of OA are not extraordinary, yet the individual experiences of the affected can help a health practitioner to fully understand the impact of the diseases in the overall population.

This case report was triggered by a patient who was eager to tell her story and also reach out to the others suffering from OA- as to how a simple Ayurveda drug helped her to manage her long term pain effectively. As the importance of narrative medicine is increasingly being recognized to have a positive impact on patients and also helps clinicians to strengthen their practices, a summary of this case highlighting the use of Trailokya Vijaya Vati was made.

Introduction

Osteoarthritis occurs when the cartilage that cushions the ends of our bones in our joints gradually deteriorates.

OA has often been referred to as a “wear and tear” disease. But besides the breakdown of cartilage, OA affects the entire joint. It causes changes in the bone and deterioration of the connective tissues that hold the joint together and attach muscle to bone. It also causes inflammation of joints.  

The pain and limited mobility in OA occurs as a result of destructed cartilages. Left bare of their padding, bones rub painfully against each other – particularly in the hands, spine, knees and hip. 

For years, there have been very limited treatment options available for OA. The treatments include pain management, steroidal injections, physiotherapy and surgery as a last resort. Out of these pain management is the best sought treatment as PAIN itself is a major symptom in this condition.

 Case Report

Patient description

A 48 yr old female was presented with complaints of pain in both knees for 8 years, since the last 3 months the pain had aggravated from moderate to severe to highly intolerable which was leading to increased anxiety and also restless sleep. The pain would increase on an activity like walking or climbing up the stairs and would be relieved by rest. 

Case history

The patient has no history of fall or trauma. She walked without a walking aid but requires support when there is a peak in pain. 

She has been on analgesics since when she doesn’t exactly remember, taking periodic physiotherapy sessions as advised by the doctor. She took Intra-articular injections a couple of times but the relief was temporary (6-8 months).  She was recently advised bilateral knee replacement by her doctor and she decided to give it a last go through an alternate option! The pain was her only concern.

Recently the severity of the pain was so intense that it was impossible for her to use stairs and she is sedentary most of the time. 

Physical Examination

• BMI – 30 (Obese)
• Gait – Antalgic
• Fell – Mild crepitus is felt upon moving both knee joints.
• ROM – Restricted and Painful
• Blood Results – ESR and CRP raised

Treatment plan

Medicines to be used – Trailokya Vijaya Vati. After a thorough clinical examination, she was prescribed with Trilokaya Vijaya Vati with one tablet two times a day for a period of seven days initially.

Expected outcome of the treatment plan

The expected outcome was to relieve her of the pain and that the patient should get a sound sleep. 

Actual outcome

Within a week, she began to notice a distant difference in her pain.

Discussion

The treatment was focused on effective pain management as that was the only factor troubling the patient at this given point. The patient was not ready to undergo surgery thou she was counseled that she might need one over a period of 5 years or so. 

She was also prescribed other drugs effective on OA and mild exercises. Trailokya Vijaya Vati not only helped the patient with pain but also gave her a sound night’s sleep. The patient also reported being less cranky throughout the day. 

Conclusion

For years, treatments for OA have majorly being planned on physiotherapy, steroidal injections, and joint replacement surgery. But as pain management is now emerging as an individual branch, there has been an increased focus on pain management in the treatment of OA. 

Unlike Rheumatoid Arthritis, OA hasn’t had any major breakthroughs that have dramatically improved its medical treatment. Drug development for OA has been slow because the disease itself follows a slow process. 

Dr. Anirudha  Mohite, Consultant Ayurvedacharya

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• International Book of Records – Women’s Health Awareness Camp 2021 - February 23, 2021
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Abstract: This case study assesses the use of Trailokya Vijaya Vati highlighting cannabis in the pain treatment during periods (menstrual pain/cramps) medically termed as Dysmenorrhoea. 

Menstrual cramps or period pain is caused largely by hormones called prostaglandins which are released from the lining of the uterus, the hormone also causes inflammation which aggravates the pain. Recent studies suggest that the female reproductive system has cannabinoid receptors and hence cannabis can prove effective in the treatment of menstrual pains, also that Cannabis has anti-inflammatory properties.

This is a case of a 21 yr old female with a known case of polycystic ovarian syndrome (PCOS) with bilateral renal calculus and how Trailokya Vijaya Vati helped her assuage the pain in a matter of just 7 days of treatment.

