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Introduction: Pain is one of the most distressing symptoms in surgical practice. In Shalya Tantra (Ayurvedic surgery), pain management was emphasized not only during surgical interventions but also in the postoperative period. Ancient texts describe a holistic approach through Shodhana, Shamana, and Satvavajaya therapies, utilizing herbal, mineral, and procedural modalities. Modern pain management primarily relies on pharmacological interventions such as NSAIDs, opioids, and regional anesthesia, along with non-pharmacological therapies. Methods: A comprehensive literature review was performed using classical Ayurvedic texts including Sushruta Samhita and Charaka Samhita as well as modern databases (PubMed, Scopus, Web of Science, AYUSH Research Portal). Search terms included “pain management,” “Shalya Tantra,” “Ayurveda analgesics,” and “postoperative pain.” Inclusion criteria comprised classical descriptions, clinical studies, randomized controlled trials, and review articles published from 1980 to 2025. Exclusion criteria were animal-only studies, non-peer-reviewed articles, and reports lacking detailed outcomes. Results: Classical Ayurvedic sources describe multiple approaches: (i) Sneha (oleation) and Sveda (sudation) therapies for musculoskeletal pain; (ii) Lepa (herbal poultices), Agnikarma (thermal cauterization), and Raktamokshana (bloodletting) for localized pain; (iii) use of analgesic herbs such as Shunthi, Guggulu, and Rasna; and (iv) psychological support via Satvavajaya. Modern research validates some of these interventions—e.g., Guggulu’s anti-inflammatory activity and Agnikarma’s efficacy in musculoskeletal pain. Clinical studies comparing Ayurvedic and allopathic approaches suggest integrative pain management strategies may enhance outcomes. Discussion: Ayurveda provides a holistic, multimodal approach to pain, while modern medicine offers rapid and targeted pharmacological control. A comparative evaluation shows that integrative strategies may reduce drug dependence, improve patient satisfaction, and minimize adverse effects. However, limitations include lack of large-scale RCTs and global standardization of Ayurvedic protocols. Conclusion: Classical Shalya Tantra offers time-tested approaches to pain management that remain relevant today. Their integration with modern pharmacological advances can provide a comprehensive, patient-centered strategy for surgical and chronic pain management.

KEYWORDS: Agnikarma, analgesics, Ayurveda, pain management, Shalya Tantra