Effectiveness of Snehana and Swedana in a Case of Unspecified Joint Pain: An Ayurvedic Case Report

doi:10.21203/rs.3.rs-7230653/v1

Musculoskeletal pain is a common ailment with a significant impact on quality of life. Ayurvedic medicine offers potential therapeutic interventions for managing such conditions. This case report explores the efficacy of Snehana (oleation) and Swedana (sudation) therapies, integral components of Ayurvedic treatment, in alleviating joint pain and improving functional outcomes in a patient with shoulder and knee pain.

A patient presented with persistent shoulder and knee pain. Following a diagnosis at a primary health center of unspecific pain and conservative management with analgesics, the patient sought Ayurvedic treatment at our hospital. The patient underwent a one-week regimen of Snehana and Swedana, along with oral Ayurvedic medications including Trayodashang Guggul, Dashmool Kwatha and Sunthi. Pain intensity was assessed using the Visual Analog Scale before and after the intervention.

Following one week of treatment, a patient with shoulder and knee pain demonstrated reduced pain, with Visual Analog Scale scores decreasing from 6-7/10 to 2/10, and further to 1/10 at follow-up. Concurrently, the range of motion in multiple planes improved, indicating enhanced joint mobility.

This case suggests that Snehana and Swedana therapies, when administered without major Panchakarma procedures or modern medications, may offer effective pain relief and improved function in patients with musculoskeletal pain. While limited by its single-case design, this report highlights the potential of Ayurvedic interventions and supports the need for randomized clinical trials with larger sample sizes to validate these findings and explore the underlying mechanisms of action.

Anesthesiology & Pain Medicine

Sports Medicine and Kinesiology

Ayurveda

Vatavyadhi

Shoulder pain

Knee pain

Snehana

Swedana

Case report

Musculoskeletal pain, including conditions such as shoulder and knee joint pain, poses a significant global health challenge, impacting individual quality of life and placing a considerable burden on healthcare systems [1]. Given its intricate architecture and wide range of motion, the shoulder joint is particularly susceptible to functional overload and instability, predisposing it to pain and dysfunction [2]. As a result, shoulder pain is a prevalent ailment in primary care settings, affecting a notable segment of the population and leading to functional impairments and absenteeism from work [3]. Unspecified shoulder and knee joint pain are typically classified under ICD-10 codes M25.51 and M25.55, respectively, for cases lacking a precise etiological diagnosis. These codes facilitate the documentation of symptomatic presentations and the initiation of appropriate conservative management strategies [4]. Epidemiological studies indicate a self-reported shoulder pain prevalence ranging from 16% to 26%, with approximately 1% of adults annually consulting general practitioners for new cases [5].

Ayurvedic literature defines different kinds of pain based on the Doshas involved, and it provides a comprehensive approach that seeks to address the root cause of the disease, rather than merely alleviating symptoms. In the context of 'Nanatmaja Vatavyadhhi' (diseases caused by the imbalance of Vata dosha), Acharya Charaka, a renowned figure in Ayurveda, has described various symptoms that arise due to the aggravation or vitiation of Vata. Essentially, Acharya Charaka has detailed the symptoms that occur when Vata Dosha becomes imbalanced, according to the Ayurvedic concept of 'Nanatmaja Vatavyadhhi.'

Ayurvedic treatments for ‘Vatavydhi’ encompass 'Snehana, Swedana, Mridu Sodhana, Sneha Basti,' and other modalities tailored to the patient's unique condition [6]. Snehana and Swedana, frequently regarded as preparatory procedures for Panchakarma, possess intrinsic therapeutic value. They can effectively pacify aggravated doshas.

