A Clinical Study on the Role of LM Potency in the Management of Pain in Cervical Spondylosis

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“A CLINICAL STUDY ON THE ROLE OF LM POTENCY IN THE MANAGEMENT OF PAIN IN CERVICAL SPONDYLOSIS”

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT

FOR THE AWARD OF THE DEGREE OF

DOCTOR OF MEDICINE IN HOMOEOPATHY: M.D. (Hom.)

ORGANON OF MEDICINE AND

HOMOEOPATHIC PHILOSOPHY By

Dr. K.SUWAAMYNAATHAN UNDER THE GUIDANCE OF Dr.M.MURUGAN., M.D. (HOM)

Prof. & HEAD., Department of Organon of medicine and Homoeopathic Philosophy

SARADA KRISHNA HOMOEOPATHIC MEDICAL COLLEGE, KULASEKHARAM, TAMIL NADU

SUBMITTED TO

THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI

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ENDORSEMENT BY THE HEAD OF THE DEPARTMENTAND THE INSTITUTION

This is to certify that the Dissertation entitled “A CLINICAL STUDY ON THE ROLE OF LM POTENCY IN THE MANAGEMENT OF PAIN IN CERVICAL SPONDYLOSIS”is a bonafide work carried out by Dr.K.SUWAAMYNAATHAN, a student of M.D.(Hom.) in DEPARTMENT OF ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY (2016-2019) in the SARADA KRISHNA

HOMOEOPATHIC MEDICAL COLLEGE, KULASEKHARAM,

KANNIYAKUMARI under the supervision and guidance of Dr. M. MURUGAN., M.D.(Hom.), PROFESSOR and HEAD, DEPT. OF ORGANON OF MEDICINE

AND HOMOEOPATHIC PHILOSOPHY in partial fulfilment of the Regulations for the award of the Degree of DOCTOR OF MEDICINE (HOMOEOPATHY) in

ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY. This work confirms to the standards prescribed by THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI.

This has not been submitted in full or part for the award of any degree or diploma from any University.

Dr.M.MURUGAN., M.D. (Hom) Dr. N.V.SUGATHAN, M.D. (Hom) Professor and Head PRINCIPAL

Dept. of Organonof Medicine and Homoeopathic Philosophy

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CERTIFICATE BY THE GUIDE

This is to certify that the Dissertation entitled“A CLINICAL STUDY ON THE ROLE OF LM POTENCY IN THE MANAGEMENT OF PAIN IN CERVICAL SPONDYLOSIS”is a bonafide work of Dr.K.SUWAAMYNAATHAN. All his work has been carried out under my direct supervision and guidance. His approach to the subject has been sincere, scientific and analytic. This work is recommended for the award of degree of DOCTOR OF MEDICINE (HOMOEOPATHY) in

ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY of THE TAMILNADU DR. M. G. R MEDICAL UNIVERSITY, CHENNAI.

Dr. M. MURUGAN., M.D. (Hom.)

Professor and Head,

Dept. of Organon of Medicine and Homoeopathic Philosophy.

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DECLARATION

I, Dr.K.SUWAAMYNAATHAN hereby declare that this Dissertation entitled “A CLINICAL STUDY ON THE ROLE OF LM POTENCY IN THE MANAGEMENT OF PAIN IN CERVICAL SPONDYLOSIS”is a bonafide work carried out by me under the direct supervision and guidance of Dr. M. MURUGAN., M.D(Hom.), Professor and Head, Dept. of Organon of Medicine and Homoeopathic Philosophy, in partial fulfilment of the Regulations for the award of degree of Doctor of Medicine (Homoeopathy) in ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY of The Tamil Nadu Dr. M. G. R Medical University, Chennai. This has not been submitted in full or part for the award of any degree or diploma from any University.

Place: Kulasekharam Dr.K.SUWAAMYNAATHAN

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ACKNOWLEDGEMENT

I consider this my privilege to thank God, The Almighty, for helping me to achieve this humble task through the following persons, who have been of immense help and

a source of encouragement in my endeavour.

I am deeply indebted to my respected and beloved teacher and guide Dr. M. MURUGAN, M .D (Hom.), Head, Department of Organon Of Medicine and Homoeopathic Philosophy, for providing me expert guidance, advice, timely support, personal attention, supervision, encouragement and love throughout my post-

graduation course and during this dissertation work. It’s my good fortune to be his

student and to do this work under his guidance.

It is my privilege to express my sincere heartfelt gratitude to Dr. MANOJ NARAYAN. V M.D (Hom.), my respectful teacher, Professor, Department Of Organon Of Medicine and Homoeopathic Philosophy, for his valuable guidance

inspiration and assistance all along for the completion of my work

My sincere and heartfelt thanks to the Chairman Dr. C. K. Mohan, M.D (Hom.) for providing me the opportunity to undertake this work and extending all necessary

facilities to carry out this work to my satisfaction in this institution.

I am thank full to Dr. N. V. Sugathan, M.D (Hom.), Principal and Medical Superintendent for his help and support in everything all the time.

My profound gratitude and deep regards to Dr. Winston Vargheese, M.D (Hom.), PG Coordinator, who has always been a source of support and inspiration.

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I take this opportunity to record my sincere thanks to all the faculty members of the Department Of Organon Of Medicine and Homoeopathic Philosophy for their help

and encouragement.

My joy knows no bounds in expressing my cordial gratitude to my seniors Dr. Suhruthom Prakash, M.D (Hom.),. Her keen interest and encouragement were a great help throughout the course of this research work.

I extend my gratitude and respect to my family especially my father Mr. A.Kannan,

my mother Mrs. Jayasree Kannan, my sister Ms. K.Kamatchi, and my better half Ms. Sukanya for their full support. I remain indebted to them for everything I have and whatever I have achieved.

I am grateful to my friends Dr. Mithun Kumar, Dr. SundarPandiya Raj, Dr. Asif

Ali, Dr. Amritha Mohan, Dr. Amrutha Manoharan, Dr. Divya Pushparaj, Dr. Fretty Paul, Dr. Brigit Cherian, Dr. Aparna, Dr. Riswana, Dr. Varun, Dr. Gokul Krishna, Dr. Sibin and Dr. Vipin Das S. M for being helpful and supportive all through our long stay together.

I extend my gratitude to all my seniors, friends, colleagues and juniors whose

cooperation and timely help considerably eased my task.

Thanks to all my patients without whose help and co-operation, this work could have seen the light of the day.

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ABSTRACT

Cervical Spondylosis is one of the commonly seen diseases nowadays. The study is made to manage the pain of Cervical Spondylosis in some extent with Homoeopathic medicine. The management for pain of Cervical Spondylosis is very much effective with

Homoeopathic medicine.

30 patients with Cervical Spondylosis are selected from OPD, IPD and from

peripheral centers of Sarada Krishna Homoeopathic Medical College. The cases were analyzed, evaluated and well selected remedy of LM potency were given.

The result of the study showed that out of 30 cases, 13 (43.33%) has Marked

improvement, 12(40%) has Moderate improvement, and 5(16.67%) has Mild improvement. The results are based on the statistical analysis of before and after

treatment score.

