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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Reviews
Full Version
Management of Pain in Children through Ayurveda: A Review of Literature
Correspondence Address :
Prasad Gajanan Yewale,
Mahatma Gandhi Ayurved college Hospital and Research Centre Salod Datta Meghe Institute of Higher Education and Research (DU), Sawangi Meghe, Wardha-441110, Maharashtra, India.
E-mail: prasadyewale2050@gmail.com
Pain is the feeling of discomfort, most of the time, it refers to physical discomfort. Children often suffer from various kinds of pain, including abdominal pain and pain due to sports injuries. Unrelieved pain may be detrimental psychologically and physically from the start. A child’s quality of life can be significantly impacted by pain if it is not addressed and treated at an early age, affecting their mood, sleep, hunger, attendance at school, academic performance, and extracurricular activities. Pain management in paediatric populations poses unique challenges, necessitating a comprehensive and holistic approach. However, the use of Ayurvedic therapies can be very effective in the management of pain in children, though it is not specifically defined by any authors or researchers. This paper offers a review of the literature with a particular focus on how Ayurveda, an ancient Indian medical system that emphasizes the harmony of the body, mind, and spirit, might be utilised to treat paediatric pain. This study includes the exploration of the historical roots of Ayurveda and its traditional applications for managing pain in children, including dietary guidelines and non pharmacological interventions like Abhyanga (oil massage) and Swedana (sudation therapy).
Angmardprashaman, Shool, Swedana, Vedanasthapana
Children are very active as they are always busy playing and engaging in various activities; therefore, the chances of accidents are much greater for them. They have a higher likelihood of experiencing pain and physical injury compared to adults. Additionally, Agni (digestive power) in children is Aniyat (irregular), hence they might suffer from digestive disorders. Krumi (worm infestation) is a common cause of abdominal pain, which is a prevalent type of pain in children (1).
Sports injuries are very common in children, as well as earaches. Headaches also frequently disrupt children’s daily routines. Pain may present as an independent symptom, such as migraines or fibromyalgia, or be associated with other diseases, such as pain caused by arthritis, cancer, or infections. According to Ayurveda, children have immature Dhatus (body tissues), making them more susceptible to diseases, with a lower tolerance for pain (2). Immature tissues are less resilient and more prone to dysfunction when exposed to stressors like physical injuries, resulting in a higher susceptibility to pain. This heightened sensitivity can make pain more pronounced, disrupting routines and affecting school attendance. Pain can also impact attention span and limit day-to-day activities.
Ayurvedic texts use terms like ruk, ruja, vedana, and shool to describe pain. “Shool” is considered the most appropriate term, meaning a condition causing discomfort to the body and mind, akin to driving a nail into a person’s body (3). There is a direct relationship between pain and the Vata dosha, as “Vatadrute nasti ruja” suggests that vitiated Vata is primarily responsible for pain (4). Pain only arises after contact with the sparshanendriya (tactile sense organ) and the mind. Due to the sparshanendriya’s pervasiveness in all sense organs, dukha jnana occurs through sparshanendriya in all sense organs. It is understood that the Vata dosha resides in the sparshanendriya. Because of its yogavaahitwa (the ability to combine with other doshas and impart its qualities without losing its own), the Vata dosha consistently manifests in pain associated with pitta or kapha (4).
Vitiation of Vata occurs in two ways: through Dhatukshayjanya (tissue destruction), such as fractures or tendon injuries, and through Margavarodhjanya (obstructive) causes, like sickle cell crises (5). Trauma is one of the main causes of Vata vitiation. While there have been many studies on paediatric pain management through Ayurveda, they have been limited to the management of udarshool (abdominal pain) only (6),(7). Therefore, this review focuses on how Ayurveda, an ancient Indian medical system emphasising the harmony of body, mind, and spirit, could be used to treat paediatric pain.
Management of Pain in Children
According to Ayurvedic pathophysiology, it is highlighted that pain occurs mainly due to the vitiation of Vata dosha. Therefore, pacifying Vata dosha is key to the treatment of pain management in children. The following treatments (Table/Fig 1),(Table/Fig 2) can be followed to control pain in children (8),(9),(10),(11),(12),(13),(14),(15),(16).
2.1 External Management of Pain according to Ayurveda
2.2 Swedan
The use of swedan in a child is mentioned in the Kashyap Samhita. There are different protocols of swedana (Sudation) for children, such as Hasta, Pradeha, Nadi, Prastar, Sankar, Upanaha, Avagaha, and Pariseka (17). The method of application of these swedana karma is explained in (Table/Fig 2) (18).
2.3 Basti (Medicated Enema)
It is the procedure in which drugs are administered in the form of medicated ghee, oil, and kashaya (decoctions) through the anal canal. Basti therapy is considered the best pacifier of Vata, Basti chikitsa as it can pacify Vata located in any region of the body (19). Acharya Kashyap explains the proper age criteria to initiate the Basti karma in a child as follows:
1) A child completing the neonatal period;
2) Children who crawl, stand, and walk without support;
3) A child who has started weaning from food. (15).
