A Simplified and Integrated Approach to Backache and

Sciatica
by
Dr. Tarul Wadikhaye Jadhav

Copyright © 2018 Shilpa Bhouraskar

All Rights Reserved
No part of this eBook may be used or reproduced by any means, graphic,
electronic, or mechanical, including photocopying, recording, taping or by any
information storage retrieval system without the written permission of the publisher
except in the case of brief quotations embodied in critical articles and reviews.

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

Chapter 1: Why Study Back Pain?.............................................. 7

Book Outline..........................................................................................................7

Chapter 2: Clinical Anatomy of the Spine................................. 9

What is the spine?.................................................................................................9
Constituents of the Spine.....................................................................................9
Where Back Pain Originates..............................................................................17

Chapter 3: General Outline: Causes of Back Pain..................18

Mechanical and Degenerative...........................................................................18
Inflammatory causes..........................................................................................30
Neoplastic............................................................................................................32
Metabolic Causes of Back Pain..........................................................................32
Referred pain.......................................................................................................32
Idiopathic - Other Causes..................................................................................33

Chapter 4: What exactly is Back Pain?.................................... 35

Types of Back Pain..............................................................................................35
Incident-specific Causes of Back Pain..............................................................35
Classification of Back Pain.................................................................................35
How presenting symptoms differ.....................................................................35
Homeopathic Red Flags.....................................................................................37

Chapter 5: Diagnosing Back Pain............................................ 39

Tips before Diagnosing......................................................................................39
Physical Examination of the Spine....................................................................39
Investigations: Confirm via Proof & Documentation.....................................40

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

Chapter 7 - Homeopathic Management: Remedies & Case

Study Synopses.......................................................................... 62
Acute group:........................................................................................................63
Chronic group:.....................................................................................................63
Intercurrent group:.............................................................................................63
Specifics:...............................................................................................................64
Remedies with Brief Case Study Reviews.........................................................64

Chapter 8: Lessons from working with Back pain cases......88

So, now what’s my learning from the cases I have learned?........................88
Predominant Mental Make-Up of Back Pain Patients....................................89

Chapter 9. My Back Ache Case Taking Approach...................90

Important questions for low back pain early diagnosis:...............................90

Chapter 10: Difficulties in Treating Back Pain, Obstacles to

Cure and Scope of Homoeopathy............................................ 97
What difficulties do we encounter?..................................................................97
So, what is the scope and limitation?...............................................................98

Chapter 11: Parting Words of Wisdom and Questions from

Students..................................................................................... 99
Answering Questions from Students...............................................................99

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

Clinical/Functional Anatomy of the Spine:

You’ll be learning the functional anatomy of the spine. This will assist you in
understanding what is normal and abnormal, which will also help you in localizing
the part affected through the symptoms, e.g. if it’s the bone, the muscles, ligaments,
nerves, etc.

Normal Movement of the Spine:

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.

Specific Questions for Patients:

What is the benefit? You’ll learn not only how to reach a diagnosis from case
taking and physical examination, but also how to assess the prognosis and decide
the curability, e.g., is this case in your treatment domain.

Homeopathic Therapeutics for Back Pain Management:

I’ll share some of the remedies that I have commonly used in my own practice,
the easy, quick prescriptions that are based on a few pointers, and the role of the
mind in causing acute as well as chronic low back pain.

Scope of Homeopathy for Back Pain:

What’s the benefit? Homeopathy will help with a better prognosis via timely
surgical intervention, if the case demands, using homeopathic medicines which are
given pre- and post-operatively. Early assessment will help in quick reference and
will reduce any damage caused. In the bargain, you’ll have a better relationship with
your patient because he’ll gain confidence in you.

Auxiliary Modes of Management:

If quick and permanent relief is to be achieved, then incorporation of complete
bed rest, even the particular position of rest, the way of sitting, lying down, and
exercises along with orthotic supports, all have to be done in addition to
homeopathic treatment. You cannot just give them medicine and expect the patient
to come back to you feeling better.

HelloHello
 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.”

What is the spine?