The results of the study were highly satisfying and the role of LM potency in management of pain in Cervical Spondylosis is very effective.

KEY WORDS

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TABLE OF CONTENTS

SL NO CONTENTS PAGE NO

1. INTRODUCTION 1

2. AIMS AND OBJECTIVES 5

3. REVIEW OF LITERATURE 6

4. MATERIALS AND METHODS 20

5. OBSERVATION AND RESULTS 22

6. DISCUSSION 37

7. CONCLUSION 41

8. SUMMARY 43

9. BIBILIOGRAPHY 45

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LIST OF TABLES

Sl.

No Description Page No

1. DISTRIBUTION OF CASES ACCORDING TO AGE 22

2. DISTRIBUTION OF CASES ACCORDING TO SEX 23

3.

DISTRIBUTION OF CASES ACCORDING TO

OCCUPATION 23

4.

DISTRIBUTION OF CASES ACCORDING TO

PLACE OF DWELLING 24

5.

DISTRIBUTION OF CASES ACCORDING TO

FACTORS AFFECTING 25

6

DISTRIBUTION OF CASES ACCORDING TO

MEDICINES 26

7

DISTRIBUTION OF CASES ACCORDING TO

POTENCY 28

8 DISTRIBUTION OF CASES ACCORDING TO DOSE 29

9

DISTRIBUTION OF CASES ACCORDING TO SCORE

CHART 30

10

DISTRIBUTION OF CASES ACCORDING TO

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LIST OF CHARTS

Sl.

No Description Page No

1. DISTRIBUTION OF CASES ACCORDING TO AGE 22

2. DISTRIBUTION OF CASES ACCORDING TO SEX 23

3.

DISTRIBUTION OF CASES ACCORDING TO

OCCUPATION 24

4.

DISTRIBUTION OF CASES ACCORDING TO

PLACE OF DWELLING 25

5.

DISTRIBUTION OF CASES ACCORDING TO

FACTORS AFFECTING 26

6.

DISTRIBUTION OF CASES ACCORDING TO

MEDICINES 27

7.

DISTRIBUTION OF CASES ACCORDING TO

POTENCY 28

8. DISTRIBUTION OF CASES ACCORDING TO DOSE 29

9.

DISTRIBUTION OF CASES ACCORDING TO SCORE

CHART 31

10.

DISTRIBUTION OF CASES ACCORDING TO

REMARKS 32

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LIST OF ABBREVIATIONS

SL

NO ABBREVIATIONS EXPLANATION

1. B.P Blood Pressure

2. % Percentage.

3. < Aggravation, more than.

4. > Amelioration, less than.

5. A/F Ailment from.

6. Agg. Aggravation.

7. F Female.

8. M Male

9. H/O History of.

10. FMP First Menstrual Period

11. LMP Last Menstrual Period

12. Lab. Investigation Laboratory investigation.

13. NAD Nothing abnormality detected.

14. O/E On examination.

15. SD Standard Deviation

16. SL Saccharum Lactis

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LIST OF APPENDICES

SL. NO: APPENDICES PAGE NO:

1. Appendix I–Glossary

49

2. Appendix II-Case Record Format

51

3. Appendix III- Score chart

61

4. Appendix IV – Case Record 63

5. Appendix V – Master Chart 92

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1.1 INTRODUCTION

Neck pain, which usually arises from diseases of the cervical spine and soft tissues of the neck, is common. “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. It covers the pathology in spine as well as the neurological syndrome associated with it.

In earlier times, people used to get affected beyond the age of 60. Nowadays, intensive use of computers and mobile phones by the young population has caused this age to come down. Even people in their 20s and 30s are affected by cervical

spondylosis.

Degeneration of disc results in reduction of disc space and pheriperal osteophyte

formation. The posterior intervertebral joints gets secondly involved and generate pain in neck. The osteophytes impinging on the nerve roots give rise to radicular pain in the upper limb. Spondylosis occur more commonly in the lowest three cervical

intervertebral joints(C5-C6).

The main symptoms in cases of cervical spondylosis are related to the neck area.

There is stiffness of the muscles of the neck and shoulder region. Pain is felt in the nape of the neck. This pain can extend upwards to back of the head or even up to the eyes. In some cases, this pain travels to the shoulders, arms and even down to the fingers.

Some patients feel vertigo which is a sensation as if the head is spinning or the surroundings are spinning. Dizziness may be felt. There is a spasm of the muscles at

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Homoeopathy offers a very effective method in management of pain in case of cervical spondylosis. The medicine is prescribed according to the totality of the

symptom. LM potencies had done many wonders in clinical condition. Hence the study has been taken to understand the role of LM in the pain management of cervical

spondylosis.

1.2. NEED AND SIGNIFICANCE OF THE STUDY

Now a days we can see that number of persons are affected with cervical

spondylosis. This is because of their change of life situation and carelessness about healthy mode of living brings about this. I have seen number of persons reporting to the

O.P with cervical spondylosis. I want to state that LM potencies have major scope in management of pain of cervical spondylosis.

Being this is the latest and new method of dynamization it will be evident that

this study helps to know about the LM potency in the pain management of cervical spondylosis.

1.3. SCOPE OF THE STUDY:

The normal practice in the Allopathic system is to treat neck pain with the usual painkillers. In cases where patients feel vertigo or some dizziness, some medicines are

prescribed to contain the vertigo that is often present with the pain. Traction is often provided as another short-term measure. All these measures are short term only and do

not help much. Wearing a collar is often recommended by doctors. Some patients get short term relief from restricting movement by the use of a collar. This cannot help them for long. Restricting the use of neck muscles for long tends to reduce the strength

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weak and are unable to provide the requisite support to the neck and the head. This in itself starts causing pain. Therefore, the use of collar should be minimal and done only

when there is acute pain. Its use should be stopped at the earliest.

In most cases of spondylotic radiculopathy, the results of conservative treatment are so favorable that surgical intervention is not considered unless pain persists or

unless there is progressive neurologic deficit.

In homeopathic practice, we have a vast scope in acute management as well as

long term relief could be given to the patient.

LM potencies is most flexible of all the ways of doing homoeopathy. Frequent

repetition is permissible for even long lasting remedies. So this study will be helpful to know about the action of LM potency. This study helps to find out the common

medicines indicated for the management of pain in cervical spondylosis

1.4 STATEMENT OF THE PROBLEM:

CLINICAL STUDY

This study is done based on the patient’s symptoms which is collected from the OPD, IPD and Rural centers of Sarada Krishna Homoeopathy Medical College. This is

clinical study which is done from the collection of symptoms from the patient.

LM POTENCY

Hahnemann explains in the Aphorism 270 foot note, “This method of new

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the medicine is lessened with each dynamization (LM potency) 50,000 times and yet incredibly increased in power”. It becomes evident that the material part by means of

such dynamization will ultimately dissolve into its individual spirit like essence.

