Low Back Pain: Experience in Homoeopathic Practice

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lumbagoFirst of all, it is necessary to point out that we have limited our study to cases of pain affecting the lumbosacral region. We have thus eliminated cases with pain radiating to a lower limb or limbs (sciatica), in spite of the fact that in either case organic lesions localized at the level of the lumbosacral spine are involved. This was done because from the point of view of homoeopathic therapy, with which we are concerned, different groups of remedies are used. We have also eliminated occipital headache, Arnold’s neuralgia, cervical pain, cervicobrachial neuralgia or radiculalgia and high dorsalgia.

The finding which impressed us most is the outstanding usefulness of a group of three remedies: Nux vomica, Sulphur and Rhus tox. Between them, they cover about 40 per cent. of cases, with 15 per cent. for Nux vomica, 13 per cent. for Sulphur, and 13 per cent. for Rhus tox. The other remedies, although obviously important, come a long way behind these three aristocrats, with Calcarea carbonica 4 per cent., Sepia 4 per cent., and Colocynthis 3 per cent. These figures only have relative value since we have not really carried out statistical analysis. In a third group, we will classify the remedies which we consider important and which deserve to be known since we come across them from time to time in our daily practice. They, too, are irreplaceable, and include Cobalt, Calcarea fluorica, Berberis and Phosphorus. A certain number of remedies will be omitted, since our aim is not to give a lecture on the homceopathio treatment of lumbago, but merely to record our own experience in the homoeopathic treatment of this condition.

Let us now go through the different remedies we have mentioned.

NUX VOMICA

First of all, Nux vomica. It is the Prince of remedies for lumbago and rheumatology in general. We prescribe it when we find this keynote: TURNING IN BED aggravates. The patient who justifies Nux presents an aggravation when he wakes up in the morning in his bed. The time of aggravation is of no importance. The mere act of turning in bed causes pain. We have the impression that this keynote has been greatly under-estimated, though it is perhaps the best one, the most faithful, in our materia medica. Faced with a case of lumbago, we have to try and check on this characteristic which, in the first place, will save us much searching. We place Nux absolutely at the top of the list. Several writers do mention it, but they do not give it enough importance.

The second observation which we would like to make with regard to Nux is
the following: The Nux patient shows aggravation on rising and improves with movement (Rhus tox.), moreover, this improvement is very distinct. Thus the remedy is Nux more often than Rhus tox. Faced with such a combination of symptoms: aggravation on rising, improvement through movement once the muscles have “warmed up”, it is necessary to think of Nux as a possible remedy and not automatically to prescribe Rhus tox. We feel that Rhus tox. is prescribed too often in place of Nux and this is certainly the reason why all writers are unanimous in awarding Rhus tox. the first place. We prescribe Nux in a single dose. When Nux is the remedy, the patient will recover. Repetition of the remedy after a few months is not necessary, and even harmful. If the patient has a relapse two months later, for example, it is better to re-examine the case and look for the possibility of another remedy, rather than repeat Nux vomica. It is a straightforward remedy and we cannot recall any disagreeable aggravation reactions as with Sulphur. It is specifically in cervical osteoarthrosis that we find a reaction of aggravation two or three days after prescribing Nux. This reaction sometimes alarms the patient if he has not been warned about it beforehand. It only lasts a few days and can, moreover, be palliated with pain relievers. But one week after taking the dose, the patient generally does not feel pain any more and the improvement is lasting.

We are going to digress a little in order to tell you of a symptom which we
feel is extremely characteristic of Nux vomica: pain at the level of the firstdorsal vertebrae as if one had been thrashed and as if one were covered with bruises. This is a symptom which is often encountered in our practice and the remedy has always been Nux. But I repeat, this symptom relates only to the dorsal segment.

Let us add that Nux seems to be the remedy most often indicated in rhiz-
arthrosis of the thumb (N1tx vomica, Thuya, Rhus tox., Natrum carb.).

To conclude, we have the impression that Nux vomica is the remedy most
often indicated, and the most important in rheumatology, definitely eclipsing
Rhus tox,

SULPHUR

We place Sulphur in second position before Rhux tox. There are several key-notes which indicate this remedy. It is not necessary for all of these to be present.

