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Introduction: Agnikarma, a para-surgical therapeutic procedure described in Ayurveda, employs controlled heat application using metallic rods, Pippali, or other instruments for managing musculoskeletal and neurological disorders. It is indicated in Vatavyadhi, Sandhigata Vata, sciatica, frozen shoulder, and other chronic pain conditions. Despite being ancient, its clinical relevance is being revisited due to its effectiveness in pain relief and functional recovery. Methods: This review critically analyzed Ayurvedic classics (Sushruta Samhita, Ashtanga Hridaya, Chakradatta), along with contemporary clinical studies. Literature search was conducted using PubMed, Scopus, Web of Science, AYUSH Research Portal, and Google Scholar with keywords “Agnikarma,” “thermal cauterization Ayurveda,” “musculoskeletal disorders Ayurveda,” and “Ayurvedic pain management.” Studies included clinical trials, experimental research, and case reports published in English between 1980–2024. Non-peer-reviewed material and anecdotal reports were excluded. Results: Classical texts emphasize Agnikarma as superior in pain management where medicines and surgery are less effective. Observations from modern studies confirm its role in osteoarthritis, lumbar spondylosis, tennis elbow, and neuropathic pain. Mechanisms include heat-induced denaturation of pain mediators, increased local circulation, reduction of stiffness, and nerve modulation. Clinical trials show significant reduction in pain scores and improved joint function compared to NSAIDs or physiotherapy alone. Evidence also suggests benefits in peripheral neuropathies and migraine. Discussion: Agnikarma demonstrates strong alignment with modern thermal therapies (radiofrequency ablation, diathermy, cauterization) while maintaining Ayurvedic principles of Daha (cauterization) and Shamana (palliation). Challenges include standardization of instruments, temperature regulation, and long-term safety validation. Conclusion: Agnikarma emerges as an evidence-based, minimally invasive, cost-effective intervention for musculoskeletal and neurological disorders. With standardization and large-scale trials, it can complement modern pain management practices globally.

KEYWORDS: Agnikarma, Ayurveda, Musculoskeletal disorders, Neurological conditions, Pain management