CERVICAL SPONDYLOSIS

Cervical spondylosis is defined as the occurrence of osteoarthritis in the cervical spine. It is characterised by degeneration of the intervertebral discs and osteophyte formation. It is more common in old age group. It may be associated with neurological

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2. AIMS AND OBJECTIVES

i) To know the various factors affecting Cervical Spondylosis.

ii) To know the various medicines of Cervical Spondylosis.

iii) To know about the use of LM potency in pain management of Cervical

Spondylosis.

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3. REVIEW OF LITERATURE

DEFINITION:

Cervical spondylosis is a chronic degenerative process of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck, and may progress into disk herniation, bone spur formation, compression of the spinal cord, or cervical

spondylotic myelopathy. Like the rest of the body, the disks and joints in the neck (cervical spine) slowly degenerate as we age.[1] Cervical spondylosis is a disorder of

age-related wear affecting the disks and vertebrae of cervical spine.[2] The most commonly affected roots are C5,6,7.[3]

CERVICAL VERTEBRAE:

The seven cervical vertebrae are characterized by their small size and by the presence of a foramen in each transverse process. A typical cervical vertebra has the

following features:

 the vertebral body is short in height and square shaped when viewed from above

and has a concave superior surface and a convex inferior surface;

 each transverse process is trough-shaped and perforated by a round foramen transversarium;

 the spinous process is short and bifid;

The vertebral foramen is triangular in shape.

The first and second cervical vertebrae-the atlas and axis-are specialized to accommodate

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The cervical vertebrae are readily identified by the foramen transversarium perforating the transverse processes. This foramen transmits the vertebral artery, the vein, and sympathetic nerve fibres. The spines are small and bifid (except C1 and C7 which are

single) and the articular facets are relatively horizontal. The atlas (C1) has no body. Its

upper surface bears a superior articular facet on a thick lateral mass on each side which articulates with the occipital condyles of the skull.

Just posteriorly to this facet, the upper aspect of the posterior arch of the atlas is

grooved by the vertebral artery as it passes medially and upwards to enter the foramen magnum. The axis (C2) bears the dens (odontoid process) on the superior aspect of its body, representing the detached centrum of C1. Nodding and lateral flexion movements

occur at the atlanto-occipital joint, whereas rotation of the skull occurs at the atlanto-axial joint around the dens, which acts as a pivot.

C7 is the vertebra prominens, so called because of its relatively long and easily felt non-bifid spine; it is the first clearly palpable spine on running one’s fingers

downwards along the vertebral crests, although the spine of T1 immediately below it is, in fact, the most prominent one. The vertebral artery enters its vertebral course nearly always at the foramen transversarium of C6; it is not surprising, therefore, that the

foramen of C7, which transmits only the vein, is small or even sometimes absent.

Intervertebral discs are found between the bodies of adjacent vertebrae from the

second cervical vertebra to the sacrum and account for about 25% of the height of the vertebral column. Each disc has an outer fibrous ring consisting of fibrocartilage called

the annulus fibrosus (annulus – ring like) and an inner soft, pulpy, highly elastic

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joints, permit various movements of the vertebral column, and absorb vertical shock. Under compression, they flatten and broaden. During the course of a day the discs

compress so that we are a bit shorter at night. While we are sleeping there is less compression so that we are taller when we awaken in the morning. With age, the nucleus

pulposus hardens and becomes less elastic. Narrowing of the discs and compression of vertebrae results in a decrease in height with age.

Since intervertebral disc are avascular, the annulus fibrosus and nucleus pulposus

rely on blood vessels from the bodies of vertebrae to obtain oxygen and nutrients and remove wastes. Certain stretching exercises, such as yoga, decompress discs and increase

blood circulation, both of which speed up the uptake of oxygen and nutrients by discs and the removal of wastes[4].

ICD – 10 CLASSIFICATION

WHO has listed spondylosis under the code M47[5]

M47.012 – anterior spinal artery compression syndrome, cervical region M47.022 – vertebral artery compression syndrome, cervical region

M47.12 – spondylosis with myelopathy, cervical region M47.22 – spondylosis with radiculopathy, cervical region

M47.812 – spondylosis without myelopathy or radiculopathy, cervical region

M47.892 – other spondylosis, cervical region

DEFINITION OF PAIN:

Neck pain, which usually arises from diseases of the cervical spine and soft tissues of the neck, is common. “SPONDYLO” is a Greek word meaning vertebra and

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degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues. It is more common in both sexes and in older ages. [3,6]

CAUSES

Cervical spondylosis is caused by chronic wear on the cervical spine.

Age: By the age of 50 years, it affects 50% of the population. In males, the prevalence was 13% in, 3rddecade to 100% by 70 yrs. In females, it ranged from 5% in 4th decade to 96%, above 70 years. Middle-aged people and women are

more prone to cervical spondylosis.Patients usually over 40 years of age.[7]Cervical Spondylosis occur in younger individuals due to sudden protrusion

of cervical disc.[8]

Trauma: The role of trauma in spondylosis is controversial. Repetitive, subclinical trauma probably can cause spondylosis.

Work activity - Cervical spondylosis is significantly higher in office workers who work for long hours looking down while at work.[8]

Geneticsmay play a role in the development of cervical spondylotic myelopathy (CSM).

PATHOLOGY:

The water content of the nucleus bulbosus and annulus fibrosus decline progressively with advancing age. Hence the deformability of the disc with changing

postures is limited. The disc degenerates and the disc space is narrowed.

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osteophytes or spurs. These osteophytes may arise from anterior, lateral or posterior margin of vertebral bodies. The posterior osteophytes encroach upon the spinal canal by

the lateral spurs extend in to intervertebral phenomenon.

There is fibrosis of dural sleeves around the nerve roots. The ligamentum flavum

may be hypertrophied and buckle in to the spinal canal during neck extension. The posterior facet joints are involved late in the process attrition of their disc lead to instability of vertebra.

Osteophytes from these joints may also impinch upon the intervertebral foramina and the spinal canal. Spondylosis occur more commonly in the lowest three cervical

intervertebral joints(C5-C6).[10] PATHOLOGICAL CHANGES: INTERVERTEBRAL DISC

 Annulus fibrosis become coarser, the collagen fibre tend to separate.

 Nucleus fibrosis loses fluid and become more fibrous. VERTEBRAL BODIES

 Lipping of vertebral bodies occurs[11]

 Due to alteration of this mechanic producing traction of the periosteum by the attachment of annulus fibrosis

 Decalcification within the bodies with predispose to crush fracture LIGAMENTS

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11 MENINGEAL SLEEVES

 Subdural matter of the spinal cord forms a sleeve round the nerve root and this undergoes the inflammatory changes because as the disc space narrows there is diminished lumen of the intervertebral canal

APOPHYSEAL JOINTS

 Osteophytes forms at the margin of articular surfaces and these together with the capsular thickening can cause pressure on the nerve root and reduce the lumen of the intervertebral foramen.

SIGNS & SYMPTOMS:

The C4/5, C5/6 and C6/7 vertebral levels and C5, C6 and C7 are most commonly affected.