The best keynote is certainly s aggravation when in a standing position,
where this is to be found. In this connection, it is necessary to compare this
with the keynote of Rauwolfia, pain in the lower limbs aggravated by the weight of the body, a keynote which we owe to our late master, W. L. Templeton. It was recalled by Doctor Gutman in an issue of the BRITISH HOMCEOPATHIC JOURNAL.

The second characteristic of Sulphur is aggravation on rising from a sitting
position. It is necessary to know that this characteristic (emphasized by Nash) does not impose Sulphur as a remedy. It may be encountered in other remedies, like Nux and Rhus tox. for instance. It is always necessary to take a complete case history. It is only when no other remedy is indicated that we prescribe Sulphur. It should also be noted that the patient is never precise when being questioned. He will regularly tell you that his pain increases when in a sitting position (which would indicate Cobaltum). This modality needs to be gone into in detail. He will tell you that he feels this pain when rising from a sitting position and you will go on to Sulphur!

The aggravation on stooping forward, or more exactly, on rising from a —
stooping position, is another characteristic in the same class as the previous one. It is not an outstanding characteristic, but it is one, and sometimes we
have to content ourselves with it.

Another characteristic, somewhat particular, which is encountered less
frequently but is valuable, is the pain which begins at the edge of the sacrum
and spreads to the groin, extending around the hip. When the pain stops at the level of the greater trochanter, the remedy is Physostigma. A pain which extends around the abdomen suggests Berberis, a very excellent indication of this remedy which Dr. Templeton taught me and which never ceases to render me service. But when the pain is located low down and when it spreads to the groin, the remedy is Sulphur. All the same, do not let an attack of appendicitis escape you.

Pain in the lumbar region, STRAIGHTENING UP agg., is another very
excellent characteristic of Sulphur, but it is the modality which is encountered least of all.

Finally, when we see a very thin and lanky patient, often leaning to one
side (antalgic attitude), enter our surgery, the remedy is nearly always Sulphur.
We have obtained some quite memorable recoveries with this indication. This type of lanky morphology suggests essentially three remedies: Natrum mur., Phosphorus and Sulphur. The Natrum mur. patient is rather reserved and belongs to the withdrawn type. The Phosphorus patient is always very cheerful, sociable and expansive. We rarely hesitate between Sulphur and Phosphorus, but one might hesitate between Natrum mur. and ‘Sulphur. Theoretically, the differential diagnosis is not difficult. In practice, it is not always easy since the Natrum mur. patient will often tell you that he likes consolation. By this he means that he is sensitive to sympathy given to him by others but in spite of your efforts, you will not succeed in making him explain what exactly he means by this. At present, when faced with such a type of patient, we do not even try to find out whether he is aggravated or improved by consolation, we prefer rather to rely on our flair. Even so, we prescribe Natrum mur. when the patient tells us that he is improved by consolation (or when he seems to be improved by consolation). A certain number of remedies and among them some of the most important cannot be shown up by even the most expert history- taking, the practitioner must sense them (Pulsatilla, Calcarea carb., Calcarea phos., Sulphur, Kali carb., Ammonium carb., Fluoric acid, etc.). Thus, Pulsatilla is wrongly considered the easiest remedy of our materia medica. It is the remedy which is the simplest to understand, the easiest to grasp by beginners, but, in my opinion, either it is prescribed too often, or its use is no longer well known
because we have not yet learned how to sense a Pulsatilla subject.

I would like again to point out that the subject who justifies Sulphur is not
necessarily untidy and dirty. If he is, this will be a further indication for’
Sulphur.

Finally, Sulphur is the remedy which most readily gives reactions of aggrava- tion. It is necessary to know this and to guard against it. But it should not be
exaggerated. We have only had two cases of aggravation, followed moreover, by a short-lived recovery. The aggravation was bearable and we could palliate it with a painkiller. We prescribe Sulphur in the 30th potency, in a single dose, and we do not repeat it.

RHUS TOX.

