Backache
Backache
Backache
Sciatica
by
Dr. Tarul Wadikhaye Jadhav
HelloHello
A Personal Letter from Shilpa
Bhouraskar.
The purpose of this book is to help you use clinically verified homeopathic
approaches for specific disease conditions confidently and successfully.
These approaches have been tried and tested in hundreds of patients in actual
hospitals and clinics by expert homeopathic doctors in India.
The major benefit you might experience as a result of deploying what you learn
is EASE. These protocols have been proven to work WITHOUT SUPPRESSION in
specific disease conditions when well chosen constitutional homoeopathic
medicines have not been able to help.
When you utilise the strategies that are shown in this book, you’ll remove
obstacles to cure, fast track the resolution process and become instantly magnetic
to your patients.
You will find yourself in greater demand and you will find yourself being able to
easily build your practice as you tap into the potential of decades of wisdom and
real life successful homoeopathy.
And if done properly, you will enjoy the same success rate as these practitioners
in an easier and more efficient manner rather than wasting time through trial and
error.
And the best part of it all is youÕll be delivering real results and creating a great
patient experience…so that your patients COMES BACK to you.
What you are about to discover will quickly position you as “a successful
practitioner” in your town.
You will turn your patients into long term clients who will continue to benefit
from your deeper work through your favourite approaches and modalities
So you are free to go on and do deeper work with them and provide them the
full potential of your favourite approaches and modalities.
Warm Regards
Shilpa Bhouraskar
Sydney 2018.
HelloHello
A Personal Letter from Shilpa Bhouraskar.............................. 3
Introduction................................................................................. 6
Please allow me to introduce myself..................................................................6
HelloHello
Chapter 6: Management of Back Pain.................................... 42
Four aspects of back pain management:.........................................................42
Preventive treatment..........................................................................................42
Conservative line of treatment:.........................................................................43
Medicinal Treatment...........................................................................................61
Surgical Treatment..............................................................................................61
HelloHello
Introduction
Please allow me to introduce myself...
I’m Dr. Tarul Wadikhaye Jadhav, M.D. Homeopathy in Practice of Medicine. Since
2010, I’ve been an Assistant Professor in the Department of Surgery and managed
orthopedic OPDs and the IPDs.
I’m a certified yoga teacher from the oldest institute in the world, the Yoga Institute
of Santa Cruz, and have been a medical speaker at The Yoga Institute for the
orthopedic camps.
I’m also affiliated with the Revival Yoga Life School in Mumbai.
HelloHello
Chapter 1: Why Study Back
Pain?
Just what is so important about the study of back pain?
First and foremost, pain in the back is the most common symptom encountered
in orthopedic practice. I say this because I sit with orthopedic surgeons in our OPDs,
and the cases of back pain coming to us account for nearly one-third of all
orthopedic outpatient attendances.
Back pain is the most prevalent cause of sickness absenteeism in the U.S. and
the U.K., and even in India. About 15% of adults are disabled due to spine problems.
Therefore, back issues result in financial losses estimated to be around $80 billion in
the U.S. per year.
Spine and spine related issues are the most common disability in the population
under 45 years of age. This is why we as homeopaths are likely to see a good
number of cases of back pain in our practices. Consequently, it’s essential that we
understand this issue in detail.
In these materials, I’ll cover certain aspects of cause, diagnosis, and treatment of
back pain that I’ve discovered so that you’ll also reap the benefits. The following is a
general outline of material to be discussed.
Book Outline
HelloHello
You’ll see how these movements work and what supports in their smooth
functioning. You’ll be enabled because this will help you to arrive at the right
diagnosis quickly during examination itself using the modalities which are often the
diagnostic modalities, too.
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Chapter 2: Clinical Anatomy of
the Spine
What’s so different in other animals and humans? The thing is that we have been
standing tall on two legs, and that’s the trademark of the human race. It’s what
separates us humans from other quadrupeds, like dogs and cats, that do not end up
with back pain. Human beings have paid the price of erect posture in the form of
acquiring “low back pain.”
The spine comprises of the structure runs from just below the head to the tailbone,
then from the cervical region to your coccyx. It’s a unique anatomical entity which
forms the axis of the human body. The head rests upon it, and the neck, chest, and
abdomen are suspended from it. It transfers the weight of the upper body to the
lower body. Its uniqueness lies in a perfect balance, flexibility, and stability.
HelloHello
Vertebral bodies consisting of:
• Joints
• Facet joints
• Discs
• Intervertebral discs
• Fatty tissues
• Neural tissues which comprise of the spinal cord
• Nerve roots
• Venous plexuses.
The spinal cord and the nerve roots are protected within the spinal canal
(shown in green).
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Intervertebral Discs
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This is a very unique structure to the spine alone. It’s the largest in the cervical
and lumbar region. These discs are elastic in youth which is why you’re very flexible.
You can do all the movements of flexion, extension, lateral flexion, lateral rotations,
etc. This elasticity is lost with age. The discs also act as shock absorbers when
walking and running, serving as a buffer between the vertebral bodies and allowing
for all the movements comfortably.
Spinal Ligaments
HelloHello
• Ligamentum flavum
• Intertransverse ligament
• Posterior longitudinal ligament
• Anterior longitudinal ligament
• Supraspinous
• Interspinous
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Regarding neural tissue earlier, the illustration shows a transverse section This
section shows us:
• The spinal cord cut with the nerve fibers within
• The nerve roots are coming out from the neural foramen
• The vertebral bodies
• The spinous processes posterior (behind)
HelloHello
Venous Plexuses
The importance of this part of the spine enters the picture when we deal with
cases of trauma. With patients who have had a fall and then undergone an MRI, and
in whom you see hematoma or bleeding, you might consider homeopathic
medicine.
