PAIN AND INFLAMMATION

1
PAIN AND INFLAMMATION

• Presented by
• Maureen Horne-Paul N.D.
• Sponsored by
• HEEL CANADA INC.

2
The Six-Phase Table

• Chronological course of the various symptoms of a
  disease
• Within the context of ground regulation
• The individual phases flow into one another
• Phase-typical cardinal symptoms

3
The Six Phase Table

• Subdivided into three blocks
• Each block has two phases

• Humoral phases
• Excretion
• Inflammation

• Matrix phases
• Deposition
• Impregnation

• Cellular phases
• Degeneration
• Dedifferentiation

4
Six-Phase Table Outline
5
The Humoral Phases

• Intracellular systems are not disturbed
• Defensive system is intact
• Homotoxins can be easily drained
• Inflammation plays a key role

6
Excretion Phase

• Bodys attempt to rid itself of toxins
• External or exocrine secretion of a product to
  the outside
• Drainage by means of bonding, dispersion, or
  dissolving the contaminants in secretory products

7
Excretion Phase

• Substances in transportable form via
• Internal or endocrine secretion
• Paracrine secretion
• Autocrine secretion
• Intracrine secretion
• All are dependent on nerve impulses
• All are interdependent

8
Excretion Phases

• Treatment Strategy
• Avoid creating blockades to healing
• Open the emunctories (OTE)
• Support excretion with constitutional therapy
  (singles, nosodes)
• Dietary support

9
Inflammation phase

• Illnesses are characterized by exudative
  inflammation, expulsion of toxins
• Accelerated draining of homotoxins from the body
• Production of annoying symptoms such as fever,
  pain, swelling, discharges
• Controlled by nerve impulses and hormones

10
Inflammation Phases

• Treatment strategy
• Facilitate elimination of toxins via the
  emunctories (Ki, skin, GIT, uterus) - OTE
• Modulation and support of the immune system if
  necessary
• Dietary measures

11
System of Ground Regulation
CNS
Endocrine system
Biorhythms
12
The Matrix Phases

• Homotoxins deposited into extracellular
  matrix/incorporated into cells
• Structural components/functions of the matrix
  changed
• Decreased ability of the matrix to detoxify

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Six-Phase Table Outline
14
Deposition Phase

• Failure of both excretion and inflammatory
  mechanisms
• Toxins are inactivated but not eliminated
• Toxins accumulate in connective tissue/ matrix,
  cell function intact
• Mucous membrane hyperplasia, hepato/splenomegaly,
  hyperkeratosis
• Symptoms due to compression or expansion of
  tissues

15
Deposition Phase

• Treatment strategy
• Reduction of toxins entering the body
• Open the emunctories - OTE
• Detoxification of the matrix
• Gastrointestinal support
• Activation/support of the immune system to cause
  effective reaction phase

16
The Biological Division

• Loss of self-regulating ability of matrix
• Collapse of filtering and cell protection
  functions of matrix
• Increasing cell damage
• Increase in homotoxin accumulation
• Development of adaptation syndromes
• i.e. sand heap

17
Immune Bystander Reaction
18
Impregnation Phase

• Invasion of the interior of the cell by
  homotoxins or retoxins (risk for AI disease)
• Homotoxins dormant or local focus of inflammation
• Disruption of function of tissues, organs, cell
  membrane due to matrix overload
• Failure of self-regulating mechanisms

19
Impregnation Phase

• Treatment strategy
• Open the emunctories
• Reduction of toxin load
• Facilitate detoxification
• Activation and removal of any pharmacological
  toxins
• Support intracellular function

20
The Cellular Phases

• Intracellular systems in the cell are
  increasingly destroyed
• Defense system no longer able to drain toxins
  from the cells and the matrix
• Loss of regulatory function of cells, tissues,
  and matrix

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Six-Phase Table Outline
22
Degeneration Phase

• Deep alteration of organ structure and function
• Altered intercellular enzymatic function
• Inability of cells to detoxify
• Ongoing toxin accumulation at tissue and cellular
  levels
• Body attempts to maintain life as long as
  possible

