‘’STUDY TO ASSESS THE USEFULNESS OF HOMOEOPATHIC CONSTITUTIONAL

MEDICINE IN PAIN MANAGEMENT OF SCIATICA- A PROSPECTIVE

RANDOMISED CONTROL TRIAL”
A Dissertation to be submitted in partial fulfillment of the requirement

The Award of the Degree of

DOCTOR OF MEDICINE IN HOMOEOPATHY

(PRACTICE OF MEDICINE)

Of

DR. BHIM RAO AMBEDKAR UNIVERSITY, AGRA (U.P.)

At

BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL,

KNOWLEDGE PARK- I, GREATER NOIDA (U.P.)

BY

DR.GEETIKA NAGPAL

SESSION: (2016-2019)

Under the guidance and supervision of

DR.HARPREET SINGH

PROFESSOR, DEPT. OF PRACTICE OF MEDICINE

BAKSON HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,

GREATER NOIDA (U.P.)

 CERTIFICATE
DR CP SHARMA

MD(Hom.)

Principal

Bakson Homoeopathic Medical College & Hospital

Greater Noida, Uttar Pradesh.

This is to certify that the dissertation entitled “Study to assess the usefulness of
Homoeopathic CONSTITUTIONAL MEDICINE in pain management of Sciatica- A
Prospective Randomized Control Trial” is a bonafide work by GEETIKA NAGPAL under the
guidance of DR. HARPREET SINGH In partial fulfillment of regulations for the award of
Degree of Doctor of Medicine in Homoeopathy [M.D.(Hom.)] in Practice of Medicine.

This work conforms to the standards of Dr. B.R. Ambedkar University, Agra. It has not been
submitted previously to any University for the award of any Diploma or Degree nor copied
from any other dissertation.

I have great pleasure in forwarding to it Dr. B.R. Ambedkar University, Agra for approval.

(CP SHARMA)

Signature of Principal

Date:
 DECLARATION

I, GEETIKA NAGPAL, hereby declare that the dissertation entitled “Study to assess the
usefulness of homoeopathic CONSTITUTIONAL MEDICINE in pain management of Sciatica-
A Prospective Randomized Control Trial” has been prepared by me under the guidance and
supervision of Dr Harpreet Singh, in partial fulfillment of regulation for the award of the
degree of Doctor Of Medicine in Homoeopathy [M.D.(Hom.)] in PRACTICE OF MEDICINE Of
Dr. B.R. Ambedkar University, Agra. It has not been submitted previously to any University
for award of any Diploma or Degree nor copied from any other dissertation.

(GEETIKA NAGPAL)

Signature of the student

Date:
 ACKNOWLEDGEMENTS
I owe gratitude to the higher power, who gave me opportunity to be a part for the noble
profession of serving the suffering humanity. The writing of this dissertation has been one of
the most significant academic challenges I have ever had to face; this task taught me time
management, critical analysis, bridging theory and practice, new research techniques and
how to work independently.

In bringing out the present work, the debts of gratitude that I owe are heavy and numerous,
but some of them need special mention.

Firstly, I am deeply indebted and will remain ever grateful to Dr. Harpreet Singh, Professor,
Department Of Practice Of Medicine; Bakson Homoeopathic Medical College and Hospital,
my Guide, for all his relentless guidance and valuable inputs for this project, despite her
many other academic and professional commitments. Her wisdom, knowledge and scientific
approach towards homoeopathy inspired and motivated me.

I wish to express my humble gratitude to DR. RASHMI CHOWDHURY(H.O.D. OF PRACTICE OF

MEDICINE) In Bakson Homoeopathic Medical College, Greater Noida, who has always been
constant source of knowledgeable guidance and encouragement throughout the study.

I believe I am tremendously fortunate to have teachers like to DR.RAJINDER AND DR.

ASHWINI NAIR (H.O.D. OF MATERIA MEDICA) of Bakson Homoeopathic Medical College ,
who not only gave their insightful comments over my work, but also became epitome for
nurturing support in my life.

The herculean task of completing the dissertation would not have been possible without the
whole hearted cooperation of my husband, parents, friends and well wishers. During the
execution of the present work, the help from library of Bakson Homoeopathic Medical
College.

Special thanks go out to my professional friends and colleagues who have been supportive
of my efforts.

Above all, I express my gratitude to the Almighty for all strength and support. He bestowed
upon me to complete this work.

Lastly, I duly apologize, if somebody, who owes special references, has not been
inadvertently included in this acknowledgement.

DR.GEETIKA NAGPAL
 CERTIFICATE
Prof. (Dr.) Harpreet Singh

MD(Hom.)

Bakson Homoeopathic Medical College & Hospital

Greater Noida, Uttar Pradesh.

This is to certify that the dissertation entitled “Study to assess the usefulness of
homoeopathic CONSTITUTIONAL MEDICINE in pain management of Sciatica- A Prospective
Randomized Control Trial” is a bonafide work by GEETIKA NAGPAL under the guidance of
DR. HARPREET SINGH In partial fulfillment of regulations for the award of Degree of Doctor
of Medicine in Homoeopathy [M.D.(Hom.)] in Practice of Medicine.

This work conforms to the standards of Dr. B.R. Ambedkar University, Agra. It has not been
submitted previously to any University for the award of any Diploma or Degree nor copied
from any other dissertation.

I have great pleasure in forwarding to it Dr. B.R. Ambedkar University, Agra for approval.

(DR.HARPREET SINGH)

Signature of Guide

Date:
 CERTIFICATE

Prof. (Dr.) Rashmi chowdhury

M.D. (Hom.)
Head, Department of Practice of Medicine Bakson Homoeopathic Medical College &
Hospital, 36-B Knowledge Park, Greater Noida
This is to certify that the dissertation entitled “Study to assess the usefulness of
homoeopathic CONSTITUTIONAL MEDICINE in pain management of Sciatica- A Prospective
Randomized Control Trial” is a bonafide work by GEETIKA NAGPAL under the guidance of
DR.RASHMI CHOWDHURY Head of the Department of Practice of Medicine, In partial
fulfillment of regulations for the award of Degree of Doctor of Medicine in Homoeopathy
[M.D.(Hom.)] in Practice of Medicine.

This work conforms to the standards of Dr. B.R. Ambedkar University, Agra. It has not been
submitted previously to any University for the award of any Diploma or Degree nor copied
from any other dissertation.

I have great pleasure in forwarding to it Dr. B.R. Ambedkar University, Agra for approval.

(DR.RASHMI CHOWDHURY)

Signature of H.O.D(PRACTICE OF MEDICINE)

Date:
 DEDICATED TO

MY
PARENTS
AND
HUSBAND
WHOSE VISION AND PRESEVERANCE
HAS BEEN THE GUIDING LIGHT OF MY LIFE
 TABLE OF CONTENTS

PAGE
List of Figures I

List of Tables II

Abstract III

Introduction 1-3

Aims and Objectives 4

Review of literature 5-41

Material and Methods 42-45

Observation and Results 46-57

Discussion 58

Conclusion 59-61

References 62-65

Appendices 66

Appendix A(Case Recording 67-68

Format)
Appendix B(Case Reports of 69-93
Selected Patients)
Appendix C (Visual Analogue 94
Scale-Intensity of Pain
assessment in sciatica)
Appendix D (Master Chart) 95-100
 LIST OF FIGURES
Figure Description Page No.
no.
1. Location of sciatic nerve 5

2. Division of segments of Spinal Cord 8

3. Branches of Sciatic Nerve 10

4. Location of Sciatic Nerve and arteries involving 11

5. Sciatic nerve Pain Patterns 12
6. Division of Sciatic Nerve 14
7. Causes of Sciatica 18
8. Straight Leg Raising (SLR) Test 20
9. Inflammation of Sciatic Nerve 22
10. Differential Diagnosis for Sciatica Patients suffering 24
from LOWER EXTREMITY complaints
11. Correct posture of doing daily routine work 26
12. Pain intensity in Visual Analogue Scale 44
13. Age Incidence 46
14. Sex Incidence 47
15. Past History 48
16. Family History 49
17. Socio-Economic Status 50
18. Presenting complaints 51
19. Lifestyle of the patients(Sedentary/Active) 52
20. Factors responsible for sciatica 52
21. Response of Auxillary treatment 53
22. Response of Homoeopathic constitutional medicine 54
23. Overall improvement in EG and CG 56

I
 LIST OF TABLES

Table Description Page No.

No.
1. Risk factors for sciatica 15

2. Symptoms of Sciatica in terms of 16

Location, Sensation, Character,
Extension, Modalities and some
associated symptoms.

3. Age Incidence 46

4. Sex Incidence 47

5. Past History 48

6. Family History 49

7. 50
Socio-Economic Status
8. 51
Presenting complaints
9. 52
Lifestyle of the
patients(Sedentary/Active)
10. 52
Factors responsible for sciatica
11. 53
Response of Auxillary treatment
54
12. Response of Homoeopathic
constitutional medicine
55
13. Overall improvement in EG and CG

14. Analysis of Result 57

15. Post-treatment outcome measure 95
by adopting VAS

II
 ABBREVIATIONS

CT Computed Tomography
M Male
F Female
H/o History of
EG Experimental Group
CG Control Group
N.A.D. No Abnormality Detected
NS Nothing Significant
SLRT Straight Leg Raising Test
DM Diabetes Mellitus
HTN Hypertension
< Aggravation
> Amelioration
O.P.D. Outdoor patient
department
t.d.s. Thrice daily
SacLac Saccharum Lactis i.e.
Sugar of milk
No. Number

III
 ABSTRACT
BACKGROUND

There are about an estimated 2% to 40% of people having sciatica at some stage of life. It is
most common among the age group of 40-60 years and females are more frequently
affected than male. A number of environmental and inherent factors thought to influence
the development of sciatica have been studied, including gender, body habits, parity, age,
genetic factors, occupation, and environmental factors. Homoeopathic remedies are
inexpensive, easy to administer, do not require much dietary or lifestyle changes. Some
homoeopathic assert that certain homoeopathic “constitutional” remedies are useful in
cases of sciatica and often achieve cure what the allopathic treatment has failed to do.
Another benefit of using homoeopathy is that along with the treatment of sciatica, it also
aims at strengthening the patient’s immunity in order to prevent further recurrences.

AIM

To assess the usefulness of homoeopathic constitutional medicine in pain management of

sciatica.

OBJECTIVE

To study the clinical presentation of pain associated with Sciatica.

MATERIALS AND METHODS

The present study consisted of 30 patients of sciatica who attended O.P.D. of Bakson
Homoeopathic Medical College and Hospital on the basis of inclusion and exclusion criteria
fixed .The cases were studied keeping the individualization and . The patients included were
suffering from pain in the buttock or leg that is worse when sitting; weakness, numbness, or
difficulty in moving the leg or foot. During the attacks of sciatic pain, on the basis of
symptoms- similarity and recorded in a case Proforma prepared for the study. Selection of
remedy was done on the basis of constitution of the individual, totality of symptoms,
reportorial result, characteristic symptoms and miasmatic diagnosis of the patient. Follow-
up criteria and parameters for evaluating the result for study were formulated.

For chronic conditions, Rhus Toxicodendron, NatrumMuriaticum ,Pulsatilla and

Gnaphallium, in higher potencies were given as per the need of each case. Follow up of each
patient was done to assess the outcome. To determine the outcome of the treatment, the
status of each patient was categorized under marked, mild, moderate and not significant
improvement and worse. To assess the pain intensity, Visual Analogue Scale (from 0-10,
where 0 is no pain and 10 is the worst pain imaginable)

IV
RESULTS

It was noted that out of 30 patients,’marked improvement’ was found in 8 cases (53.33% );
’moderate improvement’ in 5 cases (33.33% ); ‘mild improvement’ was found in 1 cases
(6.66%) ).Constitutional medicines were given to 15 patients, out of which patients had
marked improvement. And overall improvement is seen in about 75% of patients.
Colocynthis, Rhus toxicodendron, Pulsatilla, Lachesis, Gnaphalium, Natrum muriaticum,
Bryonia alba, Sepia are found effective when prescribed on the basis of constitutional
totality.

CONCLUSION

The effectiveness of homoeopathic constitutional remedies in the treatment of patients

suffering from Sciatica is confirmed through this study. However further studies should be
taken upon again Randomized Controlled Trial study design, on large sample size, in order
to reach at a rational conclusion.

V
 INTRODUCTION
Sciatica refers to pain that begins in the hip and buttocks and continues all the way down
the leg. This condition is often accompanied by low back pain, which can be more or less
severe than the leg pain. The term sciatica describes a symptom rather than a specific
disease; a nerve dysfunction caused by compression of one of more lumbar or sacral nerve
root from a spinal disc herniation. Pain typically occurs in the distribution of a dermatome
and goes below the knee to the foot. It may be associated with neurological dysfunction,
such as weakness. The pain is characteristically of shooting type, quickly travelling along the
course of nerve; the pain and tenderness usually marked along the course of sciatic nerve
through the thigh and leg.[1]

Even with the increasing value and usage of imaging techniques and promising
developments in the field of surgery there is no satisfactory results in treating sciatica, as
the high incidence of asymptomatic individuals associated with neural compromise shows
that pressure alone does not cause pain in sciatic nerve roots .This reflects the need for
study of different methods in the treatment of sciatica.
Homoeopathic medicines are found to act effectively on the
nerves and sciatica is a disease affecting the nerves therefore the present study is an
effort to know [2]
“The usefulness of homoeopathic CONSTITUTIONAL MEDICINE in pain management of
Sciatica”

AGE

Sciatica most likely to affect between the ages of 25 and 64. It may happen as a result of the
general wear and tear of aging or any sudden pressure on the discs that cushion the bones
of lower spine.

Approximately one in every 50 people will experience a herniated disc at some point in their
life. Of these 10%-25% have symptoms that last more than 6 weeks.[3]

PREVELANCE

 The prevalence of sciatica reported varies considerably ranging from 1.6% in the
general population to 43% in a selected working population. [4]
 Although the prognosis is good in most of the patients. [5], a substantial proportion
(upto 30%) continues to have pain for 1 Year or longer, [6] [7]

1
INCIDENCE

 In approximately 90% of the cases, sciatica is caused by a herniated disc involving

nerve root compression.
 However, lumbar canal stenosis or foraminal stenosis and (less often) tumors of cyst
are other possible causes. [8]

RESEARCH STUDY

There are various studies done in past which showed that homoeopathy can help in
reducing the intensity of pain and cases of sciatica one research has been done that is to
study the

Efficacy of colocynth 30 in treatment of sciatica.

 Brief about the research: The study consisted of two parts theoretical and
practical. Theoritical part study was completed by, collecting and compiling the
data through authentic literature about sciatica and homoeopathic approach with
details. And in second phase detail practical study was completed by collecting
data and treating 30 patients presenting with symptoms of sciatica where
colocynth were prescribed. The study concluded showed that homoeopathic
remedy act very effectively in the cases of right side and even left side. It have
convincing potential to reduce the pain intensity and improving quality of life of
sciatica patients by reducing pain and numbness, weakness of leg. [9]

 Researchers from the Department of clinical sciences of Urmia University in Iran,

have undertaken research (RCT) that proves the homoeopathic remedy Hypericum
improves the functional recovery of peripheral nerve regeneration.[10]

The increasing global prevalence of sciatica, the large burden it now imposes on patients,
and the high health care costs have led to extensive research into its mechanisms and
treatment. Since the consumer of health care in India is not sufficiently literate, physicians
have been assigned a lot of responsibility in decision making for the patients. There is a
paucity of data for complaints of sciatica in middle age group in India. The present study is
aimed to find the impact of homoeopathic in intervention in the pain management of
sciatica.