In those cases, it’s important to understand that this segment also is not devoid
of blood supply. It is rich in blood, therefore, improved healing occurs when the
blood supply is not disrupted.
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Muscles
The paraspinal muscles are usually seen from the back through inspection. They
comprise all the muscles in the illustration and serve to maintain the upright posture
of the body and spine. The paraspinal muscles allow you to stand tall and also help
in the extension of the spine.
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Abdominal muscles - Why Abdominal Muscles Come Into Play
Abdominal muscles are equally important in your spinal movements. They are the
most reliable safeguard during spine loading. Their function is to assist flexion and
lateral bending.
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Normal Lumbar Canal
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Chapter 3: General Outline:
Causes of Back Pain
So, what do we consider to be the causes of low back pain? According to my
clinical experience, I have made this division:
• Mechanical
• Degenerative
• Inflammatory
• Metabolic
• Neoplastic
• Referred pain
• Idiopathic
• Psychosomatic
Degenerative Disc
The cause could be a degenerated disc which is a degenerative phenomenon
seen gradually over a period of time as the individual ages, such as in this x-ray. The
vertebrae are also visible.
HelloHello
Degenerative changes seen in the spine.
There could be spinal disc herniation revealed by the MRI.
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Disc herniation with degenerative changes in spine in a 48 year old man.
In this view, you can see there is central disc herniation with compression more
towards the lateral side. Also here there is disc degeneration with degenerative
changes in the spine in the case of a 48-year-old man. This was my own patient who
was admitted to the IPD.
You can see how the disc is herniated at the level of ++L2/L3, L3/L4, L4/L5 and
L5/S1. The degenerative changes are also visible.
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Scheuermann’s Kyphosis
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Spinal canal stenosis refers to central herniation. These changes are likely
causing mechanical disturbances in the spine resulting in back pain.
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Scoliosis
For example, the lumbar and the sacral variations. Listhesis is also due to a
congenital defect in the pars articularis in the hemivertebra.
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Case Studies
Female child:
This child was an accidental finding. Because she was not sitting correctly, we
advised an x-ray. There were irregular hemivertebra as noted as well as the
congenital absence of a finger in the left hand.
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Male child:
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Physical Causes of Hip Misalignment & Pain
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2. Restricted hip movements,
3. Misaligned pelvis, and pelvic obliquity also can cause back pain.
4. Fracture, Injury and Sprains:
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Vertebral Fracture
HelloHello
Fracture may occur after a fall, or it could be a gradual fracture in a senior
person due to osteoporosis, injury, or strain. You can see two different x-rays that
show fracture of the vertebral bodies. These are lateral x-rays, with the only lateral
view taken.
Inflammatory causes
1. Seronegative spondyloarthropathy (Seronegative refers to issues
commonly encountered by the patients who present with ankylosing
spondylitis.)
2. RA (rheumatoid arthritis)
3. Infection
▪ Osteomyelitis
▪ Pott’s spine (aka TB spine)
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Ankylosing spondylitis (bridging of the vertebrae)
HelloHello
Neoplastic
1. Bone tumors. These may be the primary foci, or could be in the spine, or
could be secondary from elsewhere in the body then reflecting to the spine.
2. Intradural spinal tumors
Note: A PET scan will help in assessing if the secondaries can be seen in the
spine.
Osteoporotic fracture:
Osteomalacia
This is often encountered in people who have less sun exposure and/or poor
intake of calcium and vitamin D resulting generalized back pain.
Ochronosis
This is an accumulation of homogentisic acid in the connective tissue which
leads to pigmentation, then darkening of cartilage and hardening of
ligaments and tendons, and eventually arthropathy (joint pain and aches).
HelloHello
Referred pain
This can result from pelvic and abdominal diseases, prostate cancer, and
posture. These are also the entities that could cause back pain because they refer.
The most common examples are dysmenorrhea or renal calculi both of which cause
back pain.
HelloHello
Idiopathic refers to the spontaneous appearance or disappearance of a
condition, in this case, backache. For instance, reading or listening to a recording
while sitting with poor posture could also lead to a backache. Feeling overworked,
overstressed, and suffering mental depression can also cause back pain. (We’ll
cover mental depression a bit later.)
HelloHello
Chapter 4: What exactly is Back
Pain?
Types of Back Pain
• Mechanical local back pain: pain is localized in a particular area
• Radiculopathy: pain radiates along the course of the nerves
• Referred pain: the pain is referred from the place of origin to different
areas
• Pelvic inflammatory diseases: these refer pain to the back
• Fibroids: also refer pain to back
• UTI: causes back pain
In Mechanical symptoms:
HelloHello
• Strain in the paraspinal muscles
• Strain in the ligaments
• Irritation of the facetal joints
Note: These pains are usually localized (confined to one particular part of the
body)
Radiculopathy:
• Radiating pain from buttocks to the legs and the foot
• Can be right or left or both
Disease-related:
• Faulty posture due to sneezing, coughing and straining.
