NEUROLOGICAL DISORDERS LIKE LUMBAGO & SCIATICA

ETC. WITH MANAGEMENT BY HOMOEOPATHY

Dr. Vivek V. Kulkarni M.D. (Hom)

Assistant Professor, Department of Materia Medica, A. M. Shaikh Homoeopathic
Medical College and Hospital, Belgaum.

LUMBAGO – LOW BACK PAIN

Non specific low back pain of

mechanical origin is second only to the common

cold as a cause of self-limiting symptoms and

disability in the community Back pain,

particularly in the lower (lumbar) region of the

spine is one of the most common scourges of

Mankind. Very few people live their lives

without experiencing backache in one form or

other.

RHEUMATIC COMPLAINTS: WORLD HEALTH ORGANISATION (WHO)

CLASSIFICATION
 Back pain

 Regional periarticular or ‘soft tissue’ disorders.

 Osteoarthritis and related disorders.

 Inflammatory arthropathies.
Epidemiology:

It has been calculated that more than three quarters of the world’s population

experience back pain at some times in their lives, and in developed western countries low

back pain is the most common cause of sickness related absence from work. In the UK

approximately 10% of people who suffer from episodes of low back pain consult their

general practitioner annually, more than 2 million consultations and more than 50 million

days lost from work each year.

More than 90% of episodes of low back pain are of mechanical origin and most

resolve spontaneously within 1-2 weeks. In about 30% of patients episodes can last as

long as a month but chronic low back pain of more than 3 months duration accounts for

less than 3% of all cases.

Mechanical low back pain is particularly associate with occupations that involve

heavy lifting, bending or twisting such as manual labouring or nursing, but people whose

jobs involve awkward static posture or prolonged driving are also at increased risk.

Episodes of occupationally related low back pain are twice or common in adults over the

age of 40 years. Overall prevalence is similar in both sexes but recurrences are more

common in men (20% in 1 year). Job dissatisfaction depression, obesity, smoking,

alcohol and socio-economic deprivation have also been implicated.

AETIOLOGY

The common type of short lived mechanical low back pain is not associated with

a definable aetiology or spinal pathology. The causes of rarer but more serious chronic

back pain are as follows.

CAUSES OF BACK PAIN

Mechanical Referred pain

 Prolapsed intervertebral disc.  Peptic ulcer

 Lumbar spondylosis.  Pancreas

 Spinal stenosis  Bowel

 Congenital abnormalities  Kidney

 Non-specific.  Aortic aneurysm

Inflammatory  Endometriosis

 Infections  Ovary

 Sacroilitis  Retroperitoneal fibrosis

 Ankylosing spondylitis  Herpes zoster

  Arachnoiditis  Hip disease

Metabolic  Polymalgia rheumatica

 Osteoporosis Other

 Ostesmalacia  Scheuermann’s osteochondritis

 Hyperparathyroidism  Diffuse idiopathic skeletal

 Paget’s disease hyperostosis (DISH)

Neoplastic  Fibromyalgia

 Metastasis

 Myeloma

 Reticuloses

 Osteoid osteoma

 Intrathecal tumours

CLINICAL FEATURES

Mechanical low back pain is characteristically acute in onset and frequently

associated with a definite history of lifting or bending radiation of pain to the things can

be associated with sprains of muscles, ligaments and apophyseal joints as well as with

nerve root irritation. However pain which radiates down the back of the leg beyond the

knee and pain which is aggravated by coughing, sneezing and straining at stool is usually

associated with the disc protrusion or other causes of nerve root compression.

Radicular pain is frequently sharp and lancinating in quality and associated with

signs of lumbar nerve root irritation. Other medical and systemic causes of low back pain
are usually more insidious in onset, more prolonged in duration and not so obviously

influenced by posture and movement.

SIMPLE MECHANICAL LOW BACK PAIN

History

 Sudden onset

 Precipitated by lifting or bending

 Recurrent episodes : age 20-50

 Pain limited to back or upper leg

 No clear-cut nerve root distribution

 Improved by resting

 General health good.

Examination

 Asymmetrical movements of lumbar region.

 Asymmetrical straight leg raising.

 Pain aggravated by movements

 No neurological deficit.

 No back pain on axial loading or simulated rotation.

