A Case of Joint Pain and OCD

Name: Mr. PSK, Age: 52yrs, Education: 12^th STD; ITI, Status: married since 23 years, Address: Warora; Dist chandrapur; Maharashtra; India, Occupation: clerk in western coalfield limited company.

Family member: Father expired 10 years before due to bronchial asthma. Mother died early when patient was 1 year old due to cholera. Wife is 45 years old. Son is 20 years old and daughter 22 years old.

Chief complaints

Throbbing pain in all joints with swelling sensation ameliorated by motion and aggravated in morning after waking; stiffness lasts for 2 hours afterward, improved with motion but not completely reduced+3. Throbbing and pulsating pain in back especially in lumbar region is ameliorated by pressing with thumb+3. Sleepless nights are due to pain and other complaints with high tolerance level+2. Patient is very cautious and anxious about health+.

Burning heat sensation in body which is ameliorated by uncovering and oil application3+.

Tingling and numbness sensation+2

Cracking sound in joints that started after suppressing a skin disease+.

History: Patient was previously diagnosed and treated for leprosy which improved after allopathic medication.

Complaints start gradually since 1988 and continued for 10 years increasing in this one year. Patient took allopathic medicines with daily analgesic injections with slight momentary relief. He came under my treatment on 05/10/2008. He took treatment up to 16/08/2009 with amelioration of all complaints. During this treatment I prescribed Secale cor, Ledum pal, Kali carb, Syphilimum, Cimicifuga, Silica, Cactus, Ars alb, Bryonia and Rhus tox, with definite improvement. He was better from 2009 to 2013 and did not require any medical treatment. Now after one year his complaints returned.

Associated complaints

Weakness of memory – especially forgets keys and other important things+. Low confidence level with depressed feeling +. Uncoordinated feeling in body is present+.

Physical examination: Pallor+, weight-58kg, BP-110/70,

Back Lumbar-Sacral joint- ROM painful+3 and restricted, SLR at 30 degree. SIST-negative. Crepitation in knees.

Thick nerve is felt over elbow.

Advice– Rheumatic profile and X-Ray LS spine AP and Lat

I prescribed Thuja 200 1PHS with rii pills for 7 days and history form was given.

12/08/14– No definite improvement. Complains that pain in small finger joint started. History form filled out. Blood investigation done.

Hb-10.8, WBC-6.8, N60,L35, E05, Plt ct-2.3, ESR-08, RA test- 16 negative, S. Uric acid- 5.9

X-Ray LS spine- not done

Probable diagnosis:

? Seronegative spondyloarthopathy

? Leprous neuropathy

Prescription- Rii pills TDS for 7 days

20/08/14– History form submitted by patient

Preliminary information

DOB- 04/04/1963 male, married since 07/05/1990

Hindu, Kunbi; NV; Habits- tea, coffee, Kharra but stopped since 01/07/2014

Education: 12^th STD, ITI, service

Responsibility: collection of all working data and upload it in computer; sitting job. Address: Western coalfield ltd. Majri

Family

Mr. PSK, self, 52yrs, service

Mrs. MPK, wife, 45yr

Ms. PPK, 22yrs daughter, BHMS (pursuing)

Mr. VPK, 20yrs son, engineer (pursuing)

Daily routine

After waking up from sleep I took morning walk, brushing teeth, tea and then toilet. I took 2 chapati at breakfast. I went to office by bike about 20km distance. During office hours I draft paper and transfer it to other site upto 4pm. Office closes at 4pm. I usually drink tea after reaching home and after that take bath and go for evening walk. In evening after dinner I study before going to sleep. For dinner I take usually rice, curry, chapatti, dal and green vegetable.

Chief complaints

My chief complaint is pain in lumbar spine and throbbing in extremities, also tingling sensation in extremities, due to inadequate blood supply, also throbbing pain in nerves, neck problem (Homeopathy Treatment for Neck and Shoulder Pain), tightness in back, aching pain in fingers of hand and feet, throbbing pain in joint, crackling sound in bones (extremities), dim vision, weakness of memory with forgetfulness. Skin is dry and numb. I am sleeping less.

