A Case of Chronic Backache

First date of visit – 14/8/2015

This is a case of a 40-year-old male, working in a multinational company, who visited me for complaints of pain in the lower back for the last 3 years. Following is the exact verbatim transcript of the interview so readers can experience the exact feel of the case.

Interview:

Doctor: How can I help you?

Patient: Doctor, I have pain here in this region (the patient points to his sternal region) and pain in the lower back and the sides. This pain really worsens at nighttime, so much so that I have to take pain killers and apply some Volini gel.

Doctor: Does it hurt that bad every day?

Patient: Yes!

Doctor: Since when did this start?

Patient: This pain has been ongoing the last 2 to 3 years now; it hurts each day, but I do not take the pain killer tablets on a daily basis. I usually apply Volini gel at night only while I go to bed. During the day, it does not hurt that much, but the pain gets very intense at nighttime. I am not sure if my daily one-hour train travel to and fro from my work place is the cause of this pain….. As of now, there is intense pain in my lower back and this side region.

Doctor: Why don’t you take a pain killer then? Do you fear taking it?

Patient: No doctor, there is no fear at all. The thing is that if I take the pain killer, the pain subsides for a while and then recurs again….. so I avoid taking it.

Doctor: How does this problem bother you?

Patient: I think this pain might have come up because I do not take proper rest, which is due to my hectic schedule. Whenever I go to sleep, I get this pain which compels me to get up. Last night, I had very severe pain and even numbness over my entire back region. At work, I have a desk job; so I have to sit on a chair all through the day. I do get up in between for some exercises but there is no pain at all during that time. I assume that this has come up due to my daily train travel.

Doctor: Are you facing any kind of stress in your work place?

Patient: I work in a corporate field, so work is always stressful. I have to meet targets and deadlines in a stipulated amount of time, but all that is manageable for me. I am pretty used to this kind of a working environment; I have been working like this since many years now.

Doctor: Any other stress that you’re facing in your life?

Patient: No doctor, no family tension. (But after saying so, this patient got a little angry, his facial expression changed! Here in lies the art of Homeopathy, the skill of the physician. We cannot miss out on any piece of information.)

Doctor: What happened, why did you get angry just now?

Patient: Doctor, there was definitely some stress in the past but that has worsened recently. Some incident took place around 4 to 5 years back before all my problems started.

Doctor: What was the crisis at that time? Any financial worries or was there any other concern?

Patient: Yes……. I was facing some financial issues at that time; so much so that even managing my daughter’s expenses like the schools and tuition fees, etc was becoming difficult. I also had to repay off my credit card dues, which eventually turned into a huge amount.

Then I joined this office where I am currently working, and could gradually manage to pay off all my dues and manage the situation. I also had to take some loan from my office, but then slowly everything started falling in place and life has just started coming back to normal.

Also during that time, I had some major family issues too! My father got diagnosed with CA of the esophagus and was operated for the same. Those 15 days were the worst days of my life! I was so very much mentally disturbed then! That year was the most horrible one for me!

Doctor: Why, what else happened then?

Patient: My jijaji (sister’s husband) troubled me a lot during that phase due to some trivial financial and family issues. There were some clashes among us since many years, but then he personally started fighting with me for no reason! He unnecessarily started abusing me in front of everyone by getting all past issues out.

I tell you doctor, that thing, those incidences with him have not left my mind at all yet! Once my father passes away, I will abuse him like anything (i.e. his jijaji) and that too in front of everyone. I will give him back, all those abuses and all that hurt. Only then I will be at ease and be able to forget all this. I just cannot forget how much he has bothered me! He used to send me troublesome messages, he would abuse me on SMS. I will show all those messages to all my relatives and abuse him back in front of everyone. I will throw money on his face; the money he lent me a couple of years back while I was in need. He keeps taunting me for that money constantly! I will do this in front of everyone!

Doctor: What is stopping you now from doing so? Why are you waiting for that period to come and not reacting now??

Patient: Doctor, I do not want my dad to suffer because of all this.  If I react now, then his health will deteriorate further. I will react, but not now. I will react at a time when there are at least 50-60 people along with me to support me. I want to show him that when you trouble someone internally, you too should suffer and get to know how does it feel when you insult someone!!

Doctor: Why do you feel like doing so?

Patient: That person has abused me, he has abused my sister’s daughter too. I have not forgotten the dirty words he used. These words always linger in my mind, day and night; this angers me and then at times I am not able to focus on my work and routine too!!

Doctor: Anything else you would like to add here other than this?

Patient: No doctor, nothing else. This is what is going in my mind day and night.

