ABSTRACT
Cervical spondylosis (CS) is also called as cervical osteoarthritis, it is a degenerative disease of cervical intervertibral disc and their associated intervertebral joints. The term covers the pathology in the spine and the neurological syndrome associated with it “SPONDYLO” is a Greek word meaning vertebra and spondylosis generally mean changes in the vertebral joint characterized by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues.
This comparative study is an attempt to assess the Effectiveness of Constitutional Homoeopathic Remedies versus Picricum Acidum in the management of Cervical Spondylosis.
METHODS:
A total number of 30 cases meeting the inclusion and exclusion criteria, comparing both sexes between 30-60 years, diagnosed with cervical spondylosis based on NDI scoring up to 30, and presenting common symptoms, were induced. Group 1 patients received constitutional remedies and group 2 patients received Picricum Acidum.
RESULT AND DISCUSSION:
Out of 30 subject, 8 subjects recovered (26.6%), 13 subjects improved (43.3%) and 9 subjects (30.1%) did not improve. Notably , most patients experienced marked symptomatic relief.
CONCLUSION:
This case record analysis suggests a potential beneficial effect of Picricum Acidum 30 C potency in managing cervical spondylosis. Most patients experienced symptomatic relief, although caution is warranted due to study limitations. Future research, including well-designed randomized controlled trials with larger sample size, is needed to establish the efficacy and safety of Picricum Acidum 30 C potency in cervical spondylosis patients.
KEY WORDS:
Homoeopathy , Cervical Spondylosis, Constitutional medicine, Picricum Acidum, Cervical spine.
INTRODUCTION
Cervical spondylosis (CS) is also called as cervical osteoarthritis, it is a degenerative disease of cervical intervertibral disc and their associated intervertebral joints. The term covers the pathology in the spine and the neurological syndrome associated with it “SPONDYLO” is a Greek word meaning vertebra and spondylosis generally mean changes in the vertebral joint characterized by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues.
Cervical spondylosis is characterized by pain in the neck with or without radiation, tingling, numbness and paraesthesia and in later stages there is spondylotic myelopathy of the upper extremity. Radiologically, reduction in the intervertebral disc space and formation of marginal osteophyte is observed.
PREVALANCE
The lifetime incidence of neck-related pain in the population has been reported to be as high as 67%. Point prevalence has been placed at 3.5/1000,while the annual incidence has been reported at 83/100,000 population.
International incidence of cervical spondylosis is 2.5 cases per 1000 population and door to door study conducted in India shows an incidence of 3.5 cases per 1000 population.
Nearly 50% of people over the age of 50 and 75% of those over age of 65 have typical radiographic changes of cervical spondylosis. Symptoms of cervical spondylosis may appear in those as young as 30 years and are most commonly in those aged 40-60 years.
Indian population reported that 78% of radiological changes of cervical spondylosis, is seen at C5-C6 & C6-C7 levels in asymptomatic individuals.
ETIOLOGY
1. Wear and tear on joints that accompanies aging(osteoarthritis)
2. Arthritis (inflammation of joint)
3. Trauma such as automobile accidents with whiplash injury, athletic injuries, sudden jerks on arms and falls.
Whiplash injury is due to trauma (usually automobile accidents) causing cervical Musculo ligamental sprain or strain due to hyperflexion or hyperextension.
There are several predisposing factors, which may cause acceleration of these changes.