HelloHello
This is a condition of central disc herniation at the level of L1. The affected
nerves are usually the ganglion that supplies the genitals, urinary bladder, and
rectum. With this particular disc herniation, the chances are that patient will go into:
• Acute urinary retention
• Acute complaints of not being to pass stool since the time of back pain
• Decreased sensitivity in the lower limbs
• Paresthesia
• Weakness
• Previous or current cancer: If the person complains of back pain but has
had chemo for breast cancer, or radiation, or cancer surgery, be on high alert
to suspect secondaries in the spine as it’s better detected early.
• Intravenous drug users: These patients are prone to all kinds of blood
born infections.
• Osteoporosis: This will generally be seen in any individual who is post-
menopausal, though these days even youngsters are seen to be osteoporotic
and suffer repeated fractures.
NOTE: The best way of diagnosing osteoporosis is via a bone mineral density
test.
HelloHello
• Chronic corticosteroid use: Chronic corticosteroid use is going to mask all
the symptoms. However, people who have been taking it for a very long time
will commonly end up being more osteoporotic and therefore have a higher
likelihood of developing fractures.
• Age greater than 70 years: These individuals are more likely to end up
with fractures if even the slighted trauma is neglected.
• Focal neurological deficit: This is defined as a localized area that has a
sensitivity to touch, pain, or is having difficulty with movement.
• Physical deformities: These need no elaboration.
• Pain longer than 6 weeks: Reinvestigate this lengthy pain. Don’t rely on
repeating the same medicine or treatment.
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Chapter 5: Diagnosing Back
Pain
Tips before Diagnosing.
Before you diagnose, there are certain things which will help you diagnose. Not
always will you be lucky enough to get a ready-made diagnosis. It’s always better to
conduct a physical examination and diagnosis so that in the subsequent follow-up,
we can assess whether the patient is improving or not.
Motor examination
HelloHello
• Muscle power
• Muscle wasting
• Reflexes
• Peripheral pulsations
• Local changes
• Abdominal muscle tone
Note: Abdominal muscle tone assists in determining the line of treatment, e.g.
a decrease in tone in any other segment.
Sensory examination:
• Muscle spasm
• Any particular segment of nerve that is affected
Note: This will assist in understanding the exact position on the spine where
the disc is herniated. This can also be assessed clinically.
Confirming diagnostics
• Straight leg raising test
• Lasègue test
• FABER test
• SI joint stress test
HelloHello
3. CT scan plain: Especially indicated when pelvic or abdominal conditions
are suspected as the cause of spinal complaints.
4. Spinal MRI: This is the best diagnostic to assist in diagnosing, e.g. whether
the issues are related to the bone, the disk, the nerve, or the facet.
5. Rheumatological and Bloodwork
• Ra factor
• X-ray of small joints (indicated is rheumatoid arthritis is suspected)
• Anti-nuclear antibody (indicated in cases of seronegative
arthropathy)
• Anti-double stranded DNA test (also indicated in cases of
seronegative arthropathy)
• HLA-B27 (to confirm ankylosing spondylitis)
Note: This is especially indicated when clinical exam reveals absolute
restrictions in the movement of the spine with the Schober’s test being
positive.
• CBC
• ESR
• CRP (will assist with suspected infection)
6. Bone mineral densitometry: Assesses the degree of osteopenia or
osteoporosis
7. Bone scan: Indicated for locating occult lesions; also assists in
differentiating degenerative and neoplastic lesions.
HelloHello
Chapter 6: Management of
Back Pain
Four aspects of back pain management:
• Preventive
• Conservative
• Medicinal
• Surgical
1. Preventative management:
a. Indicated for patients with very low or dull back pain
b. Those with no deformities or abnormalities visible on MRI
c. Helps prevent additional damage
d. Helps prevent errors in the body
2. Conservative management:
a. Conserves the existing body damage
b. Prevents further damage
c. In conjunction with homeopathic treatment, will help reverse
damage in a graded manner
3. Medicinal line of treatment:
This material will not cover Western/modern medicine but do make use of
this treatment when indicated.
4. Surgical line of treatment:
This is advised when the medicinal line of treatment fails.
Let’s study each of these in detail
Preventive treatment
HelloHello
• Results in incorrect posture
• Adds stress
Note: Slouching can feel “relaxed” but is adding a load to the spine
• Results in pelvic tilt
• Improves slouch
• Physiotherapy
HelloHello
Complete Bed Rest
• Decreases spasm
HelloHello
Bolster (see illustration):
• Pelvic completely on the bolster
• Head down
• Legs up
• Note: This particular posture is very good especially in cases of severe pelvic
tilt or exaggerated lumbar lordosis.
HelloHello
Physiotherapy
Once pain began to decrease:
I prescribed physiotherapy inc. shortwave diathermy (a deep form of hot
fomentation that goes to the level of tendons and decreases the spasm).
There are also local ultrasounds which are advised, especially when a particular
tendon or a particular area is thought to be affected.
HelloHello
Benefit of orthotic supports
• Patient’s posture is corrected
• Prevents modified posture which worsens pain
• Posture automatically relieves pain
• Assists medication and hastens pain relief
HelloHello
• Vertical stretching
• Forward bending
• Backward bending
• Side bending
• Twist
• Asanas for the spine and hip
• Vertical stretches
• Assist in releasing the spasms
• Must be done in a graded manner
• Hypertensive patients: Do not go on toes
HelloHello
• Lateral spinal stretch
• Assists with lateral flexion
• Stretch can be felt along thighs to the calf
• Stretch may extend to fingertips
• Relieves myriad aches and pains
HelloHello
• Can be done even in the sitting position
• The maximum twist is obtained in the standing position
• Decreases the stress in your spine
• Assists in developing a nice curve on the flank
• Strengthens spinal muscles
• Strengthens muscles of the abdomen
• Strengthens lower limbs
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Hastapadasanana (Forward Bend)
HelloHello
• Touching hands to the feet gives a good forward flexion
• Open up the hips
• Completely opens the spine
• Releases the stress on the sciatic nerve
Chakrasana (Wheel)
()
• Provides simultaneous forward flexion and backward extension
• Completely stretches spine
• Opens the shoulder joint
• Opens the ribcage
Utkatasana (Chair)
Note: This asana looks very simple, but it is crucial when it comes to aligning the
pelvis.