Ayurveda Perspective 

According to Ayurveda, during the menstrual cycle, the APANA VAYU which is connected to the VATA DOSHA and is responsible for the downward flow of the energy and mass to the pelvis aggressively works to cleanse uterine lining.  The increased VATA DOSHA hence causes SHOOLA (RAJASHOOLA)

Vijaya is having Tikta Rasa Ushna Virya it has laghu Tiksnha Guna and Katu Vipaka. Hence it pacifies the Vata Dosha and helps in the treatment of VATAJA SHOOLA. Ayurveda Rasatarangini has attributed 29 pharmacological indications for Vijaya in which RAJASHULA is included.

 Introduction

Cannabis is believed to have therapeutic uses for a variety of illnesses, including but not limited to chronic pain, headache, epilepsy, symptoms of multiple sclerosis, and gastrointestinal disorders. 
The science around cannabis and its ability to relieve menstrual pain are scarce but strongly promoted. 

The diversity of approaches for the consumption and use of cannabis might help increase its popularity. Ideally, as more people use cannabis for period pain, researchers will produce more science about the risks and benefits in hopes that we learn all about the amazing herb. And the possibility cannot be denied that Cannabis might be the only preferred drug/herb available worldwide for Dysmenorrhea in the mere future. 

Case Report

Patient description

A twenty-one-year-old girl was a known case of polycystic ovarian syndrome(PCOS) with bilateral renal calculus. 

Case history

She was also suffering from dysmenorrhea (excessive painful menses) and metrorrhagia (excessive bleeding).  Adding to all these troubles were her mood swings and anxiety episodes, making her health a subject of concern to her parents and directly impacting her studies. Her menstrual cycle was extending up to seven days a month with an entire week going in this pain every month. 

Sonography results

Her whole abdomen ultrasonography revealed hemorrhagic cysts in her bilateral ovaries. 

Treatment plan/ Medicines to be used – Trailokya Vijaya Vati

To overcome the pain and get the cysts removed naturally, she started her treatment at ‘The Ayurvedic Thyroid Clinic’ Pune, in the month of August 2020.  To beat her pain issue, she was kept on ‘TrilokayaVijayaVati’ in the month of October 2020, with a dose of one tablet two times a day. 

Expected outcome of the treatment plan

It was expected not immediately but gradually that the patient would find relief with her pain and also that she should be able to carry out her daily activity with some ease.

Actual outcome

Within a week of administering her ‘TrilokayaVijayaVati’, she started to feel relieved in terms of her menstrual cramps and pain like never before. Although the patient is still on the medication for PCOS, her immediate concern was this menstrual pain unbearable for her. The use of ayurvedic pain killer in the form of the classical formulation of ‘TrilokayaVijayaVati’ her pain reduced considerably, and she was motivated to continue with further treatment as her faith strengthened in the process. She believed firmly with the evidence as what ‘TrilokayaVijataVati’ did for her, even Meftal-Spas could not do.

Discussion

The treatment was decided on the basis of the predominance of VATA DOSHA involvement and pain management. The Vijaya as mentioned has anti-inflammatory properties and is also an effective VATAGHNA herb. It helps in reducing the pain gradually but effectively.

Conclusion

Cannabis is believed to have therapeutic uses for illnesses and pains, including menstrual discomfort. Researches are still scarce, but some studies show the effectiveness of cannabis on the relief of menstrual pain. 

Dr. Vikrant Patil, Consultant Ayurvedacharya

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• International Book of Records – Women’s Health Awareness Camp 2021 - February 23, 2021
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Abstract: Not everyone with cancer has cancer pain, but some do. If one has cancer that has spread or reoccurred, the chances of having pain are higher. Cancer-related pain is quite underrated and most of the times un discussed – most of the times the doctors do not ask about the pain or offer any pain management treatment, sometimes as the patients avoid the issue as they do not want to BOTHER their doctor, due to fear of addiction and also due to fear of side effects. 