Investigations

 Blood ESR
  Serum Ca, phosphorus, Alkaline phosphate, Acid phosphate, prostate specific

antigen (metastatic ca from prostate).

 Test for rheumatic factor.

 X-ray

 Bone scan in fracture, neoplastic and inflammatory lesion.

 MRI.

Management

 Reassurance and positive approach

 Encourage normal physical activity.

 Limit bed rest to 1-2 days in severe cases.

 Homoeopathic similimum

 Patient education

 Yogic exercise

 Consider physical therapy

Outcome

 Recovery in 1-2- weeks.

Pointers to Back Pain with Serious Pathology

 Insidious onset

 Severe and progressive pain not relieved by rest

 Unremitting night pain

 Localisatio9n to multiple spinal levels.

  Age < 29 years or > 5 years.

 Systemic illness e.g. weight loss, night sweats

 Pain in thoracic spine

 Relevant medical history e.g. malignancy, steroid treatment.

Red flags for emergency Investigation

 Loss of bowel or bladder control

 Saddle area sensory disturbance or loss of sphincter tome

 Sensory level on neurological examination

 Bilateral leg pain with bilateral neurological deficit.

Back pain due to sacrolitis or spondylitis is typically ameliorated by physical

activity and exercise as well as being associated with prolonged early morning and

inactivity stiffness. Systematic enquiry may give important clues to rarer causes of back

pain. Anorexia, weight loss or dyspepsia may point to a penetrating peptic ulcer, or

gastric or pancreatic tumour, while changes in bowel habits, prostatism or gynaecological

symptoms can be clues to colon cancer, prostatic metastasis, endometriosis or

uterine/ovarian malignancies.

A history of intermittent claudication may be an indication of severe peripheral

vascular disease, spinal stenosis or lateral canal stenosis.

Local tenderness over the spine, loss of lumbar lordosis and postural changes

associated with muscle spasm and uncompensated non structural scoliosis are common

physical signs associated with all causes of mechanical low back pain.
CLINICAL TESTS FOR FUNCTIONAL LOW BACK PAIN

 Tenderness to superficial touch.

 Stimulation tests e.g. pain on axial loading or spinal rotation in one plane.

 Distraction tests e.g. limited straight leg raising but able to sit with legs flexed to

90º.

 Regional inconsistencies – symptoms and sensory loss that fail to follow neuro-

anatomy

 Over reaction to examination with illness behaviour.

SCIATICA

Pain in the distribution of the lumbar or sacral roots (sciatica) is often due to disc

protrusion, but can be feature of other rare but important disorders including spinal

tumour, malignant disease in the pelvis and tuberculosis of the vertebral bodies.

Acute lumbar disc herniation is often precipitated by trauma, usually by lifting

heavy weights while the spine is flexed. The muscles pulposus may bulge or rupture

through the annuals fibrosus giving rise to pressure on nerve endings in the spinal

ligaments, changes in the vertebral joints or pressure on nerve roots.

CLINICAL FEATURES

Onset may be sudden or gradual alternatively repeated episodes of low back pain

may precede sciatica by months or years. Constant aching pains felt in the lumbar region

and may radiate to the buttock, thigh calf and foot. Pain is exacerbated by coughing or

straining and may be relieved by lying flat.

 The altered mechanics of the lumbar spine result in loss of lumbar lordosis and

there may be spasm of the paraspinal musculature. Root pressure is suggested by

limitation of flexion of the hip on the affected side if the straight leg is raised (lasegue’s

sign). If the 3rd or 4th lumbar roots are involved Lasegue’s sign may be negative but pain

in the back may be induced by hyperextension of the hip (femoral nerve stretch test) the

roots most commonly affected are S1, L5, & L4

INVESTIGATIONS

Plain radiographs of the lumbar spine may show no abnormality in acute disc

herniation or there may be narrowing of the disc space. There may be degenerative

changes, including osteophyte formation of the margins of vertebral bodies in chronic

low back pain.

In lumbar disc disease CT especially using spiral scanning techniques, can

provide helpful images of the disc protrusion and or narrowing of the exit foramina.

MRI is the investigation of choice if available, since soft tissues are well imaged,

enabling the diagnosis of other causes of lumbar radicular syndromes.