PATIENTS PRESENT WITH:

1. Pain and stiffness of neck which is recurrent and is aggravated by anxiety,

tension, posture, morning[12]

- Neck pain with radiation up into the occiput, out over the shoulder or down the thorax over the scapula.

- Radicular pain secondary to osteophytic impingement and narrowing of an exit foramen (Radicular pain radiating down one or both arms and which may or may not be associated with muscle wasting, weakness and reflex changes).

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o Transverse lesion syndrome - Corticospinal and spinothalamic tracts, as well

as the posterior columns, are involved.

o Motor syndrome - This primarily involves the corticospinal or anterior horn

cells.

o Central cord syndrome - Motor and sensory involvement is greater in the

upper extremities than the lower extremities.

o Brown-Séquard syndrome - Unilateral cord lesion with ipsilateral

corticospinal tract involvement and contralateral analgesia are present below

the level of the lesion.

o Brachialgia and cord syndrome - Predominant upper limb pain is present, with

some associated long-tract involvement.

o Lower motor neuron sign including weekness,wasting and reflex impairment.[3]

1. Compression of cervical cord, which may produce

 Weakness, wasting and fibrillation in the upper limb with reduction or loss of tendon reflexes at the level of cord compression.

 Paraesthesia in the arms and legs with or without impaired sensation in the hands and feet.

 Pyramidal tract involvement with weakness, spasticity, hyper reflexia and extensor plantar responses in the feet.[12]

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3. Vertebro basilar ischaemia – often rotation to one or other side or extension of the neck and less frequently flexion may precipitate a brief attack of giddiness or a drop

attack. Probably pressure on the vertebral arteries with consequent impairment of the blood supply of the hindbrain.

SYMPTOMS

 Cervical pain aggravated by movement.

 Referred pain (occiput, between the shoulder blades, upper limbs)

 Retro orbital or temporal pain (from C1 to C2)

 Tingling, numbness and weakness in your arms, hands, legs or feet[14]

 Cervical stiffness – reversible or irreversible  Dizziness or vertigo[15]

 Poor balance

 Occipital headache usually in the morning.[16]

 Rarely syncope PHYSICAL SIGNS:

SPURLINGS TEST

PROCEDURE – the patient is seated with the head rotated and tilted to one side. The

examiner stands behind the patient eth one hand placed on the patients head. With the other hand the examiner lightly taps (compresses) the hand resting on the patients head.

With the patients tolerate this initial step of the test, it is then repeated with the cervical spine extended as well.

ASSESSMENT – this test provides clinical evidence of both the facet syndrome

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the examination is intensify the pain. Simultaneous extension of the cervical spine narrows the inter vertebral foramina by 20-30%. Existing radicular pain will be increased

by the movement.

LHERMITTE'S PHENOMENON[17]

An electric-shock-like sensation radiates down the trunk and limbs when the neck is flexed. This indicates a cervical cord lesion. Lhermitte's sign is common in acute exacerbations of multiple sclerosis. It also occurs in cervical spondylotic myelopathy,

subacute combined degeneration of the cord, radiation myelopathy, and occasionally in cord compression.

HOFFMAN’S SIGN[17]

Hold the patient’s third digit at the proximal interphalangeal joint and briskly flick the third distal phalanx. If the interphalangeal joint of the thumb or the distal

interphalangeal joint of the index finger of the same hand flexes, the patient has a positive Hoffman’s sign. The presence of hyperreflexia is also a sign of an upper motor neuron

lesion.

SHOULDER ABDUCTION RELIEF SIGN-

Abduction of shoulder relieves pain in cervical spondylosis.[18]

INVESTIGATIONS:

X-RAY OF CERVICAL SPINE : Plain cervical radiography is routine in every

patient with suspected cervical spondylosis.

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In select circumstances, flexion-extension views may be needed to detect instability.

- Lateral view shows the loss of normal lordosis[19], diminution in the disc space and growth of osteophytes.[20]

- Oblique view shows the protruding osteophytes in to intervertebral foramina.

- Lipping is also evident.[21] MAGNETIC RESONANCE IMAGING SCAN of the neck

- MRI is the very important investigation if available.[22]

- Indentation of the thecal sac, hardening of the intervertebral disc, foraminal narrowing and facet arthropathy.

- False-positive and false-negative MRI results occur frequently in patients with cervical radiculopathy; therefore,

MRI results and clinical findings should be used when

interpreting root compression.

CONTRAST MYELOGRAM

- Shows protrusion of disc in to thecal sac as negative shadow with total extradural obstruction.

EMG and NERVE CONDUCTION VELOCITY TEST

- Done to examine nerve root function[3]

GENERAL MANAGEMENT:

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- Control stiffness of the soft tissues and joints.

- Assist mobility

 MASSAGE – deep and sedative massage manipulations like effleuroage, circular kneading as well as frictions to the localised areas effectively reduces the spasm and pain and thereby induce relaxation.

 Exercises -Neck stretch, neck tilt,, neck turn[23]

 Cervical traction

 Manipulation

 Cervical collar is highly effective as it minimizes neck movement and relieves symptoms.[24]

 Postural and ergonomic advice[25]

 Surgical intervention – if pain persists or unless there is progressive neurologic deficit.

HOMOEOPATHIC MANAGEMENT:

To understand the homoeopathic concept of Cervical spondylosis, The

classification of disease should be known. Hahnemann classified the disease mainly into three types – Indisposition, Dynamic and surgical diseases. Dynamic diseases are again classified into acute and chronic diseases. Cervical Spondylosis comes under Chronic

diseases.[26] LM POTENCY:

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LM 0/1 to 0/30.In some ways, the LM potencies possess many of the positive qualities of both low and high potencies in balance.

The lower degrees of the LM potency are deeper acting then the 6c to 30c but they are also more gentle than 200c or 1M on the constitution. They reach a depth of cure without

producing the overly strong primary actions and rapid aggravations like the high Cs. They have the stability and consistency of the low potency C's but the power to cure deep chronic diseases and miasms like the high potencies.

One can tell from Hahnemann's Paris journals that the Founder considered the LM 0/1 a higher potency than 30c as he sometimes started people with a 30c for the acute and then

switched to the LM potency for the chronic conditions.

The LMs are not a "low potency" remedy that can be given daily or every other day for weeks in some mechanical fashion. They aggravate just like all other homoeopathic

remedies if misused.

The LM potency has the best qualities of the high and low potency without the aggressive

primary actions of the Cs.If the patient will over react to the action of potencies higher then 30c it is best to use the lower potency Cs like 6c, 12c, 24c, 30c. I tend to use the lower centesimal potencies in medicinal solution and the split-dose where I fear

aggravations, pathology, and crisis. Then I work my way up to the 30c and change to the LM 0/1 and go through the LM scale.

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casebooks many years later. Homoeopathic medicines in LM potencies are better than CM potencies for the pain management of Cervical Spondylosis.[27]

Hahnemann explains in the Aphorism 270 foot note, “This method of new

dynamization, I have found after many laborious experiments and counter experiments,

to be the most powerful and at the same time the mildest in action, the material part of the medicine is lessened with each dynamization (LM potency) 50,000 times and yet incredibly increased in power”. It becomes evident that the material part by means of

such dynamization will ultimately dissolve into its individual spirit like essence.[28]

Hahnemann use to write it as 0/1,0/2,0/3,0/4…………..0/30. At present a new style of writing is LM/1,LM/2,LM/3……. etc. which is more scientific.[29]

ADVANTAGES OF 5O MILLESIMAL POTENCY:

LM potencies is most flexible of all the ways of doing homoeopathy.

