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11 Articles in Volume 10, Issue #9
Activated Glia: Targets for the Treatment of Neuropathic Pain
Acute Herpes Zoster Neuritis and Postherpetic Neuralgia
Acute Treatment of Cluster Headache
Chronic Overuse Sports Injuries in the Adolescent/Pediatric Population
Clinical Recognition of Central Abnormal Neuroplasticity
H-Wave® Stimulation: A Novel Approach In Electromedicine
Homeopathy Enters Contemporary Pain Practice
Immune-modulating Effects of Therapeutic Laser
Pain and Addiction: Words, Meanings, and Actions in the Age of the DSM-5
Partial Plantar Fasciectomy With Autologous Platelet Concentrate
Tethered Spinal Cord Syndrome: Pathophysiology and Radiologic Diagnosis

Homeopathy Enters Contemporary Pain Practice

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Editor’s note: Botanicals have been studied and administered as medicinal agents for thousands of years. Until now, however, homeopathy hasn’t been well accepted in mainstream medicine, much less pain practice. Thanks primarily to some German and Italian companies, there have been marketed homeopathic solutions, topical creams, and oral agents that contain a blend of a few botanical agents that have been found effective and filtered out from the thousands of plants found in nature. Practical Pain Management has learned of this development and has taken the opportunity to observe homeopathic agents being used on bonafide pain patients. To our pleasant surprise, we have learned that modern day homeopathy can be a great adjunct to standard pain practice. To this end, we have asked Dr. Joan Lewis, who is an anesthesiologist and pain specialist, to write this article. Pain practitioners interested in homeopathy can begin by reading this excellent introduction to an age-old therapy that has progressively, and rightfully, earned its entry into contemporary pain practice.

History of Botanicals and Homeopathy
Classical homeopathy utilizing botanicals has been used as a remedy since the 18th century and is known to Western civilizations, principally through the work of Samuel Hahnemann. Naturopathic physicians have been well trained in the selection of herbal remedies, although this topic is usually omitted in conventional medical curriculums. Administration of a homeopathic medication containing a very small amount of active substance can produce different effects based on the concentration (or dilution) of the substance. This principle is known as hormesis—whereby very low doses produce a beneficial effect and higher doses produce a harmful effect. From the conventional medical perspective, this effect can be observed in an inoculation when the introduction of a minute amount of a substance (that in larger doses is harmful) stimulates the beneficial production of antibodies and does not overwhelm the immune system. The appropriate prescribing of homeopathic preparations allows for the selection of a remedy based on the patient’s specific symptoms and constitution.

A significant opinion from our perspective as pain practitioners should acknowledge that the option of homeopathy is safe, cost-effective, and can be utilized in combination with modalities and/or medications already in place. Measured outcome studies utilizing objective nationally standardized variables against which subjective responses can be compared are a desirable determination of efficacy.1

Bioregulatory Medicine and Research

Bioregulatory medicine (BRM) is an emerging field of medical care that targets the body’s normal maintenance of homeostasis through auto-regulation. When we painstakingly memorized the components of the Krebs’ cycle or the electron transport chain, the study of physiology explained our (then) more limited understanding of the extraordinarily complex choreography undertaken by the body when addressing a straightforward chore—e.g., building the right protein for increasing muscle bulk, combating a foreign protein invasion, precisely regulating serum osmolarity to remain within specific set points, or alternatively warehousing and degrading cellular waste products for elimination. It should come as no great surprise that subsequent research now reveals much more complex and elaborate interrelationships among body systems than had been previously appreciated. Biological response-modulating substances influence these systems, not by ablating the reaction completely but by allowing the body to restore its normal auto-regulation through the practitioner’s administration of infinitesimal dosages of substances that gently dislodge an abnormally functioning system back toward normal oscillation around a set point. Even ultra-low doses of medications such as seen in homeopathy can produce a significant impact on the body, by a principle known as “hormesis”—where differing concentrations of the same medication produce divergent results.2,3


Research published on hormesis has underscored its validity.2 Hormesis addresses the phenomenon that the intake of a very small amount of a substance which, in large doses, can be toxic or damaging to the person, serves a protective function.5,6 Modern medicine has taken advantage of this phenomenon with vaccinations, for example. Another example is caloric restriction as a pro-longevity strategy.3,4 The beneficial physiologic response to a transiently-manifested form of stress (or toxin) that induces the development of tolerance to low oxygen states, toxins, and dietary restriction has been observed.2,3

The understanding and acceptance of hormesis is critical to the practitioner’s understanding of the research and efficacy of homeopathic medicinal products in concentrations that radically differ from the dosing for conventional medications. For example, some homeopathic medications show an impact at concentrations in the range of 10-3 to 10-6.