While numerous case reports detail the use of Ayurvedic medications in managing musculoskeletal disorders, they commonly describe intricate protocols involving various Panchakarma procedures like Basti over extended durations, often portraying Snehana-Swedana as merely preparatory. However, this study challenges this notion. Classical Ayurvedic literature does not portray Snehana and Swedana as subordinate therapies; instead, it emphasizes that suboptimal preparation with these procedures may negatively impact the efficacy of subsequent primary interventions. This case is unique because of the complete resolution of symptoms achieved solely through Snehana and Swedana, highlighting the potential of Ayurvedic interventions in managing musculoskeletal pain and enhancing patient outcomes.

This report presents a case of a 52-year-old farmer experiencing unspecified shoulder and knee joint pain, who was treated using an Ayurvedic approach that exclusively employed Snehana and Swedana without modern medicines. Unmedicated Sesame oil was used for local massage and routine Dashmool Kwatha Nadi Swedana was utilized. This case report is prepared as per CARE guidelines.

A 52-year-old male farmer presented to the outpatient department of Panchakarma on April 1, 2025, reporting pain in both shoulder and knee joints for a duration of 3 months. The patient characterized the pain as persistent and throbbing, with movement exacerbating discomfort. On a numerical rating scale ranging from 0 to 10, the patient rated the intensity of knee joint pain as 7 and shoulder joint pain as 6. Furthermore, the patient reported experiencing fatigue following physical exertion and an inability to sustain walking for more than 10 minutes over the preceding1 week, which consequently impacted his occupational activities.

The patient resides in a rural setting and is employed as a farm laborer. His household comprises four individuals, including his spouse, a son, and a daughter. As the head of the family, he serves as the principal income provider.

Initially, the patient experienced shoulder and knee joint pain for a period of 3 years. Seeking medical intervention, he consulted with a local practitioner at a government Primary Health Care center and received a week-long course of medication, which provided transient relief lasting approximately 15-20 days. The consultant recommended X-ray imaging of both joints and advised the patient to use analgesic medication, as the investigations did not reveal any significant abnormalities. Additionally, he was advised to rest and limit physical activities; however, the patient's socio-economic circumstances rendered complete rest unattainable. (figure 1)

Diagnostic Assessment

His physical examination revealed a slender built, middle-aged person with a height of 5 feet 3 inches and body weight of 52 kg and a stable constitution. He was conscious oriented and could walk a few distance comfortably. He experienced pain in the movement of the shoulder joint at the extreme range, and tenderness on palpation around knee joints. His reflexes were normal and vital parameters were normal.

Visual inspection of both shoulder joints revealed no asymmetry, atrophy, deformity, ecchymosis, swelling, wounds, scarring, or erythema of the overlying skin. Palpation of the shoulder joints elicited tenderness bilaterally.

Radiographic evaluation (X-rays of shoulder and knee joints in 2022, exact date or report unavailable) of the shoulder and knee joints typically assesses bony structures and joint spaces. It included intact humerus, clavicle, and scapula in the shoulder, and intact femur, tibia, and fibula in the knee, with proper alignment and absence of fractures, erosions, or osteophytes. Bone density was within normal limits. Joint spaces, such as the glenohumeral and acromioclavicular joints in the shoulder, and the femorotibial and patellofemoral joints in the knee, were well-maintained, suggesting preserved cartilage

Ayurvedic examination revealed “Vata- Pitta Prakruti” (a constitution characterized by a dominance of the Vata and Pitta Doshas) (biological energies), with moderate “Agni” (healthy digestive fire) and “Kostha” was “Kroora”(slow bowel movements). Patient had “Ruksha Twacha” (dry skin), with “Avara Bala” (lower vitality).

Based on Ayurvedic principles, the patient's symptoms, including pain, throbbing, and increased discomfort with movement, were indicative of a ‘Vata Vyadhi’ diagnosis, suggesting an imbalance in Vata Dosha. His medical history was unremarkable for musculoskeletal disorders, nervous system disorders, trauma, or allergies. The patient reported a 15-year history of tobacco chewing but no other addictions. Consequently, the diagnosis was ‘Vatavyadhi with Niram Avastha,’ given the absence of ‘Ama’.