2
  Comparison of the efficacy of ibuprofen and Belladonna in the control of
orthodontic separator pain.

The study was done to compare the efficacy of ibuprofen and Belladonna in the control of
orthodontic pain and ascertain the pain relief by Belladonna in comparison with ibuprofen
during orthodontic separation. Patients, between 20-35yrs of age were included. Patients
were randomly divided into two groups; one was assigned to ibuprofen 400mg and second
group was allocated to Belladonna 6C group. Patient were given two doses of medication of
their respective groups, Pain scores recorded on visual analogue scale(VAS) as VAS was a
10cm scale with millimeter caliberation to record their pain. And the comparison conclude
with that ibuprofen and Belladonna 6C are effective and provide adequate analgesia with
no statistically significant difference. Lack of adverse effects with belladonna 6C makes it an
effective and viable alternative.[11]

3
 AIM AND OBJECTIVE

AIM
To assess the usefulness of homoeopathic constitutional medicine in pain management of
sciatica.

OBJECTIVE
To study the clinical presentation of pain associated with Sciatica

4
 REVIEW OF LITERATURE
DEFINITION

‘Sciatica’ is the term for pain that radiates along the sciatic nerve, anywhere from the lower
back, buttocks, down the back of the leg, to the foot. Sciatica is defined as pain in the area
of distribution of Sciatic nerve i.e. low back pain associated unilateral leg pain radiating to
foot to toes, numbness and par aesthesia in the same distribution straight leg raising test
induces more leg pain localised neurology that is limited to one nerve root it lasts up to six
weeks and persistent (chronic) sciatica lasts more longer . The term sciatica dates back to
1398 A.D. appearing to originate from Latin word ‘ischiadus’ meaning ‘of pain in the hip’ and
from the Greek word ‘iskhiadiakos” meaning “pain in the hips”.

Fig.1. Location of sciatic nerve, source (courtesy: Gray Henry. The Anatomical Basis of
Clinical Practice. 40th Edition. Churchill Livingstone, Elsevier. 2008)

5
The Vertebral Column

The vertebral column is the central bony pillar of the body it supports the skull, pectoral
girdle, upper limbs, and thoracic cage and, by way of the pelvic girdle, transmits body
weight to the lower limbs. Within its cavity lies the spinal cord.

Development of axial skeleton

The axial skeleton is composed of the: Skull, Vertebral column, Ribs, Sternum During
formation off this part of skeleton ,the cells in sclerotomes of the somites change their
position .During the fourth week, they surround the neural tube (primordium of spinal cord)
and the notochord ,the structure about which the primordial vertebrae develop .This
positional change of the sclerotomal cells is effected by differential growth of surrounding
structure and not by active migration of sclerotomal cells .The pax-1 gene , which is
expressed in all prospective sclerotomal cells of epithelial smites In chick and mouse
embryos ,seems to play an essential role in the development of vertebral column

Development of vertebral column

During the pre cartilaginous or mesenchymal stage, mesenchymal cells form the
sclerotomes are found are found in three main areas
· Around the notochord
· Surrounding the neural tube
· In the body wall

In the frontal section of 4 week embryo, the sclerotomes appear as paired condensations of
mesenchymal cells around the notochord .each sclerotome consists of loosely arranged cells
cranially and densely packed cells caudally . Some densely packed cells move cranially
opposite the center of myotome, where they form the interverterbal disc.
The notochord degenerates and disappears where it is surrounded by the developing
vertebral bodies, between the vertebrae the notochord expands to form the gelatinous
center of the intervertebral disc, the nucleus pulposus .the nucleus is later surrounded by
the circularly arranged fibers that form the annulus fibrosus.The nucleus pulpous and
annulus fibrosus constitute the intervertebral disc.

Bony stage of vertebral development

Ossification of typical vertebrae begins during the embryonic period and usually ends by the
twenty-fifth year .there are two primary ossification centers, ventral and dorsal, for the
Centrum primary ossification centers soon fuse one center.Three primary centers are
present by the end of the embryonic period; The vertebral body composite of anular
epiphyses and the mass of bone between them .the vertebral body includes the Centrum
,parts of vertebral arch ,and the facets for the heads of the ribs .all secondary centers unite
with the rest of the vertebrae around 25 years of age.[12]

SPINAL CORD
The human nervous system is the most complex physical system known to mankind: it
consists of many billions of interactive cellular units shows constantly changing patterns of
activity are reflected in every aspect of human behavior and experience.

6
The inner complexity of organization of nervous systems is due to its vast population of inter
communicating cells. There are nerve cells or neurons, can encode information conduct it
and then transmit it to other neurons, or to various non newer cells, besides neurons, there
is also a great number of supporting cells (neuroglia) are responsible for creating and
maintaining an appropriate environment in which the neurons can operate efficiently.
Neurons have a rounded central mass of cytoplasm enclosing the cells giving off long,
branched extensions collectively termed neuritis. In most instances, one of these processes,
the axon, is much longer, than of others, which are termed as dendrites.The spinal cord a
direct down word continuation of the medulla oblongata, starts at the upper border of the
atlas and ends at the lower border of the first lumbar vertebra as the conus medullaris.
Though cylindrical, it is slightly flattened in its anteroposterior diameter. Corresponding to
the large nerves supplying the upper and the lower limbs is a cervical enlargement from
cervical 3 to thoracic 2 and a lumbar enlargement from Thoracic 9 to 12. From the lowest
end of the spinal cord-the conus Medullaris-extends a delicate median prolongation, the
filum terminale interna which ends with the Dural sac at the second sacral vertebra. Its
extradural prolongation filum terminale externa-ends at the coccyx.
The Spinal cord is enveloped by the dura, the arachnoid and the piaMater .External to the
dura is the epidural space filled by a thin layer of fat, areolar tissue and veins. The
arachnoids and the subarachnoid spaces are filled with fluid 13 which cushion spinal cord.
The pia mater intimately surrounding the spinal cord also has lateral extensions to the inner
dural surface. These are equally spaced between nerve roots and are known as dentate
ligaments.The Spinal nerves emerge from the spinal cord in pairs; 8 in the cervical region, 12
in the thoracic region, 5 in the lumbar region, 5 in the sacral region, and 1 pair of coccygeal
nerves, making a total of 31 pairs of spinal nerves. These also correspond to varying
segments of neuromeres of the spinal cord.[13]

7
 Fig.2. Division of segments of Spinal Cord

Sciatic nerve
The Sciatic nerve is the thickest nerve in the body. In its upper part is forms a
band about 2 cm wide. It begins in the pelvis and terminates at the superior angle of
the popliteal fossa by dividing into the tibial and common peroneal nerves.

Origin and Root value

This is the largest branch of the sacral plexus. The tibial part is formed by the
ventral divisions of the anterior primary rami of L4, 5, S1, 2, 3. The common peroneal
part is formed by the dorsal divisions of the anterior primary rami of L4, 5, S1,2.

Course and Relations

1. In the Pelvis
The nerve lies in front of the piriformis, under cover of its fascia.

2.in the Gluteal Region

8
The sciatic nerve enters the gluteal region through the greater sciatic
foramen (Below the piriformis). It runs downwards with a slight lateral
convexity, passing between the ischial tuberosity and the greater trochanter.

It has the following relations in the gluteal region

(A) Superficial (Posterior). Gluteus maximums and sometimes the posterior
cutaneous nerve of the thigh.

(B) Deep (Anterior).

(1) body of the ischium, and nerve to quadratus femoris;
(2) tendon of the obturator internus with the gemelli
(3) Quardatus femoris,
obturator externus, and ascending branch of the medial circumflex femoral
artery;
(4) the capsule of the hip joint which lies deep to the forementioned
muscles; and
(5) the upper, transverse fibers of the adductors magnus.

(C) Medial.
(1) Inferior Gluteal nerve and vessels; and
(2) Sometimes the
posterior cutaneous nerve of the thigh.

(D) Lateral. Biceps femoris.

(E) The sciatic nerve is accompanied by a small companion artery which is a

branch of the inferior gluteal artery. The artery runs along the Sciatic nerve
for some distance before sinking into its substance.
The sciatic nerve may divide into terminal branches anywhere above the
usual level. When division occurs in the pelvis, the tibial nerve passes
through the greater sciatic foramen inferior to the piriformis, but the common
peroneal nerve pierces the piriformis to enter the gluteal region.

Branches
1. Articular branches to the hip joint arise in the gluteal region.

2. Muscular branches may arise lower part of the gluteal region or in the upper
part of the thigh. The tibial part of sciatic nerve supplies the
semitendinosus, the semimembranosus, the long head of the biceps femoris,
and the ischial head of the adductor magnus. The common peroneal part
supplies only the short head of the biceps femoris.[14]

9
Figure.3. Branches of Sciatic Nerve, source (courtesy: Gray Henry. The Anatomical Basis of
Clinical Practice. 40th Edition. Churchill Livingstone, Elsevier. 20080

10
 Fig.4. Location of Sciatic Nerve and Arteries involving

Applied Anatomy
1. Compression of the sciatic nerve against the femur, or unusual stretching, after
sitting for a long time, may give rise to a “sleeping foot”.

2. Shooting pain along the cutaneous distribution of the sciatic nerve and its
terminal branches (chiefly the common peroneal) is known as sciatica. Pain
usually begins in the gluteal region or even higher, and radiates along the back
of the thigh, and the lateral side of the leg, to the dorsum of the foot.
This is usually due to compression and irritation of one or more nerve roots
forming the sciatic nerve. (The cause may be osteoarthritis, lumbar disc prolapse,
spondylolisthesis, fibrositis, neuritis, etc.).

3. The sciatic nerve may be injured by penetrating wounds, dislocation of the

hip, or fracture of the pelvis. This result in loss of all movements below the
knee (with foot drop); sensory loss on the back of the thigh, the whole of the
leg, and the foot except the area innervated by the saphenous nerve.

4. In above-knee amputations, the companion artery of the sciatic nerve should be carefully
isolated and ligated separately to avoid sharp bleeding that
otherwise follows. Isolation of the artery from all nerve fibres must be perfect
because ligation of nerve fibres with the artery would be followed by severe

11
pain in the stump.[15]
be carefully isolated and ligated separately to avoid sharp bleeding that
otherwise follows. Isolation of the artery from all nerve fibres must be perfect
because ligation of nerve fibres with the artery would be followed by severe pain in the
stump.

Different Types of Pain along the Sciatic Nerve

The patient’s pain and specific sciatica symptoms can usually be traced to where the
injured/irritated nerve originates in the lower back. Typical symptoms include:

 Sciatica from L4 nerve root

Symptoms of sciatica stemming from this level, the L3-L4 level, in the lower spine may
include: pain and/or numbness to the medial lower leg and foot; weakness may include
the inability to bring the foot upwards (heel walk). The patient may have reduced knee-
jerk reflex.
 Sciatica from L5 nerve root
If the L4-L5 segment is affected, the patient may have weakness in extension of the big
toe and potentially in the ankle (called foot drop).

Fig.5. Sciatic nerve Pain Patterns, source (courtesy: Gray Henry. The Anatomical Basis of
Clinical Practice. 40th Edition . Churchill Livingstone, Elsevier.2011)

12
 Symptoms of sciatica originating at this level of the lower back may include: pain and/or
numbness at the top of the foot, particularly in the web between the great toe (big toe)
and the second toe.

 Sciatica from S1 nerve root Symptoms of sciatica originating at this L5-S1 level, which is
at the bottom of the spine, may include: pain and/or numbness to the lateral, or
outside, of the foot; weakness that results in difficulty raising the heel off the ground or
walking on the tiptoes. The patient may have reduced ankle-jerk reflex.

Patho physiology

 Sciatica is generally caused by the compression of lumbar nerves L4, or L5 or sacral

nerves S1, S2, or S3, or by compression of the sciatic nerve itself. When sciatica is
caused by compression of a dorsal nerve root (nervi spinalis radix posterior), it is
considered a lumbar radiculopathy (or radiculitis when accompanied with an
inflammatory response). This can occur as a result of a spinal disk bulge or spinal disc
herniation (a herniated intervertebral disc), or from roughening, enlarging, or
misalignment (spondylolisthesis) of the vertebrae, or as a result of degenerated
discs that can reduce the diameter of the lateral foramen (natural hole) through
which nerve roots exit the spine. The intervertebral discs consist of an anulus
fibrosus, which forms a ring surrounding the inner nucleus pulposus. When there is a
tear in the anulus fibrosus, the nucleus pulposus (pulp) may extrude through the tear
and press against spinal nerves within the spinal cord, cauda equina, or exiting nerve
roots, causing inflammation, numbness, or excruciating pain. Inflammation of the
spinal canal can also spread to adjacent facet joints and cause lower back pain
and/or referred pain in the posterior thigh(s). Pseudosciatic pain can also be caused
by compression of peripheral sections of the nerve, usually from soft tissue tension
in the piriformis or related muscles.
 The spinal discs are composed of a tough spongiform ring of cartilage ("anulus
fibrosus") with a more malleable center ("nucleus pulposus"). The discs separate the
vertebrae, thereby allowing room for the nerve roots to properly exit through the
spaces between the vertebrae. The discs cushion the spine from compressive forces,
but are weak to pressure applied during rotational movements. That is why a person
who bends to one side, at a bad angle to pick something up, may more likely
herniate a spinal disc than a person jumping from a ladder and landing on their feet.
 Herniation of a disc occurs when the liquid center of the disc bulges outwards,
tearing the external ring of fibers, extrudes into the spinal canal, and compresses a
nerve root against the lamina or pedicle of a vertebra, thus causing sciatica. This
extruded liquid from the nucleus pulposus may cause inflammation and swelling of
surrounding tissue, which may cause further compression of the nerve root in the
confined space in the spinal canal. Many herniated discs themselves, however, cause
no pain or discomfort: only occasionally does a disc herniation cause sciatica.
13
Pathways to Sciatic nerve pain
Five sets of paired nerve roots in the lumbar spine combine to create the sciatic nerve.
Starting at the back of the pelvis (sacrum), the sciatic nerve runs from the back , under the
buttock and downward through the hip area into each leg. Nerve roots are not ‘solitary’
structures but are part of the body’s entire nervous system capable of transmitting pain and
sensation to other parts of the body. Radiculopathy occurs when compression of a nerve
root from a disc rupture or bone spur occurs in the lumbar spine prior to it joining the sciatic
nerve.

Fig.6. Division of Sciatic Nerve, source (courtesy: Gray Henry. The Anatomical Basis of
Clinical Practice. 40th Edition. Churchill Livingstone, Elsevier.2008)

14
Clinical Features-

Common symptoms of sciatica include

 Pain in buttock or leg that is worse when sitting.

 Burning or tingling down the leg.
 Weakness, numbness or difficulty in moving the leg or foot.
 A constant pain on one side of the buttock.
 A shooting pain that makes it difficult to stand up.
 Pain that originates in the low back or buttock and continues along the path of the
sciatic nerve down the back of the thigh, into the lower leg and foot.
 Pain that feels better when patients lie down or are walking, but worsen when
standing or sitting.
 Some experience “Pins and Needles” sensation, numbness or weakness or a pricking
sensation down the leg.