Rx: I gave this patient a single dose of _____200  (see below) along with placebo pills. I called him for a follow-up visit after a week’s time.

First follow-up on 21/8/15:

Doctor: Tell me how are you feeling now?

Patient: Doctor, I am feeling much better now, there is definitely at least a 50% change in backache. The best part is that I am now able to sleep well; my sleep was very disturbed earlier… I used to get up at night due to immense pain and numbness, but now all that has settled. This time, please give me meds for a month as I am going out of India due to some office work.

This patient was kept on placebo for a month.

Second follow up on 01/10/15:

Doctor: So how have you been?

Patient: Doctor, I am much better than before. The pain is much better compared to past; only at times I experience some pain over the shoulders and over this area (he points out at the sternal region).

Doctor: So how much better when compared to prior?

Patient: Feeling much better than before doctor!! At least 70 to 80% better!! I have been sleeping very well! My energy levels are also good. I was out of India for a month for my office work; my schedule was very hectic there, but yet I experienced no pain at all there! This was really surprising…as I was anticipating some low back pain there but then the pain just did not occur! I feel so relaxed and comfortable!!

Doctor: What about your tingling sensation??

Patient: That is also much better as compared to prior; perhaps just once or twice a week which subsides immediately in a couple of few minutes.

Doctor: How is your temperament now?

Patient: Good! My irritability and anger is much better now.

Doctor: What about the thoughts in your mind? You were not able to focus on your routine work too. Do these thoughts of revenge still come in your mind?

Patient: Yes doctor, I will take my revenge but only at the perfect time and situation. If I do take a revenge at that time of my father’s death, it can create a problem for me only. At that time, everyone can turn against me, this is what I have been feeling since the past few days.

(This signifies that this remedy is the Similimum, because the agony which was going in the mind of the patient has reduced now; he is able to focus on his work properly and think rationally.)

He continued with medicines for around further six months and was kept only on placebo. He continued to improve mentally as well as physically. Eventually treatment was discontinued, as he was feeling absolutely fine!

Finally he came on 29/10/16 (after around 10 months since his first visit) for his daughter’s treatment; at which time, he informed me that he is absolutely fine now!!

Analysis of the case:

1) The actual problem in this patient’s life started at the time when his father got operated on for cancer. During that time, this patient’s Jijaji abused him for no apparent reason.

The patient said, “My jijaji (sister’s husband) troubled me a lot during that phase due to some trivial financial and family issues…… He unnecessarily started abusing me in front of everyone by getting all past issues out……He used to send me troublesome messages, he would abuse me on SMS.”

This patient suffered a lot of agony due to his jijaji (this is what he feels…).

• MIND- DELUSIONS – wrong – suffered wrong; he has

Suffered wrongs is a state which comes when a person feels that some other person is responsible for his problem.  Because of that person he has suffered.

2) This incident took place over three years back, but our patient remembers everything as if it had just occurred yesterday. He says, he has not forgotten anything that has happened, he remembers every word that his Jijaji has told him!

• MIND- CUT, mutilate or slit; desire to- others

3) I asked him why are you waiting for that period to come and not reacting now??…..

He replied, “I do not want my dad to suffer because of all this.  If I react now, then his health will deteriorate further. I will react at a time when there are at least 50-60 people along with me to support me.”

• MIND- DELUSION-mouth- cannot open mouth, lower jaw stiff and painful

We have to understand the metaphoric meaning of the above rubric. What will happen when one’s jaw becomes stiff and painful?  Jaw pain can be a debilitating condition that affects one’s ability to eat and speak. One experiences difficulty opening the mouth either because the joint is locked or because of pain. Problems with the jaw joint in front of your ears can have a host of effects: pain when chewing, headaches and more. When this happens, one is not able to express his/her inner desires and wishes.

This patient had a lot of anger pent up inside him, but yet he couldn’t express it, as he didn’t want his father to suffer!!

REMEDY:-LYSSINUM 200  (Single dose, without repetition)

Other supporting rubrics selected were:-

• MIND- A/F- anger suppressed
• MIND- A/F-abused; after being
• MIND- A/F- mortification
• MIND- A/F- scorned being
• MIND- ANGER- violent
• MIND- DELUSIONS-injury- being injured; is
• MIND- DELUSIONS- insulted, he is
• MIND- CURSING
• MIND- DELUSIONS- hell- in; is
• MIND- DELUSIONS- hell- torments of hell without being able to explain; suffers the
• MIND- DELUSIONS- nothing- do nothing, he could
• MIND- DELUSIONS- tormented; he is

Torment (Yaatna; abhishap in hindi):

• Experiencing intense pain especially mental pain; extreme suffering, usually mental suffering.
• Torment is to harass persistently in a cruel or annoying way, subject to torture.
• Act of harassing someone.
• To afflict with great pain, suffering, or anguish
• To tease or pester in an annoying way

The harassing factor in torment in not too great.

