Traditional and Complementary Approaches in Combating Central Sensitisation of Pain in Osteoarthritis: Trends and Advances.

Osteoarthritis (OA) is a degenerative joint disease increasingly linked to neuroinflammation, and a heightened response of nociceptive neurons called central sensitisation, leading to persistent pain and functional decline. Neuroinflammation, along with dysfunction in serotonergic and noradrenergic pathways, and chronic activation of the hypothalamus pituitary adrenal (HPA) axis, prolongs the pain sensations. Conventional treatments, including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids, primarily offer symptomatic relief but fail to address these central mechanisms while posing risks of adverse effects. This narrative review explores alternative approaches, specifically Ayurveda and yoga-based interventions, as potential strategies to mitigate neuroinflammation and pain hypersensitivity in OA. A comprehensive literature search was conducted across databases of PubMed, ScienceDirect, Scopus and Google Scholar from the year 2005 to 2025 using multiple keywords related to OA, central sensitisation, yoga, and Ayurveda. Published studies were reviewed for outcomes related to central sensitisation and OA. Ayurvedic herbs consistently have been shown to have positive results in modulating inflammatory mediators and oxidative stress without adverse effects. Yoga has been shown to regulate the HPA axis, enhance vagal tone, and promote neuroplasticity, all of which contribute to pain modulation. Furthermore, mindfulness and meditation practices stimulate the release of endogenous opioids, thereby reinforcing descending pain inhibitory pathways. Both interventions contribute to OA management by supporting weight control, improving metabolic function, enhancing executive-level modulation of pain perception, and promoting better sleep quality. Their active analgesic effects, combined with a holistic mind-body approach, offer a safe and sustainable strategy for long-term OA management. Yoga and Ayurveda have shown reliable results in providing safe and effective management of chronic OA accompanied by central sensitisation. However, there is a need for large-scale studies to integrate these into the mainstream treatment regimens.