Table 1. Risk factors for sciatica[16]

S.NO. Risk factors

1 Age(sciatica is more common between 30 and 50 years of
age)
2. Diabetes(increases the risk for nerve damage)
3 Genetics(e.g.,
inherited
spine abnormalities
4 Menopause(ending of
menstrual periods in
women;may lead to
bone loss
5 Physical activities that involve heavy lifting or twisting the
back (e.g.,golf)
6 Sedentary (inactive)lifestyle, including occupations that
require sitting for long periods of time

MIDDLE-AGED ADULTS- Degeneration of the intervertebral disk usually starts around

the age of 30, so the risk of developing sciatica begins around this time, too. But ,
overall, it’s people between the ages of 30-50 who are the most at risk for sciatica.
Because of work, social and sports activities, this age group tends to be very active in
comparison with older age groups, increasing the likelihood of injury or damage to the
spine.[9] Additionally, the disks themselves are more vulnerable to injury, seniors have
less disk material to risk, while the disk material of children and young adults is quite
resilient.

15
 Sciatica usually affects only one side of the lower body. Often, the pain extends from the
lower back all the way through the back of the thigh and down through the leg.
Depending on where the sciatica nerve is affected, the pain may also extend to the foot
or toes.[17]

CAUSES OF SCIATICA

1. True sciatic Neuritis- Nerve injury due to injections or trauma, post herpetic
neuralgia leprosy, polyarteritis nodosa.

2. Mechanical pressure on nerves or roots or referred pain.

In the thigh and buttock-Fibrositis, sacrosciatic band, neurofibroma,
haemorrhage within or adjacent to nerve sheath in blood dyscrasias and
Anticoagulant therapy.

b. In the pelvis-Sacroiliac arthritis or strain, hip disease, infection of prostate or

female genital tract, rectal impactions.

c. In the vertebral column-Arthritis, tuberculosis, spondyololesthesis, ankylosing

spondylitis,

d. In the spinal cord-Tumors of cauda equine, arachnoditis, rarely thrombosis,

haemorrhage or infection irritating meninges of the cord.

e. In the cord space-Protruded interverterbal disc, extramedullary tumors.

f. primary bone tumors, secondary carcinoma.In the back-Fibrositis of posterior

sacral ligament.

TABLE 2. Symptoms of Sciatica in terms of Location, Sensation, Character, Extension,

Modalities and some associated symptoms-

LOCATION SENSATION CHARACTER EXTENSION MODALITIES ASSOCIATED

SYMPTOMS
One side of Pins and needles Sharp, dull, Starts Pain worse Incontinence
the buttock, pricking,numbness, shooting, usually during of urine or
back of thigh Burning and episodic or from lifting, stool may
and calf tingling continuous gluteal moving, present
region with region and prolonged
weakness extends sitting and
along back standing
of thigh,
lateral side
of leg to
dorsum of
foot

16
Conditions that compresses the sciatic nerve causing sciatic pain is listed below:

 Herniated lumbar discs: Is the most common cause of sciatica in the lumbar
spine.

 Degenerative Disc Disease: Aging is known to cause disc weakness further

causing disc herniation.

 Some genetic predisposition may also make prone to disc problems.

 Diabetes: In case of diabetes, body uses blood sugar, making more likely to
develop nerve damage.

 Lumbar Spinal Stenosis: is narrowing of one or more neural passageways in the

lower spine due to disc degeneration and/or facet arthritis.

 Isthmic Spondylolisthesis: results from a stress fracture at the 5th lumbar

vertebra. The fracture combined with disc space collapse may allow the vertebra
to slip forward on the first sacral segment causing the L5 nerve root to become
pinched as it leaves the spine.

 Piriformis syndrome: Running directly above the sciatic nerve, the Piriformis
muscle starts at lower spine and connects to each thigh bone (femur). Piriformis
syndrome occurs when the muscle becomes tight or goes into spasms, putting
pressure on the sciatic nerve. Active runners and walkers, prolonged sitting, car
accidents and falls may contribute to this condition.[18]

 Trauma: A car accident, fall or blow to the spine can injure the lumbar or sacral
nerve roots. Also occupation in which people carry heavy loads or drives a motor
vehicle for long period makes more prone to develop sciatica.

 Spinal Tumors and Infections are rare disorders that may compress the sciatic
nerve.

 Sciatic nerve tumor or injury Although uncommon, the sciatic nerve itself may
be affected by a tumor or injury, leading to sciatic pain.

17
  Other causes. In some cases, no cause may be found. A number of problems can
affect the bones, joints and muscles, all of which could possibly result in sciatic
pain.

 Miscellaneous causes. These conditions may worse the back pain include being
overweight, not exercising regularly, wearing high heels, or sleeping on a
mattress that is too soft.

N.B. Sciatica also may be caused by wear and tear on the vertebrae (e.g., lumbar 5
[L5], sacral 1 [S1]) that results in pressure on the sciatic nerve root. The effects of
aging and degenerative disc disease (osteoarthritis) can damage the vertebrae.

Fig.7. Causes of Sciatica, Source (Courtesy: Kasliwal RM,et al. Incidence, Etiology and
Diagnosis of Sciatica Syndrome. 2010)

SPECIAL SIGNS
1. Tenderness of nerves.
2. Intensification of pain in back and leg during rotatory extension of lumbar
spine very suggestive of ruptured disc.
3. Popliteal compression-Radiating pain can often be aggravated by pressure
over the course of the tibial nerve through the popliteal fossa.It is additional
18
finding in favour of root compression.
4. Testing of sacroiliac joints –by pressure on two anterior superior iliac joints.
5. Estimation of range and painlessness of hip joint by passive stretching.
6. Sensations-Impairment of perception of pin-prick found on dorsum of foot if
implication of 5th lumbar and 1st sacral nerve roots.
7. Presence of tender nodules in paraspinal muscles and along iliac crest may be
found in sciatica.
36
8. Tone and size of gluteal muscles judged by asking patient to contract both
buttocks; in upper sacral root lesions marked wasting may be clearly seen.
9. Knee and ankle jerks-When L4root is involved knee jerk is depressed and
there is weakness of tibialis anterior muscle.L5 root lesions, both knee and
ankle jerks usually brisk but there may be weakness of dorsiflexion of toes
particularly of extensor hallucis longus.S1 root ankle jerk lost and weakness,
when present involves the calf muscles.

CLINICAL EXAMINATION
Local examination:
There are three important components to the examination of the lumbar spine:
· To inspect for the presence of deformity.
· To assess the movements of spine.
· To assess the effects of lumbar spinal pathology on the spinal cord or
nerve roots.

Examination of the back:

I. Inspection: With the patient in standing position look for postural

abnormalities like scoliosis, lordosis or kyphosis.

II. Palpation:
a. Tenderness: Localized tender infiltrates of the skin and subcutaneous
tissue. Palpable tender induration of small intervertebral muscles.
Tenderness at the level of posterior articulation of the involved segment and
pain on percussion of affected intervertebral space.

b. Movements: All the movements of the spine are tested:

Flexion: Instruct the patient to bend forwards as much as possible at the

waist. Normal flexion is 80° or fingertips 3-4 inches from the floor.

Lateral flexion: Instruct the patient to bend to left and to the right as far as
possible. Normal range is 35° on each side.

Extension: Instruct the patient to bend at the waist as far backward as

possible. Normal range is 20 to 30°.

19
Rotation: Instruct the patient to rotate from the waist to the left and to the
right as far as possible. Normal range is 45° per side. Note: In all the
movements of the spine the neutral position is 0°.

III: Clinical tests:

Straight leg raising test (SLRT): Patient is in supine position, the

examiner raises the leg straight one after the other. Upto 30° nerve is not put
under stretch. Between 30-70° nerve comes into contact with the prolapsed
disc and the patient complains of pain. Beyond 70° if patient complains of
pain it is usually not due to disc prolapse but could be due to sacroiliac joint
involvement.

Fig.8. Straight Leg Raising (SLR) Test, Source (courtesy: Walsh J Flatley. Slump Test: Sensory
Responses in Asymptomatic Subjects. J Man ManipTher,2007)

Lasegue test: Here the hip is flexed, knee is flexed and the leg is
slowly straightened. The patient is supine. Flex the patient’s hip and knee to
90°. The nerve roots are not under tension and no pain is elicited. Not
extend the knee. If the patient complains of pain, the test is positive and it
indicates nerve root compression or inflammation.

 MRI SCANS- This procedure uses a powerful magnet and radiowaves to produce
cross sectional images of your back. MRI produces detailed images of bone and soft
tissue such as herniated disks. During the test, you lie on the movable table inside
the MRI Machine
20
 MRI Scans often detect spine abnormalities that are not causing symptoms in the
patient. At least 40% of all adults have bulging or protruding vertebral disks, and
most have no back pain. Also, the degree of disk abnormalities revealed by MRIs
often has very little to do with the severity of the pain of the need for surgery. Disk
abnormalities in people who have back pain may simply be a coincidence rather than
an indication for treatment.

 CT Scans- When CT is used to image the spine, you may have a contrast dye injected
into your spinal canal before the X-rays are taken- a procedure called a CT
myelogram. The dye then circulates around your spinal cord and spinal nerves,
which appear white on the scan.
 Nerve conduction studies to determine the health or disease or a nerve.

Sciatica according to causative factor it is classified as

REFLEX SCIATICA:
This type of neuralgia is due to visceral causes.eg: diseases of bladder,
prostate, uterus, ovaries, etc or structures like joints ligaments and muscles. The main
features of this type of neuralgia are that neurological disturbances do not correspond
to known patterns of nerve distribution and there are no objective neurological signs.

A] Primary sciatic neuritis:

In this form, it is a manifestation of either a general systemic disease like
diabetes or syphilis, or of a generalized toxemia like alcoholism, lead and arsenic
poisoning etc.It can be diagnosed by other signs and symptoms of underlying disease.

B] Secondary sciatica:
This is due to a peripheral neuritis and is due to pressure on the nerve, which
may be

1] Outside the spinal canal as by pelvic tumors,

2] Non disc lesions inside the spinal canal; as by extra-or-intradural masses,

3] Intravertebral disc lesions.

In the words of Duplessis ,”It is becoming increasingly evident that nuclear
retropulsion is the villain of the place of sciatica and is with this form also called the
LUMBOSCIATIC SYNDROME.

21
PATHOLOGY
There are no definite changes. The inflammation may be confined to nerve
sheath [perineum], to the interstitial part, or to the axis cylinder. In the first condition
the nerve is swollen, red and infiltrated with leucocytes. In the last instance
degenerative changes of axis cylinder are seen. The degeneration may extend down
the nerve, because the fibers are cut off from the trophic cells, and the muscles may
undergo atrophy. If recovery takes place there is an increased fibrous tissue formed in
the nerve.

Fig. 9. Inflammation of Sciatic Nerve

INVESTIGATIONS
1. Blood tests have no place, except if other diagnosis needs to excluded, for
example, pain of a non-mechanical nature, atypical pain pattern, persistent
symptoms, and age older than 50 years. In these cases, consider FBC, U & E,
ESR, LFT’S, serum calcium and serum protein electrophoresis.

2. Imaging : is not necessary unless the patient is immobilized completely by

pain and requires admission

X-rays: X-rays will show if there are any abnormal bone spurs which might
be in close proximity to spinal nerve root. Almost most of these osteophytes growth
are harmless & do not cause any pain, at least the x-ray film will give the doctor
reason to persue additional testing to determine if bone spur is indeed compressing a
nerve. Osteophytes are targeted for causing many pinched nerve conditions although
most of time, these products of spinal aging are typically coincidental and innocent. Xrays
help for detecting disc narrowing in lumbar spine or lesion of sacroiliac joint.

MRI: MRI results can help to show damage to various parts of your spine such as
discs and ligaments.
22
CT scan: gives detailed picture of inside your spine are. It is similar to MRI.
A bone scan is indicated to rule out tumors, trauma, or infection.

CSF: may show increased protein with normal cell count in large protruded
intervertebral disc.

Eletromyogram(EMG):may be used to confirm presence of denervation in affected muscles.

DIFFERENTIAL DIAGNOSIS OF CONDITIONS CAUSING SCIATICA

· Disc lesion
· Spondylolisthesis
· Attrition of disc
· Sacroiliac arthritis
· Secondary deposits in spine
· Benign spinal tumor
· Dissecting aneurysm
· Ankylosing spondylitis
· Degenerative joint disease
· Renal calculi
· Fracture
· Muscular back pain

Diagnosis from muscle weakness:

Flexing the thigh (with knee bent)-: Radiculopathy at L1-2

Extending the knee-: Radiculopathy at L3-4

Walking on the heels-: Radiculopathy L4-5

Walking on toes-: Radiculopathy L5-S1

Difficulty controlling the bowel or bladder-: S1-2-3

Note: Physical therapists often treat each of these conditions with McKenzie exercises
appropriate for the level and severity of injury.

Diagnosis from numbness and/ or paraesthesias:

Inguinal region, including side of testicle, labia majoris: L1

Upper front and side of thigh: L2

23
Main region of front of thigh down to or including knee: L3

Inside of calf , top of foot: L4-5

First web space, very outside of calf: S1

Middle back of thigh: S2

Middle portion of testicles, penis, labia majora, anus: S3

Glans penis, clitoris: S4

Fig.10.Differential Diagnosis for Sciatica Patients suffering from LOWER EXTREMITY

complaints, Source(courtesy: Fishman LM, Zybert PA. Natural Review of Nerology. Nature
Publishing Group.2009).

COMPLICATIONS-

 Loss of feeling in the affected leg

 Weakness in the affected leg
 Loss of bowel or bladder function

24
  Partial or Complete loss of sensation in the leg- One of the complications of sciatica
is numbness in the affected leg. Numbness can be felt on the hip, the back of the
calf and even on the sole of the foot. Due to a loss of sensation, the affected leg
feels weak and movement, may become difficult. Numbness combined with a partial
loss of movement in the leg may require emergency treatment.
 Partial or complete loss of leg movement- loss of leg movement as a complication
of sciatica, since this condition affects the nerve that controls the back of the leg
muscles, it can cause problems where the leg muscles do not work or move
properly. This loss of muscle function can be partial or total. The complete loss of
muscle movement in the leg is called paralysis of legs.

 Loss of Bowel or Bladder Function- a complication of sciatica is the loss of bowel or

bladder function. Since the sciatic nerve runs down the buttock, it can affect a
patient’s bowel or bladder functions. In cases of severe pain in acute sciatica, the
patient may lose control of bladder or bowel functions and may need to be
hospitalized. Medicine plus reports that in some cases of sciatica, surgery may be
required to help the patient get back the control of bowel or bladder function.[19]

PREVENTION/MANAGEMENT
Prevention is always better than cure. So it is better to avoid triggers. These self measures
can help to relieve the symptoms of sciatica and also prevent recurrence.

· Sleep on firm mattress on your side or back with knees bent.

· During bad attacks, sleep with pillow under or between your knees.

· Try not to sleep on your stomach.

· Adjust the height of chairs so your feet are flat on the floor and the knees are a little higher
than the hips.

· Keep your feet flat on the floor and do not cross your legs when sitting.

· Sit in chairs that have firm back support and sit up straight against the back of chair.

· Weight reduction

· Always lift from a squatting position, using your hips and legs to do the heavy work. Never
bend over or lift with a straight back.

· Avoid sitting or standing for extended periods.

· Avoid wearing high heels.

25
· Do abdominal crunches: These exercises strengthen the abdominal muscles that help to
support your lower back. Lie with your back on the floor, hands behind your head and knees
bent. Press your lower back to floor, lift your shoulders up about 10 inches off the floor, and
then lower them. Repeat 10 to20 times daily.

· Lay in the face down position and clasp your hands behind the lower back, then raise the
head and chest slightly against gravity while looking at the floor.

· In the above position with the head and chest lowered to the floor, lightly raise an arm and
opposite leg slowly. with the knee locked,2-3 inches from the floor.