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.

Constituents of the Spine

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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

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 • Ligamentum flavum
• Intertransverse ligament
• Posterior longitudinal ligament
• Anterior longitudinal ligament
• Supraspinous
• Interspinous

Benefit of Knowing the Ligaments

There are certain conditions that affect the ligaments only, or you could say
calcification. Knowing this will also help us in understanding why there is difficulty in
movement with that particular individual.

Neural Tissue, Spinal Cord, and Nerve Roots

HelloHello
 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)

Why This Picture is Vital to Homeopaths

The patient will generally bring an MRI, or we would advise an MRI. The MRI
images should not seem too different. An MRI is a representation of this transverse
section itself so in understanding the normal, you’ll be able to differentiate the
normal and the abnormal in the patient.

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 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.

HelloHello
 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.

HelloHello
 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.

HelloHello
 Normal Lumbar Canal

This consists of:

• The vertebral bodies
• The intervertebral disc from the front
• Laminae
• Spinous processes behind
• Pedicles laterally
The measurements may not seem very important to us currently, but the
structure is important. Why? The MRI will help us know if the disc is herniated
in the lateral areas or if there is central compression on the spinal cord, or in
the nerve root, or if there is any break in the spinous processes.

Where Back Pain Originates

Does back pain actually originate from where the patient feels the pain?
Possibly but there are other areas. The origin could be the paraspinal muscles, the
ligaments, the bones, the intervertebral discs, the nerve roots, or the spinal dura.

HelloHello
 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

Mechanical and Degenerative

When considering mechanical and degenerative, I’m going to include the
conditions that bring about the back pain due to issues related to the positioning of
the spine and the mechanical access of the spine.

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.

HelloHello
 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.

HelloHello
 Scheuermann’s Kyphosis

This condition is commonly seen in adolescence. This illustration shows

abnormal osteochondrosis in which the vertebrae grow unevenly. There is an
interruption in the blood supply, particularly in the epiphysis, which leads to local
necrosis. Later there are growth spurts that cause a very uneven the vertebral
structure and brings about the kyphotic changes.
Therefore, these adolescent children would complain of back pain.

Thoracic and lumbar spinal stenosis

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HelloHello
 Spinal canal stenosis refers to central herniation. These changes are likely
causing mechanical disturbances in the spine resulting in back pain.

Spondylolisthesis and other congenital anomalies.

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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.

HelloHello
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.

HelloHello
 Male child:

Left Image: Here is a slightly clearer picture of hemivertebra with right-sided

scoliosis. This was also an accidental detection in a young boy who came with
complaints of back pain that did not subside even with copious painkillers.
Note that this cannot be corrected with homeopathy because it’s both a
mechanical error and a congenital defect.
Right Image: You can see the C2C3 and C6C7 vertebrae appear to be fused, and
block vertebrae which is a congenital finding due to the rotational movements or
flexion/extension that will be limited.

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Physical Causes of Hip Misalignment & Pain

Different causes include:

1. Leg length difference which will cause pelvic tilt, bring about scoliotic
changes and therefore back pain.

HelloHello
2. Restricted hip movements,
3. Misaligned pelvis, and pelvic obliquity also can cause back pain.
4. Fracture, Injury and Sprains:

HelloHello
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)

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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.

Metabolic Causes of Back Pain

Osteoporotic fracture:

Metabolic as a cause of back pain occurs when you have an osteoporotic

fracture which is commonly seen in post-menopausal females or males over the
age of 70.

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.

Case Example: Back pain due to renal calculi

This case resulted from renal calculi and was diagnosed in an interesting way.
A 30-year-old male presented with pain in the lumbar region occurring for a few
days. We probed, but found no specific modalities apart from concomitant of
burning urination and occasional pain in the abdomen radiating down to the
bladder.
An x-ray revealed two right-sided calculi. Therefore, Beriberis 30 tds was given,
and USG was also advised so that we could determine the size of the calculi.
This patient was much improved in a week so he did not have a sonograph.

Idiopathic - Other Causes

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.)