HelloHello
• Aligns shoulders, spine, and pelvis
• Alignment creates a correct lordotic curve
• Gradually corrects & maintains overall posture
Vajrasana (Thunderbolt)
HelloHello
• Helps correct spine posture
Shalabhasana (Locust)
HelloHello
Bhujangasana (Cobra)
Setubandhasana (Bridge)
HelloHello
• Corrects pelvic tilt
Yastikasana (Stick)
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Pavanmuktasana (Wind-Releasing Pose)
HelloHello
• Can be done lying down
• Strengthens spinal muscles
• Strengthens hamstrings
• Strengthens quadriceps
• Good hip openers in the SI joint
• Relieves stress
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• Good pelvic tilt correction
• Opens hip joint
• Compresses abdomen
• Opens spine
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Caution regarding Asanas
None of the asanas are to be done in an acute state:
• Acute spondylitis
• Acute disc prolapse of the cervical or lumbar region
• Acute facet arthropathies
• In a resolving state, they must be graded and done under observation.
• Once the issue is resolved, they still need to be graded gradually.
• Once the patient is pain-free, asanas may be used as a preventive.
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Medicinal Treatment
Allopathic approach:
• Generally have categories such as analgesics, anti-inflammatories, and
steroids
• Analgesics can be oral, local applications or injections
• Can include anti-inflammatory (NSAIDs)
• Steroids can be local, injectable or oral
Homeopathic approach:
• Acute medicines
• Constitutional
• Intercurrent
• Specific medicines
Surgical Treatment
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Chapter 7 - Homeopathic
Management: Remedies & Case
Study Synopses
HelloHello
Here are the commonly-used remedies groups in my practice:
Acute group:
• Bryonia
• Rhus Tox
• Aesculus
• Hypericum
• Colocynth
• Ignatia
• Berberis
Chronic group:
• Kali group
• Natrum Mur
• Natrum group
• Calcarea group
• Argentum group
• Aurum group
• Causticum
• Silicea
• Pulsatilla
• Phos
• Staph
• Carcinosin
• Phosphoric Acid
Intercurrent group:
• Tuberculinum
HelloHello
• Medorrhinum
• Sulphur
Note: When your case comes to a standstill, or when there are certain acute
bouts still occurring, that’s when I’ve used intercurrent medicines.
Specifics:
• Gnaphalium
• Ginseng
Note: Most of the time, specifics do not work for a longer duration, and they
need to be followed by a constitutional.
Indicated for:
• Sprains and strains
• Left-sided sciatica
• Painful stiffness
• Tingling and numbness
• Soreness to touch
Tongue is:
HelloHello
• Very dry, red and smooth
• Or red and could be dry, cracked
• Could be dry and dark-coated with triangular red tip
Aggravating modalities:
• Cold air
• Cold, wet rainy weather
• Waking up in the morning after a night repose
• Overexertion
Better with:
• Continued motion
• With heat in general
Observations:
• Lower back pain included restlessness
Restriction in movement
Remedy:
• Rhus Tox 1M was given repeatedly for a week with complete bed rest and
provided more than 50% relief.
Remedy: Bryonia
HelloHello
• Dark complexion
• Firm muscular fiber
• A tendency of bilious attacks
• Exceedingly irritable
• Inclined to be vehement and angry
• Desires things immediately which can’t be had or which, when offered, are
refused
• Anxious
• Inquietude with fear of future
Aggravated with:
• Least motion
• Raising up
• Stooping
• Exerting
• Coughing
• Deep breathing
• Hot on becoming vexed
Better with:
HelloHello
• Pressure
• Lying on painful side
• Lying on painful parts
• Bandaging
• Cool open air
• Better by being quiet
• Will not want to interact with anyone.
• Better by drawing up knees (will sleep in that position)
Thermally:
• Hot and very thirsty
Remedy:
Bryonia 1M was given repeatedly with complete bed rest.
70% improvement in a week was reported, and then she was put on exercises.
Remedy: Ignatia
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• Oversensitive
• Nervous
• Mentally and physically exhausted by long concentrated grief
• Suppressed or deep grief with long drawn out sighs and much sobbing
• Full of suppressed grief
• Effects of grief of recent origin
• Acute grief
• Oversensitive to pain
• Nocturnal pain which disturbs sleep
• Sudden loss of function in any organ
• Rapid alterations of gaiety and disposition to weep or other characteristic
emotional states rapidly alternating character of pain which is excessive
• Could also be moody
Periodicity;
• Pains have a definite direction
• Pains change their locality
• They appear gradually
• Subside suddenly
• Appear as suddenly as they disappear
• Spasms
• Convulsions after grief
Causative factor
• Back pain after grief, fright or any violent emotion
Aggravated emotions:
• Grief
• Chagrin
• Worry
• Fright
• Shock
• Touch
• Tobacco
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Better by:
• Being alone
• Change of position
• Pressure
• Urination
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Remedy: Hypericum
Coccygodynia:
• Painfully sensitive spine
• Pains in hips and small of the back after labor
• Violent pains and inability to walk or stoop after a fall on coccyx
• Aching in left sciatic after long sitting
• Feet seem furry
• Bones ache
Paresthesias:
• Aggravated by injury
• Jar
• Shock
• Touch
• Change of weather or cold
• Better bending back
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• Had more severe and excruciating right-sided radiculopathy.
