Saturday, August 9, 2014

Back pain Agony

Back pain Agony
Prof G R Mohan
M D (Hom), PGDip (Env Stud)
Principal, Devs homoeopathic medical college, Hyderabad
Visiting Professor (P G), VM Homoeopathic Medical College, Salem, TN,India.

Pain according to the International Association for the Study of Pain defined as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
There are two major types of pain, nociceptive and neuropathic. Nociceptive pain results from tissue damage. Nociceptive pain can be subdivided into somatic and visceral pain. Nociceptive pain can be experienced as sharp, dull, or aching. There may be radiation of the pain, but it will not be in a direct nerve distribution. Nociceptive pain tends to worsen when stress or pressure is applied to an affected area.
Neuropathic pain descriptions often have an electrical quality: burning, lancinating, buzzing, tingling, zapping, and lightning like. Neuropathic pain tends to radiate in a distribution that follows nerves. Classic examples include trigeminal neuralgia and herpes zoster pain. Neuropathic  pain may occur when there is either damage to or dysfunction of nerves in the peripheral or central nervous system. Neuropathic pain frequently coexists with nociceptive  pain. Neuropathic pain may have "reverb"-like phenomenon, with paroxysms of pain due to light touch, temperature change, or even air movement.

Back pain is one of humanity's most frequent complaints in the US. About eight in ten Americans are suffering from back ache at some point in their lives. Is the fifth most common reason for physician visits after colds, it's the No. 1 cause of missed work. Yet a cure for the common backache is as elusive as ever. Back pain can originate from many sources, and treatments are just as varied, Lower back pain can be very agonizing. The pain can make a person feel helpless, can irritate a person and lead to psychological distress .1,2
Back pain is divided into following grades  a) acute (less than 4 weeks), b) sub acute (4 – 12 weeks), c)chronic (more than 12 weeks).
Low back pain may be classified on the involvement are organs:  
a)   Skin: (herpies zoster ) b) muscles : sprain ,strain, myositis , fibositis  and muscular spasm c) bones :spinal disc herniation and degenerative disc disease or isthmic spondylolithesis and spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease d) spinal cord : (sub arachnoid, syringiomyelia  e) viscera : ( carcinoma of oesophagus, Acid peptic disorder, pancreatitis ,diseases of gall bladder, f)febrile conditions like Dengue, g)Psychogenic : (The researchers determined that patients suffering psychological distress were three times more likely to develop back pain than those with better coping skills) 1. In a survey conducted amongst sufferers of chronic low back pain of more than three months, it was observed psychological distress with abnormal illness behavior was about 43% and the contribution by the actual physical problem was only 67%. In 1996 published their studies on the role of psyche in 131 subjects with chronic low back pain in which they concluded that the demonstrable bone or soft tissue structural problems accounted for only 38% of the pain and the rest of it was all due to the psychological stress 2
Lumbar disc prolapse has become one of the most common problems in the Indian population.Conventional systems of medicine have its limitation in tackling these disorders, and their approach in the treatment of disc prolapse is to provide temporary relief than a permanent cure through drugs and Microdisectomy, which a common Indian cannot afford. Homoeopathic system of medicine, however, provides hope for a more permanent cure and relief if the treatment is planned methodically. With the Homoeopathic treatment with minimum rest pain reduction was seen.
Although homoeopathic medicines have been proven to be effective in treating Disc prolapse, not much evidence based ground work has been conducted in this field.
Ultimate answer from homoeopathic medicines gave good results are shown in the. Pain reduction 90%, Work returns 90% and increased physical function 60%(3,4)
A live case :

