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Alternative therapies for soft tissue inflammation and joint disease utilizing homeopathic injectables.

Physicians are faced with a wide array of modalities for the treatment of soft tissue inflammation and joint disease, along with the pain related to these conditions. These modalities range from oral analgesics that are opioid-based, nonsteroidal anti-inflammatories (NSAIDs), to various forms of glucocorticoids that can be given both orally and in injectable form. There are also various forms of injectable hyaluronic acid to rehydrate and cushion the joints for those who suffer from degenerative joint disease.

Because of the chronic nature of the diseases involving the joints, efficacy and side effects are important considerations when choosing a suitable long-term therapy. As a recent literature review has shown, many of these modalities have serious adverse reactions when taken over a period of time for the treatment of chronic joint pain due to degenerative joint disease. In particular, NSAIDs, which are the most popular drug group, have well-documented histories of adverse reactions, which include abdominal pain, diarrhea, nausea, and more serious side effects of bronchospasm, gastrointestinal bleeding, and ulcers. Most recently, COX 2 inhibitors have demonstrated severe cardiovascular adverse reactions. This resulted in their removal from the market by the Food and Drug Administration (FDA). (1), (2)

NSAIDs exert their anti-inflammatory, anti-pyretic, and analgesic actions by inhibiting the synthesis of prostaglandins by cyclooxygenase COX 1 and COX 2. The COX 2 form is induced by pro-inflammatory agents such as cytokines, bacterial stimuli, and tumor-promoting factor. (3) The preferential inhibition of COX 1 by traditional NSAIDs is thought to be responsible for their gastrotoxic effects by affecting the regulation of homeostatic functions in the gastric mucosa. A new generation of anti-inflammatory drugs is being developed, specifically targeting COX 2-induced prostaglandin production without influencing the homeostatic functions. However, while COX 2s may reduce the risk of gastropathy, recent research that led the FDA to remove several COX 2 inhibitors from the market demonstrated cardiovascular events with long-term use and adverse renal effects like sodium, potassium, and water retention as well as decreases in renal function similar to those of nonselective NSAIDs. (4), (5)

In addition, prostaglandins synthesis by NSAIDs is also associated with an increased production of leukotrienes by 5-Lipooxygenase. Since the COX isoenzymes and 5-LOX share the same substrate (arachidonic acid), the COX pathway can lead to a shift towards a reduction of leukotrienes by 5-LOX due to increased substrate availability. Leukotrienes contributed inflammatory processes and are implicated in the development of gastrointestinal ulcers. (6) Leukotrienes are also potent bronchoconstrictors and contribute to the NSAID-induced "aspirin asthma" in susceptible patients. (7) It is also been reported in the literature that long-term NSAID use may exacerbate degenerative changes in the cartilage. (8), (9)

Having seen these adverse reactions in my own patients when I utilized long-term NSAID therapy and/or steroids for long-term care of painful joints, I looked for a safer alternative for long-term management of chronic soft tissue inflammation and joint pain.

After doing an extensive literature review of alternative therapies for chronic pain management, several years ago, I determined that homeopathic injections specific for soft tissue inflammation and joint pain are uniformly efficacious and have very little adverse reactions reported by patients. I have been using homeopathic injections in my office for several years and have found that patients have greater acceptance of this modality for the treatment of their pain than with NSAIDs and steroids. Most of the lay public now have heard about or understand the adverse sequelae to long-term NSAID and steroid use and are wary of these drugs when prescribed for long-term use.

A German homeopathic combination injection has been well-researched and compared to NSAIDs in its efficacy in reduction of soft tissue inflammation and joint pain for patients with degenerative joint disease. Several head-to-head studies have been done comparing these two modalities, and these have found uniform improvement in patient symptoms. (10)

Since I was trained allopathically, I thought it necessary to know the mechanism of action of the homeopathic medicine, as it relates to its use in the treatment of chronic joint pain. I found several excellent research articles that demonstrated the duel inhibition of 5-lipoxygenase/cyclooxygenase by a reconstituted homeopathic medicine. These articles also explained the possible mechanism for their clinical efficacy and favorable gastrointestinal tolerability, over the use of traditional NSAIDs.

The homeopathic medicine used in these studies is produced in Baden Baden, Germany, by Heel Inc. and marketed under the trade name Zeel-T. This compound contains 15 homeopathic medicines in a dilution form consistent with standard homeopathic principles. The individual ingredients are formulated to work synergistically to show distinct inhibitory affects on the production of LTB4 by 5- lipoxygenase and on the synthesis of PGE -2 by COX 1 and COX 2 enzymes. (11)

I've used the injectable form of this anti-inflammatory mixed with either Marcaine or lidocaine for the treatment of degenerative joint disease. It also works well for psoriatic arthritis and rheumatoid arthritis. Zeel comes in 2 mL glass ampoules, and I mix this with 1cc or 2cc of half-percent Marcaine or two-percent lidocaine plain, depending upon the size of the joint and whether I'm going to inject the medicine periarticular or intra-articular. Since the homeopathic medicine is isotonic in nature, there is very little pain with the injection if used alone, and no anesthetic is added to the solution. Patients tolerate these injections very nicely.