A Brief Explanation of Homotoxicology (HTX)

Homotoxicology is a therapeutic modality within integrative medicine. In this system, a medical diagnosis is made then followed by an individualized assessment according to the severity of the patients’ disease. This takes into account the burden of exogenous and endogenous influences on the patient’s self-regulatory mechanisms. Treatment is then given, predominantly using homeopathically-prepared medicines, to support the inherent self-regulatory ability of the patient by means of detoxification and drainage, immunomodulation, functional organ support and support of the cellular metabolism. Research on combination homeopathic products has helped reveal their mechanisms of action on targeted portions of bioregulatory systems that helps to explain their efficacy.8,9

The therapeutic goal of the practitioner is the appropriate assignment of homeopathic products that support the specific physiologic detoxification systems associated with the known disease state. Progress can be slower than with conventional medications but results can be rewarding because the underlying physiologic reactions can begin to function normally and optimally.

How HTX Differs from Conventional Medicine

Conventionally-trained medical physicians have been taught the actions of conventional medications and developed expertise in avoiding side-effects while these medications impacted targeted end organs. In large part, our medical responsibility consisted of trying to avoid the adverse effect of those medications’ doses upon interrelated body systems between the median lethal dose (LD50) and the median effective dose (ED50). Those far-reaching “associated organ system impacts” were known to account for the bulk of side-effects arising from our armamentarium of conventional medications. While these medications can be very effective, side effects are well documented.

We know that the use of medications designed to address disease states could include stopping an otherwise auto-regulatory physiologic system—such as the impact of steroids on the cyclo-oxygenase pathway. Most of us involved in the conventional medical educational process did not receive education about alternate medication options (such as homeopathic medications) which possessed significantly less side-effects than conventional medications. Homeopathic medications utilize doses that are significantly smaller than milligrams to accomplish this gentle effect and, in this regard, are very different from conventional medications. Homeopathic doses are measured in nanograms or picograms and these low doses very subtly encourage the normal auto-regulation of a dysfunctional body system to get back on track.

Pain practitioners will readily recognize the cyclo-oxygenase cascade, which is frequently invoked by chronic disease states and responds by producing substances that result in cell inflammation and further painful sensations (see Figure 1).

Figure 1. Role of Traumeel« in the inflammation cascade (reprinted with permission from Cesnulevicius K, unpublished). Each cell commits to recruiting and activating other cells based on multiple inputs, generally requiring evidence of both injury and infection (not shown) before it joins fully in amplifying the inflammatory process. Conventional medications directly interact with the inflammatory cascade by inhibiting the arachidonic pathway at the initiation of the cascade and consequentially, impact downstream signaling. Ultralow dose medications with bioregulatory properties, such as Traumeel, influence the inflammatory cascade in a multitargeting and synergistic fashion. This is achieved by the inhibition of several pro-inflammatory pathways via interleukin-1b (IL-1b), tumor necrosis factor alpha (TNF-a), and the stimulation of anti-inflammatory pathways, like transforming growth factor (TGF-b). Actions on multiple targets complement each other to produce a synergistic effect towards the resolution of the symptoms and underlying pathophysiological mechanisms. Interactions among leukocytes, endothelium, platelets, and coagulation factors; the generation of stop signals; and the flow of information over subsequent days, including the transition to wound healing, are not shown. *The inhibition of prostaglandins by NSAIDs is not specified. ºBaldwin and Bell.13 #Porozov et al.8 $Data are taken from Heine and Schmolz.12 Figure abbreviations: APCs: antigen presenting cells; COX: cyclo-oxygenase; Hsps: heat-shock proteins; IL: interleukin; NSAIDs: nonsteroidal anti-inflammatory drugs; TGF: transforming growth factor; TNF: tumor necrosis factor.

Last updated on: March 7, 2011