Ayurvedic Management of Chronic Low Back Pain: A Case Report

Abstract

Low back pain (LBP) is one of the leading causes of disability globally. The prevalence of chronic LBP has increased dramatically, and there is a need for conservative therapeutic interventions to support patients with chronic LBP. A 66-year-old female patient presented with severe low back pain and associated disability of 2 years’ duration. The patient received 8 weeks of Ayurvedic treatment. The Oswestry Disability Index score and self-rated pain on a scale from zero to ten were used to assess disability and pain over time. The patient reported a considerable reduction in LBP over the course of the Ayurvedic intervention, and her disability score improved from 55% at the initial consultation to 20% at the end of treatment. This case report suggests the potential of an Ayurvedic approach as a complementary and alternative treatment method for chronic LBP. Larger, controlled interventional studies are needed to further evaluate the effectiveness of Ayurvedic protocols for the management of chronic LBP.

Introduction

According to the 2021 Global Burden of Disease Study, low back pain (LBP) affected 619 million people and was the leading cause of disability globally. ¹ Over 80% of the population will experience an episode of LBP during their lifetime, with 23% experiencing chronic LBP, and 12% experiencing disability. ² Chronic LBP is a leading cause of workplace absenteeism^3-6 and can cause substantial decreases in quality of life.^7-10 Numerous pharmacological and non-pharmacological treatments are available for the treatment of LBP. However, new clinical practice guidelines for LBP have focused on integrative care, occupational therapy, updated health insurance policies, and prevention strategies, while deemphasizing pharmacological and surgical interventions, ¹¹ as evidenced by guidelines in the US, ¹² UK, ¹³ and Denmark. ¹⁴ These guidelines recommend a variety of non-pharmacological therapies, including massage, acupuncture, spinal manipulation, Tai Chi, and yoga, albeit with differences by country.^11-14 They also discourage the use of opioids due to substantial risks^7-10 and poor long-term outcomes.^15-19

Role of Ayurveda in Clinical Care Pathways for Low Back Pain

Ayurveda is a traditional healing system with over 5000 years of history. Ayurvedic protocols are frequently used to treat patients with various musculoskeletal conditions causing chronic pain.^20-22 Ayurvedic pain management approaches, such as herbs, diet, body therapies, yoga, breathing exercises, lifestyle modifications, and education, align with LBP clinical guidelines by offering a personalized approach to conservatively and holistically manage LBP.

In Ayurveda, LBP is referred to as Kati Shoola, which is also considered a symptom associated with various other back disorders.^23-25 According to Ayurveda, shoola (pain) is due to the vitiation of Vata dosha,^23-25 caused by srotas avrodata (obstruction of channels), and dhatu kshaya (tissue depletion/malnutrition).^24,25 The Vata sub-dosha, Apana Vayu, located in the lower abdomen and governing downward motion, is primarily involved.^24,25 In Ayurveda, Vata imbalance is a potential cause of back pain. Several factors are known to aggravate Vata, including intake of dry, cold, deficient and light food; sleeplessness; improper panchakarma (detoxification) therapy; excessive fasting or abstaining from food; excessive sex or physical activity; excessive worry; excessive grief; debilitating diseases; use of uncomfortable beds or seats; anger; daytime sleep; suppression of natural urges; indigestion; trauma or injury to vital areas; or falls.^26,27 The treatment of Kati Shoola is aimed at pacifying Vata through an approach that may include warm, oily, unctuous qualities of foods and herbs, warm herbal oil body therapies, and therapeutic enemas.

This case report details an Ayurvedic protocol, including a combination of herbal supplements and therapies that has not previously been reported in the literature.

Case Report

Patient Information

A 66-year-old female who was 5 feet tall and weighed 128 pounds (body mass index [BMI] = 25.0 kg/m²) presented with chronic LBP of 2 years’ duration. At the initial Ayurveda consultation, the patient reported severe pain throughout the past week. The pain intensity was rated as 9-10 while walking, and 7-8 at rest on a numeric pain scale from 0-10. The patient reported that pain intensity increased during early morning, in cold weather, when walking, climbing steps, and when sitting for long periods. Laying down reduced the pain intensity. The patient had no other significant medical history, including no history of injury or trauma, osteoarthritis, rheumatoid arthritis, allergies, hypertension, or diabetes. There was no significant family medical history. She reported using nonsteroidal anti-inflammatory drugs as painkillers during episodes of severe pain (one 500 mg tablet of ibuprofen). The patient’s dietary habits included a higher intake of dry, cold, and raw foods (eg, salads, chips, iced tea, etc.), as well as staples like potatoes, peas and beans. The patient also reported eating out approximately 4-5 times per week. The patient typically went to bed late in the evening (eg, 11p.m.-12a.m.) and had been experiencing a period of heightened stress and anxiety. These dietary habits, sleep patterns, and stress are known to aggravate Vata and may have contributed to the development of LBP.