1. There may be a hereditary predisposition to intervertebral disc disease.
2. Previous injury with fracture or disc prolapses
3. Occupations requiring repetitive motion of the cervical spine.
4. Segmentation defects like hemivertebra or fused vertebrae.
5. Fluorosis may play an important part in the development of ossified posterior longitudinal ligament in India.
PATHOLOGY
Degenerative changes begin with intervertebral disc desiccation, which is associated with increase in the ratio of keratin sulfate to chondroitin sulfate. Along with desiccation, the nucleus pulposus shrinks, loses elasticity, and becomes more fibrous due the loss of water, protein and mucopolysaccharides during the aging process. Disc height is initially lost in the ventral portion of the disc, which results in a decrease in cervical lordosis. Unfortunately, this process results in positive feedback cycle due to the increase in forces applied ventrally and eventually may lead to kyphotic deformity. These early changes ultimately lead to the main pathophysiological process of cervical spondylosis, a reduction in sagittal spinal canal diameter. Additionally, these changes cause a transfer of axial load onto the facet joints, resulting in hypertrophy of joints that further decreases the spinal canal’s diameter.
DIAGRAM: 1 PATHOPHYSIOLOGY
 |
CLINICAL MANIFESTATIONS :
1. Axial neck pain
2. Cervical radiculopathy
a. Sensory change, such as tingling, known as Paraesthesia
b. Sensory loss to the skin in the dermatome (the area of skin innervated by the nerve)
c. Weakness in the myotome (the muscles innervated by the spinal nerve)
d. Diminished, or absent, reflex in the muscles controlled by the spinal nerve
e. Pain felt along the path of the spinal nerve (radicular pain).
3. Cervical myelopathy
DIAGNOSTIC CRITERIA:
NDI -SCORING: Up to 30
DIAGNOSIS:
X-rays, computed tomography (CT), and magnetic resonance imaging (MRI), Doppler ultrasound and electrodiagnosis (electrodiagnosis and nerve conduction studies and somato sensory evoked potential).
TREATMENT:
HOMOEOPATHIC VIEW OF CERVICAL SPONDYLOSIS :
MIASMATIC UNDERSTANDING OF PRIMARY OSTEOARTHRITIS:
Hahnemann tells in chronic diseases that the swellings of the bones and the curvature of the spine, and many other softening and deformities of the bones, both at an early and at a more advanced age, are caused by the psora. Under symptoms of latent Psora- “disposition to crack, strain or wrench one joint or another. Cracking of one or more joints on moving”
Hahnemann also mentions, when the outbreak of the internal Psora occurs- “thickening of joints; they remain hard swollen, and there is pain on bending them. The joints, as it were, stiff, with painful, difficult motion, the ligament seems too short. Joints painful on motion. Joints crack on moving, or they make a snapping noise.
RUBRICS FOR CERVICAL SPONDYLITIS:
1. MURPHY – Diseases
Spondylitis, neck
Murphy - Diseases
Torticollis, spondylitis suboccipital is, from
2. S.R. PHATHAK
Neck, spondylitis
spondylitis, cervical
3. WILLIOM.O. BOERICKE
Nape, of neck, pains, in general
Nape, of neck, pains, rheumatic
Neck, cracking of cervical vertebrae, on motion
4. COMPLET REPERTORY
Back -Spondylitis cervical
5. KENT REPERTORY
Back - cracking - Cervical region
Back - pain - Cervical region
Back - stiffness - Cervical region
Extremities - pain - Upper limbs – neuralgic
PICRICUM ACIDUM INDICATION:
Neurasthenia. Occipital pain; worse, slightest mental exertion.
Vertigo and noises in ear. Burning along spine.
Worse ; least exertion, after sleep, wet weather; patient is worse then.
Better, from cold air, cold water, tight pressure.
PREVENTION OF CERVICAL SPONDYLOSIS
Since cervical spondylosis is part of the normal aging process, not much can be done to prevent it. By engaging in regular physical exercise and limiting occupational or recreational activities that place pressure on the head, neck and shoulders may help to avoid some or all symptoms of cervical spondylosis. The best exercises for the health of the cervical spine are noncontact activities, such as swimming, walking, or yoga. Once symptoms have already developed, the emphasis is on symptom management rather than prevention.
OBJECTIVES:
To study the clinical course of cervical spondylosis from the age group of 30-60 years.
