CRPS, RA and steroids
A homeopathic case by barbara a. munkel, dhomM, chomm
Classical homeopaths know that any correctly prescribed remedy can cure a multitude of ailments. We also know that disease is not just cellular and that it oftentimes has deep roots into the emotional plane of a person. Modern western medicine focuses on using chemical drugs to assist the body to feel better. I would say that the majority of our population has no knowledge of homeopathy, nor do they have a proper understanding of how their own organism can heal itself. I believe that a detailed unawareness of what is happening to a person’s body when they become ill is a product of the approach allopathic medicine has taken. The increasing use of allopathic drugs to suppress disease, but rarely cures, keeps a person on a cocktail of drugs and hooked into the pharmaceutical business for the rest of their life, and forever in poor health. The case presented here is an excellent example of the healing power an organism has with the use of homeopathic medicine. Homeopaths pay close attention to all that occurs to a person: physically, mentally, and emotionally, as well as the potential causative events.
The male patient, aged 58 had been physically strong and active all his life. He injured his right shoulder while renovating a home. After several months of healing, there remained little shoulder mobility with much pain, especially with any movement of his right arm. An MRI and X-Ray revealed a diagnosis of adhesive capsulitis in the right shoulder (also called frozen shoulder). The shoulder capsule made of connective tissue was inflamed, tightened and adhered to other structures in the shoulder as a result of the trauma it experienced. Generally, a frozen shoulder will heal over time, and could possibly take up to 3 years.
To avoid surgery to the shoulder, a cortisone injection was given directly into the shoulder joint to alleviate pain, reduce inflammation. In the following six weeks he had daily physical therapy to try to release the encapsulations. The patient stated that he has a very high pain tolerance, but that the PT accelerated the pain to a level even he found difficult to tolerate. It seems he received little to no pain relief from the cortisone injection.
The patient developed a stye on his left eye exactly three weeks after the injection along with mild flu-like symptoms that lasted about three days. The following week, exactly four weeks after the cortisone injection, he broke out in a rash on the outer sides of both his thighs, being worse on the right side. The rash was intensely itchy, very red, raised and swollen, aggravated by a hot shower and scratching. There was no heat to the skin eruption when touched and it took over three weeks to disappear on its own.
Mood swings began to set in exactly two months after the cortisone injection. By this time the pain was debilitating and he now experienced tendons that would “freeze” or become hardened on his right palm. The patient rarely was able to sleep more than a few hours at a time due to the constant pain. He returned to the surgeon six weeks after the cortisone injection. No progress had been made since the injection and a shoulder arthroscopy was scheduled to cut through the adhered portions of the joint capsule.
In the two-week waiting period before surgery, his health declined rapidly. He experienced complete physical exhaustion due to pain and lack of sleep. He was now experiencing pain in both shoulders and legs, started to run a low-grade fever in the evenings, and was losing weight rapidly. His wife stated that he complained of being exhausted all the time. He said that the pain seemed to be in the muscles of his whole body.
The surgeon stated that there was quite a lot of inflammation in the shoulder, but that there were no tears or issues beyond the encapsulation. Oxycodone 5mg was prescribed for the pain along with a 3-day course of antibiotic to prevent infection. 36 hours after surgery, his temperature spiked to almost 102 degrees Fahrenheit (38.8 Celcius) with violent shaking and shivering, and he could not gain control of his body. He felt very cold and nauseous, and I suspected this was an aftereffect from the anesthesia. Nux Vomica 30C was given and the fever began a decline within 5 minutes, and was at a normal temperature in 30 minutes.
In the following two weeks after surgery, his health rapidly declined, and he barely made it through the post-op PT session everyday. He slept all day and was up all night in pain. He could no longer dress himself; he could barely walk and get into or out of a chair or bed. During the day, he had to sit on pillows to make it easier for him to rise from the sofa or chair, and often needed help. He began to develop a bedsore on his buttocks from sitting and laying down so much. He continued to have total exhaustion, chills and weight loss.
Two weeks post-op with the surgeon resulted in a diagnosis of CRPS (Complex Regional Pain Syndrome) and he was sent to a Physiatrist who is familiar with this condition. Surgery was considered a success with the mobility regained in the right shoulder. 10 mg of Prednisone was given immediately to counter the CRPS.
CRPS, also known as reflex sympathetic dystrophy, Sudeck's atrophy, shoulder-hand syndrome, or causalgia, is a rare chronic disease of the nervous system. A person feels constant debilitating pain that is often out of proportion to the original injury. The pain experienced is much more severe and long lasting than what should normally be experienced. The pain is often confined to one limb, but it has been known to spread to other parts of the body with hypersensitivity to temperature changes and touch.
The Prednisone dosage was increased to 60 mg for one week and then tapered off over the next several weeks to 10 mg. At first, the steroids gave him relief but quickly ceased with the weaning off process. The muscle pain, stiffness and swelling returned with a vengeance, along with painful welt-like skin eruptions on his upper torso, scalp, and face. Three weeks after starting the Prednisone pills he woke up with a swollen right eye, along with extremely swollen hands and pain in his calf muscles. He was constantly feeling cold which aggravated all his symptoms. The homeopathic remedy Cortisone Acetate 30C was given even though he was still taking Prednisone. Within a few hours the eye swelling lessened and there was no lachrymation or conjunctiva present. A welt-like eruption appeared on the outer lid by the lash line of his eye. The Cortisone Acetate remedy seemed to hasten the skin eruptions on his face, scalp and torso to dry up with no new eruptions developing. He was able to go for a short walk and he put on 2 pounds (1 Kilo) but exhaustion easily came on. His feet began to hurt and he found walking or standing difficult. His hands were still slightly swollen. The Prednisone was discontinued at 10 mg and within a week he began to go backwards rapidly. Blood tests were taken to test the adrenals, thyroid and sedimentation rate, thinking that his adrenals did not come back to full function after the Prednisone. The tests results gave no indication of abnormalities except for the blood sedimentation rate at 62. It was suggested that he consult a Rheumatologist. His condition continued to worsen quickly with intense muscle pain, swelling, shivering and exhaustion. His organism had moved into a systemic autoimmune condition.