MANAGEMENT

Initially bed rest in all patients on a firm mattress if necessary supported by

wooden boards. Provided rest is absolute, pain and neurological signs if present resolve

in over 95% of patients. On recovery the patient should be instructed in back

strengthening exercises and advised to avoid physical maneuvers likely to strain the

lumbar spine.
HOMOEOPATHIC MANAGEMENT

AESC, ANT-T, ARN, BERB-V, CAUL, CHAM, DULC, EUP-PER, GINS,

GNAPH, HYOS, NUX-V, RHUST, SABAL.

BACKACH
E
 Muscle wasting LUMBAR SCIATIC
bladder SPONDYLOSIS
disturbance
PAIN
paraplegia

AGAR, ARG. N, AMM. M, BELL, ACO,

CANN. I, NUX V, ARS, CHAM, COL,
PLB, RHUS. T GNAP, IGN, INDIGO,
IRIS, KALI IOD, PHYT,
BACKACH PLUM, RHUS-T,
E RUTA, SUL, VISCUM

AESC, SEP, AGAR,

BRY, CARB. AN,
CHAM, CON, KALI. C,
KALI. I, KALI. S,
RAN. B, THUJA, ZINC

LUMBAGO AND SCIATICA

SITE OF ACTION SPECIAL INDICATION MODALITY

Remedy-Aesculus. H. Dull backache, cannot stoop Chill at 4 pm up and down
Mucous membrane or rise after sitting with < Morning, every motion,
Bowels constipation and piles. walking
Veins Backache due to straining > Cool open air
Sacrum and hips sacroiliac backache during > by standing
pregnancy
Remedy-Gnaphalium Chronic backache tired < continued motion
Cerebrospinal system of aching in lumbar region > resting flexing thigh on
lower extremities
Numbness along sciatic abdomen.
particularly along sciaticnerve lumbago with
nerve numbness
Remedy-Rhus Tox Hot, painful swelling of A/f cold, wet weather
 Fasciae joints. < rest
 Tendons Pain tearing in tendons. < lying on back
 Sheaths of nerves Ligaments and fascia <1st motion
 Ligaments external Pain and stiffness in small >Continued motion
to capsule of joints of back
of back
Remedy – Bryonia Violent local inflammation < Least movement
 Synovial membrane < Warmth
 Muscularis fibre < Morning
> Lying on painful side
> Rest
> Pressure
Remedy-Calc. Carb. Sharp sticking pain as if A/f lifting
 Cartilages sprained. < Exertion
 Bones Cold damp feet with < Cold in any form
weakness of extremities and > Dry weather
small or back > Lying on painful side
Right sided

Remedy – Lycopodium Draining and tearing in < 4 – 8 p.m.

 Muscular tissue limbs pains come & go < Heat
 Fibrous tissue suddenly stiffness of left > Motion
 Nerves side right sides sciatica > On getting cold
Remedy – Plumbum met Wandering pains with < Night
 Joints stiffness < Motion
 Cartilages Camps, twitching, tingling < Over exertion
 Bursae & numbness > Hard pressure
 Muscle Sciatica-draining & > Physical exertion
pressing
Pain in sacroiliac region
 Extends down
Remedy – Kali Carb Small of back weak < Cold weather
 Spinal cord Lumbago-sharp pains run < 3 a.m.
 Serous membrane up & down the back & to < Lying on left
thighs > Warm weather
Stitching, stabbing pains > Moving while
Remedy – Causticum Affects rights side but left < Clear find weather
 Spinal cord sides sciatica with < Exposure to cold weather
numbness
Contraction & shortening of
muscles
Remedy – Kali-Iod Severe bony pains < Damp weather
 Periosteum Sensitive to touch < Warm room
 Serous membrane Sciatica-cannot stay in bed < Night
 Fibrous tissue > Motion
> Open air
Remedy – Aconite Sudden intense onset dry A/f Dry cold air
 Tendons hot skin with anxiety Checked Perspiration
 Fibrous tissue restlessness, fear numbness, < Evening
 Serous membrane tingling of hands & feet < Night
pains agonising

OTHER INDICATED REMEDIES – PHYTO, TART-EMET, NUX VOM. DULC.

COLO, CHAM, CAUL, ARNICA.

YOGIC EXERCISES BENEFICIAL FOR LOW BACKACHE AND SCIATICA