In our opinion, Rhus tox. only takes third place (13 per cent. of cases). Its
modalities are well known: aggravation through immobility, aggravation on
beginning to move, improvement on continuous movement, aggravation
through movement lasting too long. The sensation of stiffness and of ankylosis when at rest is very characteristic. We have, however, learned to be on our guard whenever we find only the sensation of stiffness when getting up, improved when the muscles begin to “warm up”, as the patients put it. It is not at all certain that the remedy is Rhus tox. in that case. There are just as many chances that the right remedy is Nux or Sulphur. We have noticed that when Rhus tox. is the remedy, the indications of this remedy are generally complete and extremely clear. The patient will tell you, for example, that he is aggravated by rest and improved by changing his position, and since often we only find the sensation of stiffness low down in the back when getting up, the patient does not suffer at all so long as he stays in bed! Pay attention, think of the possibility of Nux vomica and Sulphur. The main source of error is due to the fad that Rhus tax. is prescribed on its modalities only. Modalities and symptoms must not be confused. A modality is not a symptom. From the teaching of Kent, a symptom is complete only when it is accompanied by its modalities.

It is necessary to take into account the genius of the remedy, the general
action of the remedy and the site of this action. In our opinion, Rhus tox. is much too often prescribed in place of Nux and Sulphur, which would make up 40 per cent. of cases. This is certainly the reason why practically all writers give it first place and many colleagues systematically prescribe Rhus tox. in all cases of lumbosacral pain.

Rhus tox. is a remedy which needs to be repeated. We remember the case of a colleague whom we treated with a single dose of Rhus tox. 101\1. The dose only brought about an improvement for 4 or 5 days. It was with Rhus tox. 7 t.d.s. that we cured him afterwards, in an extremely short space of time and absolutely permanently. (This was a case of cervicobrachial neuralgia.) (Doctor Templeton also preferred the 6th t.d.s. to the higher potencies whenever he had to prescribe Ignatia.) The repetition of Rhus tox. does not generally cause an aggravation.

CALCAREA FLUORICA

The practitioner who thinks of Rhustox. must also automatically consider
Calcarea jluorica. The modalities are exactly the same. In the event of failure
with Rhus tox., Calcarea fiuorica is capable of bringing considerable relief. It is in Dewey and Lilienthal that I picked up this hint. I confirm it constantly. We give this remedy in a single dose or in a single divided dose. It will sometimes be necessary to repeat the treatment after some months. Do not repeat it on a routine base, but only in event of the re-appearance of the old symptoms. The patients generally recover after a few repetitions. We have never had to repeat this remedy indefinitely.

CALCAREA CARBONICA

Rhus tox. and Calcarea fluorica naturally lead to Calcarea carb. which is complementary to Rhus tox. Together with Colocynthis and Sepia, Calcarea forms the second group of our remedies. These three remedies are important, but even so they come a long way behind the first group (Nux, Sulphur and Rhus tox.).

Calcarea carbo is a remedy which is prescribed essentially in accordance with the morphology and not the local symptoms. It concerns a corpulent subject, who is short and big-boned. This is a good indication for Calcarea, but the morphology alone (which, moreover, is not compulsory in the prescription of Calc.), is not enough. In general, we try to find out whether the patient presents any localized sweating. If he has damp hands when shaking hands with you, this is already a good indication for Calc. If he perspires more on the head (face, forehead, nape of the neck, etc.) and especially at night, making his pillow damp, then the indication for Calc. is almost certain. Other times, we have not had many indications for this remedy, and the remedy is indicated by one of its best and usual characteristics such as breathlessness when climbing stairs or a sensation of coldness at the top of the head or in the pit of the stomach. These are excellent characteristics of Calc. carb., but even so, they are not encountered to the same extent in these cases as the “turning in bed
agg.” of Nux. Yet other times, we really do not have any indications other than the corpulence of the patient. On leafing through Hering’s Guiding Symptoms, we are struck by the quantity of symptoms shown in black type throughout the whole pathogenesis of Calcarea carb., so that we may safely prescribe this remedy to any short person who comes to consult us for rheumatic symptoms. We have made a few observations with regard to Calcarea carb.