Cancer pain takes many forms. It can be dull, achy, sharp, or burning. It can be constant, intermittent, mild, moderate, or severe. Most cancer-related pains are manageable and controlling pain is an essential part of cancer treatment. But unfortunately, the medicines available over the counter and on prescription have a long list of side effects such as sleepiness, constipation, gastritis, etc 

This is a case of a 23 yr old female from a village near Kurukshetra, Haryana. She was suffering from metastatic carcinoma of the spinal cord and reported acute pain for the last few weeks. Popping up painkillers was her only solace when the severity of pain was going unbearable. Adding more woes to the existing one, synthetic pain killers’ side effects were severe gastritis and GERD. This girl was started on the medication of ‘Trilokya Vijaya Vati’; a classical Ayurvedic formulation mentioned in the ancient Ayurvedic Samhitas. 

Ayurveda Perspective 

Vijaya in Trailokya Vijaya Vati is an effective compound that helps in pain management and also helps to elevate mood. Both these properties help in the management of cancer patients during their treatment.

Introduction

Metastatic Spinal Cord Compression is a rare but rather well-recognized complication of cancer. Metastases to the spine occur in 3-5 % of all patients who have cancer and are more common in patients with breast and lung cancer, in whom the incident is approximately 19-20%.

MSCC is usually caused by the collapse or compression of a vertebral body that contains metastatic diseases, but can also be caused by direct tumor extension in the vertebral column. The primary complaints in such patients have prolonged back pain and limb weakness. As the disease progresses the patient has to be well evaluated and given the best treatment option amongst Surgery or Radiotherapy. In patients with no neurological function for more than 48 hours symptom control or palliative care treatment are the preferred options. 

Patients undergoing cancer treatment have extreme levels of pain throughout their fight with cancer. In such conditions, alternate medicines are often sought to have incredible effects in pain relief, mental stability, and other allied complications without giving the sufferer unnecessary side effects like gastritis, nausea, vomiting, etc.

Case Report

Patient description

This is a case of a 23 yr old female from a village near Kurukshetra, Haryana. She was suffering from metastatic carcinoma of the spinal cord and reported acute pain for the last few weeks. Popping up painkillers was her only solace when the severity of pain was going unbearable. Adding more woes to the existing one, synthetic pain killers’ side effects were severe gastritis and GERD. This girl was started on the medication of ‘Trilokya Vijaya Vati’; a classical Ayurvedic formulation mentioned in the ancient Ayurvedic Samhitas.

Case history

The patient underwent radiation therapy for her MSCC and later started with her chemotherapy for her breast cancer. She had restriction of movements of the left arm and complained of GERD /  indigestion and insomnia due to pain and burning sensation throughout the body. She, as her last resort, approached the clinic in search of a better option other than her existing medicines for her complaints.

Treatment plan/ Medicines to be used – 

 She was given orally one tablet three times a day continuously for five days and the other ‘Panchkarma’ modalities. 

Expected outcome of the treatment plan

It was expected that gradually the patient would be relieved of her pain and sleep better.

Actual outcome

The pain-relieving effects of ‘Vijaya’ or ‘Bhanga’ were quite remarkable in this case, and she was relieved much from the pain within the first week of ‘TrilokyaVijayaVati’s oral administration. She started to lift her left arm without much restriction now, which she could not do earlier without any external support or support from her second arm. The patient started to move her forearm and fingers freely, almost in a state of muscle wasting due to restricted movement because of chronic pain.

Her sleep quality improved significantly, and she could digest her meals due to improved sleep quality in the nights. Most importantly, she started to smile, which she almost forgot due to this perennial pain in her arm.

Discussion

The treatment was planned to effectively treat the patient for pain and indigestion and sleep.

Conclusion

This case study shows that Trailokya Vijaya Vati has effective results in the management of Cancer-related pain.

Cancer as a disease not only affects the quantity of life but also affects the quality of life! In such a condition effective pain management and mental stability of the patient plays an important role in the overall recovery of the sufferer. Medical cannabis promises the expected result in minimal dosage and within a short period of time without any remarkable side effects.

Case study shared by Dr. Bhupesh Vashisht, Consultant Ayuvedacharya

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Latest posts by hempstreet (see all)

• International Book of Records – Women’s Health Awareness Camp 2021 - February 23, 2021
• Trailokya Vijaya Vati: Providing relief in multiple joint pains - February 22, 2021
• How Ayurveda can help to manage long-term pain in Osteoarthritis? - February 15, 2021