As we just read, the causative factor, the source or pain or worry, may just be some minor thing, but the patient feels very troubled by it and is not able to get over it. In this case too, his Jijaji would keep texting him; this patient could have conveniently ignored those texts! He was so bothered by those little messages, that he wanted to get him back for all this!

(Repertorisation was done through Radar Opus software- Schroyens Synthesis Repertory)

RADAR Keynotes:

• Feeling of being tormented.
• Impressions long retained in memory.
• Compulsive violent thoughts.

H.C. ALLEN- Materia Medica of some important Nosodes:

• Thoughts of something terrible going to happen come into his mind against his will, he feels impelled to do reckless things such as throwing the child, which he carries in his arms, through the window and like.
• Could not get rid of that indescribable tormenting feeling that something terrible was going to happen to him.
• Imagine that they are being abused and energetically defend themselves against attacks and insults which in reality are the products of their own fancy.
• Inclined to use insulting language, scold his friends, beat and abuse those near him.
• Inclined to be rude and abusive to bite and strike.

T.F. ALLEN:

• Thought came into his mind to attack others in a mean way; to cut others with a knife he holds; to throw water he has in a tumbler to another’s face.

BOGER:

• Impatience and violent temper.

DR. SANKARAN:

• The main feeling of LYSSINUM is of having suffered wrong, being tormented, especially by one whom he has served, has been faithful to and is dependent on, thus creating an intense feeling of anger and rage, in which the person can bite, strike and even violently mutilate.
• Often this rage is followed by a repentance as profound as the rage was violent.
• Or it may be an impotent anger which can lead to an impulse to stab himself.
• LYSSINUM is required in a situation where a person has to lash out against somebody because, if he keeps quiet, he will be further tormented.
• But this rage has to be followed by quick repentance, because if it persists too long, it is not good for him as he is, after all, dependent.
• CHINA also feels tormented like LYSSINUM. But in CHINA the torment is less intense and long-standing, a long-standing feeling of being persecuted and hindered at work – something that has been going on for a long time (MIND- DELUSIONS- hindered; he is). The reaction is less violent, never an uncontrolled frenzy. In LYSSINUM, the torment is very intense, very acute, and severe.
• Lyssin is more extreme, more passionate, more aggressive. The feeling of Lyssin is like someone is poking you with a stick, tormenting you, and you cannot restrain your desire to ‘bite’ back.

In LYSSINUM, the feeling of action on the other person is much stronger, he wishes to take aggressive action against that person. He loses his temper, due to which even his voice gets heavy like a mad person. LYSSIN patients are extreme people with powerful emotions.

• MIND- BARKING- growling like a dog

The madness can reach to such an extent that he wishes to destroy the concerned person completely.

• MIND- CUT- mutilate or slit; desire to others

Comparative Materia Medica

STAPHYSAGRIA :- The gist of STAPHYSAGRIA is:

MIND- FEAR- self control; of losing

• MIND- INDIGNATION
• MIND- IMPRESSIONABLE
• MIND- SENSITIVE

They are diligent, conscientious people. Too dignified to fight. Very sensitive to criticism and what people will say about him. Anger but cannot express.

What is the need for Staphysagria to control his anger?

He feels he has a dignified position in the society. Even if he feels insulted, he will not express his anger as he feels that what people will think about me. He has to control his anger just to maintain his social position. He goes home and suffers, doesn’t speak it out but controls it and then suffers from it. Staphysagria becomes speechless, that doesn’t mean he cannot speak, but the situation is such that he cannot say anything to anyone.

• MIND- FEAR- social position; about his
• MIND- DESPAIR- social position; about his

In this case, though the anger was suppressed, but there was an extreme feeling of hatred, cursing, and revenge.

The patient was not at all concerned about his social position or his image; in fact he was ready to defame the image of that person in front of 50 to 60 people!

Hence Staphysagria was ruled out.

The other remedy that comes close is:

Nitric Acid:

• Mind- Cursing

NITRIC ACID too carries the same revengeful feeling (as we see in this case), but the journey starts from nursing, wherein he has cared for and nurtured the person for years together. He now feels indignated and desires to take severe action against that offending person. He is completely unmoved by apologies.

(Mind- Hatred- Persons- Unmoved By Apologies)

A NITRIC ACID patient can use abusive language in front of the doctor against the offending person. Intense hatred. Journey starts from Nursing and ends with Cursing!!