• Severe burning pain, hyperaesthesia.
Being a doctor himself, he had tried all the allopathic treatments inc. steroidal
injections and massage.
• Nothing gave him relief.
• The pain intensity was severe.
• He couldn’t lift the leg for wearing trousers nor let anything touch the
thigh, else the pain would be excruciating.
• It would stay painful for a period of 20-25 minutes, and he could not get
up.
Remedy:
Hypericum 1M in the first dilution was given every 15 minutes.
• 70-80% relief was noted in the first 3 days, and the amelioration
subsequently followed.
• He’s pain-free now.
Remedy: Colocynth
Indicated for:
• Ill effects of anger, indignation, chagrin, grief, catching cold.
• Especially suited for irritable persons who easily angered and ill effects
which are developing afterward.
• Neuralgic pains are cutting, pinching, clamping and gnawing or boring
followed by numbness and better with pressure.
• Lumbar aches which are better with pressure.
• Cramp-like pain in the hips better lying on the affected side.
• Sensation as of a heavy weight in lumbo-dorsal region better lying on the
left side.
• Sciatica has crampy pains in hip as though screwed in, lies upon affected
side.
• Shooting pain like lightning shocks, down the whole limb, predominantly
the left hip, left thigh, left knee, into the popliteal fossa.
Worse with:
HelloHello
• Emotions
• Vexation
• Chagrin
• Anger
• Lying on painless side
• Aggravated in the night.
Better with:
• Hard pressure, on the edge
• Heat
• Rest
• Gentle motion
Remedy:
• The patient responded well to repeated doses of Colocynth 200, followed
by 1M.
• Was almost pain-free and with a near normal spine curve gradually.
Followup:
• After a year almost, there was a recurrent episode.
• Since earlier a full case wasn’t taken, this time a proper case was taken in
detail.
Mentals:
• Grief
HelloHello
• Suppressed anger
• Domination
• Humiliation
Revised remedy:
• Staph 200 in infrequent doses.
• This provided complete pain relief inc. improvement in the spine curve.
Note:
Colocynth and Staph are related and follow each other.
Remedy: Aesculus
Worse with:
• Walking
• Stooping
• Morning on awakening
• From any motion
• Lying,
HelloHello
• After stools and urinating
Better with:
• Cool open air
• Bathing
• Bleeding piles
• Continued exertion
• Summer
Remedy:
• Aesculus H 30 tds for 1 week was prescribed along with complete bed
rest.
• The pain was quite improved.
• Improvement continued as the medicine was continued.
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• During the follow-up, he revealed that his complaints of piles are also
better (he had not revealed this on day one).
• He was later put on exercises, and he continued to improve.
• Fleshy
• Flabby
• Dropsical
• Paralytic
• Very irritable
• Backache
• Sweat
• Weakness
• Anemia
• Debility
HelloHello
• Sensitive to every atmospheric change
• Sensitive to cold
• Chilly patient
• Constant backache with a feeling as if back and legs would give out.
HelloHello
• Feeling of weakness
• Thermally chilly
Remedy:
• Kali Carb 30 first dilution was given tds
• Gradually Kali Carb 200 first dilution continued
• Pain decreased, and her sleep also improved
• We had advised a splint because she had developed a foot drop.
Remedy: Gnaphalium
Better by:
• Resting on back
• Drawing up the limbs
• Flexing thigh on the abdomen
HelloHello
• Because of these aches and pains, she was not in a state to give us any
data and was in much distress.
Indications:
• Better with rest
• Back pain with numbness in both lower limbs
Remedy:
Gnaphalium 200 tds based on indications.
• She was 25% better this time and continued for a few weeks.
• Gnaphalium was followed later by the constitutional when the
improvement didn’t continue.
Note:
This wasn’t the right time for us to initiate the intercurrent, so we thought of starting
up with the constitutional.
• Fright
• Vexation
• Disappointment in love
• Reserved displeasure
• Feel that pain can’t or won’t let them stop and rest
HelloHello
• Their duties cannot be given to anyone else
• Resting is a crime
• Self-condemnation
• Is uneasy
• Is hurried
• Profound melancholy
• Boring pains
• Aggravated night
• Right-sidedness
HelloHello
• Kids were married
• Son was dead
• Wife had also expired
• The pain worsened for the last few days which prompted homeopathic
consult.
• He did not visit a doctor for pain medication; instead, he consulted a
pharmacist and took painkillers.
• Reported that the pain was tolerable with over the counter medication.
Mentals:
• Even after his fall, he did not tell his married daughters.
• Said it is not good to disturb their married life.
• Grief was also related to deceased son.
However:
• Believes that son died because of his own deeds.
• Believes wife who had cancer died because of her own deeds.
• Believes, Even I’m possibly suffering because of my own misdeeds. So to
get or not to get well also depends on my misdeeds, but I’m taking medicine
from you so that I don’t end up becoming a burden on my daughters.’