To assess the efficacy of homoeopathic constitutional medicine and Picricum Acidum in the treatment of cervical spondylosis.
MATERIALS AND METHODS:
SOURCE OF DATA:
The subjects for the study were selected from OPD, IPD, Peripheral centers, rural health camps and medical camps conducted by SIVARAJ Homoeopathic Medical College and Research institute, Salem. 30 subjects were selected based on inclusion criteria and exclusion criteria.
INCLUSION CRITERIA:
1. Subjects of all genders.
2. Subjects of age group between 30-60years.
3. Subjects are selected based on clinical history, clinical examination, clinical features of cervical spondylosis & with investigations.
4. Diagnosed cases of cervical spondylosis.
5. Subjects who give written consent.
EXCLUSION CRITERIA:
1. Subjects below 30 & above 60 years.
2. Subjects with traumatic injury of cervical spine.
3. Adhesive Capsulitis
4. Cervical Myofascial Pain.
5. Whiplash injury.
6. Spinal cord injury
7. Prolapsed intervertebral disc
8. Pregnant & lactating women.
9. Patient suffering from any systemic disease.
METHODOLOGY:
Subjects were selected based on inclusion and exclusion criteria, history, clinical findings. The data were represented in the standardized case proforma prepared for the topic. There were two groups wherein Group 1 was treated with constitutional medicines & group 2 was treated with Picricum Acidum.
Table No 1: Results of Z test
Outcome Measures | Group 1 p1 | Group 2 P2 | Z value (computed) | P value |
Recovered | 0.1 | 0.33 | 2.28 | ±1.96 |
Improved | 0.33 | 0.53 | 6.6 | ±1.96 |
Not improved | 0.13 | 0.46 | 1.3 | ±1.96 |
SUMMARY AND CONCLUSION:
Samples of 15 subjects – 15 subjects in each group were studied and totality of symptoms. Was gathered in Group 1, each case Totality was further Analysed, Repertorized and referred in Materia Medica to arrive at the most appropriate remedy that would benefit the case under consideration. In Group 2, Picricum Acidum was prescribed, based on totality.
According to statistical analysis using Z test, it may be concluded that Constitutional homoeopathic medicine is more effective than Picricum Acidum from in the management of cervical spondylosis.
ü In Group 1, the most common constitutional remedy prescribed was Rhus Tox for 4 subjects (26.6%), out of which 2 subjects got recovered, 1 subject improved and 1 subject not improved.
ü As in this study Rhus Tox was indicated in 4 subjects followed by Lycopodium in 3 subjects, Nux Vomica, Sulphur & Pulsatilla in 2 cases with marked improvement, one can think of, Ignatia and Cal. Carb as primary remedies in the management of cervical spondylosis.
ü Out of 30 subjects, 8 subjects recovered (26.6%), 13 subjects improved (86.6%) and 9 subjects (30%) did not improve.
ü The most common age group affected was seen from 30-35 years (36.6%) followed by 36 - 40 years of age group (26.6%), followed by 46-50 years of age group (16.6%), followed by 41-45 & 51-55 years of age group (10.1%).
ü In this study, male patients were more than females. 21 subjects (70%) were males, and 9 subjects (30%) were females.
ü According to the occupation, Car driver, bus drivers, tailor and painter 3 subjects each (40.1%), followed by mechanics, housewife, Teacher, Labor, 4 subjects each (53.3%), and IT worker 2 subjects each (6.6%).
Table :2 Distribution of subjects as per remedies
REMEDY | NO OF SUBJECTS | PERCENTAGE
(%) |
CALCAREA CARBONICA | 1 | 6.6 |
NUX VOMICA | 2 | 13.4 |
PULSATILLA | 2 | 13.4 |
LYCOPODIUM | 3 | 20 |
RHUS TOX | 4 | 26.6 |
SULPHUR | 2 | 13.4 |
IGNATIA | 1 | 6.6 |
TOTAL | 15 | 100 |
Out of 15 subjects, in 4 subjects (26.6%) Rhus Tox was prescribed, 3 subjects (20%) lycopodium was prescribed in 2 subjects (13.4%) Nux Vomica, Sulphur and Pulsatilla was prescribed Calcarea Carbonicum, Ignatia was prescribed 1 subject (6.6%).
