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A Clinical Prospective Study on the Efficacy of Homeopathic Remedies, Chosen with Kent’s Repertory, in the Management of Low Back Pain

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ABSTRACT:

“Low back pain (LBP), discomfort, tension, or stiffness below the costal margin and above the inferior gluteal folds, is one of the most common conditions encountered in primary care, second only to the common cold”.1 Pain in the lower back area can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, or the skin covering the lumbar area. Kent’s repertory was used for these cases as being the most authentic repertory. A total number 36 patients of various ages, both sexes and various religions were included after having been clinically diagnosed as having low back pain by fulfilling inclusion and exclusion criteria. Follow up was done at a gap of 1 month for at-least 3 visits. The improvement of Low Back Pain was calculated by using the Roland-Morris Low Back Pain , a 24 point questionnaire (Appendix no. A) and general improvement as a whole of a patient was calculated by using a Quality of Life Scale, a 16 point Scale (Appendix no. B) according to the patient’s own realization of his quality of life and the Clinical Global Impression-severity scale (Appendix no. B) before and after treatment. It was used to assess the patient’s severity of clinical condition from the physician’s perspective. All data were calculated from the study of 33 of 36 subjects. Changes in the score of QOL and RMQ before and after treatment were analyzed using Z test. Changes in both scores were statistically significant (P < 0.05). There is statistically significant change in p value indicating homoeopathy was effective in the treatment of low back pain when remedies were selected using Kent’s Repertory (5% level of significance.)

KEYWORDS: Low back pain, Homoeopathic treatment, Kent’s Repertory, Hompath- Classic 8.0 software, RMQ, QOL, CGI.

OBJECTIVE:

HYPOTHESIS: Homoeopathic treatment is efficacious for Low back pain selected on the basis of rubrics as stated in Kent’s Repertory.

METHODOLOGY: Cases of low back pain registered in the OPD & IPD of the National Institute of Homoeopathy were taken for the study. Patients of both sexes, of various age groups, from varied religions, willing to participate in the study of clinical work, of various socio-economic status should be included. Patients who were not willing to participate in the study, patients suffering from serious illness of other systems likely prolapsed of uterus, pelvic inflammatory disease, hypothyroidism, diabetes mellitus etc, and patients mentally retarded or taking any psychotropic drugs are kept in exclusion criteria. A prospective observational study was done at IPD & OPD of the National Institute of Homoeopathy. Proper case taking, repertorisation and reportorial analysis, and follow ups at regular intervals were the interventions which were taken. We uses a case recording format, Kent’s Repertory, the Computer software Hompath Classic, Roland-Morris Low Back Pain questionnaire: Quality of Life Scale [It is a 16 point Scale (Appendix no. A)] and CGI Scale format (Appendix no. B). These were taken as tools for this study throughout the period, about 12 months. After the completions of the study the results were be represented by appropriate statistical methods with proper analysis of the results.

OBSERVATIONS & RESULTS:

During the study the following observations were noted:

OBSERVATION

Comparison of Clinical Global Impression-Severity Scale-before and after treatment:

CGI(S) Scaling No. of Patients
Before treatment After treatment
1.     Normal, not at all ill 4
2.     Borderline ill 2 8
3.     Mildly ill 5 9
4.     Moderately ill 10 7
5.     Markedly ill 11 4
6.     Severely ill 5 1
7.     Among the most extremely ill

DISCUSSION:

The improvements  were  noted  clinically  in  relation  to  pain by the “Roland-Morris Low Back Pain questionnaire” which is a 24 point Questionnaire (Appendix no. A). At the beginning of treatment the mean score of RMQ of 33 patients was 15.12 ± 3.88 where as at the end of treatment was10.60 ± 4.58. The change in RMQ Scoring before & after treatment was analyzed by using Z Test. In 5% level of significance the critical value of Z (two tail test) 1.96. Since the calculated Z value (4.33) is higher than the above mentioned critical value (1.96). So, we conclude that the alternative hypothesis is true. The Quality of Life Scale is a 16 point Scale (Appendix no. B). Each point has 7 quality (Delighted 7, Pleased 6, Mostly Satisfied 5, Mixed 4, Mostly dissatisfied 3, Unhappy 2, Terrible 1) to take any one of them according to patient’s own realisation of his quality of life before and after treatment. Patient was asked to read each item and circle the number that best describes how satisfied subjects are at that time At the beginning of treatment the mean score of QOL of 33 patients was 50.30 ±17.41 where as at the end of treatment was 70.88 ± 19.13. The change in QOL Scale before & after treatment was analysed by using Z Test. In 5% level of significance the critical value of Z (two tail test) 1.96. Since the calculated Z value (4.569) is higher than the above mentioned critical value (1.96). So, we conclude that the alternative hypothesis is true. The study reflected the clinical approach of KENT’S Repertory in the management of low back pain following strict homoeopathic principles.

