Occupational injuries may often lead to delayed wound healing, presenting challenges for both patients and their families. Factors like repetitive trauma, poor circulation, and underlying health conditions can hinder the healing process.
Wound healing is a multifaceted phenomenon performed by immune cells in a highly specific sequence. If any one of the events fails, it can cause slow healing and, in such cases, homeopathy may be beneficial as it aims to stimulate the body’s immune system.
In this context, a 64-year-old individual with a slow healing work-related injury, and sinusitis was successfully treated using homeopathy. Despite antibiotic treatment, the wound infection could not be controlled, and the patient’s condition improved significantly only after homeopathic treatment.
The homeopath prescribed remedies adhering to the classical homeopathic principles. Over a few months of therapy, both sinusitis and the wound improved along with overall health and well-being. This case report highlights the potential benefits of homeopathic treatment in the management of delayed wound healing and sinusitis. Further research is needed to fully explore the efficacy of classical homeopathy in treating these conditions.
Keywords: occupational injuries, delayed wound healing, chronic wounds, sinusitis, homeopathy, case report
Occupational injuries encompass a range of physical health issues that occur as a direct result of workplace activities. These injuries can include accidents, musculoskeletal disorders, exposure to hazardous substances, repetitive strain injuries, and many more.1
They can result from sudden accidents, prolonged exposure, or cumulative stress on the body. Slow healing wounds from trauma are injuries that fail to progress through the normal stages of wound healing within an expected timeframe.1 These wounds exhibit delayed or impaired healing, leading to prolonged inflammation and tissue damage.
Some estimates suggest that incidence of occupational injuries occurring at the construction site is around 2% to 5% in developed countries.1,2 The pathogenesis of non-healing wounds involves disruption in one or more stages of the wound healing process, including inflammation, proliferation, and remodeling.3
Factors like compromised blood supply, infection, repeated trauma, poor nutrition, and systemic health issues can impede the body’s ability to heal the wound properly.3 The recurrence of ulcers at the same anatomical site is a complex phenomenon influenced by a combination of intrinsic and extrinsic factors that interact to impede the wound healing process and promote a recurring cycle of tissue breakdown.3,4
Underlying health conditions, such as diabetes or venous insufficiency contribute significantly to the pathogenesis of recurrent ulcers.5 Neuropathy, impaired blood circulation, chronic inflammation, and compromised immune responses set the stage for a recurring cycle of ulceration.
The compromised immune response, coupled with bacterial colonization, prolongs the inflammatory phase and delays angiogenesis. Scar tissue and fibrosis from previous ulcers hinder blood circulation and tissue elasticity, perpetuating the cycle of recurrent ulceration.5,6
Lifestyle factors, such as smoking and obesity, exacerbate poor circulation and contribute to ulcer recurrence. The treatment of non-healing wounds involves addressing underlying conditions, wound assessment, infection control, wound debridement, moist wound healing, offloading, advanced therapies like growth factors and negative pressure wound therapy, nutrition optimization, pain management.7
Failure to treat non-healing wounds can lead to various complications, including infection and sepsis. Recent advances such as growth factor wound therapy, stem cell therapy and bioengineered tissues promote wound healing.5 While these innovations offer promise, addressing the root causes still remains a challenge hence tailored approach is crucial for effective non-healing wound management.8
In such cases, classical homeopathy may offer a safe and effective alternative for management of non-healing traumatic wounds. Few case reports have demonstrated encouraging outcomes for the use of classical homeopathy in cases of chronic wounds in the past.9,10,11,12 This case report suggests an alternative for the treatment of traumatic non-healing wounds with classical homeopathy.
A 64-year-old male working as a bricklayer injured his right forearm with a sharp object at his work site in August 2018. Despite receiving three courses of antibiotic treatment at the time and repeatedly over the next two years, the wound kept re-opening and failed to heal.
In the last episode, it was not resolving for over two months (Fig. 5 A). The patient also had a history of chronic sinusitis since around the same time as the injury (August 2018). Interestingly, each time the patient developed an episode of sinusitis, the wound reopened and became infected. At this point, the patient decided to seek homeopathic treatment. The symptoms available for initial prescription on 17/11/2020 were as follows:
- MIND-FASTIDIOUS (++)
- MIND-INDUSTRIOUS (inclination to work) (+)
- MIND-IRRITABILITY-questioned when (++)
- CHEST-CONSTRICTION, tension, tightness-cough-during (+)
- BACK-PAIN-motion, on (++)
- GENERALITIES-FOOD AND DRINKS-fish-aversion (+)
- GENERALITIES-FOOD AND DRINKS-highly seasoned food-desire (+)
- GENERALITIES-FOOD AND DRINKS-tea-agg (++)
- GENERALITIES-INJURIES (including blows, falls, bruises) (++)
- GENERALITIES-WOUNDS-heal-slow (+)
- FACE-INFLAMMATION-sinuses, of (sinusitis) (++)
Past medical history:
- Patient had a history of bronchitis during childhood.
