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Muscle and joint problems
Treating severe aches and pains conventionally may bring unwanted side effects. Homeopathy has much to offer, says Janet Gray
Some of the most common presentations in general practice are problems of pain in joints and muscles. Sometimes these problems are acute, as in sports injuries, sometimes they are chronic, as in osteoarthritis, and sometimes they are intermittent, as in back pain. Whatever the problem, they provide the GP with a challenge for management.
The GP must take a careful history, examine the affected part, and make a diagnosis, possibly with the help of blood tests and x-rays. Having confirmed the diagnosis, the treatment option must then be decided, which may be the prescription of an anti-inflammatory drug, such as ibuprofen, a local steroid injection, a referral for physiotherapy or a referral to a rheumatologist.
As a GP myself, I use all these options, and we are lucky enough in our practice to have a physiotherapist trained also in acupuncture. However, I also have another therapeutic option up my sleeve - the use of homeopathy. This method of treatment really comes into its own when side-effects are experienced with the use of conventional medication, some of which can be very serious.
Homeopathy can offer help in many situations which otherwise might cause prolonged incapacity. For instance, the use of Arnica in acute injury is well known, but often forgotten in the heat of the moment. The sooner it can be given, the more effective it is, but it is not too late to start it even several days after an injury. I will quite often see a patient with a sprained ankle, done two to three days previously, and I will then start not only Arnica, but also Rhus tox given concurrently. This combination is very useful in other situations, such as a bad back, caused by gardening, or a knee injury done at football.
Of course, we must always remember our homeopathic basics, so Rhus tox would only be appropriate if the modalities of stiffness after rest, pain better for heat, and relief by gradual movement were present. So when Clive, aged 41, came to see me with a 10-year history of backache, caused by jarring his spine in a diving accident, I needed to know the modalities of his pain. In his case, the pain was a lot worse on moving, and pain-free at rest and was relieved by ice-packs, so I prescribed Bryonia 6c, twice daily for one month. When I next saw him, he had achieved a 90 per cent improvement, and was delighted.
Similarly Bob, aged 53, had a four-year history of pain in his knees, which had started after a strenuous game of golf. His pain was also worse for movement, and he had no early morning stiffness. As a person he was extremely thirsty, so despite the lack of a marked reaction to heat or cold, I prescribed Bryonia 6c, twice daily, for him too. Again, after one month, he had improved enough to stop his painkillers.
It is always very satisfying to treat a patient successfully using homeopathy, who has puzzled the rheumatology specialists. Margaret, aged 65, was one such case, who came to see me privately with an acute arthritis of unknown origin. When she came to me, she had severe pain in her right elbow, such that she could not even feed herself, and her left ankle and forefoot were very inflamed, making walking very painful. The joints including her elbow were very painful, such that she could not even feed herself, and her left ankle and forefoot were very inflamed, making walking very painful. The joints were swollen, but not red, very stiff in the mornings, and improved by both heat and ice-packs. The site of the affected joint flitted around, such that a week previously it had been her left shoulder and left elbow.
She was on maximum doses of ibuprofen, and also some powerful second-line anti-arthritic drugs, to no avail. In her character, she was a changeable person, describing herself as being either up or down. She was very weepy and loved consolation and cuddles. She admitted to liking to be the centre of attention and, indeed, had been an actress. She craved fresh air, was not particularly thirsty, and was averse to fatty food.
The local joint modalities were difficult to prescribe on, but her constitutional type was plainly Pulsatilla. To the amazement of her rheumatologist, within a month of taking Pulsatilla, her joint pains all subsided and the swelling resolved in all but her right ankle, which had completely resolved by the second follow-up consultation.
Prevention better than cure
Equally successful was the case of Emma, aged 28, who had developed flitting joint pains at the age of 15. Both her mother and grandmother suffered from rheumatoid arthritis, and she was obviously worried that she was developing the same. So far, her blood tests for rheumatoid had been negative.
When I saw her, the pains were worse for pressure and better for motion, with a lot of stiffness, and more comfortable in the warm weather.
As a person, she was chilly, and loved the sunshine. She described herself as an optimist, with a positive attitude to life. She was very emotional and empathetic to others; very affectionate, with a need for physical touch.
On these symptoms, I prescribed Phosphorus on a constitutional level, and this settled her symptoms very quickly. Over the years that I have been treating her, she has needed one or two doses of Phosphorus per year to keep her joint problems under control.
Although it cannot be proved, I have a strong feeling that had she not been treated homeopathically, she might well have gone on to develop rheumatoid arthritis.