Name:Mr (322H), Hindu male, aged: 31 years, married, engineer by occupation Consulted me on   Date 14/04/07 with following PRESENTING COMPLAINTS:
Patient experienced sudden pain while getting up from seat, 10 days back, for which he took pain killers without any relief , Pain in lumbar area, aching  type of pain, < lying on the back, inability to walk straight, pain the left calf muscle, numbness in the left foot since 10days, < cloudy weather,> warmth in general,
Temperament of the patient was hurry, irritable and offended easily, from the beginning,
PAST HISTORY: H/o. injury to knee joint. FAMILY HISTORY: Father & G Father: obesity, HTN. Mother: HTN & PILES,
PERSONAL HISTORY: Appetite: moderate, Thirst:  moderate Desires: NP Aversions: NP B/M: regular, Urine: N Sleep: Sound
GENERAL PHYSICAL EXAMINATION: Pt is well built and well nourished.
No pallor, Icterus, no cyanosis, no clubbing, no lymphadenopathy
CVS:   NAD .RESP: NAD .CNS: reflexes normal, motor power slightly decreased in left lower limb, Sensations normal GIT: No organomegaly, abdomen soft.
Investigations of significance:

M R I of lumbar spine  (09-04-07): central and bilateral Para central Disc herniation noted at L5---S1 level, with caudal migration causing thecal and root compression.
Spinal canal and neural foraminal stenosis noted at l5—s1 disc level. 
Nerve conduction study (19-04-07): prolonged F response suggestive early L5—S1 radicular involvement.
X-Ray L S Spine AP/LAT ( 08-04-07) : Sbluxation of L5 over S1, disc space normal.


CLINICAL CLASSIFICATION: Dynamic chronic fully developed miasmatic disease

MIASMATIC DIAGNOSIS: Psora (41.99 %) –sycotic (34.02 %)-Syphilis (23.38 %). (CARA miasmatic chart)

Mind – hurry haste
Mind –offended easily 
Mind – abusive insulting
Generals- > warmth,
Generals – cloudy weather <
Generals – obesity,
Back – pain aching lumbar area
< lying on the back,
Extremities: Numbness in left foot
Mercurius: 14/9, Nat mur-16/9, Pulsatilla 20/9, Sepia 15/9.
Nat Mur covered more marks and score more for general symptoms also.
First prescription:

16/4/07: as expressed by patient, for pain due to slip disc without seeing the case on phone Hypericum 1M, one dose in water was given, Rubrum for 2 days as he was away, was not in position to come to the clinic.
19/4/07: Still he was walking with pain, case was taken and repertorised, the remedy selected was Nat Mur 200C, and 3doses was given,
* Reason for selecting  Nat mur covered 9 symptoms with 16 marks as shown in reportorial chart given below. Even though Pulsatilla covered 20/9, numbness in left foot has been covered by Nat Mur only,                      
16/5/07:  pain in the sacral area reduced by 30% was able to walk, numbness was still persisting, and Rubrum was given.
2/6/07:  pain in the sacral area reduced 30%, numbness was still persisting Nat Mur 200C, 3doses was given,
19/6/07: pain in the sacral area reduced 50% numbness was still persisting, Nat Mur 1M, 1dose was given,
30/6/07: Numbness in the foot was better by 25% only, rubrum was given for 10days

11/07/07: Numbness in the left foot was present; he developed upper respiratory symptoms like sneezing, nose dripping. Because of change of season (wet weather <)   
Thuja 30C, 3doses were given, as Numbness in the left foot, was persisting (only two remedies are there Nat Mur and Thuja) It has 14/9 score in follow up Repertrisation it is a follower to Nat Mur.

27/07/07: Numbness in the left foot was better by 25%, upper respiratory symptoms have reduced. Thuja 30C, 3doses was repeated.

12/08/07: Numbness in the left foot was better by 35-40% only, with general well being. Rubrum for 15days was given.

23/06/08 Patient has come for his son’s problem, meanwhile he stopped treatment numbness in the left foot was better by 40-50 % only.

2) Yoga for back pain-(psychological stress)

 Tuesday, November 25, 2008, 11:7 [its)
3) Prof Gundimeda Ram Mohan, Herniated Lumbar Disc - A Clinical Study, Homoeopathic Links, Volume 21,winter 2008.
4) Prof G.R. Mohan, lifestyle and lumbar spondylosis, The Homoeopathic Heritage, vol.33, no 1, Jan 2008

 *** published in ., ( vol:3, issue :4)