Background & Objectives: Worldwide there is extensive morbidity due to musculoskeletal pain. This is problematic in developing countries due to the high cost and access to therapy. Agnikarma is an ancient surgical treatment for pain (1). It involves thermal cauterization (first or second degree burn) delivered precisely to the trigger point in the area of allodynia. Advances in herbal cream for burns has facilitated a revival and re evaluation of this technique. Our objective was to document that the technique can improve pain management for patients. In addition we set out to establish a clinical evidence base that was appropriate to time and place. This environment is not suitable for a randomised trial but holds the potential to make a significant statement on efficacy nonetheless. We set up the global Agnikarma centre - www.globalagnikarma.com to offer the treatment. Materials & Methods: The international consultants (authors) experts in pain medicine and holistic medicine agreed a protocol whereby the same clinical information was collected on every patient at each visit setting up an extensive clinical database. Furthermore an extensive video library of pre and post treatment records was generated. Having learned the technique the presenting author offered the treatment to a specific group of patients in Ireland. These patients all had a diagnosis of chronic pain and had failed all conventional pain management.They all had graduated from a cognitive behavioural pain management programme. 100 patients were invited to visit the web site and self select for treatment. Results: We treated 14173 patients with 39658 procedures as of 21-2-2016 over a two year period. The case mix was 50% knee, 25% lumbar spine, 15% shoulder & neck and 10 % miscellaneous. The average number of treatment sessions is three (range 1-6) to achieve benefit. In Ireland the one year audit data for resistant chronic pain - 51 patients self selected, 25 were deemed suitable and completed 4 sessions. 76% had greater than 50 % pain relief, 80% had improved function, 30 % had improved sleep, 60 % stated that the benefit was still present at the end of the year, 80 % would have the procedure again. Conclusion: We have introduced a novel interventional pain therapy which offers hope to patients suffering from pain as it is simple efficacious and sustained. We have set up a transparent clinical data base complemented by a clinical video library which can be audited by interested parties. We have piloted a sample audit in resistant chronic pain patients where no efficacy would be anticipated in a totally different environment and documented benefit. There is now sufficient proof of concept for a more detailed investigation.
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