AUTHORS CONTRIBUTIONS:

Ash Purnendu 1 Concept and study design, data acquisition, data interpretation, revising manuscript.
Sharma Pawan 2 Data interpretation, revising manuscript.

Authors read and approved the final manuscript.

ACKNOWLEDGEMENT:

The author would like to acknowledge Prof. Dr. S. K. Nanda, Director, National Institute of Homoeopathy for allowing us to carry out the study successfully in his institution and the author would also acknowledge Dr. Saroj Kumar Kayal, Reader Dept. of Homoeopathic Repertory, National Institute of Homoeopathy for guiding me to achieve success.

CONFLICT OF INTEREST STATEMENT:

The authors declare that they have no competing interest.

ROLE OF FUNDING SOURCES:

The authors received no external funding for the study. There was no institutional influence on the design, conduct and results reflected from the study.

APPENDIX “A”

QUESTIONNAIRE

The Roland-Morris Low Back Pain and Disability Questionnaire

Patient name:                                                     File                       Date:

Please read instructions: When your back hurts, you may find it difficult to do some of the things you normally do. Mark only the sentences that describe you today.

Instructions:

  1. The patient is instructed to put a mark next to each appropriate statement.
  2. The total number of marked statements are added by the clinician. Unlike the authors of the Oswestry Disability Questionnaire, Roland and Morris did not provide descriptions of the varying degrees of disability (e.g., 40%-60% is severe disability).
  3. Clinical improvement over time can be graded based on the analysis of serial questionnaire scores. If, for example, at the beginning of treatment, a patient’s score was 12 and, at the conclusion of treatment, her score was 2 (10 points of improvement), we would calculate an 83% (10/12 x 100) improvement.

APPENDIX “B”

SCALES FOR OUTCOME ASSESSMENT

  1. QUALITY OF LIFE SCALE (QOL)

Please read each item and circle the number that best describes how satisfied you are at this time. Please answer each item even if you do not currently participate in an activity or have a relationship. You can be satisfied or dissatisfied with not doing the activity or having the relationship.

 

Delighted Pleased Mostly

Satisfied

Mixed Mostly

dissatisfied

Unhappy Terrible
1. Material comforts home, food, conveniences,

financial security

7 6 5 4 3 2 1
2. Health – being physically fit and vigorous 7 6 5 4 3 2 1
3. Relationships with parents, siblings & other

relatives- communicating, visiting, helping

7 6 5 4 3 2 1
4. Having and rearing children 7 6 5 4 3 2 1
5. Close relationships with spouse or

significant other

7 6 5 4 3 2 1
6. Close friends 7 6 5 4 3 2 1
7. Helping and encouraging others,

volunteering, giving advice

7 6 5 4 3 2 1
8. Participating in organizations and

public affairs

7 6 5 4 3 2 1
9. Learning- attending school, improving

understanding, getting additional knowledge

7 6 5 4 3 2 1
10. Understanding yourself – knowing your assets

and limitations – knowing what life is about

7 6 5 4 3 2 1
11. Work – job or in home 7 6 5 4 3 2 1
12. Expressing yourself creatively 7 6 5 4 3 2 1
13. Socializing – meeting other people,

doing things, parties, etc

7 6 5 4 3 2 1
14. Reading, listening to music, or observing

Entertainment

7 6 5 4 3 2 1
15. Participating in active recreation 7 6 5 4 3 2 1
16. Independence, doing for yourself 7 6 5 4 3 2 1
  1. CLINICAL GLOBAL IMPRESSION- Scale