An injection technique that I have employed in my practice that seems to enhance the efficacy of the injections is to utilize local acupuncture points along with the trigger points for the injections. For example, if I am treating painful arthritic shoulder joint, I would inject one-fourth of a cc of Zeel mixed with Marcaine into the trigger point area of tenderness and then inject with a 30-gauge needle, one-fourth of a cc of this mixture into the acupuncture points LI 15; LI 14; LI 16; and TW 14. This method also helps to reduce referred pain zones from the arthritic shoulder joint.

For first metatarsophalangeal joint degenerative changes with chronic pain, I inject 1 cc of the Zeel medication intra-articular and then give one-fourth of the cc of this mixture into each of the following acupuncture points of SP 3, SP 2, and LR, utilizing a 30-gauge needle. If there is an acute pain associated with the joint, I will inject the medication periarticular and mix the Zeel with a local anesthetic in the syringe. There is no precipitation or flocculation that occurs with mixing Zeel with lidocaine or Marcaine. These injections can be given weekly without any danger of adverse reactions or soft tissue instability that can be found with using steroid injections. I usually follow up with these patients by prescribing an oral form of the homeopathic medicine (Zeel oral tablets) and a topical cream (Zeel ointment), that have similar homeopathic constituents that are in the injectable form.

This homeopathic medicine can also be given concomitantly with NSAIDs without any additive adverse reactions involving the gastrointestinal, cardiovascular, or renal systems. A study done by Olga J. Makio, "Therapy of Osteo Arthritis in the Knee With Combined Zeel T/NSAID Treatment," published in 2001 (which received the Hans-Heinrich Reckeweg publication prize), demonstrated that the combined allopathic plus homeopathic treatment, utilizing Zeel T and diclofenac, produced greater and longer-lasting improvement in specific symptoms and proved especially effective in treating periarthritis and mild to moderate synovitis in 80 patients with advanced osteoarthritis of the knee.

Another homeopathic injectable medication that I use on a regular basis is called Traumeel. Traumeel is a combination of 14 homeopathic medicines in a synergistic ratio, for the treatment of arthritic pain, inflammation, bruising, and muscular pain. Traumeel is also excellent for the treatment of sports injuries such as tendonitis, sprains, strains, and contusions. I will sometimes use Traumeel injectable in combination with Zeel for acutely swollen and painful arthritic joints, because the anti-inflammatory and analgesic component of the Traumeel is geared more toward acute inflammation, whereas the Zeel is geared more toward chronic inflammation and degenerative changes within the joint.

Traumeel is an excellent stand-alone homeopathic medicine for the treatment of plantar fasciitis, tendonitis, bursitis, and for the prevention of postoperative bruising and swelling. Again, when I utilize this homeopathic compound for painful areas, I give an injection into the trigger point areas of tenderness along with the appropriate acupuncture points involved with that particular part of the body.

I utilize both the Traumeel injectable and oral tablets preoperatively and postoperatively for the various surgical procedures that I do. I have noticed that there's a dramatic reduction in postoperative pain and swelling and a reduced need for opioid narcotics postoperatively when I preop the patients with Traumeel orally and then inject the Traumeel at the end of the procedure in the operative theater. The call that I utilize is starting the patient's preoperative weight on one Traumeel tablet taken four times a day and dissolved sublingually away from food, seven to ten days prior to surgery. It's important to have the patient dissolve the tablet slowly in the mouth sublingually to get maximum tissue absorption. I carry this through to the day of surgery, and then post-operatively, I recommend one tablet three times a day (t.i.d.) sublingually for 21 days, to be taken away from food.

For ankle sprains/strains, I utilize a combination injection of 2.2 cc of Traumeel mixed with 1 cc of half-percent Marcaine plain injected around the painful area in a fan-shaped distribution. This injection technique may be repeated twice a week for three to four weeks, depending upon the patient symptoms. I augment the patient's therapy with oral Traumeel tablets, two tablets four times a day taken sublingually away from food for seven to ten days. I also apply a combination homeopathic topical ointment that has the same constituents as the Traumeel tablet and instruct the patient to apply the cosmetically elegant cream over the affected area three times a day for 14 to 21 days, depending upon symptoms.

I have found that the homeopathic injection techniques can also be utilized for the treatment of acute Morton's neuroma pain. I utilize a combination injection of 2.2 cc of Traumeel mixed with 1 cc of half-percent Marcaine plain. I inject perineurally around the affected nerve and also the acupuncture points ST 44 and GB 43. This injection technique may be repeated every two weeks for a month, depending on the patient's response and symptoms. Utilizing this technique, I have not found any post-injection flares that you would see with steroid injections. There is, uniformly, a positive patient response to reduction of discomfort following this technique, even after the Marcaine has worn off.