Case Study: Acute Trapezitis due to wrong sleeping posture.

Here is a case of acute trapezitis that we encountered in a student of ours. She
came to the OPD with severe pain in the left trapezius muscle with spasm to the
extent that she couldn’t move her neck. This was all experienced after awakening; it
wasn’t there the night before. She suffered severe pain with restlessness which is
why she wanted medication.
Rhus Tox 1M repeatedly was given, and the pain subsided in two days. She was
pain-free on the second day without painkillers.

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

Incident-specific Causes of Back Pain

• Age-related degeneration
• Suddenly taking up heavy exercise
• Stain from lifting a heavy object
• Overdoing physical work on the weekend (gardening, yard work, home
repair)
• Pregnancy
• Sitting for long periods, e.g. office work

Classification of Back Pain

Low back pain: 3 classifications
• Acute: Pain for less than 6 weeks
• Subacute: Pain ranging from 6 weeks to 3 months
• Chronic: Pain lasting more than 3 months

How presenting symptoms differ.

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

• Generally confined to one dermatome

Disease-related:
• Faulty posture due to sneezing, coughing and straining.

Associated Sensory and motor disturbances:

• Tingling numbness
• Burning
• Any kind of paresthesia
• Motor disturbances indicating there might be a weakness
• Heaviness also in that particular limb.

Associated Muscular weakness:

• Weakness of the muscles innervated by the nerve root
• Difficulty in a particular movement
Note: This does not mean the full leg could be weak—only the muscle which
was innervated by that nerve could become weak or cause difficulty.

Associated Hypoaesthesia of involved nerve root:

• Decreased sensitivity to touch
• Total lack of sensation

Associated Development of cauda equina :

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

Homeopathic Red Flags

These red flags are symptoms and conditions that require special attention
and/or more thorough diagnostics.
• Recent significant trauma: The pain could originate from somewhere else
in the body.
• Milder trauma if patient’s age is greater than 50 years: This may indicate
some type of degeneration or decline of the body.
• Unexplained weight loss: This could be a sign of tuberculosis, an
immunocompromised status, or even malignancy.
• Unexplained fever: Again this could be tuberculosis, malignancy, some
other infection.
• Immunosuppression: Conduct additional diagnostics as needed.

• 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.

HelloHello
 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.

Physical Examination of the Spine

Examination with patient standing (including inspection and

palpation):
• Posture
• Obesity
• Kyphotic curve, scoliotic curve, lordotic curve
• Spinal movement (bamboo spine)
• Tenderness both superficial and deep
• Proper chest expansion

Range of motion - Assessment of the spine’s movement:

• Flexion,
• Extension
• Lateral flexion
• Lateral rotation
Note: Use these observations as a baseline so that in the follow-up, you’ll see
if there’s an improvement or not.

Examination with the patient lying down :

Motor examination

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 • 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

These diagnostics assist in:

• Determining and confirming your diagnosis
• Narrowing down your list of investigations
• Differentiating the affected part, e.g. if it is a muscle which is affected or
the nerve, the ligament, the bone, or a combination.
Why diagnostics are crucial:
Your line of management is dependent on these tests. You cannot always wait a few
days for an MRI. It’s preferable to do a clinical exam and begin advice and the line of
management from day one.

Investigations: Confirm via Proof & Documentation

1. X-ray of the lumbar spine: Generally AP and lateral views.
2. Myelography: Not as common now but can be helpful.

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 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.

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 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

Posture correction - Slouching

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 • Results in incorrect posture

• Adds stress
Note: Slouching can feel “relaxed” but is adding a load to the spine
• Results in pelvic tilt

• Damages/adds stress to internal organs suspended along the spine

Regular exercise: Yoga

• Helps to correct pelvic tilt

• Improves slouch

• May correct lifestyle errors

• Manages back pain

Conservative line of treatment:

• Complete bed rest (CBR)

• Physiotherapy

• Back support (orthotic support)

• Activity (physical rehabilitation activity, exercises, yoga)

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Complete Bed Rest

Posture advised for back pain:

• Supine (on the back)

• Pillows under their thighs and knees

• Pillow under the head is optional

Rationale for the supine position:

• Decreases the stress on the sciatic nerve

• Decreases back pain

• Decreases spasm

Posture to relieve spasm:

• Lie on the side

• Flex the hip

• Pillow between knees

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 Bolster (see illustration):
• Pelvic completely on the bolster

• Head down

• Shoulders on the floor

• Legs up

• Note: This particular posture is very good especially in cases of severe pelvic
tilt or exaggerated lumbar lordosis.