Table 3: Distribution of subjects as per the results in Group 1 and Group 2.
RESULTS | NO. OF SUBJECTS | PERCENTAGE (%) | TOTAL | |||
GROUP 1 | GROUP 2 | GROUP 1 | GROUP 2 | NO | % | |
Recovered | 5 | 3 | 33.3 | 20 | 8 | 26.6 |
improved | 8 | 5 | 53.3 | 33.4 | 13 | 43.3 |
Not Improved | 2 | 7 | 13.4 | 46.6 | 9 | 30.1 |
Total | 15 | 15 | 100 | 100 |
30 |
100 |
Statistical study was done to show the results. Out of 15 subjects in Group1, 5 subjects (33.3%) recovered, and 8 subjects (53.3%) improved, and 2 subjects (13.3%) did not show any improvement and out of 15 subjects in Group2, 3 subjects (20%) recovered ,5subjects (33.4%) improved and 7 subjects (46.6%) did not showed any improvement.
GRAPH NO 1: COLUMN GRAPH SHOWING DISTRIBUTION OF SUBJECTS ACCORDING TO CONSTITUTIONAL HOMOEOPATHIC REMEDIES PRESCRIBED.
GRAPH NO 2: BAR GRAPH SHOWING DISTRIBUTION OF SUBJECTS
Summary and conclusion
All the 30 subjects were studied in detail and assessed by using the following parameter- Neck disability index score. Neck disability index score was measured before and after treatment. The statistical analysis made in this study was based on the data from Neck Disability index score.
Patient will be selected based on inclusion and exclusion criteria. Patients will be categorized in to two groups, Group-I will be receiving only constitutional treatment, Group-II will be receiving only Picricum Acidum.
· In this study, male patients were more than females. 21subjects (70%) were males, and 9 subjects (30%) were females.
· Hindus were more affected by cervical spondylosis 27 subjects (90%), 3 subjects in Christian (10%).
· In this study, out of 15 subjects in Group1, 6 subjects were from age group 30-35(40%), 4 subjects from age group 36-40(33.3%), 1 subject from age group 41-45(6.8%),2subjects from age group 46-50(13.3%) and 2subjects from age group 51-55(13.3%).
· And out of 15 subjects in Group2, 4 subjects were from age group 30-35(26.6%), 5 subjects from age group 36-40(33.3%), 2 subject from age group 41-45(13.3%),3subjects from age group 46-50(20%) and 1subjects from age group 51-55(6.8%).
· Out of the 15 subjects in Group 1, 11 were male and 4 were female and out of 15 subjects in Group 2, 10 were male and 5 were female.
· In this study in Group -I (Constitutional treatment) Male patients are 11(73%) and Female patients are 4(27%), Group-II (Picricum Acidum) male patients are 10(66.6%) and Female patients are 05(33.4%), in this total study 30% (09 patients) were female 70% (21 patients) were male.
· Out of 15 subjects , in 3 subjects (20%) lycopodium was prescribed and in 4 subjects (26.6%) Rhus Tox was prescribed, in 2 subjects (13.4%) Nux Vomica, Sulphur and Pulsatilla was prescribed Calcarea Carbonicum, Ignatia was prescribed 1 subject (6.6%).
· Statistical study was done to show the results. Out of 15 subjects in Group1, 5 subjects (33.3%) recovered, and 8 subjects (53.3%) improved, and 2 subjects (13.3%) did not show any improvement and out of 15 subjects in Group2, 3 subjects (20%) recovered, 5subjects (33.4%) improved and 7 subjects (46.6%) did not show any improvement.
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