This potency is best for treating hypersensitive people.

It is also best for treating chronic diseases, severe pathologies and miasm.

Hahnemann says “Highest development of power and mildest in action”.

Medicines of LM potency are milder in reaction.

Frequent repetition is permissible for even long lasting remedies.

The course of treatment can be minimized to half quarter or even more less than

that of centesimal potency.[27]

RESEARCH STUDIES

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19

Randomized exploratory clinical study conducted by Central Council for Research in Homoeopathy during June 2009-June 2010

A multicenter prospective randomized clinical pilot study was conducted by Central Council for Research in Homoeopathy as its three centres during June 2009-June

2010.Out of 148 patients screened,56 patients were enrolled and randomized as per the pre-set inclusion criteria. However 54 patients,LM group (n=28) and CM group (n=26) were analyzed. Pain was assessed using visual analog scale. The primary end point for

pain is 1 to 60 days was calculated using Area under the curve method. Secondary outcome was to assess the quality of life using WHO QoL Bref questionnaire. Medicines

were prescribed to the enrolled patients on the basis of their totality of symptoms and according to principles of Homoeopathy. Area under Curve for pain was significantly less in the LM group[Median (IQR): 112(86 to 299); p=0.007] after the prescription of

Homoeopathic medicines. Overall quality of life of the patients after homoeopathic medications showed significant improvement in the WHO-BREF domains: Physical,

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20

4. MATERIALS & METHODS

4.1. SOURCE OF DATA

A sample of 30 cases with Pain of Cervical Spondylosis with LM potencies taken from Sarada Krishna Homoeopathic Medical College Hospital OPD, IPD and from Peripheral Centre for homoeopathic treatment will be randomly selected for the study.

4.2. METHOD OF COLLECTION OF DATA

Sample size:Minimum 30 cases.

Sampling technique: Purposive Sampling.

4.3. INCLUSION CRITERIA

 Samples on both sexes.

 Diagnostic criteria mainly based on the Clinical Presentation. In suspected cases ECG will be done to rule out the cardiac ailments.

4.4. EXCLUSION CRITERIA

 Samples below 30 and above 70yrs of age in both sexes.

 Cases with malignant diseases.

 Cases with other joint diseases.

 Cases complicated with other systemic disorders.

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21 4.5. METHODOLOGY

 Selection of 30 cases of patients with Pain of Cervical Spondylosis is carried out from OPD, IPD and from peripheral centers of Sarada Krishna Homoeopathic

Medical College.

 The cases will be analyzed and evaluated. It is repertorised and a well selected remedy will be prescribed after referring the Materia Medica.

 Potency and repetition of doses will be done based on the homoeopathic principles.

 Assessment will be done once in a week or two weeks and the changes will be recorded.

 Life style management will also be advised to patients.

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22

5.1 OBSERVATION AND RESULTS

In this section the investigator is informing the observation and findings of this study.

5.1.1. TABLE 1: DISTRIBUTION OF CASES ACCORDING TO AGE

S.NO AGE CASES PERCENTAGE

1 30-40 11 36.67%

2 41-50 8 26.67%

3 51-60 6 20%

4 61-70 5 16.67%

Chart No-1

FINDINGS:

Out of 30 cases studied 36.67% (11 cases) are between the age group 30-40 years, 26.67% (8 cases) are between the age group 41-50 years, 20% (6 cases) are between the age group 51-60 years and 16.67% (5 cases) are between 61-70 years. Maximum prevalence of

Cervical Spondylosis was noted in the age group of 30-40years (36.67%).

11

8

6

5

36.67% 26.67% 20% 16.67%

0 2 4 6 8 10 12

30-40 41-50 51-60 61-70

DISTRIBUTION OF CASES ACCORDING TO AGE

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23

5.1.2. TABLE 2: DISTRIBUTION OF CASES ACCORDING TO SEX

S.NO SEX CASES PERCENTAGE

1 MALE 8 26.67%

2 FEMALE 22 73.33%

Chart No-2

FINDINGS:

Out of 30 cases studied, 22 were females and 8 were males, i.e. 73.33% of patients are female and 26.67% of patients are males. So females are highly affected by Cervical Spondylosis.

5.1.3. TABLE NO 3: DISTRIBUTION OF CASES ACCORDING TO OCCUPATION

S.NO OCCUPATION CASES PERCENTAGE

1 HOUSEWIFE 17 56.67%

2 COOLIE 4 13.33%

3 TAILOR 3 10%

4 DRIVER 2 6.67%

8 26.67%

22 73.33%

DISTRIBUTION OF CASES ACCORDING TO SEX

CASES

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24

5 MASON 1 3.33%

6 FARMER 1 3.33%

7 BUSINESS 1 3.33%

8 FIBER

MANUFACTURER

1 3.33%

Chart No-3

FINDINGS:

Out of 30 cases, 17 (56.67%) are Housewife, 4(13.33%) are Coolies, 3(10%) are Tailors,

2(6.67%) are drivers, and 1(3.33%) are Mason, Farmer, Business, Fiber Manufacturer. So the Housewifes are predominantly affected with Cervical Spondylosis.

5.1.4. TABLE NO 4: DISTRIBUTION OF CASES ACCORDING TO PLACE OF DWELLING

S.NO PLACE OF DWELLING

CASES PERCENTAGE

1 URBAN 7 23.33%

17 4 3 2 1 1 1 1 56.67% 13.33% 10% 6.67% 3.33% 3.33% 3.33% 3.33%

0 2 4 6 8 10 12 14 16 18

HOUSEWIFE COOLIE TAILOR DRIVER MASON FARMER BUSINESS FIBER MANUFACTURER

DISTRIBUTION OF CASES ACCORDING TO

OCCUPATION

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25

2 RURAL 23 76.67%

Chart No-4

FINDINGS:

Out of 30 cases, 7 (23.33%) are from Urban area, and 23(76.67%) are from Rural areas. So the Urban area peoples are predominantly affected with Cervical Spondylosis.

5.1.5. TABLE NO 5: DISTRIBUTION OF CASES ACCORDING TO FACTORS AFFECTING

S.NO FACTORS

AFFECTING

CASES PERCENTAGE

1 OCCUPATION 15 50.00%

2 AGE 11 36.67%

3 COLD

EXPOSURE

9 30%

4 TRAUMATIC 7 23.33%

5 TRAVEL 2 6.67%

0 5 10 15 20 25

CASES PERCENTAGE

7 23.33%

23 76.67%

DISTRIBUTION OF CASES ACCORDING TO PLACE

OF DWELLING

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26 Chart No-5

FINDINGS:

Out of 30 cases, 15 (50%) by Occupation factor, 11(36.67%) by Age factor, 9(30%) due to exposure to cold, 7(23.33%) by Traumatic factors, and 2(6.67%) by Travel. So the factor

predominantly affects Cervical Spondylosis is Occupation.