2.4 Ahara (Diet)
Ayurvedic science focuses on dietary changes in the management of diseases. According to Dosha Dushya, each disease involves specific Dosha, and Ayurveda recommends incorporating specific Rasas (tastes) in the diet for Dosha pacification. Since Vata Dosha is involved in pain, Ayurveda advises including Vata shamak Rasas in the diet. Vata shamak Rasas include Madhur (sweet), Amla (sour), and Lavan (salty) tastes, as they help pacify the Vata Dosha, making them beneficial for chronic pain. Madhura Rasa is alhadakar, Amla Rasa is manaprasadana (20), and the qualities of Lavan (salty) Rasa are Snigdha (unctuous), Ushna (hot), and Guru (heavy), which are opposite to Vata’s properties, thus aiding in Vata Dosha pacification (21) (Table/Fig 5).
The aforementioned procedures are very effective in pain management, but it is not possible to perform every procedure, such as Shodhan Chikitsa, on every child, and it cannot be continued for the long-term (22). Therefore, Shaman Chikitsa has its importance in pain management for children. It might be said that it is the most preferred way to relieve pain in children. As discussed earlier, vitiated Vata is the main root cause of pain, so pacifying Vata dosha is important. Ayurvedic literature contains various drugs under the Angmard Prashamana (Table/Fig 6) and Shool Prashamana (Table/Fig 7) groups, which may be beneficial for children (23). The drugs in the Angmard Prashamana group have properties like Madhura Rasa and hot potency, which pacify Vata dosha and help alleviate pain (24).
The ingredients of Shoolprashaman Mahakashaya consist of Katu (pungent taste) and Tikta Rasa (bitter taste), Laghu (light), Tikshna (sharpness), Ruksha (dryness) and Snigdha guna (unctuousness), Ushna Virya (hot potency), and Katu Vipaka (bio-transformed taste), which, due to their nature, have an obvious alleviating action on Vata dosha, enabling them to actively address pain (25).
2.5 Internal Management (Abhyantara Chikitsa) to the baby/Children
Abdominal colic is a common concern causing pain or discomfort in babies. Due to various physiological limitations of babies, physicians should be very careful when administering medications (Table/Fig 8) (22). In cases of abdominal colic, medications with Deepana (metabolism-enhancing), Pachana (digestive), and Anuloma (proper functioning of va¯ yu) actions are typically prescribed for internal administration in palatable formulations containing drugs like Ajamoda, Shunthi, Jeeraka, Vacha, Shatapushpa, and Hingu (26). Additionally, drugs can be given by placing a Lepa (covering of the body) on the mother’s breast before nursing (22).
Vidarigandhadi gana comprises a group of 20 medicines, including vidaarigandha, vidaari, Vishwadeva, and others, as described in the Sushurut Samhita (23),(24),(25),(26),(27),(28). Vidarigandhadi gana is used for conditions such as gulm (gastritis), body aches, fractures, particularly when vata dosha is aggravated and bala (strength) is diminished. Varunadi gana includes 22 medicines such as Varuna, Shigru, Agnimanth, Bruhati, and others, and is utilised for headaches and gastritis. Virtarvadi gana comprises 19 medicines including Veertaru, Shwet Sahachar, Nala, and others, specifically indicated for pain in burning micturition and calculi. Brihatyadi gana comprises a group of five medicines, including Brihati, Kantakari, Kutaja Phala, Patha, and Madhuka, which are indicated for pain relief (29) (Table/Fig 9).
All these drugs can be used to alleviate pain. These herbs can be used in palatable formulations for children to relieve pain. Various other books of Ayurvedic literature also mention different formulations for pain management (27),(28),(29),(30),(31),(32),(33),(34),(35),(36),(37),(38),(39),(40),(41),(42).
1. Sahastra yoga: This well known book contains 1000 medicinal formulations, including those mentioned in the following formulations (Table/Fig 10) for pain management.
2. Arogya raksha kalpadrum: Another well known reference book used by physicians to treat children. It lists the drugs used to treat pain in children as follows (Table/Fig 11),(Table/Fig 12) (27),(28),(32),(33),(34),(35),(36),(37),(38),(39),(40),(41),(42).
3. Anupana (Adjuvants) in shool (pain) (Table/Fig 13) (41).
4. Dose calculation in children: When treating paediatric patients with Ayurvedic treatment, most doctors encounter complexity. General guidelines for the dosage of Ghrita, Kashaya (decoction), Churna (herbal powder), and Kalka (paste) have been provided by Acharyas or ancient Ayurvedic physicians, as given in (Table/Fig 14) (43).
Ayurvedic treatises provide many drugs for effectively managing pain in children with fewer adverse effects and long-term safety. It is essential to focus on modifying these drugs into palatable forms for effective use. Many of these drugs are readily available at home and are cost-effective. Therefore, applying Ayurvedic principles and drugs in managing pain in children would be beneficial for society. It is a timely need to explore and conduct research on these drugs.
DOI: 10.7860/JCDR/2024/68723.19767
Date of Submission: Nov 22, 2023
Date of Peer Review: Jan 31, 2024
Date of Acceptance: Jun 04, 2024
Date of Publishing: Aug 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 23, 2023
• Manual Googling: Feb 02, 2024
• iThenticate Software: Jun 03, 2024 (6%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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