Therapeutic Intervention

Following a comprehensive assessment, a tailored Ayurvedic intervention was formulated, incorporating Snehana and Swedana therapies to address the patient's specific condition. The treatment plan consisted of the following components:

Local Abhyanga: The affected joints, namely the shoulder and knee joints, were subjected to Abhyanga (massage) using unmedicated sesame oil.
Swedana - Nadi Sweda: Following the Abhyanga, Nadi Sweda was administered using Dashmool Kwatha for 10 -15 minutes for each affected site.
Trayodashang Guggulu - 250 mg three times.
Dashmool Kwatha - 10 ml two times with equal water.
Sunthi Lepa once at night.
Duration of the treatment - 8 days.
The patient provided written consent for the Snehana-Swedana procedure.

The treatment protocol was meticulously implemented over a period of 8 days, with daily sessions of Abhyanga and Nadi Sweda, each lasting approximately 60 minutes. The treatment was administered at the inpatient department of the Panchakarma clinic. The therapeutic approach remained consistent, and no adverse drug reactions were reported during the treatment period. The Ayurvedic medicines, including Trayodashang Guggul and Sunthi Lepa, were compounded in the affiliated pharmacy, while Dashmool Kwatha was freshly prepared for each administration. The raw materials for Dashmool Kwatha were sourced from the same pharmacy. All preparations adhered to Standard Operating Procedures.

The patient underwent the treatment regimen for a duration of 8 days, during which notable improvements were observed in his condition. The outcome measures have been tabulated below (Table 1)

Table 1: Parameters and Assessments

VAS	Before Treatment		After Treatment		follow-up
	Left	Right	Left	Right
Shoulder Joint Pain	6	6	2	2	1
Knee Joint Pain	7	7	2	2	1
Flexion	0-97	0-97	0-150	0-150	-
Extension	0-44	0-44	0-60	0-60	-
Abduction	0-77	0-77	0-140	0-140	-
Adduction	0-30	0-30	0-50	0-50	-
Internal rotation	0-74	0-74	0-90	0-90	-
External rotation	0-30	0-30	0-80	0-80	-

Prior to treatment, the patient reported a pain intensity of 6/10 in both shoulder joints and 7/10 in both knee joints, as measured by the Visual Analog Scale. Following one week of Ayurvedic treatment consisting of Snehana and Swedana, the patient's reported pain intensity decreased to 2/10 in both shoulder and knee joints. At follow-up, the patient reported a further decrease in pain intensity to 1/10 in both shoulder and knee joints. The range of motion in the shoulder joints was within normal limits for adduction before and after treatment. Pre-treatment measurements for flexion (0-97 degrees), extension (0-44 degrees), abduction (0-77 degrees), and internal/external rotation (0-74 and 0-30 degrees, respectively) improved at follow-up to flexion (0-150 degrees), extension (0-60 degrees), abduction (0-140 degrees), adduction (0-50 degrees) and internal/external rotation (0-90 and 0-80 degrees respectively).

This case underscores the potential efficacy of Ayurvedic interventions, specifically Snehana and Swedana, in the management of musculoskeletal pain and the improvement of patient outcomes. Snehana and Swedana therapies, integral components of Ayurvedic treatment modalities, are traditionally employed to alleviate pain, reduce stiffness, and enhance mobility in affected joints [7].

Within the Ayurvedic medical community, Snehana and Swedana are frequently characterized as preparatory interventions rather than primary therapeutic modalities. Current case report shows that the above procedures also can be employed independently to provide benefit to the patient [8]. Further studies could also focus on shoulder pain with exercise and manual therapies to advance self-efficacy and reduce medical intervention in patients.