23
Degeneration Phase

• Treatment strategy
• Emunctory activation and drainage - OTE
• Stimulation of detoxification of most affected
  organ
• Activation of specific defenses against the basic
  illness with nosodes
• Stimulation of cellular detoxification

24
Dedifferentiation Phase

• Proliferation of undifferentiated,
  non-specialized cell forms
• Loss of cell specificity and function
• Loss of oxidative energy, glycolysis and
  anaerobic metabolism dominates
• Malignant diseases at the end of this phase
• Progression of tumor growth may be associated
  with emunctory function

25
Dedifferentiation Phase

• Treatment strategy
• Emunctory stimulation and activation
• Lyphosot, Berberis-Homaccord, Nux
  vomica-Homaccord, Galium-Heel
• Stimulation of psychophysical reactivity
• Constitutional compound remedy (Sil, S, Phos,
  Calc carb)
• Decrease toxin load
• Dietary measures

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Dedifferentiation Phase

• Treatment Strategy cont
• Inhibition of proliferation at cellular level
• Viscum album, colchicum, etc.
• Specific inhibition of neoplasm
• Tumor-specific single remedy
• Anti-neoplasic nosode stimulus
• Stimulation of cellular detoxification
• Re-initiation of cellular enzyme function

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PAIN

• Most conditions cause pain
• Protective mechanism
• Occurs whenever tissues being damaged

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Types of Pain

• 2 types of pain
• Acute
• Slow
• Each type has its own transmission pathways and
  qualities

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Acute Pain

• Sharp, pricking, fast, electric
• Occurs within 0.1 seconds of the stimulus being
  applied
• Not felt in deep tissues

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Slow Pain

• Burning, aching, throbbing, chronic
• Begins after a second or more
• Increases slowly over seconds to minutes
• Associated with tissue destruction
• Can become excruciating
• Can occur both in skin or any internal organ or
  tissue

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Pain Threshold

• Skin temperature at which pain is first perceived
• 45- 47C

32
Pain Receptors

• Free nerve endings
• Widespread in superficial layers of skin and some
  internal tissues
• Fewer numbers in deep tissues

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Types of Pain Receptors

• Mechanosensitive
• Chemosensitive
• Thermosensitive

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Characteristics of Pain Receptors

• Non-adaptive
• Generally sensitive to more than one type of
  stimulus
• Increased activation over time
• Intensity of pain correlates with degree of
  tissue damage caused by other factors

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Causes of Pain

• Chemical stimuli
• Tissue ischemia
• Muscle spasm

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Referred Pain

• Pain felt in an area away from the actual tissues
  causing the pain
• Initiated by visceral organs
• Likely occurs as a result of visceral pain fibers
  in the spinal cord synapsing with fibers from the
  skin

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Visceral Pain

• Any stimulus that excites nerve endings in the
  viscera can cause visceral pain
• Stimuli can include ischemia, chemical damage,
  spasm of hollow organs, distension of hollow
  organs, stretching of ligaments
• Transmitted by C-type sympathetic sensory nerve
  fibers
• Chronic, burning, aching

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Pain Originating in Specific Organs

• Cardiac
• Ischemic, referred to neck, shoulders, pectoral
  muscles, down the arm (especially left)
• Esophageal
• Referred to pharynx, lower neck, arms, midline of
  chest
• Gastric
• Referred to anterior chest from below heart to
  xiphoid process, burning

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Pain Originating in Specific Organs

• Biliary/gallbladder
• Similar to gastric, burning, cramping, can
  radiate to R scapula
• Pancreatic
• Intense, severe burning, can be anterior or
  posterior to pancreas

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Pain Originating in Specific Organs

• Renal
• Pain fibers direct from skeletal nerves, felt in
  flank area
• Bladder pain felt directly over bladder, in men
  can radiate into testicles
• Uterine
• Lower abdominal cramping associated with
  dysmenorrhea
• Lesions in uterus/surrounding adnexa cause pain
  in the lower back or side sharp

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Organ-Specific Pain Remedies

