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Background: Musculoskeletal pain conditions such as plantar fasciitis, knee osteoarthritis, lateral epicondylitis, sciatica and frozen shoulder are leading causes of disability worldwide. Agnikarma, therapeutic thermal cautery described by Sushruta, is widely used in Ayurvedic surgical practice for such pain, with claims of rapid and lasting relief. Objective: To review the classical basis, instruments and technique of Agnikarma, proposed mechanisms of action, and clinical evidence in musculoskeletal pain. Methods: Narrative review of Sushruta Samhita, reviews of Agnikarma research, and modern literature on thermal therapy, pain modulation and the closely related practice of moxibustion. Results: Sushruta describes Agnikarma as superior to Kshara and medicines for Vata and Kapha disorders of skin, muscle, tendon, bone and joint, and specifies the instruments, burn patterns, indications, contraindications and after-care. Reviews of Agnikarma research in knee osteoarthritis identified around 15 small Indian studies, most reporting reductions in pain, tenderness and stiffness, sometimes sustained for months, but without radiological change. A 2026 narrative review concluded that Agnikarma gives short-term pain relief in sciatica and osteoarthritis but that studies are small, heterogeneous and unstandardised. A meta-analysis of moxibustion, a related East Asian thermal therapy, found moderate evidence of pain reduction in knee osteoarthritis. Proposed mechanisms include counter-irritation, local vasodilation and modulation of pain signalling. Conclusion: Agnikarma is a low-cost, quick, outpatient procedure with promising but low-quality evidence. Standardised protocols for temperature, duration, points and number of sittings, and sham-controlled randomised trials, are needed.

KEYWORDS: Agnikarma; thermal cautery; musculoskeletal pain; plantar fasciitis; knee osteoarthritis; sciatica; Shalya Tantra; moxibustion