- No history of fevers in the past.
- Patient took radiotherapy for head injury fifteen years ago.
- He got frustrated very easily and never voiced his opinions in front of superiors.
- He was very keen on his work and was ambitious.
- He was fastidious about his clothes and his surroundings.
- He found fault in everyone at work place and became very irritated and impatient at times.
- Desires- highly seasoned food (++)
- Aversion – fish (+)
- Aggravation – tea (++) – nausea from.
Diagnosis: Occupational injury (ICD-10: Y92.6)13 , Sinusitis (ICD-10:J32.9)14
Case analysis and prescription:
Repertorisation was carried out (Fig. 1) and his case analysed. After a thorough investigation, it was obvious that the nervous irritability along with fastidiousness were striking and gave rise to a specific totality of symptoms.
A dose of Nux vomica 200CH one dose was prescribed on 17/11/2020.
Fig. 1. Reportorial result of first intake on 17/11/2020 (Vithoulkas compass)
The follow up of the case is listed in Table 1.
Table 1 – Follow up of the case.
|01/02/2021||Energy levels are better. Patient is able to work more efficiently.
Patient developed sore throat that resolved quickly compared to before.
Sinusitis had increased during first few days followed by gradual improvement. The discharge has reduced.
Wound has started to heal. (Fig. 5 B)
|There is gradual improvement of symptoms. The case needs repetition of lower potency for continuous stimulation.||Nux vomica LM3 one dose every alternate day for two weeks|
|11/08/2021||Patient injured his back again at work.
The area around wound has gotten infected and caused severe burning. It re-opened again. (Fig 5 C)
His sleep is disturbed, and he wakes up at 2AM. Snoring has increased.
He is unable to tolerate hot weather.
|The case points to a new clear remedy pattern and needs a change of remedy. (Fig. 2)||Sulphur 1M one dose followed by
Sulphur LM3 one dose every day for a month.
|24/03/2022||Patient has an episode of severe sinusitis since yesterday. There is postnasal catarrh.
He is very irritable and impatient.
Snoring has increased a lot.
Face is swollen and tender to touch. (++)
Sleep is restless since few days.
Appetite has reduced drastically.
Nausea on eating (+)
Local area around the wound has become more sensitive and painful.
|Patient is having an acute that is not resolving and few physical symptoms are persistent and pointing towards a remedy. (Fig. 3)||Kali bichromicum 200CH one dose|
|05/04/2022||Sinusitis –slightly better.
The wound has started discharging yellow pus after the remedy.
Mouth smells offensive.
Appetite is still low.
Ears are painful.
|The remedy is still acting and we must wait.||Nil|
|02/05/2022||Sinusitis persists but better compared to before.
He finds fault with people at work but never voices out the issues in front of his superiors or managers.
His wife says he has been very uncooperative and difficult to handle around the house.
The discharge from the wound is now greenish. The wound healing is still slow (Fig. 5 D)
Appetite still low.
Desires- sweets (++)
|The slow healing tendency is still not better and patient has developed new symptoms pointing towards a clear remedy pattern. (Figure 4)||Lycopodium 200CH one dose|
|14/09/2022||After the remedy, the discharge from wound increased and it completely resolved. It has not re-opened since then. (Fig. 5 E)
He still cannot stand up in front of superiors and express his opinions.
Sinusitis is much better.
One episode of high BP-152/70 mm Hg. He is not taking any medications for the same.
|Case needs a repetition of the same remedy as he is still indicating same remedy.||Lycopodium 200CH one dose|
|02/11/2022||Patient started anti- hypertensive medicines as per doctor’s prescription.
Patient developed warts last month and it fell off on its own.
Irritability is much better.
Confidence is getting better.
Wound has completely healed.
Sinusitis is much better.
|Case is doing better emotionally and generally. We must wait and watch.||Nil|
|02/12/2022||Patient developed COVID-19 with high fever for which he was prescribed acute remedy.