• That was his motive for coming to us.
Remedy:
Aurum 200 then gradually raised it to 1M.
• He became pain-free and happy.
• We then we put him on exercises.
HelloHello
• Shed tears only when alone
• Wants consolation but is aggravated by it
Appearance:
• Face looks pale
• Shining
• Greasy looking
• Upper lip swollen easily
• Violent thirst
• Lower extremity dropsical
• Mapped tongue
• Sensation of hair on tongue.
• Tears
• Lachrymation when laughing
• Dryness of stool
• Craving for salt
• Aggravated sun
• Emotional stress;
• Aggravated between 10-11 a.m.
Better by:
• Seaside
• Open air
• Moderate exertion
Remedies:
• Initially, Rhus Tox was given but no relief.
• Bryonia also gave no relief.
HelloHello
Upon second or third follow-up:
• We probed in detail because he was SQ every time.
Third follow-up:
• He spoke more freely.
• Data was obtained from his wife.
• We realized that he’s a closed person.
• He had a recent history of the death of his daughter who was murdered.
• When there has been grief, he has not revealed much.
• He had turned to spirituality secondary to the grief.
• He doesn’t confide in others saying, What is the use? Only I have to deal
with it and sort it out.’
Based on this:
Natrum Mur 200 in infrequent doses was given.
• This resulted in almost 40% relief in the first 10 days.
• He continued to improve.
Remedy: Staphysagria
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• Great tenderness and weakness all through the body
• Stitching tearing pains are felt along the course of nerves
• Concomitants are often sexual complaints:
• Relaxation or atrophy of sexual organs
• Tendency to take cold.
• [WHAT?] After mechanical injuries from sharp cutting instruments or
surgeries.
Aggravated by:
• Emotions
• Insults
• Chagrin with indignation
Better by:
• Lying down all the time in bed
Interpersonal relationships:
• Feared his father.
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• Has issues in developing friendships or relationships with anyone around.
• Is a loner.
Indicated for:
• Sudden violent effects in ailing patients
• Piercing pains
• Rheumatic hydrogenoid constitution
• Sour, bilious and lithemic diathesis
• Sadness
• Suicidal impulse
• Dirty brown or greenish, yellow, thick, pasty tongue and more at the base
• Tip feels burnt
• Flatulence is painful
• Rumbling, gurgling in bowels
• GI complaints
• History of injuries, especially head injuries
• Extremely sensitive to dampness of weather
• Damp houses
• Feels every change from dryness to dampness
• Cannot tolerate watery foods
• Doesn’t like a warm room
• Is better in open air
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• He came with a complaint of back pain, neck pain, and generalized aches
and pains for almost 20 years.
• Before coming to us, he had been to many specialists, done all the
investigations, took lots of painkillers.
• All the investigations were normal, yet there was no relief.
On inquiry:
• 20 years ago, he was badly beaten by local goons.
• He was pulled by the hair and battered.
• Since then, he had a swelling on the head, which still is there along with
the pains.
• The patient was having a lot of GIT complaints like acidity, sour
eructations.
• All complaints were worse under a fan, in cold, and in the damp/rainy
season.
• He was depressed about his state of health and would have suicidal
thoughts.
Remedy:
Patient was given Natrum Sulph 200, 2 doses.
• In a week, he was 70% better.
• Exercises were started, and he continued to improve.
Remedy: Phosphorus
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• Sinking feeling in stomach, sometimes at 11 a.m.
• A ravenous hunger
• Must eat often or faints
• Longs for cold things
• Short naps and frequent wakings
• Sudden symptoms
• Profuse clammy night sweats aggravated during sleep without relief
• Violent thirst
• Burning thirst for cold water
• Burning pains
• Burning in between the shoulder blades, in spots along the spine
Worse by:
• Lying on left side
• Lying on back
• Lying on painful sides
• Slight emotions
• Warm foods
• Sudden change of weather
Better by:
• Eating
• Rubbing
• Being magnetized
She was advised admission on day one, but she couldn’t do so.
Remedy: Bryonia, but no relief
HelloHello
Case review at 1 week:
• Issues of family stress
• Husband too was bedridden due to paralysis
Physical:
• Sole characteristic observed was vomiting which started at the same time
as the back pain.
• She couldn’t tolerate anything that was hot, and it would be vomited out.
Remedy:
• Phosphorus 200 first dilution, was given every 30 minutes
• Also, pelvic traction once admitted.
Note:
• We did the orthopedic examination before starting treatment.
• She was also assessed by the orthopedic surgeon who reported SLR was
25 degrees.
• In a week, her gait improved.
• SLR also became 90 degrees which is SLR negative.
• She was then discharged.
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Chapter 8: Lessons from
working with Back pain cases
So, now what’s my learning from the cases I have
learned?
Physical Stress
The usually cause of back pain is stressphysical stress like lifting anything or any
acute trauma. If it is not managed with rest and medication, your vital force comes
into the picture. With the neglect, there are alternations occurring or will happen
eventually at the level of the patients’ perception about the disease. Coupled with
other stressorrs, they lead to chronic low back pain.
Emotional Stress
If physical stress is not the cause, emotional stress often becomes one due to
the patient’s mental state and his reaction to the environment. He’ll initially try to
adjust, but there’s a breakdown with the second or third event. If his back is the
sensitive area, and if the issues are related to his support and finances, a chronic
series of back pain begins.
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Predominant Mental Make-Up of Back Pain Patients
• These people generally come up to be conscientious, duty and task-
oriented, and therefore they feel guilty if the task is not done.
