back-pain-1491803_1920by Nancy Gahles, DC, CCH, RSHom(NA), OIM

Structural theory tells us that misalignment has an overall effect on the operation of a system, and leads to wear, tear, and, eventually, degradation.

The whole systems theory in healthcare references the dynamic interaction between all parts of the organism to work together to maintain equilibrium of the system. In the event that one part is misaligned in structure or in function, there is a threat presented to  homeostasis. Intrinsic self-healing is thwarted to the degree of the misalignment.

Vitalistic healing disciplines, notably homeopathy and chiropractic, are representations of the whole systems theory. Vitalism is a philosophy that hypothesizes that living organisms are fundamentally different from non-living organisms, because they contain some non-physical element or are governed by different principles than are inanimate things.

Homeopathic and chiropractic medicines are disciplines that operate on this principle. Homeopaths call this non-physical element the “vital force”. In his seminal work, the Organon of the Medical Art, Samuel Hahnemann, MD, posits, “In the healthy human state, the spirit like force…that enlivens the material organism as dynamis, governs without restriction, and keeps all parts of the organism in admirable, harmonious, vital operation, as regards both feelings and functions so that our indwelling, rational spirit can freely avail itself of the living, healthy instrument for the higher purposes of our existence.”

Similarly, Ralph Stephenson, DC, in Chiropractic Textbook, presented the core principle of chiropractic philosophy, Innate Intelligence, thusly, “A Universal Intelligence is in all matter and continually gives it all its properties and actions thus maintaining its existence. Interference with the transmission of Innate forces causes incoordination or disease. The forces of Innate Intelligence operate over the nervous system in the body.”

The operation of the central nervous system reveals its miraculous, dynamic interplay of structure and function when presented with a threat, perceived or real, to the organism.

We can call this a generic response stress.

picture1

Stress is a trauma in that it causes an alarm reaction in the organism. The macro traumas to the spine that cause physical stress include accidents, falls, sports injuries, and repetitive motion injuries. The emotional causes of misalignments in the spine and through the CNS include stress, fear, and anger. Mediation of both is accomplished through the HPA axis. One expression of the fight, flight, freeze, or faint response results in muscle tension causing vertebral misalignments and the resultant and concomitant repetitive thoughts that cause inflammation and persistent pain.

Rumination about the event(s) that caused the trauma has been demonstrated to increase inflammation. In the case of physical trauma to the spine, as in whiplash injuries, for example, each time that a movement causes pain, recall of the event triggers a perception that initiates the neuroendocrine response.

The recycling of nervous irritation was documented in this study whereby nervous irritation triggered by memories or residual pain or by associative stimuli—neck or back pain to sight of car accident or pain triggered by any activity produces more pain thus triggering the memory of the incident and stress, anxiety and emotional sequelae.

As a doctor of chiropractic for 37 years, my expertise began with my work in the field of neuromusculoskeletal injuries and soft tissue damage associated with personal injury accidents. The hyperextension and hyperflexion diagnosis was meant to quantify, for insurance reimbursement purposes and monetary remuneration, the extent of the injury. The quantification of the pain and suffering, however, was never able to be substantiated due to this prolonged emotional stress response in these cases.

The chronic pain from muscle spasms and diffuse trigger points has plagued practitioners who must quantify the condition with a diagnostic code (ICD-10 codes) and a treatment protocol that will reduce or eliminate the symptoms (CPT codes). Insurance reimbursement is dependent on achieving that goal in a specified number of visits.

The recycling of nervous irritation and the emotional complexity eluded us for years. From this quandary was born the diagnosis of fibromyalgia, the new and modified one outlined in The New and Modified Fibromyalgia Diagnostic Criteria from the Rheumatology Network. The limitations are excerpted in the following:

“The finding that as many as 25 percent of patients with physician-diagnosed FMS did not satisfy the 1990 ACR classification criteria was an important one. The new criteria do not solve this problem. Because inflammatory and other painful disorders were excluded, the new criteria cannot be applied to patients with RA, systemic lupus erythematosus, or other conditions.

The new criteria do not distinguish between primary and secondary FMS. The performance of these criteria in the primary care setting has not been validated by prospective studies. It could be argued that making a diagnosis of a condition without physical examination probably will miss important physical findings and other potential causes for patients’ symptoms. In addition, these criteria still rely on clinical grounds and do not incorporate any objective laboratory or imaging data in making the diagnosis, although currently no objective parameters are widely accepted for routine use in clinical practice.”

Clearly, the inflammatory process, pain perception, recycling of nervous irritation, and emotional causation and sequelae have not been addressed.

In her article, Cervical Trauma and Chronic Pain, Fibromyalgia caused by Cervical Injury, Carolyn McMakin, MA, DC makes astute observations from her clinical practice and postulates, “the clinical picture suggests that the central nerve pain facilitates the sympathetic nervous system causing a chronic fight or flight response, especially when the disc is damaged at the C5-6 level causing stimulation/facilitation of the C5 sympathetic ganglion.”

“The sympathetic response is characteristic,” she says. “The body’s repair systems are put on hold, circulation to the digestive system is reduced, myofascial circulation is altered, immune system function is compromised, the adrenals produce elevated levels of endogenous cortisol and are constantly taxed to keep up and the system gradually experiences more and more dysfunction. When the gut is compromised in this fashion for a year or more it is prone to dysfunction including “leaky gut” and the resultant food and systemic allergy reactions.”  

