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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

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) ScalingNo. of Patients
Before treatmentAfter treatment
1.     Normal, not at all ill4
2.     Borderline ill28
3.     Mildly ill59
4.     Moderately ill107
5.     Markedly ill114
6.     Severely ill51
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 1Concept and study design, data acquisition, data interpretation, revising manuscript.
Sharma Pawan 2Data 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.

 

DelightedPleasedMostly

Satisfied

MixedMostly

dissatisfied

UnhappyTerrible
1.Material comforts home, food, conveniences,

financial security

7654321
2.Health – being physically fit and vigorous7654321
3.Relationships with parents, siblings & other

relatives- communicating, visiting, helping

7654321
4.Having and rearing children7654321
5.Close relationships with spouse or

significant other

7654321
6.Close friends7654321
7.Helping and encouraging others,

volunteering, giving advice

7654321
8.Participating in organizations and

public affairs

7654321
9.Learning- attending school, improving

understanding, getting additional knowledge

7654321
10.Understanding yourself – knowing your assets

and limitations – knowing what life is about

7654321
11.Work – job or in home7654321
12.Expressing yourself creatively7654321
13.Socializing – meeting other people,

doing things, parties, etc

7654321
14.Reading, listening to music, or observing

Entertainment

7654321
15.Participating in active recreation7654321
16.Independence, doing for yourself7654321
  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.NAMEAGE/SEXRELIREG. NO.DATE OF 1ST VISITMEDICINED MOUTCOME MEASURES
1.SG56/MH5866716/06/14SULPH.PSORAIMP
2.SB46/FI6124318/06/14PULS.PSORAIMP
3.PD46/FH6549621/06/14NAT SULPPSORAIMP
4.RM38/MH6934224/06/14RHUS TOXPSORANOT IMP
5.NNB43/FI7046328/06/14SEPIAPSORAIMP
6.SH49/FI7250630/06/14THUJASYCOSISNOT IMP
7.KM55/FH7537502/07/14BRYOPSORANOT IMP
8.RS31/MI7662804/07/14NAT.MURPSORANOT IMP
9.BG46/MH7995808/07/14BRYONIASYPHILISIMP
10.SB43/FI8112611/07/14SULPHPSORADROP OUT
11.FK52/MI8364015/07/14SULPHSYCOSISNOT IMP
12.SB43/FI8499818/07/14PHOSPSORAIMP
13.AR36/MH8784621/07/14RHUS TOXSYPHILISIMP
14.IA46/MI8895922/07/14CALC PPSORAIMP
15.HB35/FI9125028/07/14RHUS TOXSYCOSISIMP
16.SM50/MH9352102/08/14SUPLHPSORADROP OUT
17.AS50/FI9521104/08/14CAUSTPSORANOT IMP
18.TB41/FI9759206/08/14RHUS TOXPSORAIMP
19.BS50/FH9887707/08/14LYCOPSORANOT IMP
20.AK41/FI10123409/08/14KALI BICHSYPHILISIMP
21.AS45/FH10256211/08/14LYCOPSORANOT IMP
22.MB50/FI10442112/08/14MERCSYPHILISIMP
23.SG44/FH10859716/08/14BRYOPSORANOT IMP
24.JM64/FI11153218/08/14THUJASYCOSISIMP
25.AB39/MH11466820/08/14RHUS TOXPSORAIMP
26.NG42/FH11771022/08/14PULSPSORAIMP
27.AB54/FI11952623/08/14SULPHPSORAIMP
28.HB56/FI12632527/08/14LACHESISSYCOSISNOT  IMP
29.MA47/MI13246602/09/14LYCOPSORADROP OUT
30.MC56/MH13469803/09/14NAT. MURPSORAIMP
31.JK52/MH13694405/09/14NAT. MURSYCOSISNOT IMP
32.MR54/MI13942608/09/14SEPIAPSORAIMP
33.KB50/FI14361910/09/14MEDOPSORAIMP
34.SD39/FH14654612/09/14NAT. SULSYCOSISIMP
35.SM56/MH15115716/09/14BRYOPSORAIMP
36.RB50/FI15521618/09/14SULPHURPSORAIMP

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.