Severe rheumatoid arthritis
Obviously, prevention is better than cure, and the treatment of patients with established rheumatoid arthritis is often less dramatic. However, some help can be given with symptom control, as was the case with Miss S.G., aged 67, who came to see me with very long-standing rheumatoid arthritis, which had caused severe deformities of her hands and feet. She had had a knee replacement, and had had operations to both feet.
She had had gold treatment 20 years ago, which had caused some kidney damage. By the time she came to me, her disease had more or less burnt out, but she was suffering from extreme fatigue and some residual joint pains. I treated her constitutionally with Natrum muriaticum, and gave her Bryonia as a local prescription for her joint pains. On this regime she managed very well over the several years that I looked after her.
Tennis and golfer’s elbow
Tennis elbow is an incapacitating condition. It is pain on the outer side of the elbow, caused not only by tennis, but also any other repetitive action that involves flexion of the forearm muscles, like cleaning windows. Golfer’s elbow is identical, but on the inner side of the elbow. It often responds extremely well to Ruta graveolens, which is a remedy that affects the insertion of tendons into the periosteum of the bones. Ruta has exactly the same modalities as Rhus tox, ie better for heat, stiffness after rest, better on gradual movement, but has different tissue affinities - tendons and periosteum rather than muscle.
Conditions such as gout can also be managed successfully using homeopathic remedies. Colchicum, the autumn crocus, has in its materia medica an exact description of the symptoms of gout “Inflammation of the great toe, cannot bear to have it touched or moved” (Boericke). Ledum (marsh tea) has the clinical picture of swollen, hot, pale joints, with the ball of the great toe swollen. Formica rufa (crushed live ants) is excellent for chronic gout and stiffness in the joints. The skin on the gouty joint is red, itching and burning.
Conditions of muscles
Conditions of the muscles such as fibrositis, fibromyalgia and polymyalgia rheumatica are difficult to treat conventionally. Diagnosis is often delayed and can be very difficult.
Fibrositis is thought to be caused by small adhesions between individual muscle fibres, causing stiffness and pain in isolated spots, “trigger points”, mainly in the back, shoulders and buttocks. The remedy Kali bichromicum fits this description well, having “pain in small spots”.
Fibromyalgia is very similar but involves more diffuse tenderness and pains in the muscles. Remedies such as Rhus tox, if the modalities fit, can be very useful.
Polymyalgia rheumatica is a specific inflammation of the proximal muscles of the upper arms and thighs, which are very tender and weak. Climbing stairs is particularly difficult, as is raising the arms above the head to open cupboards, etc. This condition responds very well to steroids, but as the disease usually takes a couple of years to run its natural course, the steroids may have to be maintained for this length of time. To avoid the side-effects of steroids, homeopathic treatment can be tried.
Mrs E.C., age 45, developed pains in her upper arms and thighs, and a blood test showed she was suffering from polymyalgia rheumatica. She asked me to treat her homeopathically rather than go on steroids, so I gave her Rhus tox, which fitted her modalities well. However, after some weeks of treatment, there was very little improvement, so I gave her Sycotic co, which is a bowel nosode, useful if the well-indicated remedy fails to work. The improvement with this was dramatic, causing a rapid decrease in pain and increase in strength.
Homeopathy on a constitutional basis is the most successful way of treating all these conditions, but local prescribing can be very useful.
Frozen shoulder is another condition that runs a very prolonged course. It often seems to be provoked by minimal trauma, or by painful conditions of the chest wall causing lack of use of the shoulder, which then seizes up. The natural course is severe pain in the shoulder for a year, and then complete “freezing” of the joint for another year. After that the whole thing resolves spontaneously. Of course most people do not want to wait for natural resolution, and various homeopathic shoulder remedies can be useful. Kalmia latifolia (mountain laurel) is indicated for right-sided shoulder pain and Ferrum metallicum for left-sided shoulder pain.
Repetitive strain injury
Repetitive strain injury should be treated by immobilisation of the painful part for two weeks, accompanied by an appropriate remedy, such as Ruta grav. Obviously it is important to modify the behaviour that caused the problem in the first place, by paying attention to posture and hand positioning at a keyboard, for example.
This article by no means comprehensively covers the whole field of joint and muscle problems but hopefully gives a flavour of what homeopathy can do in this area. I do not want to give the impression that homeopathy is a miracle cure in all such cases, and indeed some patients fail to respond to apparently well-indicated remedies. A lot of improvement can be achieved by homeopathic self-help, but more complicated problems will need to be managed by a homeopathic practitioner.
Janet Gray MA MBBChir MRCOG MFHom DRCOG DFFP, a GP for over 20 years, has used homeopathy in her Bristol practice for the last 15 years. She lectures in homeopathy at the Bristol Teaching Centre and has a small private practice near Chippenham.