Enter the clinical picture of complex chronic diseases stemming from unrecognized, untreated spinal trauma appearing in a catch-all diagnosis of fibromyalgia. Squeezing a round peg in a square hole hasn’t been accomplished. In truth and fact, spinal trauma from physical etiology is only one face of this complex issue. My presentation at the Integrative Health Symposium on The Hidden Faces of PTSD incorporates others.

From a chiropractic perspective, removal of nerve interference through manual spinal manipulation is the first course of intervention. Adjunctive modalities including TENS, microcurrent, ultrasound, cryo and thermal therapies, cervical traction, and physiotherapeutic exercises are effective in relieving symptoms.  

McMalkin found best results from this protocol, “the patients with disc injuries and the characteristic pain pattern were helped only by 40Hz and 10Hz (microcurrent) applied polarized positive at the cervicals and negative distally. Patients with pain associated with a central injury above the cervical level were helped by 320Hz on channel A and 10Hz on channel B.”  

“There have been no patients with this history and symptom combination in whom this treatment was ineffective,” McMalkin concluded.

Thankfully, chiropractic has wonderful efficacy. In my clinical experience, I, too, had successes with this treatment protocol. I had failures as well. Those who were repeat patients, who relapsed frequently, who couldn’t “hold” their adjustments, were the cases that prompted me to look further. They were the ones who led me to discover the adaptive network system of nanomedicine called homeopathy. A homeopathic prescription must take into consideration the totality of symptoms that a person presents with, in addition to their chief complaint of, in this case, neck pain, spasms, and trigger points.

Iris Bell, MD, is a premier researcher in the alternative medicine field of homeopathy. Her work has yielded information that is a disruptive innovator in healthcare. In particular, this study, Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo, demonstrates that individualized homeopathy is significantly better than placebo in lessening tender point pain and improving the quality of life and global health of persons with fibromyalgia.

“Individualized” means that the remedy selection will fit the uniqueness of the person who is suffering. From an integrative practitioner perspective, a person may come to see me for consultation as a chiropractor because of the accident or injury and the resultant symptom complex. The chief complaint will be neck or back pain and soft tissue or muscle pain. The treatment protocol will follow ICD-10 diagnostic code and CPT procedures. Some cases will be well managed with this protocol.

There are other people who will come to me for consultation as a homeopath who are  suffering from IBS, acid reflux, allergies, adrenal fatigue, insomnia, anxiety and PTSD, back pain, osteoarthritis, fibromyalgia, and autoimmune disorders. They will describe the onset as a trauma of some type recent or in the distant past. In these cases, I will take the case and include every symptom from every area of mind, body, emotion, and spirit, that is, the hopelessness, despair of recovery and depression that is a feature of chronic pain.

The Materia Medica of homeopathic remedies is vast and covers all aspects of human nature, sensation, and function. Selection of the remedy closest to the totality of symptoms that the person is expressing will be the “simillimum”, the remedy that is similar to the whole person suffering. In my experience, addressing the root cause, the underlying vital disturbance in the organism, is the key to solving the puzzle of fibromyalgia. Self-regulation ensues, homeostasis is established and Innate Intelligence is free to restore the admirable, harmonious, vital operation so that the indwelling, rational spirit can freely avail itself of this living, healthy instrument for the higher purpose of our existence. In my understanding, this is called health, wellness, well-being, happiness, and quality of life.

Integrative healthcare providers and those seeking answers to pain management, for, say, fibromyalgia, may be well-served to consider the homeopathic and chiropractic approaches in tandem.

An observational study of patients receiving homeopathic treatment reported that their treatment had been highly effective in resolving physical and psychological symptoms which, in 78 percent of cases, had been sufficiently severe to interfere with their lives. These findings were corroborated by their physicians. The patients’ satisfaction levels with their treatment were very high.

According to the study, “In contrast, both satisfaction with and the reported outcome of previous orthodox treatment was poor and failure of previous treatment may account both for the selection of the homeopathic therapy by the patients and the large contrast between the ratings of the two. Over half were able to discontinue previously prescribed conventional drugs…consultations were on average more than twice as long as for previous conventional treatments but cost the patients less.”

Counterintuitive though this may seem, the largest cost savings were made by patients with the worst initial ratings of their physical condition. In other words, the more complex the condition, the greater the value of homeopathic intervention both in resolution of symptoms and in cost savings. The ultimate ideal outcome was that patients were very satisfied with their homeopathic treatment and both they and their physicians recorded significant improvement.

Integrative healthcare recognizes an array of practices outside of allopathic medicine. Chiropractors are licensed in every state and are able to practice homeopathy in 11 states. Classical homeopaths are able to practice in some states as licensed MDs or NDs, and in all states as nationally certified with a credential accredited by the Institute of Credentialing Excellence. The advancement of technology has enabled those in rural areas or in states without a large number of practitioners to access a homeopathic practitioner using HIPPA-compliant video consultation platforms. Licensed practitioners must check with their state licensing boards for ability to provide services across state lines. Ease of access is a great benefit for those restricted in mobility from the pain of fibromyalgia or the emotional connection to car accidents or spinal trauma exacerbated by travel.

By working together, in an integrative way, for the greatest good of the person suffering, contributing graciously to the pool of knowledge, we can all share in the bounty of a culture of collective well-being.

“The physician’s highest and only calling is to make the sick healthy, to cure, as it is called. The highest ideal of cure is the rapid, gentle and permanent restoration of  health…in its entire extent in the shortest, most reliable, and least disadvantageous way according to clearly realizable principles.” —Organon of the Medical Art by Dr. Samuel Hahnemann