• Cardiac-Glonoinum-Injeel, Emerg Tx
• Esophageal-Astricumeel
• Gastric-Astricumeel, Spascupreel
• Biliary/gallbladder-Chelidonium Homaccord P
• Renal kidney, bladder-Cantharis-Injeel
• Uterine-Metro-Adnex-Heel

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HomotoxicologyApproach to Treatment

• Multicentred approach i.e. treating symptoms and
  causative factors
• Use of compound remedies
• Treatment strategy with remedies acting on
  different levels

Prescription on a Clinical Basis
43
Principle of Therapeutical STAR

• Synergistic
• Therapy
• with Associations
• of Remedies

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Homotoxicological Cocktail
Homeopathic Single Remedy
Immune- stimulating Remedies
Drainage and Detoxification Remedies
Symptomatic Compound Remedies
Tissue specific Remedies
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Headache

• Several types of headaches
• Tension
• Depression headache
• Migraine
• Cluster
• Temporal arteritis
• Posttraumatic
• Cough
• Other neurological causes

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Headache
Basic Remedy Spigelon
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Headache
Basic Remedy Spigelon
Tissue remedy Cralonin
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Headache
Basic Remedy Spigelon
Tissue remedy Cralonin
Drainage remedy Lyphosot Apis Homaccord
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Headache
Basic Remedy Spigelon
Tissue remedy Cralonin
Drainage remedy Lyphosot Apis Homaccord
Homaccord remedy Apis Homaccord
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Headache
Basic Remedy Spigelon
Tissue remedy Cralonin
Drainage remedy Lyphosot Apis Homaccord
Homaccord remedy Apis Homaccord
Symptomatic remedy Belladonna Homaccord
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Spigelon

• Spigelia
• Belladonna
• Bryonia
• Gelsemium
• Melilotus officianalis
• Natrum carbonicum
• Silica
• Thuja

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Spigelon

• Indications
• Headaches of various origins and causes
• Neuralgic headaches
• Adjuvant in headaches due to fever, infection,
  abuse of alcohol
• Premenstrual headache

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Spigelon

• Dosage
• 1 tablet or 10 drops 3 times daily dissolved
  under the tongue
• In acutes, 1 tablet or 10 drops every 15 minutes
  up to 2 hours

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The Inflammatory Process

• Inflammation is a sign of healing and repair
• Involves 3 processes
• Battle the offender
• Clear impurities and toxins
• Repair damaged site

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Local Reaction
Agent/Noxae Antigen
cortisone antihistamine
Tissue Damage Release of Mediators
PGs, bradykinin,serotonin,kallikrein,
histamine, Hageman Factor
NSAID, COX-2
edema,increased permeability
Plasma extravasation into tissues
W
Cell immigration
W
Fibroblasts
Granulocytes,macrophages
W
W
SCAR TISSUE
PHAGOCYTOSIS
reparation
clearance
56
Systemic Reaction
Agent/Noxae Antigen
Bradykinin, PGS kalli, hist etc.
TH1/TH2 cells
Cytotoxic T cells
B cell antibodies
W
Immune complexes
Complement activation
pain fever leukocytosis
Complement cascade
Degradation of Ag/ foreign cells
W
PHAGOCYTOSIS
57
Otitis Media

• Signs and symptoms
• Ear pain
• Pressure inside the ear or behind the ear
• Decreased hearing
• Fever
• Redness and decreased mobility of the tympanic
  membrane

58
Otitis Media

• Conventional treatment
• Acute
• Antibiotics, decongestants
• Surgical drainage if severe otalgia or with
  meningitis or mastoiditis
• Recurrent
• Long-term prophylaxis with antibiotics
• Adenoidectomy and/or tympanostomy tubes