Wound has resolved completely without any relapse. (Fig. 5 F)
Sinusitis is much better.
Appetite is much better.
|Case is doing better. We must wait until any new symptoms appear.||Nil.|
Figure 2 – Reportorial result as on 11/08/2021 (Vithoulkas compass)
Figure 3 – Reportorial result as on 24/03/2022(Vithoulkas compass)
Figure 4 – Reportorial result as on 02/05/2022 (Vithoulkas compass)
Figure 5. Photos before, during and after treatment
Occupational injuries pose a significant threat to worker well-being and productivity. Addressing these challenges requires a multi-pronged approach, including proper training, implementing safety protocols, fostering a culture of safety and regular assessments of workplace risks.1
While many injuries heal within a reasonable timeframe, some can develop into non-healing wounds, leading to potential complications.3 Non-healing wounds arising from work-related injuries often result from a combination of factors including insufficient wound care, inadequate circulation due to vascular problems, compromised immune responses, and underlying health conditions that can hinder the body’s natural healing mechanisms.6
Furthermore, factors intrinsic to certain occupations such as repetitive trauma, exposure to harmful substances, and prolonged pressure on specific areas can aggravate wounds and delay healing. Therefore, dealing with the underlying causes necessitates continuous oversight.2
Few studies have shown a significant association between sinusitis and delayed wound healing.15 Sinus inflammation can accumulate bacteria and mucus, spreading harmful microorganisms to nearby areas, including wounds.
Infections from sinusitis can reach adjacent tissues, hindering wound healing and causing infection.3,16 Compromised immune responses due to sinusitis further reduce the body’s ability to fight wound infections. If the non-healing wound is primarily due to factors other than infection, antibiotics might not provide a significant benefit.5 In such scenarios, classical homeopathy could potentially offer an alternative approach.
Classical homeopathy is a holistic system of medicine that aims to stimulate the body’s innate healing abilities. Professor Vithoulkas’ “Levels of Health” concept is a unique approach within homeopathy which guides the homeopath during the course of chronic treatment to assess the prognosis of the case.17
There are four groups (A-D) and twelve levels (1-12), with each individual having a distinct level of health that represents their overall vitality. The level of health is impacted by various factors, such as genetics, lifestyle, environment, and emotional stress.17 The guiding principle is to select a remedy that matches the unique characteristic symptoms of the person, not just the disease and stimulate the body’s own healing mechanism.18
In light of the concept, the above case was born in group C-level 8 with rare history of infections in the past. After a series of correct homeopathic remedies, the recurrent wound infections resolved along with sinusitis over a period of two year.18
The patient also developed a high fever after two years of correct homeopathic treatment offering a good prognosis. It is generally recommended to allow the acute disease to progress naturally without intervention unless it is deemed necessary to address it.17
The Modified Naranjo Criteria for Homeopathy (MONARCH) causality assessment provided a score of 11/13, indicating a strong causal association between the homeopathic treatment and the observed outcome (Table 2).19
Table 2: Modified Naranjo Criteria for Homeopathy (MONARCH) – for causality assessment
|Criteria||Y||N||Not sure/NA||Score in case|
|1. Was there an improvement in the main symptom or condition for which the homeopathic medicine was prescribed?||2||-1||0||2|
|2. Did the clinical improvement occur within a plausible time frame relative to the drug intake?||1||-2||0||0|
|3. Was there an initial aggravation of symptoms?||1||0||0||1|
|4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed?||1||0||0||1|
|5. Did overall well-being improve?||1||0||0||1|
|6 (A) Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease?||1||0||0||1|
|6 (B) Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms: from organs of more importance to those of less importance, from deeper to more superficial aspects of the individual, from the top downwards||1||0||0||1|
|7. Did “old symptoms” (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement?||1||0||0||0|
|8. Are there alternate causes (other than the medicine) that with a high probability could have caused the improvement? (consider known course of disease, other forms of treatment, and other clinically relevant interventions)||-3||1||0||1|
|9. Was the health improvement confirmed by any objective evidence? (Photos before and after treatment)||2||0||0||2|
|10. Did repeat dosing, if conducted, create similar clinical improvement?||1||0||0||1|
The promising result of this case report proposes that classical homeopathy may offer a safe and effective alternative to invasive treatments and antibiotics, especially in occupational injuries and sinusitis. Additional research is necessary to validate the efficacy of this treatment approach and to improve outcomes for individuals dealing with chronic wounds.