· Stretch: Sit in a chair and bend down toward the floor, stop when you feel just discomfort,
hold for 30 sec then release. Repeat 6-8 times.

· Lay on the back and gently pull the knees to the chest until a comfortable
stretch is felt.13

Fig.11. Correct posture of doing daily routine work,source (courtesy: Kline DG, Kim D,
Midha R, Harsh C, Tiel R. Management and results if sciatic nerve injuries: a 24-year
experience. J Neurosurg1998)

26
CONSERVATIVE/ NON-SURGICAL TREATMENTS FOR SCIATICA

 Bed rest (trade-off)

 Explain cause of the symptoms and reassure patients that symptoms usually
diminish overtime without specific measures.
 Advise to stay active and continue daily activities; a few hours of bed rest may
provide some symptomatic relief but does not result in faster recovery.
 Analgesics or non-steroidal anti-inflammatory drugs, acupuncture, epidural steroid
injections, spinal manipulation, traction therapy, physical therapy, behavioral
treatment, multidisciplinary treatment (unknown effectiveness)
 Prescribe drugs, if necessary, according to four steps[19]:
1) Paracetamol ;(2) non-steroidal anti-inflammatory drugs;(3) tramadol, or
non-steroidal anti-inflammatory drug in combination with codeine; and(4)
morphine

SURGICAL TREATMENT FOR SCIATICA-

 When disabling leg pain after 3 months or more of non-surgical treatment or in case
of intractable radicular pain (not responding to morphine) or if pain does not
diminish after 6-8 weeks of conservative care[20].
 In cases of herniated disc may be removed to stop it from pressing on nerve

Laminectomy with dissectomy may be done under local, spinal or general anesthesia[22

PHYSIOTHERAPY
Physiotherapy is directed at:
1. Relief of pain.
2. Restoration of movement.
3. Strengthening of muscles.
4. Education of posture.
5. Analysis of precipitating factors to reduce recurrences.
43
The following treatments may be used:
1. Heat:
A heat pad can help to relieve the aching which comes from prolonged muscle
spasm.
2. Corsets:
A lumbar corset will help in restricting movements and thereby relieve pain. In men who are
employed in heavy work, a corset may be supplied for working hours.
3. Posture education:
Posture education involves teaching the patient the correct position in sitting ,standing and
lying and then basing activity on these positions.
4. Traction:
Vertebral traction for patients suffering from severe nerve root pain. The initial examination
will emphasize the acute irritable nature of this type of pain as will the dermatomal

27
distribution. Intermittent sustained traction is carried out after careful positioning has
localized the involved segment. In such cases treatment at least once a day is essential;
prolonged pain relief will take several days to obtain. The more chronic aching pain of
osteoarthritic changes in the apophyseal joints may respond to regional intermittent
traction used as a passive mobilizing technique. Passive mobilizing techniques are valuable
together with light, general back exercise. If the muscles are in a state of spasm, pelvic
traction is sometimes helpful.[22]

28
 ROLE OF HOMOEOPATHY IN TREATMENT OF SCIATICA
In homoeopathy, a medicine is selected on the basis of principle ”Similia similibus curentur”,
i.e. like cures like. A medicine capable of producing symptoms in a healthy person can cure
similar symptoms in a sciatica patient. Since no two individuals are same, different
medicines are required for different patients suffering from sciatica.[23]. In acute cases of
sciatica, the medicine is generally selected on the basis of acute totality with reference to
location, sensation, modalities and concomitants in respect of each complaint. But in
chronic cases, apart from the above, the physical attributes, mental symptoms, relevant
family, personal and past history of the patient are taken into account to determine the
constitutional remedy.

Homoeopathy as a natural system of medicine offers distinct advantages to the people who
suffer from sciatica. Homoeopathy is able to treat the sciatica pain very effectively and is
able to rectify the compression or irritation on the sciatic nerve. Another great benefit of
using homoeopathy is that besides curing the sciatic pain, homoeopathy also aims at
strengthening the patient’s immunity in order to prevent further reoccurrence of pain.[23]

CONSTITUTION

No knowledge is perfect unless it includes an understanding of the origin — that is, the
beginning; and as all man’s diseases originate in his constitution it is necessary that his
constitution should be known if we wish to know his diseases. Paracelsus
Constitution is defined as the structure, composition, physical make up or nature of a
person, comprising inherited qualities and modified by the environment. The English word,
constitution, comes from the Latin root, constituere, which means constitutes: to set up, to
establish, to form or make up, to appoint to give being to.
In homoeopathy, the choice of remedy is based on a consideration of the totality of an
individual's symptoms and circumstances, including personality, behaviours, fears,
responses to the physical environment, food preferences and so on.
Hahnemann and Constitution
Dr. Hahnemann gives a fair idea on the importance of the constitution in Aphorism 5 of
Organon of Medicine, where +in he sates “Useful to the physician in assisting him to cure
are the particulars of the most probable exciting cause of the acute disease, as also the
most significant points in the whole history of the chronic disease, to enable him to discover
its fundamental cause, which is generally due to a chronic miasm. In these investigations,
the ascertainable physical constitution of the patient (and intellectual character, his
occupation, mode of living and habits, his social and domestic relations, his age, sexual
function, ..etc., are to be taken into consideration. Thereafter, at least at 20 places he
mentions about the constitutions in different context. He mainly refers constitution to the
inherent in the natural frame, or inherent nature of the individual. Hahnemann used the

29
word Beschaffenheit in German, which usually translated as constitution in relationship to
the Latin root "constiture" in homoeopathic works. Chambers Dictionary defines
constitution as the natural condition of the body or mind; disposition.
The term constitution is used at least 16 times in The Chronic Diseases. Pages 30, 34, 35, 48,
75, 90, 98, 99, 101, 103, 142, 143, 145, 181, 242, 243, etc.

Homeopathic concepts
BAZIN classified constitution into 3 types as SCROFULOUS, GOUTY and SYPHILLITIC
VANNIER’S & ZISSUS
Carbonic constitution – The characteristics of carbonic constitution are mentally and
physically upright persons, having square white regular teeth, slight acute angle between
Lower-arm and upper-arm, orderly, undemonstrative, responsible and capable. Cal carb,
Kali carb, Mag carb, Nat carb, Graph, Carbo veg, Carbo animalis are the drugs having this
constitution.
Phosphoric constitution has scrofulous or tubercular diathesis. Tall, thin delicate, easily
tired persons with long yellow teeth but well fitted. Arm forms perfect straight line when
stretched. Dislike hardwork but orderly and fastidious. Calc phos, Phos acid, Kali phos, Phos,
Mag phos are the main drugs.
Flouric constitution is characterized by unbalanced irregular body formations with obtuse
angle or outstretched arm, teeth irregular and ill fitted, untidy, cunning and unreliable.
Capable or heroism, sanctity and wickedness. Predisposed to diseases or nervous system,
dislocation of the joints and suicide.. Flouric acid, Calc flour are the main drugs.
Von Grauvogl classified constitution as Oxygenoid, Carbo – nitrogenoid and Hydrogenoid
Oxygenoid constitution is characterized by the accumulation of excess of oxygen with
resultant destruction of tissues. Body is thin and thus ill on change of season. Destructive,
disorders involving the genitalia and diseases of central nervous system. Body is prone to
ulcerations and self –destruction. Numerous white spots on the nails. Calc phos, Ferr phos,
Nat phos, Phos, Phos acid, Iod, Sil, Calc, Nat mur, Hell, Tuberc, Syph, Merc sol are the main
drugs.
Carbo – Nitrogenoid constitution is characterized by excess of carbon and nitrogen and
suffers from functional disorders of body and mind, diminution of the absorption of oxygen
by the tissues. Psora, eczema, arthritism, marked by erratic working or the heart, lungs,
kidneys, liver, spleen etc. Ars, Ars iod, Calc phos, Carbo veg, Hep, Iod, Kali bich, Lach, Lyco,
Natr mu, Sulph, Zinc met etc. are the main drugs.
Hydrogenoid constitution is characterized by the excess of water in the body. They are
aggravated by moisture and humidity, prone to dropsy and anasarca, and suffers from
tissue growth of benign type. They are slow, fatigued, without life, apathetic, heavy, and

30
indolent. Slow nutrition. Asthmatics, rheumatics, obesity. Ars, Dulc, Nat sulph, Nit acid
phytolacca, Rhustox, Thuja, Dig etc. are the main drugs.[24]
A constitutional remedy removes an inherited tendency for the disease ,our system not only
works wonders in treating diseases but also in preventing them it guards against increasing
this load by enabling his vital energy to provide its own immunity against disease .we
consider the health of individual as a precious charge and his return to health as almost
certain if but we follow the fundamental law. The dynamic force in homoeopathy which
acquired through the potentisation of crude drugs which goes deep to nervous system re-
vitalizing and normatising the natural healing process & thus silencing the cry of pain.

Sciatica Homoeopathic interpretation of pathogenesis:

Allen says: “All the disease was first disturbed function and later on, as functional
disturbances increased & become intensified, it becomes pathological”
“ pathology may be a death process ,but it was first a perverted life process,first a perverted
physiology ,a perverted function ,and functional change preceded and do precede ,all
pathology ‘
In sciatica, pathogenesis proceeds from stage of dysfunction, (in response to micro trauma,
the inflammation may be confined to nerve sheath [perineum], to the49interstitial part, or
to the axis cylinder. In the first condition the nerve is swollen, red and infiltrated with
leucocytes...During this phase the pathological changes are relatively minor and perhaps
reversible),To stage of instability (progression to degeneration due to repeated micro
trauma and pressure produces forming, osteophyte) Finally to stage of stability (In the last
instance degenerative changes of axis cylinder are seen. The degeneration may extend
down the nerve, because the fibers are cut off from the trophic cells, and the muscles may
undergo atrophy. If recovery takes place there is an increased fibrous tissue formed in the
nerve).
In brief functional changes finally lead to irreversible pathological changes.20

Miasmatic interpretation of sciatica

Interpretation of miasmatic background in sciatica depends upon the or stages. Depending
upon the expression available it can be identified psoric, sycotic, tubercular or syphilitic, also
combination of miasms may present with advanced irreversible structural changes.
The family history and past history are appreciated as predisposition leading to the current
presentation, and by analysing the presenting symptomatology the predominating and the
underlying fundamental miasm can be identified. Disease is always expressed by the signs
and symptoms and these permit the individual expression of the characteristic of miasms
which allow us to determine, recognise and handle out the patients individually.

“sciatica” is age related disease, as age is one of the important factor for the occurance of
any disease, so as sciatica, the occurance of disease is co related by In the first phase, there
are always or usually inflammatory or infective diseases. This shows that in first phase of life
when the child is in learning stage, the diseases encountered are due to the first defence
i.e.) physiological defense. This is predominantly by PSORA. In the second phase, a middle
aged person usually suffers from back ache, arthritis, hypertension or diabetes and
sometimes with more severe diseases like psoriasis, tumors, fibroids etc. These diseases are
either accumulative or constructive.Those who go into accumulative or constructive type of
31
disease have entered the sycosis phase of their life.The third phase is the stage
characterised by catabolism, after every construction, there has been destruction, and this
is rule of life. The catabolic stage in life may start in middle age or in the late sixties or
sometimes even seventies, the aging process depends upon genes and telomeres varies
with individual subjects .this change in defence at the genetic can occur as a consequence to
sycotic diseases or even directly after psoric diseases if the genes show syphilitic traits,
inherited or acquired.25
Sciatica & its miasmatic manifestation:
Psora: hands & feet dry hot, often with burning sensation in palms & soles cramp in
lower
extremities in calves of in feet toes ankles’ &in steps
Burning of soles of feet, numbness of extremities with tingling sensation feeling as

if parts with sensations ,feeling as if parts were going to sleep worse lying down or

after sleep or if any pressure is brought to bear on the part as lying on the arm or

crossing the limbs pricking or tingling in fingers or extremities due to poor

circulation coldness of singles parts as knee’s hands feet ear nose etc

Sycosis:

Over stimulated responsive system with failed arrested activity, loss of control

leads to inefficient aberrant immune responses and metabolic maladjustment

.miasm engulf severe refractory anemia, weakness disproportionate aggravations

by suppression of discharges, fatigue with with slowness, indolence, altered mental

expressions, slow registration of sensory inputs, inadequate interpretation ,with

paranoid ideas ,guilt ,feeling of insecurity which are mostly seen in majority

geriatric patients ,sycotic miasms express physically as hypertrophies and over

growths

32
Syphilis:

A whole miasmatic disease expression terminates in the phase of syphilis

characterized by destruction all over and all levels. Homoeopathic physician with

right appreciation promotes. Gradual reversal of disease .over stimulated and

exhausted system under continued adverse environmental inputs leads to loss of

controls at intellect, emotional and physical levels .progressive loss of life leads to

lack to of discriminative intelligence ,perception ,thinking and ,worst feeling of –

anger ,hate ,envy ,jealously, suspicion leading to paranoid traits with violent

outbursts .Stitching, shooting or lancinating pains in the periosteum or long bones of

the upper or lower extremities .worse at night or approach of night, worse change of

weather, by cold and damp .feet become deformed because legs cannot take weight

of osteoarthritis signifying combination of miasm.

Miasm express in the level of physical as cracks, fissures, ulcerations with destructions,

abscess carries, explosive inflammation with toxaemia, malignant rapid spread, necrosis

with crippling deformities, osteoporotic changes and fractures ,deep disfigured scar

,atrophy ,degeneration of tissues ,vessels .calcium deposition ,damage of myelin sheath

,organic paralysis.

Dr. Hahnemann: denounced the concept of treating the disease in man and proposed the
concept of treating the man in disease. As “Sciatica” is a chronic disease, there fore owes
its origin to miasmatic cause.” Homoeopathy views the constitution as a pathogenic
dynamism which the individual inherits and modifies during his life, in three distinct
directions – inflammations, destruction of tissue or its proliferations, these dynamic
morbid tendencies were called by Hahnemann as “miasm”. In every case of chronic
disease, it is either any one or any two or all the three miasms that are in the background
making disease chronic.

33
The Homoeopathic concept of treating the diseases includes:

1. The Holistic approach.

2. Individualization

3. Selecting a similar medicine based on the totality of symptoms.

Holistic concept is absolutely necessary to understand the living phenomena of any

being. Man is an aggregate of material units – of flesh and blood, muscles and nerves

and organs. But in addition to being the sum of these constituents, the human being

has a personality of his own which is more than the arithmetical sum total of the

constituent parts of the body. Life, mind and personality are conceived as Successive

advances in the holistic structure of matter. This holistic concept is applicable to

disease and drug also. Holism or holistic approach is one of the basic tenets of

Homoeopathy. So that disease is defined as affecting the whole and not just as part.

The Homoeopathic physician notes down the state of the patient’s mind in addition

to listing his physical symptoms and attempts to match the patient to a

homoeopathic remedy with a similar set of symptoms. Even the medicines produced

changes not only in some particular region in the body but affected the whole body

and also the mind.26

Individualization:

J.T. Kent says “the homoeopathic physician must individualize, he must

discriminate. The substitution of one remedy for another cannot be thought of, or

entertained in homoeopathy. Without the generals of a case no man can treat

34
 homeopathically, for without these no man can individualize and see distinction.

While several medicinal substances did produce symptoms resembling the same

disease condition each substance did so in its peculiar way, with its own distinct

conditions of aggravation and amelioration of symptoms, its unique accompanying

sensations etc. In treating an individual also a homoeopath will look for these

peculiar symptoms which individualize the patient, so that treatment is not diagnosis

based but individual based”.