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Otitis media
Basic remedy Traumeel Ear Drops Traumeel
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Otitis media
Basic remedy Traumeel Ear Drops Traumeel
Tissue remedy Endoteel
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Otitis media
Basic remedy Traumeel Ear Drops Traumeel
Tissue remedy Endoteel
Drainage remedy Lyphosot
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Otitis media
Basic remedy Traumeel Ear Drops Traumeel
Tissue remedy Endoteel
Drainage remedy Lyphosot
Homaccord remedy Belladonna-Homaccord
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Otitis media
Basic remedy Traumeel Ear Drops Traumeel
Tissue remedy Endoteel
Drainage remedy Lyphosot
Symptomatic remedy Viburcol Osteel
Homaccord remedy Belladonna-Homaccord
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Belladonna Homaccord

• Belladonna
• Echinacea angustifolia

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Belladonna Homaccord

• Indications
• Treatment of all localized inflammations with
  redness, pain (usually throbbing), heat, and
  swelling
• Use before suppurative or erosive conditions
  emerge (1st stage)
• As adjunct for all types of organ specific
  inflammatory conditions

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Belladonna Homaccord

• In addition to
• Hepeel-liver
• Chelidonium-Homaccord P-gallbladder
• Reneel-genito-urinary
• Viburcol-adjunct in small children

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Belladonna Homaccord

• Dosage
• In acutes, 10 drops every 15 minutes
• 1 ampule per os o.d.
• Long-term treatment 10 drops t.i.d. p.r.n.

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Viburcol

• Chamomilla
• Belladonna
• Dulcamara
• Plantago
• Pulsatilla
• Calcarea carbonica

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Viburcol

• Indications infants and children primarily
• Restlessness with/without fever
• Common infections
• Gastrointestinal disturbances
• Detoxification

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Viburcol

• Dosage
• 1 suppository q.h. p.r.n. in acute cases
• Then b.i.d./t.i.d. prn
• For infants up to 6 months maximum dosage 1
  suppository bid
• Oral monodoses are also available
• See monograph for particular dosing info

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Gastroenteritis/Food Poisoning

• Signs and symptoms
• Acute anorexia
• Nausea
• Vomiting
• Diarrhea

• Causes
• Food intolerance
• Bacteria/viruses
• Stress
• Poisons (organic or inorganic)
• Drugs

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Gastroenteritis/Food Poisoning

• Conventional Treatment
• Antimicrobials (if specific agent identified)
• Antibiotics (bacterial infection)
• Fluid and electrolyte replacement

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Gastroenteritis/Food Poisoning
Basic remedy Areel
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Gastroenteritis/Food Poisoning
Basic remedy Areel
Tissue remedy Endoteel
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Gastroenteritis/Food Poisoning
Basic remedy Areel
Tissue remedy Endoteel
Drainage remedy Lyphosot
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Gastroenteritis/Food Poisoning
Basic remedy Areel
Tissue remedy Endoteel
Drainage remedy Lyphosot
Homaccord remedy Veratrum-Homaccord Nux
vomica-Homaccord
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Gastroenteritis/Food Poisoning
Basic remedy Areel
Tissue remedy Endoteel
Drainage remedy Lyphosot
Homaccord remedy Veratrum-Homaccord Nux
vomica-Homaccord
Symptomatic remedy Spascupreel
78
Areel

• Argentum nitricum
• Colchicum
• Colocynthis
• Tormentilla
• Cinchona
• Ipecac
• Phosphoricum acidum
• Sulphur

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Areel

• Indications
• Acute and chronic diarrhea
• Acute and chronic gastritis
• Gastroenteritis

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Areel

• Dosage
• Generally 1 tablet t.i.d.
• In acutes 1 tablet every 15 minutes for up to 2 h

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Traumeel

• Mechanism of action
• Anti-inflammatory, antiviral
• Elimination of venous stasis, antithrombotic
• Support cellular respiration
• Stimulation of immune system
• Stimulation of injury healing
• Analgesic

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Component Remedies of Traumeel

• Arnica
• Calendula
• Hamamelis
• Achillea millefolium
• Belladonna
• Aconitum

• Hepar sulphuris
• Chamomilla
• Symphytum
• Bellis perennis
• Echinacea angustifolia
• Hypericum
• Echinacea purpurea