All above mentioned sign and symptoms are since 1988, starting gradually and I took medicine for it. I took treatment from Dr S. during 1996-1999 but again complaints increased after 10 years so I took treatment from Dr M. during 2008-2009 and during period of 2010-2013 I was free from suffering and did not take other medicine. But disease is again established and I suffer same complaints so I am hopeful of full recovery under your treatment.

Sphere of disease: I mentioned above

Sensations: pain, tingling, numbness (anesthesia)

Personal information:

Physical: height 5’2’’, weight 55kg

Nature: calm, IPR with friend good

Responsibility: children’s education

Food: simple, no drinking habit

Bathes with cold water

Sleeplessness, dreams: not remembered

Other complaints: My muscles and nerves are becoming hard. Motion aggravates pains. I felt dryness in joint. Aching pain. I felt like compression of nerve in lumbar spine. Joints are painful, swelling and stiffness. I felt weakness, prostration and easily prone towards tingling with Ghabarahat.

Recording of case

All chief and associated complaints are mentioned above. Patient’s main concern was his sensation of tightness and stiffness; he said it is important to relax and make it soft+3. He must move constantly and strain and stretch limbs so as to reduce suffering+3. He started playing tabla at jagran which relieved his suffering much. Violent exercise of playing tabla made good circulation in his body and otherwise his nerves started aching+3. He has to stretch and bend back especially backward towards night, otherwise possibility of sleep is less+3.

His skin is very dry and he has to apply Ghee (oil) at night+3. During office hours he frequently washes his hands after picking up files+2. He has to wash more than 5 times a day. He bathes at least 3-4 times with tepid water which reduces his dryness and tightness+2. He bathes after waking from sleep, after morning walk, leaving the office and at bed time. Even in cold winters he bathes at night with tepid water. He washes compulsively and uses oil application+3. He is fastidious and wants everything in the proper place with neatness and cleanliness+2. He made himself busy in cleaning and does not tolerate dust. Due to forgetfulness he has to retype letters many times in the office.

He was born in low socioeconomic situation. Good academic achievement but cannot complete higher education due to poor financial support. His handwriting is good and made him topper in his region in matriculation. Although he is recruiting from mechanical branch, due to good handwriting he was given office work.

Physical attribute-

Wheatish complexion, rough thick skin especially soles

Hunger aggravation+3

Wants fanning all season, direct exposure, wants it cooler, covering in winter, otherwise not, and bath with tepid water all season.

Analysis of case

Pre-disposition Family history: father- bronchial asthma, mother- cholera

Pre-disposition Past history: Leprosy

Type Behavioral: Wash compulsiveness, Fastidious

Type Physical: Thermal- towards Hot

Diathesis: uric acid and rheumatic

Structural Phase: Leprous Neuropathy

Aggravations in general: Morning waking after, Cloudy weather

Ameliorations in general: Bathing, Washing, cold, affected part of, Oil application, hunger, uncovering, Pressure, Motion,

Sensations and complaints in general; Pathological generals; Sleep: Tightness, Hardness, Stiffness, Tingling, Numbness, Swelling, Throbbing pain, Aching pain, Burning heat, Dryness, Sleeplessness, Roughness, Uncoordinated feeling

Mental symptoms: weakness of memory, forgetfulness, lack of confidence, depressed feeling, anxiety about health

Reportorial philosophical approach

Considering sensation and complaints in general with modalities and dispositional characteristics, Boenninghausen’s reference is selected.