The concept of totality of symptoms & the principle of individualization, together, permit

the Homoeopathic physician to perceive the disease in a manner suitable for

homoeopathic prescribing.27

In aphorism 10 Hahnemann says: The material organism, without the vital force, is

capable of no sensation, no Function, no self-preservation 1, it derives all sensation

and performs all the functions of life solely by means of the immaterial being (the vital

principle) which animates the material Organism in health and in disease. So when there

is dynamic deviation the vital force perceptible Signs and symptoms are seen.27

Totality of symptoms:

In aphorism 17 and 18 Hahnemann stresses the importance of totality of symptoms. He

says that physician only needs to remove the totality of symptoms in order to cure the

disease and totality of symptoms is the only indication and guide to the selection of the

remedy.

According to Hahnemann, Totality of Symptoms in a case means a group of related

symptoms, not expressing the disease so much as expressing the individual who suffers.

Homoeopathy takes more to account the patient who has the disease than the disease
35
affecting the individual. As every man is unique by reason of his individuality so is every

patient who is nothing but diseased man. In medicine we are concerned with the

individuals, though we need the knowledge of the general concepts for the

comprehension of the individual. An individual is never without his universal or general

aspects. Human beings are not found anywhere in nature; there are only individuals. The

individual differs from the human being because he is a concrete event. Individuality gives

in our uniqueness. Individuality causes every man to be himself and nobody else.

According to aphorism 153, “one should look for the more striking, singular, uncommon

and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and

most solely to be kept in view, for it is more particularly these that very similar ones in the

list of symptoms of the selected medicine; must correspond to, in order to constitute it

the most suitable for effecting the cure”.

In treatment, Hahnemann stresses on the individual who is to be relieved of his suffering.

A Homoeopath should find an individual picture of a drug disease which will correspond

to the natural disease picture of the individual patients. Now to individualize either a

patient or drug means to pick up symptoms which are “striking, singular, uncommon and

peculiar (Characteristic) signs and symptoms”. As some unique feature distinguishes one

individual from another, So in the matter of matching the symptoms totality of an

individual patient with that of a drug, the matching will never be most similar unless the

individualizing or striking, uncommon, singular, uncommon and peculiar feature was first

ably done by Boenninghausen to whom Hahnemann also refers in his footnote 109 to the

sec. 153.

36
Hahnemann’s “striking, singular, extraordinary and peculiar symptoms” are basic

miasmatic ones such symptoms; they are capable of reaching down deep enough to

extinguish or what is a better term, to separate their miasmatic bond from the life

forces.28

Hahnemann says, the true healing art is that reflective work, the attribute of the higher

powers of human intellect, of unfettered judgment of reason selecting and determining

on principle in order to effect an alteration in the instructive, irrational and unintelligent,

but energetic automatic vital force, when it has been diverted by a homoeopathically

chosen remedy, to excite in it a medicinal disease. Somewhat greater in degree, so that

the natural disease, has now only the similar, somewhat stronger, medicinal morbid

affection to contend with, against which it now directs its whole energy and which it soon

overpowers, whereby the vital force is liberated and enabled to return to the normal

standard of health and to its proper function, “the maintenance of the life and health of

the organism”, without having suffered, during this change, any painful or debilitating

attacks.29

“On the other hand, constitution is not also super able to ‘Hereditary’; at least this word is
used in its current meaning. This case belongs to the field of pathology where manifestly
exogenous factors come into play. Thus syphilis may be hereditary,but it may not be
constitutional in the strictest sense of the term. The predisposition to tuberculosis and
many other diatheses may in all probability, be anomalies of constitutional nature”.

“The notion of constitution as we have defined above, introduces in the biological

becoming (of an individual) he idea of immutability and continuity of the same thing. That
continuity and immutability cannot have evidently a mathematical character. They may
be adopted to the particular types of the life and to the biological becoming. A
constitutional character which was apparent in childhood may not manifest itself
apparently after that period but for that reason it will not be les constitutional. In other

37
words, the constitution, which we called the Homoeostatic vital interior, is not completely
stagnant. It changes more or less, but at the same time remains more or less constant.29

Directions for Cure:

For all the acute miasmatic diseases the human constitution possess that process which

,as a rule ,is so beneficent ; to wipe them out in the course of form two to three weeks

,and of itself to extinguish them again ,through a kind of decision ,from the organism ,so

that man then is wont be entirely healed of them and, indeed ,in a short time ,unless he

be killed by them.

In the chronic miasmatic disease nature observes the same course with respect to the

mode of contagion and the antecedent formation of the internal disease, before the

external declarative Symptoms of its internal completion manifests on the surface of the

body ; but then that in the chronic miasm the entire internal disease ,as we have

mentioned before ,remains in the organism during the whole life ,yet ,it increases with

every year ,if it is not exterminated and thoroughly cured by art.30

Physiotherapy its interpretation according to Homoeopathy:

There are some diseases where some medicines alone cannot give relief to sick

.apart from some physiotherapy. Hahnemann has recognised the importance of active

exercise diet and regimen and is evident in his aphorisms.

In aphorism 261 Hahnemann states “the most appropriate regimen during the

employment of medicine in chronic diseases consist in the removal of obstacles to

recovery and in supplying where necessary the reverse; innocent, moral and intellectual

recreations, active exercise in the open air in almost all kind of weather (daily walks, slight

manual labour) suitable, nutritious, un medicinal food and drink, etc

In the foot note to aphorism 261-262, Hahnemann says “one should coffee, all excess in
38
food, spirituous drinks, sedentary life, anger, grief, over exertion of body and mind etc. in

order that the cure may not be obstructed or rendered impossible”24

Many homoeopathy stalwarts have suggested certain medicines for treatment of sciatica.

EA Farrington recommended Ammonium muriaticum, when pain is worse while patient is

sitting, somewhat relieved while he is walking, and entirely relieved when he lies down. In
Belladonna, pain is worse in the hip joint at night, compelling change of position. All these
pains are apt to show exacerbation at 2 or 3pm, and again at 11pm. In Colocynth, pain
extends down the sciatic nerve to the knee or even to the heel, aggravated by any motion.
The attacks of pain are followed by numbness of the whole limb, and partial paralysis. If the
case is of long duration, the nutrition of the whole limb is deficient. Sometimes, the cramps in
the leg are so severe that the patient feels as if whole leg were fastened down by iron bands.
The pains are usually worse at night. In Gnaphalium there is intense pain along the course of
sciatic nerve, alternating with numbness. Kali hydroiodicum pains are worse at night, and
from lying on affected side, and the trouble is of mercurial or syphilitic origin.[31]

EB Nash says that in Arsenicum album the pain is marked by complete intermissions; it is
increased by vigorous and relieved by gentle motion. It is aggravated by cold, but relieved by
gentle motion. It is aggravated by cold, but relieved momentarily by warmth. It is a pure
neuralgia, neither inflammatory, toxaemic nor reflex. Chamomilla should also be thought of
in pure neuralgias of the sciatic nerve with unbearable pains, and the more it pains the hotter
the patient becomes.[32]

HC Allen recommends colocynthis where pains in the sciatic nerve extend to the knee or to
the heel, worse from any motion, and especially aggravated by cold. The pain is paroxysmal,
followed by numbness and partial paralysis. There is a sensation which has been described as
if the thigh were bound with iron bands, or as though screwed in a vise;the muscles are
fearfully tense and fixed. Particularly is the right side involved and there are stitches during
walking.[33]

William Boericke says Gnaphalium has intense neuralgic pains along the sciatic nerve and
numbness. The whole trunk and the main branches seem affected, worse when lying
down,worse from motion, stepping and better while sitting in a chair. The pains extend to the
toes. Terebinth has a exquisite sensitiveness; of the lower extremities, with painfulness along
the tract of the nerve; drawing ,tearing, paralytic pains. Colocynthis typifies the sciatica due
to nerve changes with no special inflammatory conditions attending it. The 6 th potency will be
found to act better than low potencies.[34]

JH Clarke emphasizes Rhus Toxicodendron is especially useful in sciatic pain with muscular
and ligamentous involvement. The pains are tearing and burning, worse during rest,
alleviated a short time only during motion. It is a rheumatic sciatica,the fibrous sheath of the

39
nerve being involved. Sciatica arises from over-exposure to wet or from lifting,wrenching and
over-exertion and relief from warmth. Arnica is also a remedy for sciatica due to over
exertion. The acute pains are followed by a sensation as if bruised. Ruta also has shooting
pains down the back,down the sciatic nerve on first moving or on rising after sitting; the
patient is obliged to walk about constantly during the paroxysm of pain. The pains are felt
most in the region of the knee. It is worse during damp or cold weather and from cold
applications. Bryonia has shooting pains worse from motion and relieved by hard pressure. It
is a valuable drug in the treatment of sciatica of rheumatic origin. Ledum also has sciatic pains
mixed with rheumatism.[35]

CM Boger quotes a case of a female of 42 years, having severe stiffness and aching in lumbar
region on rising or sitting down. Now confined to bed by throbbing, quivering, soreness,
numbeness and shooting pains downright sciatic nerve to foot,which feels as if she were
stepping on. And the thigh as if lying on rocks; pains aggravate on outside of thigh. Aching in
right calf on standing and right sole burns. Menses profuse, with backache and aphthae.
Leucorrhoea causes itching. Sleeps in catnaps. Easy fatigue in hot weather. Thirsty. No
appetite. Nervous, weepy and restless. Hot flashes. Aggravation : motion and evening,
pressure of clothes, before storms, trifles. Amelioration :rubbing, motion, heat locally. This
case was cleared by Lachesis 200 one dose;the patient was better in five days and in ten days
entirely well.[36]

As per ML Tyler, Magnesia phosphorica has aching pain in small back. Dorsal spine very
painful and sensitive to touch. Sciatica with tender feet. Cramping of muscles with radiating
pains. One vertebra seems absent.[37]

Samuel Lilienthal says that Nux Vomica is frequently the remedy in sciatica. It has lightning-
like pains,with twitching of the parts. Violent pains,has to change position; pains shoot down
upto the foot, the limb is stiff and contracted and the parts feel paralyzed and cold. Better
when lying on the affected side and from the application of hot water. Constipated bowels
and sedentary habit. Plumbum also has lightning-like pains and in paroxysms. Pains and
cramps along the sciatic nerve, and especially where the atrophy is present. Use the
potencies not lower than the 12th to 30th . Coffea may be indicated where there ia great
hyperaesthesia of the senses and physical exhaustion and debility present. If the sciatica be in
those of a haemorrhoidal constitution Sulphur may be the remedy. If dependent on vertebral
disease then such remedies as Phosphorous, Silicea, Natrum muriaticum and Sulphur will
need to be prescribes according to the symptoms.[38]

WH Schuessler says that Magnesia phosphorica and Kali phosphorica are tissue remedies
undoubtedly cure sciatica.[39]

40
There are more than 96 rubrics in respect of sciatica in the kent’s repertory. Out of the 98
drugs covered in the main rubric of sciatica,the first grade remedies are;

Bryonia alba, bufo rana , colocynthis, iris, kali iodium, Mag phosphorica, Nux vomica, Rhus
tox and Tellurium.

The first grade remedies for right sided sciatica are;

Colocynthis, Dioscorea, Lachesis, Lycopodium,Phytolacca and Tellurium whereas

For left sided sciatica;

Ammonium muriaticum, kali bichromium, kali carbonicum. But for alternating side only one
remedy is given that is, Lac caninum.[40]

However there are only two medicines given in first grade medicines in the Boericke’s
Repertory, namely, Arsenicum album and Phosphorous. Boger has suggested Aconiteum
napellus, Belladonna, Iris, Lycopodium, Phytolacca, Ruta, and Zincum metallicum in the first
medicines in his repertory.[41] grade

41
 MATERIAL AND METHODS
STUDY SETTING:-

The study was carried out in the Out Patient Department, In Patient Department and Peripheral
OPDs of Bakson Homoeopathic Medical College and Hospital, 36B Knowledge Park Phase 1,
Greater Noida,(U.P.)

STUDY DURATION:-

The study duration is of 18 months.

SELECTION OF SAMPLES:-

Samples would be selected on the basis of random sampling method.

INCLUSION/EXCLUSION CRITERIA:-

Inclusion criteria-
 It includes the clinical history and findings.
 Patients from both the sexes between the age of 25yrs-65yrs having pain will be
included.
 Diagnostic criteria includes the Lasegue’s sign or straight leg raising test (SLR).
 Patients are included those who are suffering from conditions like post
traumatic, degeneration of spine, low back strains.
 Patients/Attendants willing to give consent for the study.
 Patients/Attendants who are thoroughly interested in follow up visits.

Exclusion criteria-

 Patients suffering from congenital deformities/Spinal or intra spinal tumors/disc

prolapsed/Lumbar canal stenosis/Systemic disorders.
 Patients suffering from metabolic disorders like diabetes.
 Patients taking any allopathic medicine.
 Patients concomitant systemic disease like cardiovascular diseases like coronary
artery disease, high BP, cardiac arrest.

STUDY DESIGN:-

Study Design was Prospective Randomized single blinded placebo control trial.

42
STUDY POPULATION:-

 Number of patients participated in the study-

 Patients informed consent- A written informed consent was taken as per the Informed
Written Consent Form(Appendix A).And case proforma has been given to the patient for
filling the basic information (Appendix B).

INTERVENTION:-

Constitutional Medicine according to the case was given to the patients of Experimental group
and Placebo was given to those of control group.Medicines were available from the pharmacy
of Bakson Homoeopathic Medical College & Hospital, Greater Noida.

POTENCY : 30C, 200C, & 1M potencies were used following Homoeopathic Principles, according
to need of each case.

FOLLOW-UP: Of cases was done according to the progress of individual case. Status of the
patient and prescription was recorded at each follow-up.

DATA COLLECTION

Data were collected from the patients in the case recording formats during their first and
subsequent visits.

BRIEF STUDY PROCEDURE:-

The cases were enrolled following inclusion and exclusion criteria and the patients were
asked to fill up the consent form (Appendix A). Thorough case taking of every enrolled case, at
entry, was done and score for sciatica was recorded. The enrolled cases were allocated in the
Experimental group and in the Control group. Placebo was given to the patient in the Control
group. The constitutional medicine prescribed to the patients of Experimental group general
management like hot application was adviced in required cases. Follow-up was done after 7
days of administration of placebo/medicine in all cases. After every follow-up VAS was filled
which has score ranging from 0-10; score greater than > 7 shows patient with sciatic pain.
Follow-ups were done for 3 months for every patient, the interval between the two follow-ups
depended upon the need of each patient. In case of acute exacerbations, patients reported
even before the scheduled date of reporting. On reporting, the cases were followed up properly
and data were recorded on the basis of their particular symptoms, mental and physical general
symptoms as well as physical examinations, and improvement of the patient as a whole, but
with special reference to the VAS. All the patients were finally assess at the termination of the
study by using VAS. The data of the patient administered with homoeopathic constitutional
medicine as well as placebo were analyze using unpaired T- test.

43
DIAGNOSIS

Each case was diagnosed and clinically assessed on the basis of X-ray, MRI, CT scan of the
spines.

OUTCOME ASSESSMENT

The intensity of sciatic pain of each patient was assessed by adopting VAS (Visual Analogue
Scale-0-10). [36]. VAS consists of a line, usually horizontal and 10cm long, the ends of which are
marked with the extreme states of the pain being measured. VAS scoring is done on scale of 0-
10, where 0 is no pain and 10 is the worst pain. In this study, the patients were asked to mark
their current sciatica pain intensity on this scale.