5.1.6. TABLE NO 6: DISTRIBUTION OF CASES ACCORDING TO MEDICINES

S.NO MEDICINE CASES PERCENTAGE

1 LYCOPODIUM

CLAVATUM

6 20.00%

2 NUX VOMICA 4 13.33%

3 NATRUM MURIATICUM 4 13%

4 CALCAREA

CARBONICA

3 10.00%

5 KALI CARBONICUM 3 10.00%

6 RHUSTOXICODENDRON 2 6.67%

15

11

9

7

2

50.00% 36.67% 30% 23.33% 6.67%

0 2 4 6 8 10 12 14 16

OCCUPATION AGE COLD EXPOSURE TRAUMATIC TRAVEL

DISTRIBUTION OF CASES ACCORDING TO

FACTORS AFFECTING

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27

7 SEPIA OFFICINALIS 2 6.67%

8 SULPHUR 2 6.67%

9 CAUSTICUM 1 3.33%

10 IPECACUANHA 1 3.33%

11 GRAPHITES 1 3.33%

12 LACHESIS 1 3.33%

Chart No-6

FINDINGS:

According to the study, 6 (20%) cases were treated with LYCOPODIUM CLAVATUM ,

4 (13.33%) cases were treated with NUX VOMICA, 4 (13%) cases with NATRUM MURIATICUM, 3 (10%) cases with CALCAREA CARBONICA, 3 (10%) cases with

KALI CARBONICUM, 2 (6.67%) cases with RHUSTOXICODENDRON, 2 (6.67%) cases with SEPIA OFFICINALIS, 2 (6.67%) case with SULPHUR, 1 (3.33%) case with

6 4 4 3 3 2 2 2 1 1 1 1 20.00% 13.33% 13% 10.00% 10.00% 6.67% 6.67% 6.67% 3.33% 3.33% 3.33% 3.33%

0 1 2 3 4 5 6 7

LYCOPODIUM CLAVATUM NUX VOMICA NATRUM MURIATICUM CALCAREA CARBONICA KALI CARBONICUM RHUSTOXICODENDRON SEPIA OFFICINALIS SULPHUR CAUSTICUM IPECACUANHA GRAPHITES LACHESIS

DISTRIBUTION OF CASES ACCORDING TO MEDICINE

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28

CAUSTICUM, 1 (3.33%) case with IPECACUANHA, 1 (3.33%) case with GRAPHITES, 1 (3.33%) case with LACHESIS. From this it is noted that LYCOPODIUM CLAVATUM

(6cases) and NUX VOMICA (4cases), NATRUM MURIATICUM (4cases) more indicated for Cervical Spondylosis.

5.1.7. TABLE NO 7: DISTRIBUTION OF CASES ACCORDING TO POTENCY

S.NO POTENCY CASES PERCENTAGE

1 0/1 2 6.67%

2 0/3 28 93.33%

Chart No-7

FINDINGS:

In this study of 30 cases which had been treated with 2 different potencies, they are 0/1, and 0/3. In that 0/3 potency given in 28 (93.33%) cases, 0/1 for 2 (6.67%) cases. Thus from this it is clear that in Cervical Spondylosis 0/3 potency is more indicated.

0/1 0/3

0 10 20 30

CASES PERCENTAGE

2

6.67% 28

93.33%

DISTRIBUTION OF CASES ACCORDING TO POTENCY

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29

5.1.8. TABLE NO 8: DISTRIBUTION OF CASES ACCORDING TO DOSE

S.NO DOSE CASES PERCENTAGE

1 DAILY 20 66.67%

2 WEEKLY 10 33.33%

Chart No-8

FINDINGS:

In this study of 30 cases 2 different doses were given, they are daily, and weekly. In that

daily dose given to 20 (66.67%) cases, weekly dose for 10 (33.33%) cases. Thus from this it is clear that in Cervical Spondylosis daily dose is more effective.

20 66.67%

10 33.33%

DISTRIBUTION OF CASES ACCORDING TO DOSE

CASES

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30

5.1.9. TABLE NO 9: DISTRIBUTION OF CASES ACCORDING TO SCORE CHART

S.NO BEFORE

SCORE

AFTER SCORE

1 3 1

2 3 1

3 3 2

4 3 1

5 3 2

6 3 2

7 3 2

8 3 2

9 3 1

10 3 2

11 3 2

12 3 2

13 3 1

14 3 2

15 3 2

16 3 2

17 3 1

18 3 2

19 3 2

20 3 2

21 3 2

22 3 2

23 3 2

24 3 2

25 3 1

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31

27 3 1

28 3 1

29 3 2

30 3 1

Chart No-9

FINDINGS:

In all the thirty cases studied there was a marked improvement in the scores before and

after treatment. In all the cases the intensity of the symptoms has markedly reduced.

5.1.10. TABLE NO 10: DISTRIBUTION OF CASES ACCORDING TO REMARKS

S.NO REMARKS CASES PERCENTAGE

1 MILD

IMPROVEMENT

5 16.67%

2 MODERATE

IMPROVEMENT

12 40%

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

1 1 2

1

2 2 2 2

1 2 2 2

1 2 2 2

1

2 2 2 2 2 2 2

1 2 1 1 2 1 0 0.5 1 1.5 2 2.5 3 3.5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

DISTRIBUTION OF CASES ACCORDING TO SCORE

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32

3 MARKED

IMPROVEMENT

13 43.33%

Chart No-10

FINDINGS:

Out of 30 cases, 13 (43.33%) has Marked improvement, 12(40%) has Moderate improvement, and 5(16.67%) has Mild improvement.

5.2. SUMMARY OF FINDINGS

The result is based on the observation and outcome of 30 cases under study and

interpretation was done based on statistics. The following findings been drawn from the study.

 Maximum prevalence of Cervical Spondylosis was noted in the age group of 30-40years (36.67%).

5

12 13

DISTRIBUTION OF CASES ACCORDING TO

REMARKS

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33

 Females are highly affected by Cervical Spondylosis.

 Housewifes are predominantly affected with Cervical Spondylosis.

 Urban area peoples are predominantly affected with Cervical Spondylosis.

 The factors predominantly affects Cervical Spondylosis is Occupation.

 LYCOPODIUM CLAVATUM (6cases) and NUX VOMICA (4cases), NATRUM MURIATICUM (4cases) are more indicated for Cervical

Spondylosis.

 0/3 potency is more indicated in Cervical Spondylosis.

 Daily dose is more effective in Cervical Spondylosis.

 In all the thirty cases studied there was a marked improvement in the scores before and after treatment. In all the cases the intensity of the symptoms has markedly

reduced.