First of all, the type of morphology which we have just described is not
absolutely compulsory. Secondly, when faced with a morphology of this type,
it is also necessary to think of the possibility of Sulphur (which is presented by both a lanky type and a short type). The short Sulphur type is generally
plethoric with a red face, or he gives the impression of being dirty. It is also necessary to consider the possibility of Natrum carb., but Natrum carbo is more cheerful and absolutely cannot bear the heat in summer. When the organicity of the case is important, Calc. carbo is often the remedy; for example, we have recently had a case with demineralization, spontaneous fractures, compression of the vertebrae, etc. We have the impression that Calc. carbo acts better in higher potencies than in lower potencies. We tend to use it in the 1M or 10M. It is not a difficult remedy and it does not give any disagreeable reactions of aggravation.

The last comment which we would like to make about this remedy is the
following, and I am sure that you have all made the same observation. Often, when treating our patients successfully with Calc. carb., for example, for a scapulohumeral peri-arthritis (our favourite therapy), the pain disappeared very quickly and definitively, but the patient generally did not lose any weight, or only very little. We have only to recall a single case of a young girl whose figure should have been literally transformed with a single high dose of Calc. However, with Antimonium crudum 10M, we often obtain spectacular results with a drop in weight of about 33 pounds within a lapse of time of three months. We have even made lipomas disappear in two people with Antimo nium crudum. Sometimes, the weight only begins to go down a month and a half after administration of the dose in the 10M. Therefore, do not repeat it too soon and do not go on to another remedy at the risk of spoiling your case. We have noticed that when a case comes to a standstill, the administration of a further dose of Antimonium crudum 10M generally no longer gives the same result as the first dose. We have been able to make cases progress after an intercurrent dose of Sulphur. At present, we tend to administer simultaneously a dose of Antimonium
crudum 10M with a dose of Sulphur in order to avoid any loss of time, sino
female patients quickly lose patience. In short, we are still at the experimental stage. The main indication for Antimonium crudum is obesity in young subject: and in cases with recent obesity. The patient does not necessarily presen’ digestive disorders, or a white tongue.

To come back to Calcarea carb., we have recently seen again a case of hirsutisn whom we treated successfully with Calc. carbo 10M repeated at long intervals. It concerned an unmarried woman of 36, weighing 7 stone 10 lbs and 5 ft. tall at the present time, who had been treated during puberty with a total ovarial complex (crinex). At the age of 20, hairs appeared on her chin, neck and legs and she was continually obliged to have these removed. She was seen by a well known endocrinologist who thought that she presented a virility complex inreaction to the female hormones which she had received for quite a long time during puberty. As a concomitant phenomenon there was a new weight gait of over two stone at the same time as the first hairs appeared at the age of 20. We obtained an appreciable result (improvement estimated at more that 50 per cent. by the patient who is delighted with the homeeopathic treatment but her weight only dropped by seven pounds in spite of dieting. We have also treated a 62-year-old woman who had come to consult us for rheumatic pain; (in particular, she had rhizarthrosis of the thumbs and presented with pain it
the heel at the same time). It was a typical Natrum carb.: short, cheerful, lively “upset by the great heat in summer”. Natrum carbo 10M made all her pain disappear, but she did not lose one ounce in weight. It is true she adores fruit. Natrum carb is only shown in roman letters in Kent and not at all in Lilienthal. Lachesis is another remedy which has made several of our patients lose weight. In one of them, who had responded perfectly to Lachesis, we administered dose of Antimonium crudum 10M in order to observe the effect. Well, the young girl lost a few pounds after the administration of Antimonium and afterward; responded brilliantly to Lachesis. The loss in weight was greater with Lachesis which is her remedy than with Antimonium crudum. We have recently brought about an appreciable loss of weight in an obese person with Graphites and this
subject presented the famous characteristic of Graphites: weeping from music Kali Carbo is also an excellent remedy when the gain in weight follows child birth. The patient jumps very easily at any sudden noise. Often, young women and young girls come to consult us for “cellulitis”. This is a difficult affection to treat. We have obtained results with Chamomilla! It might be said that then is a parallelism between this affection and the nervous state of the subject The hip measurements decrease as the subject becomes less nervous. We have given Chamomilla on the following indications: violent angry outbursts, breaking something in a fit of temper, agitated sleep. Please forgive this long digression and let us return to our subject.