Case study: Adult female

Presentation:
• Housewife with chronic back pain.
• She failed to rest. (I may have failed to ask as we generally don’t ask
unless there’s a need.)
• She reported tingling numbness.
• Said nothing is helping in spite of a month or treatment with medication.

Response to follow up questions regarding medication:

• She reported no improvement.
• In answer to what she does after taking medication: "I am doing nothing. I
am just doing my household work; the grocery things that I’m buying, I’m
washing the clothes. That’s it, nothing else I’m doing.’
How much does she rest?
‘Who is going to rest after taking of medicine?’
The husband failed to understand that there is a need for rest.
Result:
• You can do no more.
• Rest is mandatory; medicine alone is not a cure.

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 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.

Orthotic Support Options for the Spine

• Anterior hyperextension brace: Indicated in cases of osteoporotic

fractures or any kind of vertebral fractures; the brace prevents the back from
going into a kyphotic curve.
• Contoured LS support belt: Indicated for acute intervertebral disc
collapse.
• Taylor brace: Indicated for Scheuermann’s Kyphosis and other conditions.

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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

Special note for contoured LS belt:

• Cannot be worn indefinitely
• Is not a life-long cure
• Once pain has subsided, exercises are required to strengthen the spinal
and abdominal muscles
• Exercises should be graded, e.g. yoga
• Yoga exercises must begin under supervision

Exercise - Yoga for Back Pain

Note:
• The asanas are meant to result in a pain-free back.
• Definite protocol is required.
• Deliberate, mindful abstinence from negatives posture, etc. is required to
prevent pain & strengthen the spine.
Additionally:
• Gradual lifestyle alterations are mandatory
• Develop a healthy routine
• Develop a good mental attitude
• Develop patience and persistence
• Dietary changes as required

When advising yoga for pain relief:

Emphasize that yoga empowers the patient to participate in his or her pain relief.
Sets of asanas advised for the spine:

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 • Vertical stretching
• Forward bending
• Backward bending
• Side bending
• Twist
• Asanas for the spine and hip

Talasana I, Talasana II (Mountain Pose)

• Vertical stretches
• Assist in releasing the spasms
• Must be done in a graded manner
• Hypertensive patients: Do not go on toes

Konasana II (Angle Pose)

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 • 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

Standing Vakrasana (Standing Twisted Pose)

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• 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)

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 • 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.

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 • Aligns shoulders, spine, and pelvis
• Alignment creates a correct lordotic curve
• Gradually corrects & maintains overall posture

Vajrasana (Thunderbolt)

• Excellent stretch for spine and hip

• Helps correct spine posture

Bhadrasana (Gracious Pose)

• Excellent stretches for spine and hip

• Releases stress in the SI joint

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 • Helps correct spine posture

Yogamudra (Forward Bend Sitting on Heels)

Paschimottanasana (Seated Forward Bend)

• Are forward flexion asanas

• Open up and give maximum stretch to the spine
• Gives a quick compression to abdominal muscles
• Correct pelvic tilt

Shalabhasana (Locust)

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Bhujangasana (Cobra)

• Strengthens the gluteus

• Strengthens the cervical spine
• Strengthens the lumbar spine
Note: Must be done in a graded manner

Manjarasana (Cat Pose)

• Corrects pelvic tilt

Why the emphasis on pelvic tilt:

• Once pelvic tilt is corrected, many back pain issues are resolved.