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34

5.3. STATISTICAL ANALYSIS

X Y d = X -Y d-d̅ (d-d̅)2

3 1 2 0.67 0.4489

3 1 2 0.67 0.4489

3 2 1 -0.33 0.1089

3 1 2 0.67 0.4489

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 1 2 0.67 0.4489

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 1 2 0.67 0.4489

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 1 2 0.67 0.4489

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

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35

3 2 1 -0.33 0.1089

3 2 1 -0.33 0.1089

3 1 2 0.67 0.4489

3 2 1 -0.33 0.1089

3 1 2 0.67 0.4489

3 1 2 0.67 0.4489

3 2 1 -0.33 0.1089

3 1 2 0.67 0.4489

Total ∑d = 40 ∑(d-)2=6.667

X= Score before treatment

Y= Score after treatment d= Mean

d̅ = Mean difference

A. Null Hypothesis:

There is no difference between the scores before and after the Homoeopathic

Treatment.

B. Alternate Hypothesis:

There is difference between the scores before and after the Homoeopathic treatment.

C. Standard error of the mean differences: The mean of difference, d̅ = Σd /n =40/30 = 1.33

The estimate of population standard deviation is given by, S.D2= Σ (d-d̅) 2/ (n-1)

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36 = 0.23

Standard error (S.E) =√ S.D2/n =√ 0.23/30 = √0.008=0.089

Critical ratio =t = d̅ Sd/√n

= 1.33/ 0.089 = 14.94

D. Comparison with tabled value:

This critical ratio, t follows a distribution with n-1 degrees of freedom. The 5% level is 2.045 and 1% level is 2.756 for 29 degrees of freedom. Since the

calculated value 14.49 is greater than tabled value at 5% and 1% level, the test is statistically significant and hence the null hypothesis is rejected.

E. Inference:

This study provides an evidence to show that there is significant reduction in the disease intensity scores after administering the homoeopathic remedies. Hence,

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D

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37

6. DISCUSSION

The subjects of the study were selected from those patients with Cervical

Spondylosis who attended the Out Patient Department, In Patient Department and Rural Health Centers of Sarada Krishna Homoeopathic Medical College, as per the inclusion criteria. A total 30 cases detail were recorded in pre structured case record

format. Then the cases were analyzed and the totalities were erected. The medicine been prescribed on the consideration of totality of symptoms. Improvement is noted

based on the general and symptomatic relief of the patient. For clinical assessment before and after treatment, symptom assessment scores were used. Pre-treatment score and after treatment score was calculated, then paired ‘t’ test was applied to test the

level of significance. This study been conducted to know the role of LM potency in management of pain in Cervical Spondylosis, and thus the treatment of cases been

done.

Based on the analysis from 30 cases of Cervical Spondylosis, following

observations are made.

AGE:

Out of 30 cases studied 36.67% (11 cases) are between the age group 30-40

years, 26.67% (8 cases) are between the age group 41-50 years, 20% (6 cases) are between the age group 51-60 years and 16.67% (5 cases) are between 61-70 years. Maximum prevalence of Cervical Spondylosis was noted in the age group of

30-40years (36.67%). Somen Das in his A Concise Textbook of surgery says that Cervical Spondylosis starts in the age of 3rd decade and this study also proves that

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38 SEX:

Out of 30 cases studied, 22 were females and 8 were males, i.e. 73.33% of

patients are female and 26.67% of patients are males. So females are highly affected by Cervical Spondylosis. Somen Das in his A Concise Textbook Of Surgery says that females are more prone to get Cervical Spondylosis and this study also proves that

females are more affected.

OCCUPATION:

Out of 30 cases, 17 (56.67%) are Housewife, 4(13.33%) are Coolies, 3(10%) are Tailors, 2(6.67%) are drivers, and 1(3.33%) are Mason, Farmer, Business, Fiber

Manufacturer. So the Housewifes are predominantly affected with Cervical Spondylosis. The Textbook of Surgery by the Association of surgeons of India says that who works for long hour will affect Cervical Spondylosis and this study also says

that Housewife who works for longer hour is affected with Cervical Spondylosis.

PLACE OF DWELLING:

Out of 30 cases, 7 (23.33%) are from Urban area, and 23(76.67%) are from

Rural areas. So the Urban area peoples are predominantly affected with Cervical Spondylosis. This study shows that people in rural area is affected more by Cervical

Spondylosis due to their long term working.

FACTORS AFFECTING:

Out of 30 cases, 15 (50%) by Occupation factor, 11(36.67%) by Age factor, 9(30%) due to exposure to cold, 7(23.33%) by Traumatic factors, and 2(6.67%) by Travel. So the factor predominantly affects Cervical Spondylosis is Occupation. The

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39

long hour will affect Cervical Spondylosis and this study also says that Occupation is

the majot factor that affects Cervical Spondylosis.

MEDICINE:

According to the study, 6 (20%) cases were treated with LYCOPODIUM

CLAVATUM , 4 (13.33%) cases were treated with NUX VOMICA, 4 (13%) cases with NATRUM MURIATICUM, 3 (10%) cases with CALCAREA CARBONICA, 3 (10%) cases with KALI CARBONICUM, 2 (6.67%) cases with

RHUSTOXICODENDRON, 2 (6.67%) cases with SEPIA OFFICINALIS, 2 (6.67%) case with SULPHUR, 1 (3.33%) case with CAUSTICUM, 1 (3.33%) case with IPECACUANHA, 1 (3.33%) case with GRAPHITES, 1 (3.33%) case with

LACHESIS. From this it is noted that LYCOPODIUM CLAVATUM (6cases) and NUX VOMICA (4cases), NATRUM MURIATICUM (4cases) more indicated for

Cervical Spondylosis.

POTENCY:

In this study of 30 cases which had been treated with 2 different potencies, they are 0/1, and 0/3. In that 0/3 potency given in 28 (93.33%) cases, 0/1 for 2 (6.67%) cases. Thus from this it is clear that in Cervical Spondylosis 0/3 potency is

more indicated.

DOSE:

In this study of 30 cases 2 different doses were given, they are daily, and weekly. In that daily dose given to 20 (66.67%) cases, weekly dose for 10 (33.33%) cases. Thus from this it is clear that in Cervical Spondylosis daily dose is more

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40 SCORE CHART:

In all the thirty cases studied there was a marked improvement in the scores

before and after treatment. In all the cases the intensity of the symptoms has markedly reduced.

REMARKS:

Out of 30 cases, 13 (43.33%) has Marked improvement, 12(40%) has Moderate improvement, and 5(16.67%) has Mild improvement.

6.1. LIMITATIONS

1. Number of samples used in this study is very small. Therefore generalization of the result and inferences of the study need to be done cautiously.

2. There was no control group since the sample size was small.

6.2. RECOMMENDATIONS:

1. Bigger sample size with extended time of research would provide better results.

2. It will be always scientific if control (placebo) group would have been kept simultaneously to verify the effectiveness of treatment.

6.3SUGGESTION FOR FUTURE RESEARCH

1. As my study states that the pain of Cervical Spondylosis gets aggravated during the cold climate and exposure to the cold climate. There is no related

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C

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41

7. CONCLUSION

The sample for the study were constituted by thirty patients with Cervical

Spondylosis from In Patient, Out Patient and Rural Health Centers of Sarada Krishna Homoeopathic Medical College and Hospital and following conclusion were obtained

after statistical analysis.