Fig.12. Pain intensity in Visual Analogue Scale

Outcome of each patient was determined by assessing the progress/ status of the symptoms
after administration of indicated homoeopathic remedy. Patients were grouped into no pain,
mild, moderate, severe and worse imaginable pain on the basis of score obtained from Visual
Analogue Scale (VAS) according to intensity of pain. Outcome of each patient was determined
by assessing the progress/ status of the symptoms after administration of homoeopathic
medicines. At the end of the treatment scoring was done and the improvement percentage was
assessed as

44
 Baseline score- Score at end x 100

Baseline score

The marked improvement status of the patients was measured in the following categories:

Marked improvement: 75-100%

Moderate improvement: 50-74%

Mild improvement: 25-49%

Not Significant: 1-24%

Static: No change in symptom

Worse: An increase in symptom score

45
 OBSERVATION AND RESULTS
In order to find out the usefulness of constitutional medicine in pain management of sciatica,
30 patients were enrolled in the research study, out of whom 15 were in the experimental
group and 15 in the control group. These patients were enrolled from the O.P.Ds & P.O.P.Ds of
Bakson Homoeopathic Medical College & Hospital, Greater Noida.

The following Observations have been made:

AGE INCIDENCE

In this study it is observed (Fig. ) that the number of patients belonging to the different age
groups are: 25-34yrs (n=6;20%), 35-44yrs (n=7;23.33%), 45-54yrs (n=12;40%), 55-64 (n=3;10%),
65-74(n=2;6.66%)

TABLE NO.3.

SNO. AGE GROUP NUMBER CONTROL PERCENTAGE

OF
GROUP(C)
CASES(E)
1. 25-34 3 3 20%

2. 35-44 4 3 23.33%

3. 45-54 6 6 40%

4. 55-64 2 1 10%

5. 65-74 1 1 6.66%

TOTAL 30 100

46
 6

4
NUMBER OF CASES(E)
3 CONTROL
2 PERCENTAGE

0
25-34 35-44 45-54 55-64 65-74

AGE GROUPS
Figure no.13 . Age incidence of patients suffering from Sciatica
SEX INCIDENCE
The following graph (Fig. ) shows patients from both the sex groups. It was noted that female
patients (n=9;70%)were more in number than the male patients (n=6,30%)

TABLE NO.4.

SNO. SEX NO. OF CASES(E) CONTROL PERCENTAGE

GROUP
1 Female 9 12 70%
2 Male 6 3 30%

12

10

8
Female
6
Male
4

0
NO. OF CASES(E) CONTROL GROUP PERCENTAGE

Fig. 14 Simple bar diagram showing Sex incidence

47
PAST HISTORY

In the study of 30 Cases, Injury 9(30%) cases, Headache 5(16.66%) cases, Sinusitis 2(6.66%)
cases, tonsillectomy 1 (6.66%) cases, Hysterectomy 1(6.66%) cases, Malaria 1 (3.33% ),
Scabies 1 (13.33% ), Joint pains 1 (3.33% ), Hyperthyroid 1 (3.33% ), Dysmenorrhoea 1
(3.33% ), Apthous ulcer 1 (3.33% )
TABLE NO.5.
S.No Past History No. of CONTROL Percentage
Cases(E) GROUP
1 Injury 4 5 30.00
2 Headache 2 3 16.66
3 Sinusitis 1 1 6.66
4 Gastritis 0 3 10.00
5 Hysterectomy 1 1 6.66
6 Tonsillectomy 1 2 10.00
7 Malaria 1 0 3.33
8 Scabies 1 0 3.33
9 Joint Pains 1 0 3.33
10 Hyperthyroidism 1 0 3.33
11 Dysmenorrhoea 1 0 3.33
12 Apthous Ulcer 1 0 3.33

30
25
20
15 No. of Cases(E)
10 CONTROL GROUP
5 Percentage

Figure no.15 showing past history of patients

48
FAMILY HISTORY

The following simple bar diagram shows patients family history with Hypertension 7(23.33%);
Tuberculosis 5(16.66%); Diabetes Mellitus 2(13.33%); Heart Disease 3(10%); cancer 3(10%),
Asthma 1(3.33%), Disc prolapsed 1(3.33%), joint pain 2(6.66%) , Allergic rhinitis 4(13.33%),

TABLE NO.6.

S.No Family History No. of Control Percentage (%)

Cases(E) group(c)
1 Hypertension 4 3 23.33
2 Tuberculosis 3 2 16.66
3 Diabetes 2 2 13.33
Mellitus
4 Heart Diseases 1 2 10.00
5 Cancer 1 2 10.00
6 Asthma 1 0 3.33
7 Disc Prolapse 1 0 3.33
8 Joint paints 1 1 6.66
9 Allergic Rhinitis 1 3 13.33

25

20

15

No. of Cases(E)
10
Control group(c)
5 Percentage (%)

Figure no.16 showing family history of patients

49
SOCIO ECONOMIC STATUS OF PATIENTS IN SCIATICA

The following bar diagram (Fig. ) shows patients in this study were from low socio-economic
status (n=10;33.3%), medium socio-economic status (n=15;43.35%), high socio-economic group
(n=5;23.33%).

TABLE NO.7.

SNO. SOCIO-ECONOMIC NO. OF CONTROL PERCENTAGE

STATUS CASES(E)
GROUP(C)
1. LOW 5 5 33.3%
2. MEDIUM 8 7 43.35%
3. HIGH 2 3 23.33%

5 NO. OF CASES(E)
4 CONTROL
3 PERCENTAGE

0
LOW MEDIUM HIGH

Figure no.17 Showing Socio Economic status of patients

50
SHOWING DISTRIBUTION OF CASES ACCORDING TO THE PRESENTING COMPLAINTS
TABLE NO.8.

SNO. PRESENTING NO. OF CONTROL PERCENTAGE(%)

COMPLAINT CASES(E)
GROUP(C)
1. Back pain 10 10 43.33
2. Back pain 2 3 16.66
radiating down to
limbs
3. Numbness in limbs 2 1 10.00
4. Stiffness of back 1 1 6.66

50

45

40

35

30

25 NO. OF CASES(E)
20 CONTROL

15 PERCENTAGE(%)

10

0
Back pain Back pain Numbness in Stiffness of
radiating limbs back
down to limbs

Figure no.18 showing presenting complaints of the patients

51
 LIFESTYLE(SEDENTARY/ACTIVE)

TABLE NO.9.

SNO. Lifestyle Number Control Percentage

of group
cases(E)
(C)
1. Sedentary 11 11 73.33%
2. Active 6 2 26.66%

12

10

6
Sedentary

4 Active

0
Number of cases(E) Control group Percentage

Figure no.19 Showing lifestyle of the following patients

FACTORS RESPONSIBLE FOR SCIATICA
TABLE NO.10.

SNO RISK FACTORS NO. OF CONTROL PERCENTAGE(%)

PATIENTS(E) GROUP(C)
1. Age 7 6 27.00
2. Occupation related-lifting heavy 3 6 23.00
weights ,driving motor vehicle for
long periods
3. Post- traumatic conditions 2 2 13.33
4. Sedentary lifestyle- prolonged sitting 2 1 10.00
5. Obesity 1 0 3.33

52
 45
40
35
30
25
20
15
10 PERCENTAGE(%)
5
0 CONTROL GROUP(C)
NO. OF PATIENTS(E)

Figure no.20 Showing risk factors leads to Sciatica

AUXILLARY TREATMENT

TABLE NO.11.

SNO. PARTICULARS NUMBER OF PERCENTAGE(%)

CASES
1. Auxillary treatment 28 93.33
Given
2. Not Given 2 6.66

Auxillary treatment Given

NUMBER OF CASES
PERCENTAGE(%)

Figure no.21 showing number of patients given auxillary treatment

53
 Expect in two cases, the Auxillary methods like application of hot fomentation to the
Back, back care exercises, sleeping on a firm mattress, wearing a lumbar corset were
Recommended in almost all the cases.

RESPONSE OF CONSTITUTIONAL MEDICINES(EXPERIMENTAL GROUP) IN SCIATICA

TABLE NO.12

SNO CONSTITUTIONAL TOTA IMPROVEMENT STATUS

MEDICINE GIVEN L

MARKED MODERAT MILD NOT WORSE

E SIGNIFICAN
T
1. SILICEA200 2 1 - 1 - -
2. LACHESIS200,1M 2 - 1 1 - -
3. SEPIA200,1M 2 1 1 - - -
4. PULSATILLA200 1 - 1 - - -
5. GNAPHALIUM200 1 1 - - - -
6. ACID NITRICUM1M 1 - - - 1 -
7. NATRUM 1 - 1 - - -
MURIATICUM1M
8. COLOCYNTHIS200 1 - 1 - -
9. KALI CARB30 1 - 1
10. RHUS 2 1 1 - - -
TOXICODENDRON200
11. BRYONIA ALBA30 1 - - 1 - -

54
1.2

0.8

0.6

0.4

0.2

MODERATE MILD NOT SIGNIFICANT WORSE MARKED

Figure no.22 Showing the response of constitutional medicine in Sciatica

OVERALL RESPONSE OF HOMOEOPATHIC TREATMENT OF SCIATICA PATIENTS

TABLE NO.13.

Improvement No. of Control Percentage Percentage

status cases(E) group( C)
(E) (C)
Marked 8 1 53.33% 6.66%
improvement
Moderate 5 4 33.33% 26.66%
improvement
Mild improvement 1 4 6.66% 26.66%
Not Significant 1 3 6.66% 20.00%
Worse 0 3 0 20.00%

55
60

50

40

30
No. of cases(E)
20
Control group( C)
10 Percentage (E)
0 Percentage (C)

Figure no.23 Showing overall improvement from EG AND CG

56
 ANALYSIS OF RESULTS
The data obtained from this study were analyzed with the help of Student T test(unpaired).
This test was performed to assess the statistical significance of “ Homoeopathic constitutional
medicine in pain management of sciatica”.

H0 (Null Hypothesis): There is no difference in improvement rates of experimental group and

control group.

HA (Alternative Hypothesis): There is a remarkable difference in improvement rates between

experimental group (constitutional medicine) and control group (placebo).

BASED ON DEMOGRAPHIC PRESENTATION AND BASELINE READINGS

TABLE NO.14

SNO. Variables Group A Group B

1. Mean 5.07 7.40
2. Standard Deviation 2.89 2.41
3. Standard Error of Mean 0.75 0.62
4. Standard Error of Difference 0.972
5. T value 2.399
6. Df 28

Hence, the two- tailed P value = 0.02

By conventional criteria,this difference is considered to be statistically significant.

57
 DISCUSSION
After completion of the study, the comparison of various post treatment outcome measures,
showed that the 13 patients were successfully treated by constitutional remedies by decreasing
the intensity and sciatica pain and ease the living of patient, while 4 patient got relief from pain
in sciatica by placebo.

In the study it was found that patient were most vulnerable to stress related disorders due to
fast modern life,competition in every field due to vast population, nuclear family system, family
pressure to do well in every aspect, lack of parental care and in some cases lack of affection,
tension regarding carrier etc. giving birth to depression and frustration among them.

The result obtained from the present study was very encouraging especially confirming the
already known fact that well selected homoeopathic constitutional medicine are capable of
tackling enumerable acute as well as chronic disease. Homoeopathy is a natural system of
medicine. Its strength lies in its marked effectiveness as it takes a holistic approach towards the
sick individual to through promotion of inner balance at mental, emotional, spiritual levels.
Homoeopathy recognize the inseparability of body and mind. Homoeopathy treats the patient
as a whole and not just the disease. It believes in a Holistic, Totality and Individualistic
approach.

The homoeopathic medicines can be symptomatic relief to the patients who can’t opt for
surgery due to other medical reasons. The homoeopathic constitutional treatment can prevent
the recurrence of pain.

Atlast, it could be concluded that homoeopathy has enough scope in the treatment of sciatica
and the result of the study inspite the limitations were satisfactory. Constitutional treatment
provides a long-lasting relief to the patient and episodes of recurrence can be avoided.

58
 CONCLUSION
In this study on the topic “study to assess the usefulness of Homoeopathic Constitutional
Medicines in pain management of Sciatica”. The objective was to study the clinical presentation
of pain associated with sciatica to be effective in treating the patient of middle age group
suffering from sciatica and to assess the progress of pain by adopting the Visual Analogue Scale
30 cases were examined and analyzed statistically on the basis of Age, Sex, Occupation,
Lifestyle, Presenting complaints, Socio-economic conditions.

From this study it has been observed that the majority of the patients who reported to the
O.P.Ds belong to middle age or old age, with over 50% of people being more than 35 years of
age. A preponderance of male to ratio of 1:4 was also observed in this study, as revealed by the
data. Besides, it was observed that those with sedentary kind of occupation or lifestyle were
more prone to developing the condition with 73% of the study sample belonging to this
category. However, the data confirms the understanding of history of injury as an etiological
factor with 30% of the sample. Medicines gives as constitutional remedies are: - Colocynthis,
Rhustoxicodendron, sepia, lachesis, silicea, gnaphalium, Natrum muraticum, Pulsatilla.

After thorough case taking of each and every patient, constitutional medicine given to
experimental group(EG) i.e., Group A and control group(CG) i.e., Group B received as placebo.

After completion of the study, Group A(Experimental group) showed marked improvement with
13 patients out of 15 patients. In Group B (Control group) showed marked improvement with 4
patient out of 15.

It was seen that some case does not show improvement because of carelessness of the patient
constant stressful condition and lack of exercise. This hampered effectiveness of the drug for
the case.

In every case 3 month follow-up has been done. The interval between the two follow-up was
more or less 30 days. On feedback reporting the cases were followed up properly and results
were evaluated on the basis of enquiry about increase or decrease in the intensity of pain or no
improvement in pain. No supplementary, intermittent therapy or acute remedies were adopted
for any type of casualities or adverse or undesirable symptom-spectra during the treatment
span, as these might affect the inferential quality of the study.

After the interrogation as per the case taking proforma, 1 dose of constitutional medicine and 1
dose of placebo was given to the patient respectively. The medicine was selected on totality of

59
symptoms of the particular cases. The medicines were dispensed from dispensary of Bakson
Homoeopathic College and Hospital.

Auxiliary and physiotherapy measures were advised in every case. The outcome measures were
assess on the basis of clinical parameters and also by the improvement in the intensity of pain
of the patient.

60
 LIMITATIONS AND RECOMMENDATIONS
Despite the sincerest approach adopted to study to assess the usefulness of Homoeopathic
Constitutional Medicine in pain management of sciatica, few lacunas were evident in the study.
This study therefore demands reconfirmation.

The main problem with this study was the paucity of samples (30) in the out patient
department, therefore the study was limited to very small circumference, which needs further
study comparing a wide range of patients. In this study, the sample size was not adequate. The
sensitivity of the outcome measures is directly proportional to sample size and therefore
increases with it.

The time estimated for the study was not adequate, therefore cases with Sciatica could not be
studied for longer period. The probability of a better yielding of outcome measures could not
be ignored by any means from the cases, which can at the terminal phase of the study.

Administration and repeated succession in case of constitutional medicine in between dose is

the real obstacle especially for the illiterate patients. As it remains that we are unable to
foretell the patient regarding the duration for which he will have to take medicine. Besides
constitutional medicine auxillary treatment also being provided for relieving acute episodes.

Recommended Physiotherapy and auxillary treatment such as hot application use of pain oil for
early healing.

61
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1. Bailey and love, Short Practice of Surgery, 21st Edition, Arnold, a member of the Holder
Headline Group, London.