Clinical Findings

An Oswestry Disability Index score of 55% at the initial consultation indicated severe disability. Ayurvedic examination revealed severe pain, stiffness, rigidity in the lower back, irregular appetite, and constipation, which indicated Vata imbalance. Specifically, the patient was experiencing difficulty bending forward and lifting heavy weights, as well as having difficulty sitting or walking for extended periods of time. The patient’s pain also led to disrupted sleep, and the patient reported being unable to sleep for more than 6 hours due to pain. Radiological imaging was not considered necessary based on the clinical examination. The Ayurvedic diagnosis was Kati Shoola.

Ayurvedic Treatment

Holistic Ayurvedic treatment principles include local oil application and sudation therapy with herbal oil, internal administration of herbs, dietary and lifestyle modifications, and yoga to reduce pain and improve mobility.

It was recommended that the patient receive an Ayurvedic therapy called Katibasti for 45 minutes, once a week for 8 weeks. The traditional Ayurvedic herbal oil Mahanarayana Tailam was used. For Katibasti therapy, the warm herbal oil is gradually poured and held in reserve on the lower back. The process is repeated several times, and at the end of the procedure, a gentle massage of the lower back and lower limbs is performed. After the massage, a warm moist compress is given to the affected area for 10 minutes.

Diet and lifestyle recommendations were provided based on Ayurvedic principles to address Vata imbalance and relieve pain. The patient was instructed to avoid cold and raw foods, eating late at night, irregular eating habits, ice cold drinks, dry foods (eg, chips, crackers, popcorn), potatoes, cauliflower, beans, peas, barley, and millet. It was also recommended that the patient should attempt to go to sleep earlier in the evening and rise earlier in the morning. After 4 weeks of treatment, the patient was advised to practice yoga asanas (poses), such as Uttana padasana (straight leg raise pose), Ardha kati chakrasana (lateral arc pose), and Supta udarakarshanasana (sleeping abdominal stretch pose), and Marjaryasana and Bitilasana (cat and cow poses).

The patient was also instructed to take 2 pills each of Kaishore Guggulu (450 mg) and Yogaraja Guggulu (450 mg) twice a day with hot water after breakfast and dinner, and take a Dashamoola decoction (one part Dashamoola to 16 parts water, boiled and reduced to ¼ volume) with 5 mL Eranda Taila (castor oil) twice a day after breakfast and dinner.

Additional information about the Ayurvedic treatments, including ingredient lists for the herbal formulas, are provided in Supplemental Materials.

Follow-Up and Outcomes

The patient’s low back pain almost completely resolved over the course of 8 weeks with Ayurvedic treatment protocols. After 4 weeks of treatment, the patient rated her pain at 5 out of 10 while walking, and at 2-3 out of 10 while resting. During the visit on the fourth week, the Kaishore Guggulu and Yogaraja Guggulu doses were reduced to one pill after breakfast, lunch, and dinner. The patient was also asked to continue taking the Dashamoola decoction with Eranda Taila as previously recommended. By the end of the eighth week, the patient rated her pain at 0-2 out of 10 while walking and zero while resting. The patient’s Oswestry Disability Index score was 20% at the end of the eighth week, indicating minimal disability. All functional activities, including bending forward, lifting heavy objects, walking, sitting, and traveling, had improved. Specifically, the patient could bend forward without restriction, lift heavy weights with minimal pain, and sit comfortably as long as desired. The patient’s appetite and bowel movements returned to normal, and sleep quality improved, with only occasional disruptions due to LBP. Changes in pain and Oswestry Disability Index scores from the initial visit to the end of treatment are shown in Figure 1. The patient also reported an improvement in overall quality of life since starting the Ayurvedic interventions. No adverse events were reported.

Figure 1.