Setubandhasana (Bridge)

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 • Corrects pelvic tilt

Paryankasana (Couch Pose)

• Stretches the gluteus

• Stretches the hamstrings
• Stretched the quadriceps
• Decreases stress along the SI joint

Yastikasana (Stick)

• Completely stretches the spine

Note: The Yastik stretch is a lying down version of the Talasana standing
stretch.

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Pavanmuktasana (Wind-Releasing Pose)

• Also called flatus releasing pose

• Causes good abdominal compression

• Relieves lordotic curve

• Excellent to correct pelvic tilt

Note: Must be done in a graded manner.
• Beginners: One leg at a time only.

Hastapadangusthasana (Standing Hand to Big Toe) Variations I, II and III

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 • Can be done lying down
• Strengthens spinal muscles
• Strengthens hamstrings
• Strengthens quadriceps
• Good hip openers in the SI joint
• Relieves stress

Parsva Balasana (Threading the Needle)

• Good gluteal stretch

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 • Good pelvic tilt correction
• Opens hip joint
• Compresses abdomen
• Opens spine

Shavasana (Corpse Pose)

• A complete relaxing asana.

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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.

General comment regarding Asanas

I have made it a point to advise asanas only after 60% amelioration of the
complaints. That’s the time to take on the asanas properly, strengthen them, and the
cure is hastened. Advising on day one will likely exacerbating the pain.

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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

When is surgery advised?

Only when it is absolutely indicated in the following cases
1. Cauda equina syndrome:
This is a medical emergency if there is acute stoppage of urine, acute
paresthesia or paralysis felt in the lower limbs, or acute sensory and motor
loss to the lower limbs.
2. Foot drop:
3. Exruciating radicular pain,
4. Neurogenic claudication.
Do not wait for your patients to experience this. It’s better to advise surgery.

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 Chapter 7 - Homeopathic
Management: Remedies & Case
Study Synopses

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 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

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 • 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.

Remedies with Brief Case Study Reviews

Remedy: Rhus Tox

Indicated for patients who are:

• Easily sprained
• Extremely restless
• Continually change of position in the bed which temporarily relieves pain
• Soreness
• Feeling of uneasiness
• Pain in the affected part is as if it is torn
• Pain as if it’s bruised all over and sore

Indicated for:
• Sprains and strains
• Left-sided sciatica
• Painful stiffness
• Tingling and numbness
• Soreness to touch

There is continued motion which temporarily seems to ameliorate the pain,

soreness, and stiffness, but is exhausting to the patient.

Tongue is:

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 • 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

Rhus Tox Case Study: 29-year-old Male

Presenting symptoms:
• Severe left-sided pain.
• Seemed to be a bit agitated and restless due to the pain.
• The pain began after heavy weightlifting activity a few days back.
• Pain was aggravated with sitting and lying down.
• Pain was better with moving around.

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

Indicated for patients with:

• Black hair

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 • 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

In Bryonia, there are classic symptoms of:

• Gradual onset of most of the complaints
• Slowly advancing, forcible processes
• Localizing in unyielding tissues
• Very painful
• Muscular rheumatism
• Muscles sore to touch, sometimes swollen
• Worse from least motion
• Bursting, stitching or heavy, sore pain going backward

Characteristic physical generals:

• Dryness everywhere
• Thirst for large quantities of water

Aggravated with:
• Least motion
• Raising up
• Stooping
• Exerting
• Coughing
• Deep breathing
• Hot on becoming vexed

Better with:

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 • 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)

Bryonia Case Study: 36-year-old Female

Employed in a multinational company.
Presented with severe back pain for the past 2 or 3 days.
• Pain was severe enough to restrict all the activities.
• The pain was gradually increasing.
• Was worse with the slightest motion.
• Was better by lying on the affected side.

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

Suitable for patients who are:

• Sensitive
• Excitable
• Nervous temperament
• Woman of a sensitive
• Easily excitable nature
• Quick to perceive
• Rapid to execute
• Alert

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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

Ignatia Case Study: 49-year-old female

Post-menopausal housewife presented with low back pain.
• She initially did not trust in homeopathic treatment, so took allopathic
treatment from the ortho surgeon who sits with us.
• A week later, returned with no change. He had obviously given her just
paracetamol.
• Because there was no relief, there was a desire to try homeopathy.