2. Hahnemann Samuel; “The Chronic Diseases, Their Peculiar Nature And Their Homoeopathic
Cure” New Delhi; Indian books and periodical publishers.

3. Hill, Mc Graw, Harrison’s Principles of Internal Medicine, Vol II, Medical Publication
division,XIIth edition.

4.Konstantinou K, Dunn KM (2008) Sciatica; review of epidemiological studies and prevalence

estimates. Spine (Phila P 1976)33:2464-2472.

5.Legrand E,Bouvard B Audran M,Fournier D,Valat JP.Sciatica from disk herniation; medical
treatment or surgery?Joint Bone Spine.2007;74:530-535.doi:10.1016/j.jbspin.2007.07.004

6. Vroomen PC,Krom MC, Slosfstra PD,Knottnerus JA. Conservative treatment of sciatica: a

systematic review. J Spinal Disord. 2000; 13:463-469.

7.Weber H,Holme I,Amile E (1993)the natural course of acute sciatica with nerve root
symptoms in a double blind placebo control trial evaluating the effect of piroxicam.Spine (Phila
Pa 1976)18:1433-1438

8. Valat JP,Genevays,Marty M,Rozenberg S,Koes B.Sciatica .Best Pract Res Clin

Rheumatol.2010;24:241-252.

9. www.homoeobook.com/efficacy-of-colocynth-30-in-treatment-of-sciatica/

10. Researchers from the Department of Clinical Sciences. Faculty of Veterinary Medicine.
Homoeopathic Successful Trial (RCT) Of Hypericum for peripheral (sciatic) nerve regeneration.
Urmia University. Published in Iran.2012.

11.www.ijrh.org; IP:103.72.10.184

12. Samuel L. Turek M.D. Orthopaedics-Principles and Their Application 3rd edition, J.B.
Lippinicott Company.(DEF)

13. Moore L. Keith, Persaud T.V.N. “The Developing Human – clinically Oriented Embryology”;
W.B. Saunders Company; 6th edition.

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14. Snell, Richard S; “Clinical Anatomy for Medical Students” 6th edition; Lippincott Williams
and Wilkins, 351 Camden Street, Baltimore, Maryland; 2000. 6th edition.

15. Gray’s; “ Textbook of Anatomy” ; Churchill Livingstone; 200038th edition

16. Chaurasia .B.D.; “Human Anatomy Regional and Applied” Volume 2; 2001

17.Yoshimoto M. Sciatica: A Look at recent research[internet]2014[cited 2015 Mar12. Available

from: http://www.patient.co.uk.html.]

18. The Anatomical Basis of Clinical Practice. 40th Edition . Churchill Livingstone, Elsevier.2011

19. PubMed Health[internet]: U.S. National library of Medicine; Sciatica;2009 Nov 27.(cited 2014
Nov 13).

Available from: http:www.ncbi.nlm.gov/pubmedhealth/PMH0001706

20.Bombardier C. Outcome assessments in the evaluation of treatment of spinal

disorders;summary and general recommendations.2000 Aug; 25(3); 3100-03(cited 2015 June 12).
Available from: http://www.ncbi.nlm.nih.gov./pubmed/11124724

21. Kaupilla T. Correlation between autotomy-behaviour and current theories of neuropathic pain.
Neurosci –Biobehav Rev,23(1998),pp. 111-129.(cited 2015June 12). Available from
http://www.ncbi.nlm.nih.gov/pubmed/9861616

22.Ridley K. The evidence of complementary medicine 2nd edition,The Royal London Homoeopathic
Hospital,1999 Jan:29(2): 206-10

23.Hughes, R. The Principles and Practice of Homoeopathy,(vol. 1 and 2 combine)New Delhi: B.Jain
publishers Ltd;2008

24. [www.nhp.gov.in]

25. Close Stuart; “The Genius of Homoeopathy” New Delhi; Indian books and periodical
publishers; reprint edition 2008. 17.

26. Kent J.T. “Lectures on Homoeopathic Philosophy” New Delhi; Indian books and periodical
publishers; reprint edition 2003.

27. Hahnemann Samuel; “The Chronic Diseases, Their Peculiar Nature And Their Homoeopathic
Cure” New Delhi; Indian books and periodical publishers.

28. Ortega P.S. “Notes on Miasms” New Delhi; National Homoeopahtic Pharmacy; first edition
1980.

63
29. Allen J.H. “The Chronic Miasms” New Delhi; B. Jain Publishers Pvt. Ltd; Reprint edition 1998.

30. Vijaykar Prafull.; “The end of Myasmation of Miasms”. Predictive Homoeopathy Part III;
2003.

31. Bernoville .fortier; Rousseau.L.A.; “Chronic Rheumatism”; B.jain publisher pvt. Ltd.

32. Sarkar B.K. “Organon of Medicine by Samuel Hahnemann” New Delhi; Birla Publications
Pvt. Ltd. 100

33. Hahnemann Samuel; ‘Organon of Medicine” New Delhi; B. Jain Publishers Pvt. Ltd; Reprint
edition 1994.

34. Mukerji R.K “Constitution and Temperament” New Delhi; B.Jain Publishers Pvt. Ltd; Reprint
edition 1999.

35. Roberts H.A. “The Principles and Art of Cure by Homoeopathy” New Delhi; Indian books and
periodical publishers; reprint edition; 2008.

36. Boericke.W. “Pocket Manuel of Homoeopathic Materia Medica and Repertory”; New Delhi;
B. Jain Publishers Pvt Ltd; 1998.

37. Lutez .H .F. “The Therapeutics of Facial & Sciatic Neuralgias”; New Delhi Mayur jain Indian
Books & Periodicals Publishers; 2003

38. Kent, J. T. “Lectures on Homoeopathic Materia Medica”; New Delhi; B.Jain Publishers Pvt.
Ltd; Reprint edition; 1992.

39. Dewey, “W.A. Practical Homoeopathic therapeutics”; New Delhi; B. Jain Publishers Pvt. Ltd;
Reprint 1992.

40. Nash, E.B. “Leaders in Homoeopathic therapeutics”; New Delhi; B. Jain Publishers Pvt. Ltd;
2001.

41. Paul.Rajendra kumar. “Sciatica Journal Homoeopathy for the Entire Complete Health
Monthly Magazine”; ISSNO973-0823. VOL 9 N0 (3)

42. Burt H .Willium. “Physiological Materia Medica”; New Delhi; B. Jain Publishers Pvt. Ltd;
1999. 101

43. Farringnton. E.A ; “Clinical Materia Medica” ; New Delhi; B. Jain Publishers Pvt. Ltd; 1997.

44 .Burneet . “On Neuralgia Its Causes & its Remedies”; New Delhi; B. Jain Publishers Pvt. Ltd;
1999.

64
 APPENDIX A
CONSENT FORM

65
 INFORMED WRITTEN CONSENT FORM

For participation in clinical study

STUDY TITLE: STUDY TO ASSESS THE USEFULNESS OF HOMOEOPATHIC CONSTITUTIONAL

MEDICINE IN PAIN MANAGEMENT OF SCIATICA- A PROSPECTIVE RANDOMISED CONTROL
TRIAL”

CONSENT : 1.) I have had the study explained to me and have read the patient
information sheet/had the contents of patient information sheet read to me and I have
understood the same. I have been given the opportunity to ask questions and all my
questions and doubts have been answered to my complete satisfaction.
2.) As per the information sheet, I will be available for the follow-ups and for laboratory
investigations.
3.) I understand that my participation in the study is voluntary and that I am free to
withdraw at any time, without giving reasons, without my relationship with the attending
physician being compromised or my legal rights being affected.
4.) I understand that my identity will not be revealed in any information released to third
parties or published, unless as required under the law. I agree not to restrict the use of any
data or results that arise from the study,
5.) I agree not to withhold any information about my health form the investigator and will
convey the same truthfully.
6.) I agree to mu taking part in the above study and to comply with the instruction during
the study and to cooperate with the study team.
7.) I give my consent to my undergoing a complete physical examination as specified in the
protocol and explain to me.
I am willing to enroll myself in the study.
Name of the patient: --------------------------------------------------------------------------------------------
-
Age: Sex: -------------------------------- ------------------------------------
Address:

Signature/Thumb impression of the patient: ----------------------------------------------------------

66
Date: - -----------------------------
Name of the Attendant/Witness/Guardian (In case, if patient is minor):---------------------------------
-
Address of the Attendant/Witness/Guardian (In case, if patient is minor):------------------------------
-------

Signature of the Attendant/Witness/Guardian (In case, if patient is minor):----------------------------

---------
Date: - -----------------------------
Name of the investigator:- ---------------------------------------------------------
Signature of the investigator: - ----------------------------------------------------

67
 APPENDIX B
CASE RECORDING FORMAT

68
 BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

Plot No. 36 B, Knowledge Park Phase-I, Greater Noida- 201306 (U.P.)

CASE RECORD FORMAT

1. INTRODUCTION

IPD/OPD Registration No.: _________________________________ Date:

_____________________
Name of Patient:
___________________________________________________________________
Age: ___________ Sex: ___________________ Religion:
__________________________________
Occupation: _______________________Marital Status:
___________________________________
Name of Father/Husband/Guardian:
____________________________________________________
Address (Res.): ___________________________________________ Tel.
No.:_________________
Attending Physician:
___________________________Department/Unit:______________________

2. INTERROGATION

2.1 Presenting Complaints(With reference to Duration,Location;Sensations/Character/

Pathology; Modalities; Concomitants&Extension of each complaint, write separately for each
complaint)

69
2.2 History of PresentComplaints(In chronological order of their appearance;mode of onset-
(sudden/insidious); probable immediate cause; course of illness, treatment adopted for each
complaint and effect thereof)

2.3 Past History(any major illness, surgery, accident, hospitalization, vaccination, drug
reactionetc. in the past; age/year in which occurred, etc.)

2.4 Personal History(marital status;development landmarks; diet (veg/non-veg);

habits/addictions; surroundings at home; any allergy;profession; relationship at home &
workplace; history of illicit sexual contact; hobbies &educational status etc.

70
2.5 Family History(any chronic disease with blood relations, presently or in past; their present
state of health; if dead, cause of death)

2.6 Gynecological& ObstetricsHistory

 2.6.1 Gynecological History(Menarche/Menopause(age), LMP( 1st day of last

menstruation), Menstruation(Duration, Quantity, interval, Color: red/dark red/dark,

Consistency: partly clotted fluid/clotted/partly fluid &Cycle Pattern of bleeding:

regular/irregular, Any associated complaint(s), Any other vaginal discharge (quantity,

color, odour, presence of blood, consistency, character, before during or after menses),

Intermenstrual bleeding, Pelvic pain(site of pain, nature and relation to periods), Major

gynecological disorders in the past, Gynecological treatment including surgery in the past)

 2.6.2 Obstetrical History(GPA( Gravida, Parity, Abortion and Live births), Major

complications during past pregnancies, Mode of past deliveries:

normal/caesarian/episiotomy/forceps, Abnormal presentations in the past

71
 pregnancies, Puerperal complications, Sexual History: discomfort, pain, bleeding

during intercourse, H/o contraceptive use:

2.7 Treatment History(including outcome)

2.8 Physical Generals

Thermal Perspiration
Reaction

Cravings Sleep

Aversion Dreams

Intolerance Sexual functions

Appetite Sensations

Thirst Diathesis

Taste Stool

Urine Side(s) of body

affected

General
modalities

2.9 Mental(Will & Emotion; Intellect and Understanding; Memory)

72
 3. PHYSICAL EXAMINATION

3.1 General Examination

Level of Anaemia
consciousness
Physical attitude Jaundice

Decubitus Pigmentation

Facies Oedema

Built Cachexia

Gait Emaciation

Deformity Respiratory
rate
Obesity Height

Lymphadenopathy Weight

Clubbing Temperature

Nutrition Pulse

Cyanosis BP

Skin/hair/nails

Scalp (dandruff, hair

loss, discoloration,
overgrowth)
Oral (teeth, tongue ,
ulcers,
discoloration)
Neck (lymph glands,
thyroid, pulsations)

Axilla

Groins

73
Hands & Feet

3.2 Systemic ExaminationABDOMEN: (Inspection: Shape of Abdomen, swelling, condition of

umbilicus, dilated veins, movement with perspiration, visible peristalsis, hernia etc.
Palpation: Tenderness, guarding, rigidity, organomegaly, etc. Percussion: Dullness, shifting
dullness, fluid thrill, etc. Auscultation: Bowel Sounds, Peristalsis, arterial bruit, venous hum
etc. Special Examination: Examination of rectum if required. )

JOINTS & BONES:(Inspection: Screen for GALS (Gait, Arms, Leg & Spine) deformed shape,
swelling, etc. Palpation: Temperature, Tenderness, Swelling, etc. Joint Movement)

RESPIRATORY SYSTEM: (Inspection: Shape of chest, respiratory movements, & any other
conspicuous observation. Palpation: Chest Movements, trachea, apex beat. Tactile vocal
fremitus, etc. Percussion: Anteriorly, Posteriorly, Axilla, Upper Lower, and Auscultation:
Breath Sounds, Added Sounds(bronchi, crepitation, and pleural rub) vocal resonance etc. )

74
CARDIOVASCULAR SYSTEM: (Inspection: Precordium, apex impulse, pulsation, scars, dilated
veins/arteries & any other conspicuous. Palpation: Apex beat, left parasternal heave,
diastolic surf, thrills. Percussion: Left border, right border (in case of pericardial effusion).
Auscultation: Heart sounds: 1st 2nd& 3rd sound, murmurs, pericardial friction rub & its
radiation)

CENTRAL NERVOUS SYSTEM: (Higher Functions: intellect, memory, speech, level of

consciousness. Meningeal signs: neck stiffness, photophobia, Kernig’s sign. Cranial Nerves:
Individual nerve examination for 12 cranial nerves. Sensory Functions: Spinothalmic
sensation (pain, fine touch, temperature), posterior column sensation ( crude touch, position,
vibration). Motor Functions: Muscle Strength and tone, gait, coordination, weakness on
movement of muscles (UMN/LMN Lesions))

4. LABORATORY INVESTIGATIONS

Previous Investigations and reports Investigations advised

75
5. DIFFERENTIAL DIAGNOSIS

6. PROVISIONAL DIAGNOSIS

7. ANALYSIS OF SYMPTOMS

8. EVALUATION OF SYMPTOMS

9. MIASMATIC DIAGNOSIS

76
10. TOTALITY OF SYMPTOMS [Peculiar& characteristic features relating to Mind,Physical
Generals&Particulars (PQRS); causative factors (exciting, maintaining, fundamental) etc.]

11. SELECTION OF MEDICINE

11.2Non- Reportorial Method(remedy selection with justifications at least 4 remedies)

12. FIRST PRESCRIPTION (medicine, potency, dose, repetition)

13. GENERAL MANAGEMENT

Signature of Attending Physician

77
 APPENDIX C
CASE REPORTS OF SELECTED PATIENT

78
 BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

Plot No. 36 B, Knowledge Park Phase-I, Greater Noida- 201306 (U.P.)

CASE RECORD FORMAT

CASE 1

1. INTRODUCTION

IPD/OPD
Registration No. 889/14
Date: 21/04/2018
Name of Patient: Mrs. K R
Age: 38years
Sex: Female
Religion: Hinduism
Occupation: Teacher
Marital Status: Married
Name of Husband: Mr. Ram Rawat
Address (Res.): 29/5, Laxmi Nagar,Delhi
2. INTERROGATION

2.1 Presenting Complaints

Violent pain in the back especially in the lumbar region with right calf muscle pain since one
month.