Repertorial Totality: Rubrics taken for repertorisation      

Generalities, Hunger aggravates                                   General Modality Aggravation

Generalities, Bathing, washing ameliorate                     General Modality Amelioration

Generalities, Bathing, washing ameliorate, cold             General Modality Amelioration

Generalities, Bathing, washing ameliorate, affected part of     Modality Amelioration

Generalities, Dry sensation, internal part             Sensation & complaints in General

Generalities, Tension, tightness externally           Sensation & complaints in General

Generalities, Tension, tightness internally            Sensation & complaints in General

Mind, Fastidious                                                    Mental symptoms

 

 

 

 

 

 

 

Remedies for differentiation

Alumina and Sulphur

The prime location or seat of disease of our patient is nerves, so Alumina has a better sphere of action on it than Sulphur. Sensations of dryness and tightness are more pathogenetic to Alumina than Sulphur. Bathing or washing ameliorates which is more contradictory to Sulphur, as commonly we have seen Sulphur is worse from bathing. There is no such data about Alumina. Both are worse from warmth and have hunger aggravates. Hence considering location, sensation and modalities Alumina was selected as constitutional medicine.

Selection of medicine

Alumina 200 selected

Follow up criteria

1. Hunger tolerance/ sleeplessness
2. Compulsion to wash/ oil application
3. Dryness/ tightness sensation
4. Heat sensation in sole and back
5. Forgetfulness/ vertigo
6. Lumbago/ cervical pain
7. Swelling sensation
8. Tumor on left elbow joint

Progress notes

Date	Symptom changes	Interpretation	Prescription
08/09/2014	G > >10% 0 + + + > > After 3-4 days of taking medicine his face start glowing, dryness thickness and stiffness reduced. Hand washing reduced; he is surprised that now he forgets to applied oil which was continued for m any years.		Alumina 200 1PHs (single dose) followed by Rii pills TDS for 15 day
23/09/2014	G 0 >20% 0 +/0 + + 0 >30% Joint pain increased since 2 days. Does not wash hands after touching a file. Only one bath and no need to bathe at night. Forgets to apply oil. No heat sensation in foot and back. His thick nerve became normal. No swelling sensation.		Ct all for 15 days
09/10/14	G 0 >30% 0 +/0 occ + 0 0   Crackling in joints reduced 75%. Since this Ganpati season for 1 month daily he continues exertion in Jagran for playing Tablas but no problem. Now he can sleep well without bathing and applying oil and he feels fresh.		Thuja 200 1PHs Alumina 200 1PHs (next day) followed by rii pills TDS for 15 days
12/11/2014	G 0 >30% 0 >/0 0 >10% > 0 Skin patch of leprosy not felt now	BP- 120/80	Ct all for 15 days
28/11/2014	G 0 >35% 0 0 > > > 0	BP- 120/80	Ct all for 15 days
13/12/2014	G 0 >55% 0 >/0 0 0 0 0	BP- 110/70	Ct all for 15 days
26/12/2014	G 0 >65% 0 0 0 > ) 0		Ct all for 15 days
10/04/2015	G 0 0 0 0 0 0 0 0 Gap of 4 months, no complaints in this period. For 1-2 days feels unwell.	BP- 110/70 SLR/ SIST- Neg	Ct all for 15 days
10/08/2015	No complaints, neck pain since 4-5 days		Ct all for 15 days
18/08/2015	Throbbing pain in nape of neck extending to right side of head	ROM painful of neck	Sangunaria can 200 4hrly for 2 days
11/09/2015	No neck pain. Was better with single dose in 5 min after taking medicine. Since 2-3 months his habit of chewing Kharra (tobacco with betel nut) completely ceased.		Thuja 200 1phs Alumina 200 1PHS followed by rii pills TDS for 15 days

Discussion

In 1988 this patient started treatment for leprosy patches and took one year of allopathic Dapsone treatment. 10 years later he again took MDT treatment for 3 years from dermatologist. Later he took steroids and other allopathic injections for leprous neuritis, but did not get full recovery. After his daughter was admitted for BHMS he came to know about homoeopathic treatment and came under my treatment. His symptoms reduced but were not cured. Hence complaints recurred. Now I took a fresh look at the case and this time considering general constitutional disposition I prescribed again and the patient recovered totally.

We have seen that compulsiveness is gone after administration of a single dose of constitutional medicine (within 15 days). Dryness and tightness sensation was only 10% reduced in initial 15 days but patient completely forgot to apply oil and wash hands compulsively, which was his behavior for many years.

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