SEPIA

Sepia is used above all in the chronic, not too violent, cases. The great characteristic is the improvement from pressure. The patient, more frequently a woman or girl, always carts a cushion around with her and wedges her back when sitting down or presses up against the back ofthe chair. Poor blood circulation (varicose veins of the lower limbs) is an excellent indication for Sepia, also the presence of leucorrhoea. The other usual characteristics of this remedy, which everybody knows only too well, will also put you on to Sepia. Natrum mur. presents the same characteristic of improvement from pressure, but Sepia is more often the remedy than Natrum mur.

COLOCYNTHIS

Colocynthis is indicated by two characteristics which are not necessarily present simultaneously. The first is a LANCINATING PAIN (therefore the pain only covers a very small and very limited surface area) in the lumbar region or in the lumbosacral region. It is an intermittent pain. The remedy is not Bryonia when we have to deal with lumbago, but Colocynthis! It is a sure indication for Colocynthis.

The second is obviously CONTRACTURE of the lumbar muscles. It is a
common symptom, but from a certain degree, it becomes a characteristic
exactly like the hypersomnia of Nux moschata. We also give Colocynthis in a single dose, in contradistinction to Rhus tox. In general, recovery is permanent. We have never had to repeat Colocynthis. If the improvement is not a lasting one, it is necessary to prescribe a dose of Sulphur rather than repeat Colocynthis.

REMEDIES USED OCCASIONALLY

Now here is the third group, that of the remedies used occasionally. We have already given you the keynotes for the prescription of Cobaltum and Berberis. We have had a fantastic recovery in a case with Hypericum. The young woman had been suffering from lumbago for some time and had been treated in a truly untimely manner by a bonesetter who had tried to put the vertebrae back into place and had dealt her a violent blow on one vertebra with his fist. On leaving the bonesetter’s, she had a fit of trembling. The next day, she was overcome by tiredness and she was on the verge of a nervous breakdown with insomnia. Her back was terribly sore. She was suffering from loss of appetite, asthenia and anxiety. She recovered very quickly with Hypericum 30 t.d.s. for 3 days, then b.d. for 2 days.

Lycopodium, which is an excellent remedy for functional back pain in young
women, is rarely indicated in lumbago. We have used it once with success;
the pain was localized right in the middle of the sacrum, it was especially
aggravated when rising from stooping and there was a strong desire for sweet things. The patient did not present any other general signs of Lycopodium, nor of dyspepsia, flatulence, etc. We did look for these signs afterwards.

We would ask your permission once again to say something in parenthesis,
with regard to the longing for sweet things. We consider the symptom of
longing for sweet things as defined when the patient puts four pieces of sugar in his coffee in the morning, at least in France. It sometimes happens that the patient does not take so many lumps of sugar but experiences a real longing for sweet things during the day, but this is extremely rare. And when this longing for sweet things is well-defined, the remedy is rarely anything other than Argentum nitricum or Lycopodium. In the repertory, Argentum nitricum is shown in black type for longing for sweet things and longing for salt. We have tried to prove the frequency of longing for salt in A rgentum patients and we have come to the conclusion that really and truly, there is no need to mention it.

To conclude, we are going to insist a little on Phosphorus in this third group (used once during this study, but which does not represent 1 per cent. of the
cases in our opinion, if we bear in mind the cases not taken into consideration) because this remedy has a certain interest and it deserves to be better known. Whenever we get stuck in a case, it is always with Phosphorus that we manage to get out ofthe difficulty. It always concerns a subject belonging to the cheerful type, who is very sociable, but the presence of Phosphorus is a symptom which is detected by the practitioner and not revealed by history taking, exactly like the reserve of the Natrum mur., the gentleness of Pulsatilla and the “head of Don Juan” of Fluoric acid (optimism). And Phosphorus naturally leads to Calcarea phosphorica. Apart from the very characteristic attack of the sacro- iliac symphysis of this remedy, Calcarea phosphorica presents quite a lot of pain in the lumbosacral region in Hering’s Guiding Symptoms. We use this
remedy very much in rheumatology in general, when we have a subject of the cheerful and sociable type, and the pain is aggravated by the changes in weather. I have the impression that this remedy is not used often enough in lumbosacral pain. In lumbago we do not have great experience with it. Finally, we have the impression that the women or girls likely to be candidates for beauty contests are Calcarea phosphorica subjects, but this impression needs to be confirmed.