- Varacallo M, Knoblauch DK. Occupational Injuries and Workers’ Compensation Management Strategies. StatPearls. Published online August 4, 2023. Accessed August 28, 2023. https://www.ncbi.nlm.nih.gov/books/NBK470372/
- Abukhashabah E, Summan A, Balkhyour M. Occupational accidents and injuries in construction industry in Jeddah city. Saudi J Biol Sci. 2020;27(8):1993. doi:10.1016/J.SJBS.2020.06.033
- Kumar V, Abbas A, Aster J. Robbins Basic Pathology E-Book.; 2017. Accessed August 28, 2023. https://books.google.com/books?hl=en&lr=&id=YYZMDgAAQBAJ&oi=fnd&pg=PP1&ots=YjBnI0mZuv&sig=fqENfHu2uMK_xioZcx8P_N7JPtQ
- Bhat S. SRB’s Manual of Surgery.; 2019. Accessed August 28, 2023. https://books.google.com/books?hl=en&lr=&id=P3KSDwAAQBAJ&oi=fnd&pg=PR1&ots=n-dm6em6OK&sig=w8rriXcQlpo-GwyKKepscte9_do
- Tammelin A, Lindholm C, Hambraeus A. Chronic ulcers and antibiotic treatment. J Wound Care. 1998;7(9):435-437. doi:10.12968/JOWC.19126.96.36.1995
- Calis H, Sengul S, Guler Y, Karabulut Z. Non-healing wounds: Can it take different diagnosis? Int Wound J. 2020;17(2):443-448. doi:10.1111/IWJ.13292
- Alam W, Hasson J, Reed M. Clinical approach to chronic wound management in older adults. J Am Geriatr Soc. 2021;69(8):2327-2334. doi:10.1111/jgs.17177
- Yang H, Wang WS, Tan Y, Zhang DJ, Wu JJ, Lei X. Investigation and analysis of the characteristics and drug sensitivity of bacteria in skin ulcer infections. Chinese J Traumatol – English Ed. 2017;20(4):194-197. doi:10.1016/j.cjtee.2016.09.005
- Mahesh S, Mallappa M, Vithoulkas G. Gangrene: Five case studies of gangrene, preventing amputation through Homoeopathic therapy. Indian J Res Homoeopath. 2015;9(2):114. doi:10.4103/0974-7168.159544
- Mahesh S, Mallappa M, Vithoulkas G. Gangrene – Healing Through Classical Homeopathy – Seema Mahesh. hpathy.com. Accessed January 19, 2021. https://hpathy.com/clinical-cases/gangrene-healing-through-classical-homeopathy/
- Dayananda G C, Management of Diabetic Foot with Classical Homeopathy Case Report. Accessed May 3, 2022. https://hpathy.com/clinical-cases/management-of-diabetic-foot-with-classical-homeopathy-case-reports/
- Choudhury S, Khuda-Bukhsh AR. Deep vein thrombosis cured by homeopathy: A case report. J Ayurveda Integr Med. 2020;11(2):181-184. doi:10.1016/J.JAIM.2019.10.003
- 2023 ICD-10-CM Diagnosis Code Y92.6: Industrial and construction area as the place of occurrence of the external cause. Accessed August 28, 2023. https://www.icd10data.com/ICD10CM/Codes/V00-Y99/Y90-Y99/Y92-/Y92.6
- 2023 ICD-10-CM Diagnosis Code J32.9: Chronic sinusitis, unspecified. Accessed August 28, 2023. https://www.icd10data.com/ICD10CM/Codes/J00-J99/J30-J39/J32-/J32.9
- Mahesh S, Mallappa M, Vacaras V, et al. A Novel Outlook on the Correlation Between Acute and Chronic Inflammatory States, a Retrospective Observational Study. Authorea Prepr. Published online October 14, 2020. doi:10.22541/AU.160269741.18547290/V1
- Kozuma A, Sasaki M, Seki K, Toyoshima T, Nakano H, Mori Y. Preoperative chronic sinusitis as significant cause of postoperative infection and implant loss after sinus augmentation from a lateral approach. Oral Maxillofac Surg. 2017;21(2):193-200. doi:10.1007/S10006-017-0611-8
- Vithoulkas G. Levels of Health.; 2017.
- Vithoulkas G and Tiller.w. The Science of Homeopathy. 7th Edition.; 2014.
- Lamba CD, Gupta VK, Van Haselen R, et al. Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports. Homeopathy. 2020;109(4):191-197. doi:10.1055/s-0040-1701251