This study helps to understand the role of LM potency in management of pain in cervical spondylosis and various medicine that helps in pain management of

Cervical Spondylosis, which is found by pain management chart.

In this study the maximum prevalence of Cervical Spondylosis was noted in the age group of 30-40years (36.67%). The cervical spondylosis starts merely at 30-40

years of age.

This study 30 cases states that females are highly affected with Cervical

Spondylosis.

From the study it shows that Housewifes are predominantly affected with

Cervical Spondylosis. Because of the suffering they could not able to do the day to day activities. Since it affects their usual works, the pain can be managed by

homoeopathy because this gives more trouble to the housewifes.

This study shows that persons of Rural areas are markedly affected by Cervical Spondylosis. These are due to their work activities and occupation of the

persons.

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42

In this study the most commonly used medicines were LYCOPODIUM CLAVATUM, NUX VOMICA and NATRUM MURIATICUM. The rest of cases

were treated with CALCAREA CARBONICA, KALI CARBONICUM, RHUSTOXICODENDRON, SEPIA OFFICINALIS, SULPHUR, CAUSTICUM,

IPECACUANHA, GRAPHITES, LACHESIS.

In this study of 30 cases treated with 2 different potencies, they are 0/1, and 0/3. In that 0/3 potency given in 28 (93.33%) cases, 0/1 for 2 (6.67%) cases. Thus

from this it is clear that in Cervical Spondylosis 0/3 potency is more indicated.

In all the thirty cases studied there was a marked improvement in the scores before and after treatment. In all the cases the intensity of the symptoms has markedly

reduced.

From this study out of 30 cases, 13 (43.33%) has Marked improvement,

12(40%) has Moderate improvement, and 5(16.67%) has Mild improvement. So this study shows that LM potency is most valuable in management of pain in Cervical

Spondylosis.

So from this study it is noted that most cases there is improvement in pain of

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43

8. SUMMARY

Cervical Spondylosis is one of the commonly seen diseases nowadays. The

study is made to manage the pain of Cervical Spondylosis in some extent with Homoeopathic medicine. The management for pain of Cervical Spondylosis is very much effective with Homoeopathic medicine.

The following objectives were fixed up for the study:

i) To know the various factors affecting Cervical Spondylosis. ii) To know the various medicines of Cervical Spondylosis.

iii) To know about the use of LM potency in pain management of Cervical Spondylosis

iv) To know the necessity of repetition of medicines in Cervical Spondylosis. 30 cases of patients with Cervical Spondylosis was selected randomly for the study from the OPD, IPD and rural health centers of Sarada Krishna Homoeopathic Medical College and Hospital. The case was taken according to the pre structured case

record format. The diagnosis was made according to the clinical presentation of Cervical Spondylosis. The case was analysed and the totality was erected. The medicine

was selected and prescribed according to the similarity in LM potency. The pain management score was analysed before and after the treatment. The symptomatic improvement was analysed by before and after treatment symptom score. The different

presentation and various medicines of Cervical Spondylosis was understood through this study. The factors that affects the Cervical Spondylosis was also understood through the study.

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44

The result is based on the observation and outcome of cases under study and interpretation was done based on statistics. The following findings been drawn from

the study.

 Maximum prevalence of Cervical Spondylosis was noted in the age group of 30-40years (36.67%).

 Females are highly affected by Cervical Spondylosis.

 Housewifes are predominantly affected with Cervical Spondylosis.

 Urban area peoples are predominantly affected with Cervical Spondylosis.

 The factors predominantly affects Cervical Spondylosis is Occupation.

 LYCOPODIUM CLAVATUM (6cases) and NUX VOMICA (4cases), NATRUM MURIATICUM (4cases) are more indicated for Cervical Spondylosis.

 0/3 potency is more indicated in Cervical Spondylosis.

 Daily dose is more effective in Cervical Spondylosis.

 In all the thirty cases studied there was a marked improvement in the scores before and after treatment. In all the cases the intensity of the symptoms has markedly reduced.

 Out of 30 cases, 13 (43.33%) has Marked improvement, 12(40%) has Moderate improvement, and 5(16.67%) has Mild improvement.

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45

9. BIBLIOGRAPHY

1. Cervical Spondylosis (Arthritis of the Neck) - OrthoInfo - AAOS [Internet].

[cited 2019 Apr 14]. Available from:

https://www.orthoinfo.org/en/diseases--conditions/cervical-spondylosis-arthritis-of-the-neck/

2. Wang C, Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis

decreases with aging in the elderly, and increases with aging in the young and adult population: a hospital-based clinical analysis. Clin Interv Aging. 2016 Jan

12;11:47–53.

3. Davidson Stanley. Davidson’s Principles and Practice of Medicine. 20th Edition. China: Churchill Livingstone Elsevier; 2006. p. 1221-1222, 1241-1242.

4. Gerard.J.Tortora, Bryan Derrickson. Principles of anatomy and physiology. 12th edition. p. 220

5. Switzerland. WHO. Alphabetical index, The International classification disease 10 International Statistical Classification Of Diseases and Related Health Problems. 2nd Edition. Geneva: WHO; 2004; Vol.3, 2004. p. 547.

6. Das.P.C. Textbook of Medicine: Nervous system. Kolkatta:Current Books International;Jan 2000 p.478-479.

7. Das Somen. The Spine and Pelvis. A Concise Textbook of Surgery. Fourth Edition: p. 517-518.

8. The Associations of Surgeons of India. Orthopaedic Surgery-I Diseases of Bones

and Joints. Textbook of Surgery: p. 953-954.

9. The Associations of Surgeons of India. Orthopaedic Surgery-I Diseases of Bones

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individualized LM-potencies versus Centesimal potencies for pain management of Cervical Spondylosis: A Multicentre Prospective Randomized exploratory

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APPENDIX I

GLOSSARY

1. Aggravation: A situation in which the patient feels worse from or symptoms are increased by a remedy.

2. Amelioration: An improvement of the patient or decrease in symptoms.

3. Dose: A dose is the quantity of drug or other therapeutic agent taken at a time or in fractional amounts within a stated period.

4. LM potency: LM potencies were developed by Dr. Samuel Hahnemann and introduced in the 6th edition of Organon of Medicine. In this scale the material part of medicine was decreased by 50,000 times for each degree of

dynamisation.

5. Miasm: Miasm is an influencing or infecting agent being a particular forms of

minute, invisible, animated being or specific to particular form of disease. 6. Potency: Potency is the degree of dilution that a homoeopathic remedy has

undergone in its manufacturing process. This is indicated by the number and

letters listed after the name of the remedy.

7. Potentization: Potentization is the process of minimising the toxic effects of the

crude drug substance and increasing its dynamic, curative property. Succussion and trituration are the methods involved.

8. Remedy: A medicine, application or treatment that relieves or cures a disease.

9. Repertorization: Repertorization is a method that is used to analyse the patient’s symptoms and thus compare the various medicines that may be appropriate.

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11.Totality: The aggregate of the characteristic symptoms in a case.

Figure

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