Her case was then taken in detail:

• This wasn’t an acute event nor the first.
• There were approx. three episodes in the past.
• Death of the near ones was always the reason. In order:
• Death of father-in-law
• Death of mother-in-law
• Death of mother.
• Everything was centered around death.
• After every event of death, there would be shock status followed by
severe back pain.
Patient’s state during the interview:
• The patient was crying as though it’s a recent event.
• She was bitterly crying.
• The strangest aspect was that this patient worked as a counselor in an
organization, but she wasn’t able to get over this.
Remedy:
Ignatia 200, 2 doses were prescribed.
• In a week, she was 70% better.
• Later, I advised exercise, and she continued to improve.

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Remedy: Hypericum

Indicated for patients who are:

• Plethoric with great soreness (plethoric refers to very energetic)
• Lacerated, injured or inflamed nerves esp. areas full of sentient nerves
• Very painful sore areas
• Intolerably, violent, shooting, lancinating pain along the nerves
• Excruciating pain
• Sensitiveness to touch

Neuritis would be:

• As an outcome of injury
• Accompanied by tingling, burning or numbness.

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

Hypericum Case Study: 43-year-old male

The patient is an orthopedic surgeon sitting with us.
• Presented with severe back pain for the past few days.

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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:

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 • Emotions
• Vexation
• Chagrin
• Anger
• Lying on painless side
• Aggravated in the night.

Better with:
• Hard pressure, on the edge
• Heat
• Rest
• Gentle motion

Colocynth Case Study: 54-year-old Female

Married housewife presented with:
• Sudden onset of back pain, severe enough to disable her walking.
• Noted a temporary flexion deformity at spine.
• She walked as if she was completely bent up.
• We advised admission, but she refused.
• She said, —You treat me on OPD basis, and I’ll come.’
• Presented with severe left-sided radiculopathy.
• Included tingling and numbness which was only better with pressure.

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

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 • 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

Indicated for patients with:

• Haemorrhoidal tendencies
• Who suffer from gastric, bilious or catarrhal troubles
• Experience fullness in various parts as from undue amount of blood
• Heart, lungs, brain, pelvis, etc.
• Severe dull back pain in lumbosacral articulation
• More or less constantly affecting sacrum and hips
• Back “gives out” during:
• Pregnancy
• Prolapse
• Leucorrhoea
• When walking or stooping
• Must sit or lie down
• Sensation of heaviness and lameness in back
• Pain as if breaking
• Has to make repeated efforts at rising

Worse with:
• Walking
• Stooping
• Morning on awakening
• From any motion
• Lying,

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 • After stools and urinating

Better with:
• Cool open air
• Bathing
• Bleeding piles
• Continued exertion
• Summer

Aesculus Case Study: 48-year-old Male

Worked as a laborer in a factory.
• After spinal surgery for disc herniation, he presented with complaints of
back pain.
• There was a recurrent episode of severe post-operative pain.
• Surgeons advised him corrective surgery.
• He was restricted to bed for the last 6 months, but he couldn’t afford
surgery and so came to us.
The pain was:
• Severe on getting up
• In the morning
• With walking
• Felt as if the spine was going to break

Physical exam and palpation:

• Limited due to the patient’s pain level.

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.

One month followup:

• The patient was confident about his spine and resumed his job.

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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.

Remedy: Kali Carb

Best suited to patients who present as:

• Old

• Fleshy

• Flabby

• Dropsical

• Paralytic

• Tubercular diathesis, usually right-sided

• Very irritable

• Full of fear and imaginations

• Great aversion to being alone

• Face yellow or pale

• Sickly-looking with sunken eyes

• Haggard lifeless expression

• Bag-like swelling over the upper eyelids

• Backache

• Sweat

• Weakness

• Anemia

• Debility

• Desire to lie down

• Drowsiness in daytime and early in evening

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 • Sensitive to every atmospheric change

• Sensitive to cold

• Chilly patient

• Backache while walking

• Feels as if she must give up and lie down.