Change in Patient Pain Score and Oswestry Disability Index Score From Initial Ayurvedic Consultation to End of Treatment

Discussion

LBP is very common and a leading cause of disability.^1,2,28 While rapid improvement in pain and disability is normal for acute episodes of LBP, some patients will experience chronic LBP lasting longer than 12 weeks. ²⁹ In this case, the patient experienced severe, debilitating pain for 2 years before seeking Ayurvedic care.

The initial Ayurvedic examination revealed experience of pain, difficulty walking, disrupted sleep, irregular appetite, and constipation, indicating Vata imbalance. The patient’s dietary patterns, sleep habits, and stress are known to aggravate Vata and may have contributed to Vata imbalance. Therefore, Vata-balancing herbs and therapies were prescribed, alongside lifestyle and dietary recommendations. The patient received Katibasti applied with Mahanarayana Tailam (a polyherbal oil with antioxidant, anti-inflammatory, and analgesic properties) ³⁰ , a commonly used Ayurvedic treatment for Kati Shoola.^25,31-34 Katibasti provides moist heat to the lumbar area, helping to increase blood flow, reduce inflammation, decrease stiffness, and relieve muscle pain and spasms. ³¹

The patient was also prescribed Kaishore Guggulu, Yogaraja Guggulu, and Dashamoola, which are traditional polyherbal formulations. Kaishore Guggulu is used to support healthy joints, muscles and connective tissues. ³⁵ One of the key ingredients in Kaishore Guggulu is Guggulu, known for its potent anti-inflammatory and analgesic properties. ³⁶ Yogaraja Guggulu is commonly used to treat musculoskeletal disorders and arthritis, ³⁷ and has been successfully used for LBP and disability due to intervertebral disc prolapse. ³⁸ Dashamoola, an herbal tea blend that can balance Vata and Kapha doshas, ³⁹ was also prescribed. Dashamoola has potent anti-inflammatory and antioxidant properties, and is often used to treat painful, inflammatory musculoskeletal disorders, including LBP. ³⁹ It is traditionally mixed with Eranda Taila (castor oil) to enhance Vata-balancing and deep-penetrating properties, which also has anti-inflammatory and analgesic effects. ⁴⁰ Additionally, castor oil acts as a natural laxative, ⁴⁰ supporting detoxification and ensuring the proper elimination of undigested metabolites, which can contribute to inflammatory conditions.

Additionally, after 4 weeks of treatment, the patient began to practice yoga asanas (poses) specific to LBP under guidance to ensure that movements were safe and pain-free. There is strong evidence that yoga may be an effective therapy for chronic LBP.^41-43 Yoga asanas (poses) are regularly recommended in the Ayurvedic treatment of Kati Shoola,^31,32,44,45 specifically to stretch and the strengthen muscles of the low back and thigh. ³¹

An important limitation of this study is the combined effect of the therapeutic interventions. The patient was treated with Katibasti and herbal supplements, along with diet and lifestyle recommendations. Therefore, independent assessment of each intervention was not possible. However, this case report provides valuable insights into how Ayurvedic care is provided in a real-world setting. Additionally, the nature of a single case report limits generalizability; findings may not be applicable to a broader population. A longer follow-up period and larger sample size are necessary to evaluate the long-term effectiveness and reproducibility of Ayurvedic interventions in the management of LBP.

Conclusion

In this case report, a patient experiencing severe, chronic LBP received Ayurvedic treatments, including Katibasti, herbal supplements, and diet and lifestyle recommendations over the course of 8 weeks. The patient’s LBP almost completely resolved over the course of treatment, without the use of any conventional pharmaceuticals. Her disability score improved from 55% at the initial consultation to 20% at the end of treatment. This case suggests that Ayurvedic treatment may be effective for the management of chronic LBP with no adverse effects. In particular, the Ayurvedic protocols utilized in this case helped to reduce pain and improve functional abilities and overall quality of life. Robust controlled interventional studies are needed to evaluate the effectiveness of Ayurvedic protocols for the management of chronic LBP.

Supplemental Material

Supplemental Material - Ayurvedic Management of Chronic Low Back Pain: A Case Report

Supplemental Material for Ayurvedic Management of Chronic Low Back Pain: A Case Report byAnupama Kizhakkeveettil, Leah Grout, Jayagopal Parla in Global Advances in Integrative Medicine and Health