Having come to the end of our study, we were curious and glanced at a few
well-known writers who have written very simply about their experiences, such as Hugues, Clarke, Jahr, and Dewey, eliminating those whose work consisted in compilation, and we noticed that the lists correspond more or less, with a few exceptions, with ours. We have no experience with Antimonium tartaricum. Baers preferred it to Rhu« tox. and even to Arnica! But Baers was a specifist and he does not give the keynotes for the prescription of this remedy. Clarke places Ant. tart. at the top of his list and gives the following indications: “Backache as from fatigue, especially after eating and while sitting; violent sacro-lumbar pain, the slightest effort to move causing retching and cold, clammy sweat; sensation of a weight hanging on coccyx and dragging downwards”, and he adds, “I find Antimonium tart. one of the most useful of remedies in this condition and one of the most commonly indicated.” We have tried on several  occasions to prescribe Antimonium tartaricum on the indication of heaviness,
but we have only met with failure. We think that this remedy must suit
especially acute cases and the indications given by Clarke and Lilienthal seem interesting: “violent sacro-lumbar pain, the slightest effort to move causing retching and cold, clammy sweat”. Another remedy approaching Antimonium tartaricum is Bryonia. Everyone knows the symptoms and the modalities of this remedy. We feel that, like Rhus tox., Bryonia is too often wrongly prescribed, especially on its modality of aggravation from movement. In the area of rheumatology, aggravation from movement does not seem to us to be so characteristic. In reality, Bryonia is aggravated by the slightest movement. Pains of the stitching type are characteristic, although sometimes the remedy may be Colocynthis. But the pain may take different forms: tearing, dull aching, stiffness, and tenderness. The presence of thirst is not essential, but it is a very good indication which weighs in favour of Bryonia.

We have no experience with Oxalic acid, a remedy valued by Dewey.We have no experience either with Variolinum, but it is necessary to have this
remedy in mind in very acute cases, since it may render a service. Doctor S. K. Ghosh of Calcutta has great experience of this remedy. He has used it in cases of lumbago. It has been found to be a great remedy especially in haemorrhagic cases, whether it concerns uterine haemorrhage or haemorrhage in relation to typhoid with backache very prominent. Burnett has used it extensively in uterine haemorrhage due to fibroids and other tumours of the uterus (quoted by Dr. Ghosh in his book: Clinical Experience ioith. some Rare Nosodes, a book published by P. K. Bose, ll/D, Guruprosad Chowdhury Lane, Calcutta-6, in 1956, one of those rare books which teach you many useful things without boring you and which I highly recommend).

 

SUMMARY
Nux vomica :  turning in bed agg., motion amel.

Sulphur: standing agg.; rising from sitting agg.; rising from stooping agg.; pain in sacral region extending to groin

Rhus tox: prescribed on its modalities only

Calcarea fluor.: when Rhus tox. fails

Calcarea carb.: special type; local sweats, especially head sweats; coldness of local part (vertex); subjectively respiration difficult on least exertion

Sepia : pressure amel. varices, leucorrhoea; Sepia  symptom complex

Colocynthis: stitching pain in lumbar region; intermitten pain; pain confined to a small spot (Kali bich.); contracture

Cobaltum:  pain in lumbosacreal region, sitting agg.

Berberis: pain extending around abdomen

Hypericum: after spinal injury

Kali carb.: lumbago after parturition

Phosphorus: in a typical Phosphorus patient. Difficult cases.

Antimonium tart.: in very acute cases. The slightest effort to move causes retching and cold clammy sweat.

Bryonia :  pain agg. slightest motion

Variolinum: in very acute cases

Author: JACQUES HUI BON HOA, M.D.

Source: The British Homoeopathic Journal, April 1975.

 

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About Author

Dr Abha B.H.M.S is an alumni of Bharati Vidypeeth Deemed University's Homoeopathic Medical College, Pune. She has more than 10 years of clinical experience into practising homeopathy. Currently, she is Editor, The Homoeopathic Heritage and www.homeopathy360.com.

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