A CASE REPORT ON EFFICACY OF MARMA CHIKITSA IN MANAGEMENT OF PIRIFORMIS PAIN SYNDROME

Piriformis Pain syndrome is a neuromuscular condition characterized by compression of the sciatic nerve by the piriformis muscle, which is located deep in the buttock region. when this muscle becomes tight, spasms, or presents with anatomical variations, it can compress the sciatic nerve, leading to pain and neurological symptoms along the sciatic nerve pathway.[1] Compression of the sciatic nerve by the piriformis muscle can produce buttock pain radiating along the posterior aspect of the ipsilateral lower limb, thereby mimicking lumbar radicular pain or sciatica. The considerable overlap in clinical presentation with lumbar spine disorders makes piriformis syndrome difficult to diagnose and may result in it being overlooked or misattributed to a spinal source of sciatica.[2,3] Although traditionally considered an uncommon diagnosis, contemporary epidemiological data suggest that Piriformis Pain syndrome may be responsible for 0.3% to 6% of all low backache and sciatica cases.[4] The annual prevalence rate of newly diagnosed cases of low back pain and sciatica is 40 million. The incidence rate of Piriformis Pain syndrome is 2.4 million per year, and it occurs mainly in middle-aged patients of the female gender[5] Piriformis Pain syndrome occurs frequently during the fourth and fifth decades of life; found in individuals of all occupations and activity levels. Jawish, et al. found only 26 of 3,550 complaining of sciatica were found to have piriformis syndrome.[4] As much as 50 percent of patients with Piriformis Pain syndrome have a history of trauma direct from buttock contusion or a hip/lower back torsional injury.[2] Initially, non -operative treatments measures such as internal medications, e.g., Non -Steroidal Anti-inflammatory Drug (NSAID), Muscles relaxant, Pregabalin or Gabapentin (especially for neuropathic pain), local anesthetic agent (Lidocaine and Triamcinolone), Botulinum toxin (BTX), local injection or and physiotherapy (piriformis stretching) are standard in clinical practice for its management. Surgery is the last consideration in such a patient, especially those who don't respond to conservative therapy, including physical exercise.[6] However, all these conventional measures have specific limitations, such as symptomatic relief, multiple side effects, or specific contraindications. Therefore, it is highly needed to focus on effective but safe measures in alternative science, e.g., Ayurveda. The treatment of PS is typically multimodal, it consists of the nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and neuropathic pain medications, such as gabapentin or pregabalin. From an Ayurvedic point of view the clinical picture of Piriformis Pain syndrome shows substantial resemblance with Gridhrasi, a Vata‑dominant Vatavyadhi characterized by radiating pain, stiffness and functional limitation in the lower limb, which provides a conceptual framework for traditional interventions such as Marma Chikitsa. Marma Chikitsa, by precise stimulation and modulation of specific Marma sthans, has been reported to exert analgesic, anti‑inflammatory and neuro‑modulatory effects through mechanisms that include inhibition of pro‑inflammatory cytokines, activation of endogenous opioid pathways and modulation of descending pain processing, thereby offering a rational integrative approach.[7]