• Generally, they have lowered self-esteem or self-worth which they
compensate for by doing their task properly.
• They stretch beyond their capacity, either on purpose or from no choice.
• They take on responsibility early and will volunteer to take responsibility
for others.
• He or she feels that they do not have the support required, either financial
or emotional.
• Generally, financial worries predominate, especially when it comes to the
lumbar area.
• They’re anxious: “What will happen if it worsens? Who will do the
household chores or my routine things for me? I will be useless.”
• He’s image conscious.
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Chapter 9. My Back Ache Case
Taking Approach.
I usually take the complete preliminary data, the complete chief complaint at
history along with its mental concomitants, as well as physical and mental generals,
if available, on day one.
In Preliminary Data -
1. Age & sex
2. Education & occupation
3. If those have changed, how many time and why
4. Marital status (single/ married/divorcee/ widow)
5. Change in religion
Your preliminary data can often be a window into your mental life space. Let me
give you a couple of case examples
Case Study # 1
This is a case of Argentum Nitricum with cervical spondylosis and
breathlessness in a geriatric male who is a widower.
Argentum Nitricum was prescribed on the basis of:
• His fear about his health, about death, about being alone.
• This fear was understood because he had no one of his age around him,
neither a spouse nor his friends (most of whom were dead).
• He was almost 86 or so.
• His daughter had come to stay with him.
• While the daughter was there, there would not be a problem.
HelloHello
• However, the moment the daughter would be out for a job, he would go
into panic attacks with severe pain in the back, cervical neck region, and
breathlessness, and often end up with vertigo.
• He would fear so much that something might happen to him that he
would call for her to come home and attend to him.
On this basis, Argentum Nitricum was given, and there was almost a 40-50%
amelioration in one week.
Case Study # 2
This second case of Argentum Nitricum is that of an unmarried female who
presented with vertigo due to cervical spondylosis along with low back pain.
She had similar issues of security:
• Who will look after me?
• Fear of being alone
In Chief Complaint
1. It’s important to assess the ailments from’ and the mental/physical stress.
2.How did this complaint start?
3.Was it preceded with any kind of illness (fever, gastro, UTI, trauma)
If so, we need to rule out any seronegative arthropathies.
We also need to rule out infective causes also like tuberculosis and
malignancies.
Any stressful event before or during the onset of pain is important.
2. Assess the onset: Was it sudden or gradual? What was the duration (how
many days/weeks of pain)
3. Any tingling and numbness in lower limb? Any radiculopathy?
4. Any radiation and with what sensation?
Is it burning, tingling numbness?
What is the assessment of the paresthesia?
If anything else started with the low back pain, that gives us the
concomitants.
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7. Pain and Disability Scale
There are some patients now who are excessively hypochondriacal. They say,
My pain is so bad that I cannot do without the painkillers.’
It is important for us to understand either that the painkiller is taken out of
fear, or the painkiller or pain medication is taken because of the disability that
he’s experiencing.
So assessing the disability and the pain on day one and doing the same in the
subsequent follow-ups helps us in understanding if our remedy is working
well, and also how severe the case is.
8. We need to know what treatment has been done thus far. Was it self-
medication or was it given by a consultant?
9. Modalities of aggravation and amelioration: These should be specific -
with flexion, extension, lying down - on the back, stomach, side; sitting,
walking, twisting, etc.
They are helpful for reaching Specific Diagnoses
• Compression fracture: There is aggravation with flexion and
aggravation with getting up.
• Herniated disc: You have worsening of the pain when sitting. You
commonly encounter worsening of movement in lumbar strain and
sprain which is better with rest, too.
• Spinal canal stenosis: You have the leg pain which is more than the
low back pain. The patient is generally worse, or the pains are generally
worse with standing and walking, and there is amelioration with rest
when the spine is flexed.
• Spondylolisthesis: Pain is worse with walking and standing and
better when there is flexion and the resting of the spine.
• Spondylolysis: If there is disc pain, the pain is worse with flexion
and sitting.
• Facetal pain: Pain is worse with extension.
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• When is it felt to be maximum?
• How long does it last?
Stiffness with an assessment of the range of motion will also be a good
pointer for assessing the follow-ups later.
12.Weight gain or loss:
Any weight gain or weight loss must be investigated to rule out any metabolic
issues like hypothyroidism, obesity-related conditions, malignancies which
will lead to weight loss, and again tuberculosis which will lead to weight loss.
13.Weakness:
Any kind of weakness in the lower limbs with difficulty in movement and loss
of strength will help us in understanding if there is more nerve damage.
14.Joint pain:
Any other joint pain, stool or urine abnormality must be investigated to rule
out cauda equina syndrome.
15.Breathing difficulties or gynecological symptoms:
Breathing difficulties are mostly seen in cases of ankylosing spondylitis as
there is decreased rib cage movement because of the complete fusion of the
spine. That’s why we take chest expansion.
Any gynecological symptoms, whether pregnant or not pregnant, are
important. Pregnancy will cause alterations in the lordotic curve and/or
physiological changes because of the axis deviation which will lead to back
pain.
16.Urinary or GI symptoms:
Any urinary or GI symptoms current to pain could be secondary to a non-
spine related complaint.
17. There could even be a mental concomitant.
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Note: Not every case of acute intervertebral disc prolapse will require the same
medicine, nor will every case of ankylosing spondylitis or even lumbago. Why?