A Rheumatologist ordered more blood tests and he was put back on Prednisone (even though details of his case were presented to this doctor). Within two weeks, his sedimentation rate increased to 91, his C-reactive protein was high at 10.60, but all the other tests (Creatine Kinase, Adolase, Parvovirus B19, Cyclic Citrul Peptide AB, IGG, Rheumatoid Factor Screen) came back within normal range. The Rheumatologist suggested it could be inflammatory rheumatoid arthritis that “just happened” but could not give a definite diagnosis based on the lab work, nor could he give an explanation of why the patient’s own body was attacking itself. He did not offer anything other than prescribing the toxic drug Methotrexate for the rest of his life to give relief. The patient told the Rheumatologist that he wanted to try homeopathic medicine before resorting to the allopathic drug, and the doctor said to come back when he was ready to take the Methotrexate.
At this point I took over his case. The patient said the best way to describe how he felt was that his muscles were too small for his body. Causticum was prescribed based on his symptoms and he was slowly weaned off Prednisone. Great care was given in this process over the next 3 weeks until he ended the Prednisone at 2.5 mg every other day for 3 days before stopping it totally, and taking 10M Causticum daily. After 3 weeks he was able to perform household chores and the exhaustion and pain were less, but still present. Swelling of his hands and feet also had decreased, but sleep at night was still not good, waking up often with pain.
He also decided to try acupuncture at this time. He would feel better after a treatment, but I advised him that it was probably interfering with the homeopathic treatment. He would be exhausted after a treatment and it was hard to tell if they were helpful. He stopped the acupuncture after four treatments (two weeks). I believe the acupuncture forced his organism to move in directions it was not yet ready for, not allowing the healing to be in the organized manner that was needed and that homeopathy produces.
Oxycodone was still being used at night to help give him some pain relief in order to get some sleep. Two weeks after stopping the Prednisone he got up during the night and accidentally took a 5 mg of Prednisone instead of an oxycodone pill. He relapsed immediately and spent the next two days in bed with complete exhaustion. His hands and feet swelled back up and the stiffness in his legs returned that he found it difficult to walk again. Causticum 10M was given twice daily. By the third day after the accidental Prednisone dose, Causticum 50M was given.
After 10 days he was not bouncing back to the level he had been before the accidental dose of Prednisone. He had become very depressed, and very sad. He was refusing to eat and was even talking about ending his life due to the pain and his concern that he would never recover. The remedy was changed to Aurum. (Five years before the patient suddenly lost his only child in a motorcycle accident. Aurum got him through the severe depression at that time.) Results from one dose of Aurum 10M were immediate with better sleep that night, uplifted mood, and less muscle pain.
He returned to see the Physiatrist D.O. for physical rehabilitation. He was given a prescription of Vicadin to continue the management of pain at night when needed, otherwise he would take Ibuprofen. His Sedimentation Rate was tested again and in two months of homeopathic treatment it dropped from 91 to 47. He continued to take a dose of Aurum 10M daily.
Three months after starting homeopathic treatment, he was able to take a long trip to visit family. From the time of surgery to this point (7 months) he had not been able to drive a vehicle and he rarely went out of the house. Healing at this point seemed exponential, as he continued to take Aurum 10M as needed. The patient was able to start serious physical rehabilitation to bring back the atrophied muscles of his body.
Five months after starting homeopathic treatment his sedimentation rate and C-reactive protein were within normal range. He was strong enough to return to light construction work. He was sleeping well at night, maintaining his weight, and any pain he experienced was due to the rehabilitation of his muscles and was felt in a more normal pain mode of exercising atrophied muscles.
One year later, the patient was doing very well, working a very physical job, enjoying hiking, yet finding that his body was still not what it was before the CRPS developed. The healing is continuing to occur as he does more and more physical activity every day. He is a person who always had an abundance of athletic energy and I think the combination of this disease along with being 59 years of age impacted him dramatically, and a life-style change has had to occur for him. He still takes a dose of 10M Aurum every now and then, taking it when he begins to feel “off balance”.
My thoughts as to why this case needed daily doses of a high potency: Hahnemann states in his “Chronic Diseases” that remedies continue to act over longer periods of time with chronic illnesses and exhaust themselves more quickly in acute illnesses. Perhaps this case of CRPS and RA can be considered very potent acute chronic diseases. Also, the potency of the illness for this particular case needed to be matched by the remedy, which exhausted itself very quickly.
This is a unique case in that this patient had a bad reaction to the cortisone drug, but it remains important that in cases of CRPS and Rheumatoid Arthritis, allopathic drugs do not cure, and cortisone is the drug of first choice, suppressing the immune system. In this case, the allopathic doctors did not recognize the cortisone injection as a possible source, or contribution to this man’s spiral into CRPS; they felt it was the surgery that produced the CRPS, but he was well into the symptoms before surgery.
I believe the unmanaged pain the patient endured for several months followed by a reaction to the cortisone injection moved his organism into what is labeled CRPS. Further bombardment of cortisone on his organism brought out a sleeping predisposition of Rheumatoid Arthritis that he inherited from his maternal grandfather. This man had an adverse response to cortisone that most people do not show, but whatever the cause, the symptoms of the illnesses corresponded to the homeopathic remedies prescribed, which brought his organism back to good health once again.