• Backache as if bruised and broken during rest

• Constant backache with a feeling as if back and legs would give out.

Stitching pains aggravated by:

• Rest
• Lying on affected side
• Aggravated with pressure
• Stitching back pain back at 3 am compelling the patient to get up and
walk
• Feeling of fullness even after very little food or drink with gas troubles.
• Pain aggravated in the early morning
• Symptoms come on at 2, 3, 4 or 5 a.m.
• Better with warmth.

Kali Carb Case Study: Female, Chronic Low Back Pain

The patient presented with:
• Low back pain for the last 3-4 years
• Bilateral radiculopathy
• Burning sensation with right foot drop
• Investigation revealed:
• L3-l4, l4-l5 disc herniation

Details of the case:

• No marked worries
• Diligent, loving, family woman with daily responsibilities on her mind
• Sleep was disturbed due to pain
• Pain woke her after 3 am, lasted until 5-6 a.m. then subsided

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 • 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

A remedy of unquestionable benefit in:

• Sciatica
• Pain associated with numbness of affected part
• Rheumatism
• Morning diarrhea
• Chronic backache in the lumbar region
• Lumbago with numbness in lower part of the back
• Weight in pelvis
• Generally experiences anterior crural neuralgia
• Cramps in calves of legs and feet when in bed
• Intense pain along the sciatic nerve
• Numbness alternates with pain
• Pain as if the joints lacked oil

Better by:
• Resting on back
• Drawing up the limbs
• Flexing thigh on the abdomen

Gnaphalium Case Study: 38-year-old Female

The patient presented with dull back pain and tingling in both lower limbs.
• She had been taking medications earlier, but there was no relief.

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 • 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.

Remedy: Aurum Met

Note: This is a very commonly-indicated remedy if rightly elicited during

case taking.
• Is a very emotional remedy

• Complaints are seen to be coming after:

• Fright

• Vexation

• Disappointment in love

• Reserved displeasure

• Frequent back pain complaints

• Feel that back pain is a hurdle in routine work

• Feel that pain can’t or won’t let them stop and rest

• Feel they have to work come what may without rest

• Feel they are the only person who is responsible

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 • Their duties cannot be given to anyone else

• Resting is a crime

• Self-condemnation

• Blame self a lot (I’m at fault; I’m this, I’m that)

• Imagines neglecting something or duties and for that reason, deserves

reproach
• Deserves a severe form of punishment

• Is uneasy

• Is hurried

• Great desire for mental and physical activity

• Profound melancholy

• Constantly dwells on suicide

• Longing for death

• Suited to corpulent old people for whom life is a burden

• Face glowing red

• Boring pains

• Oversensitiveness to all pains

• Aggravated night

• Generally with hypertension or people with cardiac complaints

• Right-sidedness

• Thermally they are hot

Aurum Met Case Study: 68-year-old Male

Retired widower who presented with a complaint of back pain for the last 2
months.
• Gave a history that he had had a fall.
• Being a widower, he was the only person who was in the house.

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 • 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.

Remedy: Natrum Mur

This remedy is suited to patients who are:

• Cachectic
• Anemic
• Older
• Anger with much suppression
• Will not disclose or confide easily
• Often broods over the past

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 • 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

Natrum Mur Case Study: 48-year-old Male

The patient presented with a complaint of cervical and lumbar pain for the last
few months with bilateral radiculopathy.
• X-ray showed signs of degenerative changes.
• Only common modalities were observed.

Remedies:
• Initially, Rhus Tox was given but no relief.
• Bryonia also gave no relief.

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 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

These patients tend to be:

• Very sensitive to least impressions, whether mental or physical
• Take offense at every little meant or unmeant insult
• Easily excited to anger
• Very sensitive to what others say about them
• Suffer effects of sexual abuse
• Subdued anger
• Are insulted or too dignified to fight back
• Swallowed wrath
• Retreat to home trembling and exhausted

This is what is commonly seen as the picture that comes up before

suffering:
• Cravings for tobacco
• Desire for stimulants

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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

Staphysagria Case Study: 25-year-old Male

Recent graduate in search of a job.
• Presented with severe chronic back pain and occasional radiculopathy.
• MRI showed lumbar spondylosis with spondylolisthesis of L4 vertebrae.

