A Contradictory Case of Sciatica

Thursday, November 18th, 2010

The patient was referred by his sister to a college clinic where I regularly see live cases.

This 44-year-old man appeared to be strong and healthy. He presented as very friendly and aware of being proper. I mean by this last comment that he seemed astutely aware of when to laugh and when to be serious. He felt genuine in response, but crisply aware of how to respond.

Since 1992 he had been employed in a factory involved with woodworking. This involves a lot of lifting. In 1998 after lifting a table he developed a severe back pain. It became a chronic situation that ultimated in a diagnosis of lumbar disc herniation.

The pain had been in his right leg as well since about 2006. This limb pain had the sensation of “needles” and could move around the lower limb.

The spasm and pain was much worse in the winter, sometimes to the point that he could not walk. In this state he would require help to rise from a chair or the bed. It felt like a knife in the back. It was immobilizing.

Lifting was a definite aggravating factor.

During the winter the ache would aggravate later in the evening. The first phase of pain kicked in after supper by 7 p.m. Later at night, say by 10 p.m., there was even more ache and stiffness. At this point he regularly used a hot bath with epsom salts to soothe, but it only moderately relieved.

During sleep, movement was treacherous. Every time he moved there was pain, and turning in bed was especially difficult.

While on the subject of sleep, he had had night sweats for about one year. The description was of cold sweats and, oddly he says, the perspiration smelled a bit of tobacco (he reported smoking about 2 cigarettes per day).

On waking the next day, the familiar spasm would be there and the need for assistance to rise from bed. Once up, he would make his way to a hot shower.

Prior to coming to see me he had been having bad dreams every night. He dreamed of a dog following him and repeatedly biting him.

He seemed to fight more with his girlfriend. It had become easier to irritate him toward anger. Sometimes without much provocation. This was disturbing as his self-image is one of being easy going.

There is a history of arthritis in the hands, knees and legs. This too will be worse in the winter. It is noticed that when walking in the night during the winter months his knees would be painful and he could not squeeze his hands. This has been so for about 2 years.

On the day I saw him he had precordial chest pain. It was worse that morning at about 8 a.m., but was still there. In conversation at this point the patient noted that he had been sedentary and gained weight these last months.

On reflection, our patient expressed, “I used to be happy and joke. I was very friendly, kind and happy. When the pain came I changed. It was severe and I would cry with the pain. I was very sad. Occasionally I will have a fear of the devil at night.”

So the symptoms I took from the case were:

GENERALITIES; SEASON; Winter; agg. (86)
EXTREMITY PAIN; GENERAL; cold; becoming; agg. (29)
PERSPIRATION; SLEEP; during; agg. (130)
MIND; DREAMS; animals, of; dogs; bitten, by, of being (8)
BACK; PAIN; General; lifting, from (22)
BACK; PAIN; General; morning; rising; agg.; on (38)
MIND; RESERVED (100)
MIND; SADNESS, despondency, depression, melancholy; pain, from (15)
MIND; WEEPING, tearful mood; tendency; pains; with (39)
MIND; ANGER, irascibility; tendency; pain; about (13)
MIND; IRRITABILITY; pain, during (22)
MIND; FEAR; evil, of (121)
MIND; FEAR; night (86)

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I know what you’re thinking — Nux is a slam dunk! Wait, what about those nightly dreams? There is a sensitivity to cold in the joints and back, but not generally. He has a mild and generally pleasing presentation, which I guess Nux can have.

My warped mind headed towards Calcarea, then back to Nux, and around and around. Okay, so what can I use as a tie breaker?

Well, Calcarea is known to have back pain in morning worse on rising and Nux is not.

BACK; PAIN; General; morning; rising; agg.; on (38) : aloe, am-m., ang., arg., arg-n., calad., 2calc., caust., cedr., chel., cinnb., cocc., euphr., form., graph., 2hep., hipp., kali-bi.Alle, 2kali-c., 2lyc., 2nat-m., nit-ac., ox-ac., petr., ptel., ran-b., rat., sanic., 2sil., stann., staph., stry., sul-ac.Ken, sulph., syc-co.Pater, 2thuj.Mor, valer., verat.

Nux will have back pain in the morning generally.

Gets out of bed at four AM on account of pain in back, better from rising and walking about.

Backache, must sit up to turn in bed.

Pains in small of back, as if bruised or broken, worse 3 or 4 AM.

—Hering’s Guiding symptoms on Nux.

Pain in small of back: could hardly rise from seat.

Painful stiffness in back, making change of posture very difficult.

—Hering on Calcarea

So Calcarea it is with a possibility of falling back to Nux.

I began with Calcarea 30c once per day. I also requested he visit a local emergency room (now) to get a cardiovascular exam.

Two weeks later: The perspiration had vanished after a few days, but has lately returned a little. Dreams are gone. Generally feels more relaxed. The pain in the precordium was ruled as musculoskeletal.

Plan: Because of the relapse of the perspiration I increased the posology to twice daily. Pain has not been an issue (but the weather has been unusually warm).
Two weeks later: Patient called to say that after a few days of the remedy twice daily he is constipated without any urge. He stopped the remedy and was fine and then restarted and the bowel issue returned. The weather has become chillier and the leg pain is again evident. Last week he quit smoking and the night sweats returned moderately.

Plan: I’m stubborn. Calcarea 200 one pellet once and call in 2 days.

Two days later: No change. Reschedule to retake the case.

Assessment: The remedy had some degree of similitude but insufficient to finally propel a curative response. It had a proving-like effect producing constipation. Even this last result did not maintain at a higher potency because this remedy was only a distant simile.

At the initial case the patient talked of his ex-wife, but had said really there were no stressors in his life, no emotional baggage to speak of. He insisted there was nothing in life very stressful going on around the time of the initial back pain or in 2006 when the leg pain entered the picture.

Nux is looking good. However I still don’t feel right about this whole thing. I decide to go back over the emotional life at the time the sciatic pain entered the leg. After I got to talking about this timeframe, more it seems that when he was having marital issues with his past wife she left him with his child and suddenly left the country. The time lines did overlap.

So now I needed to know which emotion was suffered here. All I get was stress and anger and not much more defined expression.

He, however, kept saying that winter was here and his sciatica was getting bad. I found this repetition annoying.

Wait just a minute. If it’s annoying it is probably important and something I had not considered appropriately yet.

Let’s look at the repertory again. My eyes found:

EXTREMITY PAIN; LOWER LIMBS; sciatica; Winter, in (1) : ign.

Could it be? Well sciatica worse in the winter is dramatically unusual. The etiology might fit. I like it.

Three weeks later: It is much colder, especially the last 2 days and no pain at all since the day after the remedy.