2.2 History of Presenting Complaints

The patient was apparently well 1 month ago when she complained of mild pain while doing
exercise . Stitching pain <on the expose to cold damn weather. As these pains grow worse they

79
become tearing down the limbs drawing pains. Paralytic, benumbing the affected parts along
with numbness in the joints. Pain > from motion and worse from keeping still.

2.3 Past History

Malaria (one year back)

2.4 Personal History

 Born and brought up in Dehradun, after marriage relocated in Delhi.

 Developmental landmarks are normal.
 Non Vegetarian
 Happy surroundings at home.
 Congenital relation at home
 Hobbies reading books.

2.5 Family History

 Mother Hypertensive
 Father diabetic

2.6 Gynecological& Obstetrics History

 2.6.1 Gynecological History

Menarche/Menopause(age): At the age of 12 years

LMP(1ST Day of last menstruation): 15/4/2018

Menstruation:

Duration: 4-5days

Quantity: Normal[cycle(interval)]: regular

Color: dark red

Consistency: partly fluid & partly clotted

80
 Pattern of Bleeding: regular

Any other vaginal discharge: nothing significant

 Intermenstrual Bleeding: Absent

 Pelvic Pain: Absent

 Major gynaecological disorders in the past: Nothing Significant

 Gynaecological treatment including surgery in the past: Nothing Significant

2.6.2 Obstetrical History

 GPA-G1P1A0

 Major complications during past pregnancies

 Mode of past deliveries: caesarian

 Abnormal presentations in the past pregnancies: Breech presentation with big head

of baby

 Puerperal complications: nothing significant

 Sexual History: Nothing Significant

 H/o contraceptive use: Use Copper-T for last 5 years

2.7 Treatment History Took painkillers(allopathic medicines) for pain in leg 20 days ago but not

relieved.

81
 2.8 Physical Generals
Thermal Chilly Perspiration Normal
Reaction

Cravings Warm drinks Sleep Restless, constantly changing

position, dullness in morning

Aversion Nothing Significant Dreams Great exertion; climbing, walking

Intolerance Cold air Sexual functions Active,Normal

Appetite Moderate Sensations Stiffness and soreness of parts

Thirst Normal Diathesis Rheumatic

Taste Normal Stool Normal

Urine Normal Side(s) of body Right

affected

General <on the expose to cold damn weather and rest

modalities
>From motion

2.9 Mental Symptoms

 Speaks but little

 Imagine that people are finding fault in her
 Unable to retain ideas for long due to confusion of mind
 Mind is always full of thoughts

3. PHYSICAL EXAMINATION

3.1 General Examination

Level of Conscious and well oriented Anaemia

consciousness Absent
Physical attitude Normal Jaundice Absent

Decubitus Normal Pigmentation Absent

Facies Normal Oedema Absent

82
Built Endomorphic Cachexia Absent

Gait Normal Emaciation

Absent

Deformity None Respiratory

rate 15/minute
Obesity Absent Height 152cm

Lymphadenopathy No abnormality detected Weight 52Kg

Clubbing Absent Temperature 98.4°F

Nutrition Normal Pulse 80/minute

Cyanosis BP 120/80mmHg
Absent
Skin/hair/nails
N.A.D
Scalp (dandruff, hair N.A.D
loss, discoloration,
overgrowth)
Oral (teeth, tongue , N.A.D
ulcers,
discoloration)
Neck (lymph glands,
thyroid, pulsations) N.A.D

Axilla
N.A.D

Groins N.A.D

Hands & Feet N.A.D

83
 3.2 Systemic Examination ABDOMEN: N.A.D

JOINTS & BONES :

While stretching right leg, pain in lower half of leg-SLR test positive.

RESPIRATORY SYSTEM: N.A.D

CARDIOVASCULAR SYSTEM: N.A.D

CENTRAL NERVOUS SYSTEM: N.A.D

4. LABORATORY INVESTIGATIONS

Previous Investigations and reports Investigations advised

Not Required
X-Ray

5. DIFFERENTIAL DIAGNOSIS

 Psoriatic Arthritis
 Polyarthritis
 Radiculopathy

6. PROVISIONAL DIAGNOSIS

Sciatica

84
7. ANALYSIS OF SYMPTOMS / EVALUATION OF SYMPTOMS

Mental Symptoms

 Speak but little

 Imagine that people are finding fault in her
 Unable to return ideas for long due to confusion of mind
 Mind is always full of thoughts

Physical Generals

 Desire – Warm things

 Chilly
 Sleep – restlessness, constantly changing position, dullness in morning
 Dreams-Great Exertion, Climbing, Walking
 Sensation- Stiffness and Soreness of parts

Particulars

 Paralytic benumbing affected parts

 <Cold damp weather, rest
 >motion

8. MIASMATIC DIAGNOSIS

Symptoms Miasmatic Analysis

Speak but little Syphilis
Imagine that people Sycosis
are finding fault in
her
Unable to retain Syphilis
ideas for long due to
confusion of mind
Mind is always full Psora
of thoughts
Craving warm things Psora
Intolerance Cold air Psora
Sleep- Restless, Sycosis
constantly changing
position, dullness in
morning
Great Exertion; Sycosis
climbing, walking

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Sensation-Stiffness Psora
and soreness or
parts
Paralytic benumbing Psora
affected parts
<cold damp Sycosis
weather, rest
>motion Sycosis

Predominant Miasm= Psorosycotic

10. TOTALITY OF SYMPTOMS

 Speak but little

 Imagine that people are finding fault in her
 Unable to return ideas for long due to confusion of mind
 Mind is always full of thoughts
 Desire – Warm things
 Chilly
 Sleep – restlessness, constantly changing position, dullness in morning
 Dreams-Great Exertion, Climbing, Walking
 Sensation- Stiffness and Soreness of parts
 Paralytic benumbing affected parts
 <Cold damp weather, rest
 >motion

11. SELECTION OF MEDICINE

Rhus tox.

12. FIRST PRESCRIPTION (medicine, potency, dose, repetition)

Date :- 21.04.2018

Rx

Rhustox 200/1dose

Sac lac 200/tds/1week

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13. GENERAL MANAGEMENT

Conservative

14. FOLLOW –UP

DATE SIGN AND SYMPTOMS PRESCRIPTION

21.05.2018 Sound sleep, Pain slightly Rhustox 200/1dose
relieved after doing yoga. Sac lac 30/tds/4weeks
VAS Score 4-6 Shows mild
improvement
20.06.2018 Paralytic pain, numbness Sac lac30/tds/4weeks
absent.
VAS Score 1-3 Shows
Moderate improvement
21.07.2018 General improvement. VAS Sac lac 30/tds/4weeks
Score 0 shows Market
improvement

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 BAKSON HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL

Plot No. 36 B, Knowledge Park Phase-I, Greater Noida- 201306 (U.P.)

CASE RECORD FORMAT

CASE 2

1. INTRODUCTION

IPD/OPD
Registration No. 934/18
Date: 12/05/2018
Name of Patient: Mr. S N
Age: 44years
Sex: Male
Religion: Hinduism
Occupation: Bank Accountant
Marital Status: Married
Name of Husband: Mr. Om Prakash Narayan
Address (Res.): 28/C-Wing, Mayur Vihar Extension,Delhi
2. INTERROGATION

2.1 Presenting Complaints

Sudden attack of pain after straining and lifting heavy loads since 20 days. Neuralgic pain
alternate with numbers of the left leg and foot.

2.2 History of Presenting Complaints

The patient was apparently well 20 days back while shifting room he lifts heavy households
articles latter on in the evening he develop pain in left lower limb with tingling sensation

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 followed by numbness left leg and foot. Feeling as if partial paralysis of the part, heaviness of
the limb while moving, < at night.

2.3 Past History

Measles in childhood at the age of 7 years.

2.4 Personal History

 Born and brought up in Karnataka.

 Developmental landmarks - Normal.
 Non Vegetarian
 Happy surroundings at home.
 Congenital relation at home
 Hobbies reading books.
 Has done studies up to post graduation

2.5 Family History

Mother is suffering from Psoriasis.

Father is diabetic
2.6 Physical Generals
Thermal Ambithermal Perspiration Normal
Reaction

Cravings Sour Sleep Sound sleep lying on same position

Aversion Nothing Significant Dreams Nothing Significant

Intolerance Nothing Significant Sexual functions Normal

Appetite Normal Sensations Stiffness and soreness of parts

Thirst Dryness of mouth and throat Diathesis Rheumatic

Taste Normal Stool Normal

Urine Normal Side(s) of body N.S.

affected

General <night
modalities

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 2.9 Mental Symptoms

 Well mannered, cooperative

 Friendly interactive

3. PHYSICAL EXAMINATION

3.1 General Examination

Level of Conscious and well oriented Anaemia

consciousness Absent
Physical attitude Normal Jaundice Absent

Decubitus Normal Pigmentation Absent

Facies Normal Oedema Absent

Built Mesomorphic Cachexia Absent

Gait Normal Emaciation

Absent

Deformity None Respiratory

rate 18/minute
Obesity Absent Height 174cm

Lymphadenopathy No abnormality detected Weight 72Kg

Clubbing Absent Temperature 98.6°F

Nutrition Normal Pulse 80/minute

Cyanosis BP 120/80mmHg
Absent
Skin/hair/nails
N.A.D
Scalp (dandruff, hair N.A.D
loss, discoloration,
overgrowth)
Oral (teeth, tongue , N.A.D
ulcers,
discoloration)
Neck (lymph glands,

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thyroid, pulsations) N.A.D

Axilla
N.A.D

Groins N.A.D

Hands & Feet N.A.D

3.2 Systemic Examination ABDOMEN: N.A.D

JOINTS & BONES :

 On palpation of the affected side, tenderness present

 SLR test positive

RESPIRATORY SYSTEM: N.A.D

CARDIOVASCULAR SYSTEM: N.A.D

CENTRAL NERVOUS SYSTEM: N.A.D

4. LABORATORY INVESTIGATIONS

Previous Investigations and reports Investigations advised

1. Complete blood count with ESR-Normal finding

2. X-ray Normal finding Not Required

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5. DIFFERENTIAL DIAGNOSIS

 Psoriatic Arthritis
 Polyarthritis
 Radiculopathy

6. PROVISIONAL DIAGNOSIS

Sciatica

7. ANALYSIS OF SYMPTOMS / EVALUATION OF SYMPTOMS

Mental Symptoms

 Friendly, interactive

Physical Generals

 Sour thing
 Dryness of mouth
 < at night

Particulars

 Tingling sensation
 Pain alternate with numbness

8. MIASMATIC DIAGNOSIS

Symptoms Miasmatic Analysis

Friendly, interactive Psora

Sour thing Sycosis

Dryness of mouth Psora

< at night Syphilitic

Tingling sensation Psora

Pain alternate with Syphilitic

numbness

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Predominant Miasm= Psoro –syco-Syphilitic

10. TOTALITY OF SYMPTOMS

 Friendly, interactive
 Sour thing
 Dryness of mouth
 < at night
 Tingling sensation
 Pain alternate with numbness

10. SELECTION OF MEDICINE

Gnaphalium

11. FIRST PRESCRIPTION (medicine, potency, dose, repetition)

Date: - 12.05.2018

Rx

Gnaphalium 200/1dose

Sac lac 30/tds/4week

12. GENERAL MANAGEMENT

Conservative

14. FOLLOW –UP

DATE SIGN AND SYMPTOMS PRESCRIPTION

12.06.2018 No more tinging sensation Sac lac 30/tds/4weeks
of heaviness of limb but
slight pain in remaining.
VAS score is 0 shows
Marked improvement.
11 .07.2018 Pain totally absent. Sac lac 30/tds/4weeks
VAS score is 0 shows
Marked improvement

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 APPENDIX D

VISUAL ANALOGUE SCALE ASSESSMENT OF SYMPTOMS

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 Post-treatment outcome measure by adopting VAS
Table no.15.

Improvement status Criteria in terms of percentage

Marked improvement Score of 75-100 in sciatic patient where
absence of pain and other associated
symptoms
Moderate improvement Score of 50 to less than 74 in sciatic patient
where moderate intensity of pain and other
associated symptoms remain
Mild improvement Score of 25 to less than 49 in sciatic patient
where mild intensity of pain and other
associated symptoms still remains
Not Significant Score of 1 to less than 24 in sciatic patient
where severe intensity of pain with no
improvement in pain and other associated
symptoms
Static No change in symptom score, sciatic pain and
other associated symtoms are standstill, no
changes observes in before and after
treatment
Worse Symptom score 0 shows aggravation of
present complaints

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 MASTER CHART KEY

IMP. Improvement Status

b/f Before

t/t Treatment

M Male

F Female

EG Experimental group

CG Control Group

NS Nothing Significant

Med. Medium

VAS Visual Analogue Score

Eco. Status Economical status

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 APPENDIX E
MASTER CHART

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 MASTER CHART

SNO Name Age Sex Eco. Occupation Presenting B/F T/T Follow IMP. Status
of status symptom T/T up
subject VAS VAS
Score Score
1. KC 38 F Med. Teacher Back pain 9 EG 6 Moderate
2. SN 44 M Hi. Bank Acc. Back pain 10 EG 9 Marked
radiating
down to
limb
3. SG 30 M Med. Engg. Back pain 9 CG 9 Not Significant
with
stiffness
4. MH 35 F Low Farmer Backpain 9 CG 9 Not Significant
with
numbness
of limbs
5. JK 39 F Low Housewife Back pain 6 CG 6 NS
6. PC 41 F Med. Teacher Back pain 9 CG 6 Mild
radiating
down to
limbs
7. KP 48 M Med. Business Back pain 9 EG 6 Moderate
8. RS 40 F Med. Teacher Back pain 6 EG 6 NS
radiating
down to
limb
9. SS 32 M Med. Shopkeeper Back pain 10 CG 6 Moderate
with
stiffness
of back
10. RG 46 F Med. Receptionist Backpain 9 CG 9 Worse
11. SH 46 F Med. Housewife Back pain 6 EG 3 Mild
with
numbness
12. ST 56 M Med. Shopkeeper Back pain 6 EG 0 Marked

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13. PK 46 M Med. Hotel Back pain 9 EG 3 Mild
manager radiating
down to
limbs
14. SI 48 F Low. Housewife Back pain 6 CG 0 Marked
15. SB 50 F Med. Hotel Back pain 9 CG 9 Not Significant
manager with
radiating
down to
limbs
16. KG 51 F Med. Housewife Back pain 10 CG 10 Worse
17. IM 29 M Low Farmer Severe 9 EG 3 Mild
back pain
18. SD 33 M Low Farmer Back pain 10 EG 0 Marked
with
stiffness
19. ST 52 F High Teacher Back pain 10 CG 10 Worse
20. KG 60 F Low Housemaid Back pain 9 CG 9 Not significant
radiating
down to
limbs
21. DK 71 F High Housewife Back pain 9 CG 3 Moderate
22. JM 39 F Med. Housewife Stiffness 9 EG 9 Marked
of back
23. PP 45 F High Receptionist Numbness 9 EG 0 Marked
of back
24. RW 56 F Med. Tailor Back pain 6 EG 0 Marked
25. PU 41 F Low Farmer Stiffness 10 EG 6 Moderate
of back
26. AT 49 F High Receptionist Stiffness 9 CG 3 Mild
of back
27. SK 54 F Low Housemaid Back pain, 9 EG 0 Marked
Numbness
of limbs
28. MK 47 F Low Housemaid Back pain 10 CG 6 Mild
29. PS 26 M Med. Student Back pain 9 CG 6 Moderate

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30. RN 27 F Low Housewife Back pain 10 EG 10 Not significant

100