Note: This is a degenerative change a 23-year-old male, so we probed in detail.

Revealed in an interview:
• Many mental symptoms
• Emotional stress
• Feelings of humiliation
• Shame
• Timidity
• Suppressed anger
• Lack of confidence

Interpersonal relationships:
• Feared his father.

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 • Has issues in developing friendships or relationships with anyone around.
• Is a loner.

Remedy: Staphysagria 200, infrequent doses were given.

• Immediate and radical relief was experienced by the patient at the
physical as well as mental level in the first week itself.
• He gradually developed confidence and good interpersonal relationships
with family and cleared his interview.
• He continues to improve.

Remedy: Natrum Sulph

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

Natrum Sulph Case Study: 47-year-old Male

This is a very interesting case of a 47-year-old real estate agent.

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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

This remedy is suited to:

• Tall, slender persons of sanguine temperament
• Young people who have grown too rapidly and are inclined to stoop
• Old people with morning diarrhea
• Premature old age
• Hemorrhagic diathesis; left-sided
• Anguish regarding future
• Nervous
• Weak with a desire to be magnetized
• Great tendency to start
• Tendency to strain back

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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

Phosphorus Case Study: 52-year-old Female

A female farmer by profession presented with back pain and left-sided sciatica
with radiculopathy and burning pain.
• She was better with pressure, worse with least motion.
• Spine movements were restricted.
• SLR was 20 degrees on the left.

She was advised admission on day one, but she couldn’t do so.
Remedy: Bryonia, but no relief

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Case review at 1 week:
• Issues of family stress
• Husband too was bedridden due to paralysis

This time she was willing to be admitted.

Observations:
• Caring
• Smiling
• Loving

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 stress—physical 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.

Important questions for low back pain early diagnosis:

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

Argentum Nitricum: Two Case Studies

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.

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 • 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

Argentum Nitricum was prescribed on this basis.

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.

This is why we need to ask the modalities.

10.Fever:
The presence of fever will help us know if there is any kind of infective lesion
like tuberculosis or any other infection, malignancy, or even
spondyloarthropathy.
11. Stiffness:

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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.

Benefits of Thorough Interview

Why are these questions asked?
By reaching diagnosis quickly, you’re able to shortlist the probable examination and
accordingly the investigations. There is an increased likelihood of accessing the
prognosis correctly, and you can decide on day one when to start the adjuvant line
of treatment.

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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?

Two Case Study Interview Examples

Pulsatilla Case Study: 26-year-old Female

Now, here’s this case of a female to whom Pulsatilla was prescribed. This female
was a designer, almost 26 years of age. She presented with a complaint of back
pain, lumbago, and no radiation. A detailed history was taken because she was
comfortable with it. Elements of fear, forsaken feeling were evident, due primarily to
childhood sexual abuse.
Later on, her confidence was shaken because of it. She had developed a fear of
interacting with men, fear of how people look up to her, and fear of interacting on a
day-to-day basis with the customers. The stress of it and the responsibility of the
family added to her low back pain.
Remedy:
Pulsatilla 200, gradually 1M and 10M, helped relieve her back pain to a great extent.
She was later put on physiotherapy and exercises also.

Aurum Met Case Study: Ankylosing Spondylitis

This is a case of Aurum Met for ankylosing spondylitis. What was so specific
about this individual was now he was working in a factory; not a very high position
but definitely not a very low position either. Now he was very stressed about the job,
the reason being the sudden demise of his boss.
This added much responsibility, and he felt that he was the only one who could take
care of his boss’s family.
Based on this, Aurum Met was given.
He experienced gradual pain improvement as well as Schober’s test and chest
expansion.

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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.

Aurum Met Case Study: Lumbar Spondylolysis

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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.

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 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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