For chronic tendinitis/tenosynovitis, I use a combination of 1 cc of Traumeel mixed with 1 cc of the injectable Zeel and 1 cc of half-percent Marcaine plain local anesthetic. I inject directly into the inflamed thickened fibrotic area of the tendon sheath in a fanshaped manner, also employing the appropriate acupuncture points involved with a specific tendon. I also recommend that the patient apply the topical Traumeel cream to the affected tendon t.i.d. for seven to ten days. The rationale for combining Traumeel and Zeel is that they work synergistically to help reduce both the acute pain and swelling and long-term chronic inflammation with fibrosis that we see in many cases of chronic tendinitis that becomes irritated due to activity.

Plantar fasciitis with or without heel spur formation is a very common malady that we see in our practice. I have approached this condition with many modalities over the years. A few years ago, I added the modality of homeopathic injections for the treatment of plantar fasciitis. This modality has proven to be highly successful in cases of chronic plantar fasciitis, in conjunction with the standard modalities such as stretching exercises, Dorsiflexor night splints, weight loss, and orthotics. The protocol that I find to be successful is the injection of 2.2 cc of Traumeel mixed with 2 cc of half-percent Marcaine. Pain in the plantar fasciitis is acute. In chronic, intermittent plantar fascial pain, I recommend a 50-50 combination of Traumeel and Zeel mixed with half-percent Marcaine plain given as an injection at the trigger point area of tenderness, around the plantar medial calcaneal tuberosity area of the foot, along with the following acupuncture points: KI 3, KI 4, and KI 5.

After having used these homeopathic injections, oral homeopathic medications, and topical creams for a number of years, I have found them to be efficacious and with a very low adverse reaction profile. Homeopathic medicines work well with standard medical protocols such as NSAIDs and physical therapy modalities such as rest, ice, elevation, orthotics, and splints.

I highly recommend the consideration of these homeopathic medications as an additional modality in the treatment of many common foot problems that we see in our office. I also recommend the use of Traumeel for the more acute symptoms seen as a result of injury or surgery. The inclusion of homeopathic Traumeel in the treatment of fractures has significantly reduced the amount of swelling, bruising, and pain without the adverse side effects of high doses of NSAIDs or the addictive properties of opioids.

There is sufficient well-parametered scientific research that demonstrates the efficacy and safety of these homeopathic medications that we can prescribe them with confidence to our patients.

John Hahn, DPM, ND, is currently a professional consultant for Ellman International, Cryosurgical Concepts Inc., Heel Inc., Integrative Therapeutics Inc., and is a member of the Medical Advisory Board for the Journal of Longevity. Dr. Hahn maintains a private clinical practice in Portland, Oregon, combining both podiatry and naturopathic medicine modalities in the treatment of his patients. His practice includes the performance of independent medical evaluations for several companies in Oregon and Washington. Readers can contact Dr. Hahn at jmhahn2@verizon.net.

Notes

(1.) Berges-Gimenco MP, Simon RA, Stevenson DD. The natural history and clinical characteristics of aspirin exacerbated respiratory disease. Annals of Allergy Asthma Immunology. 2002; 89:474-78.

(2.) Kimmey MB. NSAIDs, ulcers and prostaglandins. Journal of Rheumatology. 1992; supplement 36:68-73.

(3.) Vane JR,Botting MR. Anti-inflammatory drugs and their make mechanism of action. Inflammatory Research. 1998; 47 supplement. 2: S78-87.

(4.) Breyer MD, Harris RC. Cyclooxygenase 2 and the kidney. Current Opinions Nephrology Hypertension. 2001; 10:89-98.

(5.) Ahmad SR, Kortpeter C, Brinker A, Chen. Renal failure associated with the use of celecoxib and rofecoxib. Drug Safety. 2002; 25:537-44

(6.) Hudson N, Balsitis M, Everett S, Hawkey CJ. Enhance gastric mucosal leukotriene B-4 synthesis in patients taking nonsteroidal anti-inflammatory drugs. Gut. 1993; 30 4:742-7.

(7.) Lee TH, Christie PE, Leukotrienes and aspirin-induced asthma. Thorax Editorial. December 1993; 48(12): 1189-1190.

(8.) Herman JH, Hess EV. Therapeutic impasse and osteoarthritis. Nonsteroidal anti-inflammatory drug modulation of prosthesis pseudo membrane induced bone resorption. British Journal of Rheumatology. 1994; 33 (supplement 12): 1098-100.

(9.) Huskisson EC, Berry H, Gishen P, et al. Effects of anti-inflammatory drugs on the progression of osteoarthritis of the knee. LINK Study longitudinal Investigation on Nonsteroidal Anti-inflammatory Drugs in Knee Osteoarthritis. Journal of Rheumatology. 1995; 22 (supplement. 10): 1941-6.

(10.) Maiko OJ. Therapy of osteoarthritis of the knee with a combined Zeel T/NSAID Treatment. 2001 research paper.

(11.) Jaggi R, Wurgler U, and Weiser M. Dual inhibition of 5-lipoxygenase/cyclooxygenase by a reconstituted homeopathic remedy; possible explanation for clinical efficacy and favorable gastrointestinal tolerability. Inflammation Research. 53 (2004): 150-157.

by John Hahn, DPM, ND
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Title Annotation:Homeopathic Injectables
Author:Hahn John
Publication:Townsend Letter
Geographic Code:1USA
Date:Jul 1, 2008
Words:2573
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