Rate patient’s improvement on this seven point scale

1 – Patient very much improved

2 – Much improved

3 – Minimally improved

4 – Unchanged

5 – Minimally worse

6 – Much worse

7 – Very much worse

Rate patient’s severity of illness on this seven point scale

1 – Normal, not at all ill

2 – Borderline ill

3 – Mildly ill

4 – Moderately ill

5 – Markedly ill

6 – Severely ill

7 – Among the most extremely ill

APPENDIX “C”

MASTER CHART

SL. NO. NAME AGE/SEX RELI REG. NO. DATE OF 1ST VISIT MEDICINE D M OUTCOME MEASURES
1. SG 56/M H 58667 16/06/14 SULPH. PSORA IMP
2. SB 46/F I 61243 18/06/14 PULS. PSORA IMP
3. PD 46/F H 65496 21/06/14 NAT SULP PSORA IMP
4. RM 38/M H 69342 24/06/14 RHUS TOX PSORA NOT IMP
5. NNB 43/F I 70463 28/06/14 SEPIA PSORA IMP
6. SH 49/F I 72506 30/06/14 THUJA SYCOSIS NOT IMP
7. KM 55/F H 75375 02/07/14 BRYO PSORA NOT IMP
8. RS 31/M I 76628 04/07/14 NAT.MUR PSORA NOT IMP
9. BG 46/M H 79958 08/07/14 BRYONIA SYPHILIS IMP
10. SB 43/F I 81126 11/07/14 SULPH PSORA DROP OUT
11. FK 52/M I 83640 15/07/14 SULPH SYCOSIS NOT IMP
12. SB 43/F I 84998 18/07/14 PHOS PSORA IMP
13. AR 36/M H 87846 21/07/14 RHUS TOX SYPHILIS IMP
14. IA 46/M I 88959 22/07/14 CALC P PSORA IMP
15. HB 35/F I 91250 28/07/14 RHUS TOX SYCOSIS IMP
16. SM 50/M H 93521 02/08/14 SUPLH PSORA DROP OUT
17. AS 50/F I 95211 04/08/14 CAUST PSORA NOT IMP
18. TB 41/F I 97592 06/08/14 RHUS TOX PSORA IMP
19. BS 50/F H 98877 07/08/14 LYCO PSORA NOT IMP
20. AK 41/F I 101234 09/08/14 KALI BICH SYPHILIS IMP
21. AS 45/F H 102562 11/08/14 LYCO PSORA NOT IMP
22. MB 50/F I 104421 12/08/14 MERC SYPHILIS IMP
23. SG 44/F H 108597 16/08/14 BRYO PSORA NOT IMP
24. JM 64/F I 111532 18/08/14 THUJA SYCOSIS IMP
25. AB 39/M H 114668 20/08/14 RHUS TOX PSORA IMP
26. NG 42/F H 117710 22/08/14 PULS PSORA IMP
27. AB 54/F I 119526 23/08/14 SULPH PSORA IMP
28. HB 56/F I 126325 27/08/14 LACHESIS SYCOSIS NOT  IMP
29. MA 47/M I 132466 02/09/14 LYCO PSORA DROP OUT
30. MC 56/M H 134698 03/09/14 NAT. MUR PSORA IMP
31. JK 52/M H 136944 05/09/14 NAT. MUR SYCOSIS NOT IMP
32. MR 54/M I 139426 08/09/14 SEPIA PSORA IMP
33. KB 50/F I 143619 10/09/14 MEDO PSORA IMP
34. SD 39/F H 146546 12/09/14 NAT. SUL SYCOSIS IMP
35. SM 56/M H 151157 16/09/14 BRYO PSORA IMP
36. RB 50/F I 155216 18/09/14 SULPHUR PSORA IMP

BILIOGRAPHY

  1. Charles W. Webb, Francis G. O’Connor: Low Back Pain in Primary Care: An Evidence-Based Approach. Current Diagnosis & Treatment in Family Medicine., 3e Chapter 24. The McGrawHill Companies Inc. 2011;257.
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