This case report offers a key takeaway message: even in certain conditions, Snehana-Swedana, combined with routine Ayurvedic medicines, can provide significant relief in joint pain and associated symptoms, even without major Panchakarma procedures like Basti, Virechana, or others. Trayodashang Guggul, a polyherbal Ayurvedic medicine, is beneficial for joint pain, muscle pain, inflammation, and neurological conditions. The components in Dashamoola Quatha are beneficial in pain and inflammation [9]. Sunthi is also known to have anti-inflammatory and analgesic properties, which can help alleviate pain and discomfort associated with musculoskeletal conditions. The current study also highlights the importance of integrated approach of using multiple medicines and treatment modalities to provide relief to the patients [10].

This case report is subject to certain limitations. Notably, there is a lack of objective criteria or pre- and post-treatment investigative reports to substantiate structural modifications. The one-week treatment duration may be insufficient to conclusively demonstrate effectiveness. Furthermore, the single-case study design inherently presents limitations. Future research endeavors could benefit from the incorporation of objective outcome measures, extended treatment durations, and larger sample sizes to enhance the validity and generalizability of findings. The study also showed the importance of non-pharmacological treatments in musculoskeletal disease.

The substantial reduction observed in the Visual Analog Scale scores for both shoulder and knee joint pain following the described treatment indicates effective pain management and improved capacity for the patient to engage in daily activities without significant discomfort. The patient has provided documented feedback, both written and via video, detailing their experience with the treatment.

This case report suggests that Ayurvedic oil massage and Swedana, when administered without primary Panchakarma procedures or modern medications, may offer effective pain relief. However, the generalizability of this finding is limited due to its basis on a single case. As noted in the discussion, the absence of objective criteria, such as pre- and post-treatment X-rays or other scans, to substantiate structural modifications represents a limitation. To rigorously evaluate the efficacy of Snehana-Swedana in managing joint pain, future research should include randomized clinical trials with robust sample sizes and follow-up periods. Additionally, advanced diagnostic investigations, such as nerve conduction studies, are crucial to substantiate these claims. Such investigations could offer additional options to reduce the need for pharmacological interventions.

Patient perspective

I, ABC, am the resident of XYZ. I was suffering from severe pain in my shoulder and knee joint. I consulted at DEF hospital on April 1, 2025, where I received Ayurvedic Massage and Swedana therapy. After just one week of treatment, my pain was relieved markedly, and I can walk and move without pain now”

Acknowledgements

We acknowledge Panchakarma staff, nursing staff and the patient for their cooperation.

Ethics

Human subjects Consent was obtained by participants in this study for treatment and publishing this case report in scientific journals. Given the retrospective nature of this case report, formal approval from the Institutional Ethics Committee was not deemed necessary. The data presented herein was collected as part of routine clinical practice, and all patient identifiers have been removed to ensure confidentiality. The authors adhered to the ethical principles outlined in the Declaration of Helsinki, prioritizing patient welfare and respecting their autonomy throughout the study. A patient perspective through video has been obtained and consent has been obtained for its publication in scientific journals or social media for the purpose of promotion.

Conflicts of interest

In compliance with the Committee of Medical Journal Editors uniform disclosure form, all authors declare the following:

Payment/services info All authors have declared that no financial support was received from any organization for the submitted work.

Financial Relationships: All authors have declared that they have no financial relationships present or within previous three years with any organizations that might have an interest in the submitted work. All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Data availability statement

The data supporting the findings of this case report, including the patient's medical history, details of the Ayurvedic treatment protocol, and the patient's perspective, are available upon reasonable request from interested researchers. To access this data, please direct inquiries via email to the first author. We are committed to ensuring data security and patient confidentiality, and data will be shared in compliance with relevant ethical guidelines and institutional policies.

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Effectiveness of Snehana and Swedana in a Case of Unspecified Joint Pain: An Ayurvedic Case Report

Status:

Version 1

Abstract

Figures

Introduction

Case Details

Diagnostic Assessment

Therapeutic Intervention

Outcome

Discussion

Conclusion

Declarations