We all know that we believe and practice in individualization. How do we separate
two patients of ankylosing or lumbago? Modalities or concomitants definitely help,
but the real nailing will be by asking about his perception:
• How is this complaint affecting you at your family, social, professional and
personal level?
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Additional Considerations
Does that end our case taking? If yes, why or why not?
We have to diagnose our back pain cases based on trauma and determine if it
is:
• Congenital
• Degenerative
• Inflammatory
• Immunological
• Endocrinological
• Neurological
• Hereditary
• Due to malignancy
• Psychological
Some systems in our body which cannot be examined physically are better
assessed by asking about their functioning at the general physical level. This can be
assessed by evaluating:
• Appetite
• Urine
• Stool
• Sweat
• Sleep
• If any issues arose before the low back pain or with low back pain
• The patient’s dreams or menses
I mentioned earlier a case of renal calculi to whom we had given Berberis. This
was predominantly because we knew of burning urination which was a concomitant
along with the back pain.
Evaluation of mental life, including events and response of the patient since
childhood, are also important as we assess the impact of the illness on the patient’s
daily routine.
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There are many Aurum Met cases which come to us with a backache.
This was an Aurum Met case of spondylolisthesis with lumbar spondylolysis in a
male aged 63.
He was given Aurum Met on the basis of feeling an extreme duty to the extent that,
during his son’s engagement when he was in hospital for a catheter insertion, he
went to the event insisting on discharge against medical advice.
He said that, apart from him, there is no one else in the family to manage the event.
In addition, even at the age of 63, he feels the need to work because it is his
responsibility to see his kids settled as well as the future generation. He feels it is
not wise to rest and that he should get back on his feet at the earliest to make
everyone comfortable.
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Chapter 10: Difficulties in
Treating Back Pain, Obstacles to
Cure and Scope of Homoeopathy.
What difficulties do we encounter?
Many.
It is generally observed that the patients with low back pain take their pain or their
conditions too lightly. They expect a magical cure within the first visit and if not well,
they’re less likely to follow up.
It therefore becomes mandatory to explain to them, in black and white, the gravity
of their participation in getting well, and the need and benefits of complete bed rest
or fomentation and exercises later.
Yet by and large, poor compliance is seen because they want to work no matter
what and they feel as if the world will come to an end if they rest.
Many times, this has been observed when IPD admission is advised. They flatly
deny, saying the house won’t run without them run or they don’t have the money.
Perhaps because of this very reason, they resort to too many painkillers that are
advised by local doctors or self-medicate with over-the-counter medicine.
Patients resort to quick fixes even after failed surgical relief for low back pain.
They do this to such an extent that, after taking too many steroids and painkillers, it
makes it difficult for their body to respond to homeopathic medicine. They would
have otherwise experienced relief if no steroidal injections had been taken.
In many cases, even surgeries have failed to give relief. This indicates that the
surgical corrections were perhaps like external paint and plaster while the inner
defect, which usually is at the level of the mind, are still uncorrected.
Patients show much initial hesitation unless oriented regarding our approach.
They don’t see any logical reason why we are asking about their life, stress, and
phases. They have been programmed to treat their body and mind separately. It
either takes a while to obtain data, or a tactful inquiry is required without letting
them know we are asking.
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So, what is the scope and limitation?
The scope is limited especially if the patient is not compliant, either if they do
not rest or if their case is surgically advanced. It is good, especially in acute states
without neuro deficit, based on their nature of presentation and ailments from, if
they fall under the scope. However, they cannot treated completely unless and
without the assistance of physiotherapy, surgery if the need arises, and orthotic
supports.
We need to assess every case for the dynamicity in its nature, if it is functionally
and structurally involved, and the extent of pathology if it is present. We also need
to know the number of characteristics. Depending on that, we can say our scope is
good.
In chronic cases, if there is gross pathological involvement, our role remains
palliative. So, adjust through a poem to all the readers and listeners.
It’s back pain
don’t let it be at the back of your list to deal with.
HelloHello
Chapter 11: Parting Words of
Wisdom and Questions from
Students
Answering Questions from Students
1. Back pain after reproterol injection:
It’s very difficult to advise any particular remedy for back pain after reproterol
injection because every individual will respond differently to the injections.
Also, any kind of steroidal medicine will decrease the characteristic
symptoms that are presenting, and so our possibility of giving immediate
relief also decreases.
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2. Back pain with hip degeneration:
You need to understand that there is radiation to the back because of the hip
pain, so the symptoms and totality must be taken. We are not treating just the
diagnosis; we are treating the individual. So the cause, ailments from,’ and the
presentation of the patient along with his perception is what we’ll deal with for
management.
3. Causes of pain in thoracic vertebrae more than a low backache:
More often the causes of pain in thoracic vertebrae, especially in the geriatric
age group, are due to compression fractures in osteoporotic patients.
4. Causes of osteoporosis at the age of 24:
Early osteoporosis could be due to taking heavy steroids or may have a
pathological cause. By pathological I mean that you could be seeing
osteochondritis dissecans or any pathology that is causing early osteoporosis.
Or it could be simply because you are not exposed to sun and have a low
intake of vitamin D. This is commonly encountered in Muslim females who
wear a burka throughout the day.
5. Managing acute conditions:
When in acute pain, almost no patient will give you the entire case history.
You have observe. You’re going to prescribe completely on observation so
look at how the patient is presenting and how the characteristic physical
generals are evolving. That’s how you manage acute cases which demand
IPD admission.
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