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Traumeel

• Indications
• Injuries of all kinds including sprains,
  dislocations, contusions
• Effusions of blood and joint effusions
• Fractures, post-traumatic edema
• and inflammatory process especially if
  tendons, cartilage, and joints are involved
• Concussion, bursitis, epicondylitis, etc.
• Mucosal tissue damage

84
Principal Effects of Traumeel

• Regenerative
• Anti-exudative
• Anti-inflammatory

85
Contraindications

• Hypersensitivity to one of the active ingredients
• Hypersensitivity to Compositae family
• Patients with TB, collagen disorders, MS,
  HIV/AIDS, other autoimmune disorders

86
Side Effects

• Drops and Tablets
• Increased flow of saliva
• Rashes, itching, swelling, respiratory distress,
  vertigo, acute hypotension
• Ointment
• Hypersensitivity reactions
• Local skin inflammation

87
Traumeel

• Dosage
• Drops in general 10 drops t.i.d. for soft
  tissues swelling, 30 drops t.i.d.
• Tablets 1 tablet S/L tid
• Ointment apply to the affected parts and rub in
  bid, increase frequency p.r.n.

88
Arthritis
Strain Strain limit
Abrasion of cartilage free particles
Unfortunate application of loads leads to muscle
pain
Inflammation of the internal synovial membrane
Pain leads to unfortunate application of loads
Inflammation of the joint impaired functions
Cartilage Degeneration and Pain
89
Arthritis
Basic Remedy Zeel
90
Arthritis
Basic Remedy Zeel
Tissue remedy Ubicoenzyme
91
Arthritis
Basic Remedy Zeel
Tissue remedy Ubicoenzyme
Drainage remedy Lyphosot
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Arthritis
Basic Remedy Zeel
Tissue remedy Ubicoenzyme
Drainage remedy Lyphosot
Homaccord remedy Rhododendroneel S
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Arthritis
Basic Remedy Zeel
Tissue remedy Ubicoenzyme
Drainage remedy Lyphosot
Homaccord remedy Rhododendroneel S
Symptomatic remedy Neuralgo-Rheum Heel
94
Zeel

• Indications
• Arthrosis
• Osteoarthritis
• Arthritic pain syndroms
• Degenerative joint disease
• Maintenance of normal articular function

95
Contraindications

• Tablets hypersensitivity to the genus Rhus of
  the Anacardiaceae family
• Ointment hypersensitivity to Arnica, to the
  genus Rhus of the Anacardiaceae family,
  ingredients of the ointment base, allergic skin
  reactions
• Rarely anaphylaxsis in patients with
  hypersensitivity to Compositae and Anacardiaceae
  families

96
Zeel comp. vs. Diclofenac Study Overview
Design double-blind, randomized,
controlled, multi-center clinical study with
125 patients Indication osteoarth
ritis (degenerative arthritis in the
knees) Medication 3 x 1 tabl. Zeel comp./day
for 10 weeks 3 x 1 tabl. (25 mg)
Diclofenac/day for 10 weeks Target criteria
efficacy (Womac Arthritis Index)
safety
Maronna, Weiser, Klein Orthopäd. Prax. 2000
36(5) 285291
97
Result WOMAC Arthritis Index - Global
Mean Values
Global Index
6
5
4
3
2
90 CI upper/lower bound
1
Zeel comp. (N53)
Diclofenac (N61)
0
Start
Week 2
Week 4
Week 6
Week 10
0 No symptoms of arthritis 10 very severe
symptoms of arthritis
98
Zeel As Effective As Diclofenac
99
On the Safe Side with Zeel and Traumeel
Zeel/Traumeel vs NSAIDs Zeel/ NSAIDs Traumeel Eff
ective for reducing arthritic pain Yes Yes Effect
ive for restoring joint Yes Yes flexibility
Observed adverse reactions G.I.
toxicity No Yes Platelet aggregation
inhibition No Yes Sodium and fluid
retention No Yes
100
Enzymes

• Most highly specialized and the largest class of
  proteins
• Proteins are chains of amino acids strung
  together like a string of pearls
• Primary mediators of gene expression
• Catalyze thousands of chemical reactions that
  constitute the intermediary catabolism of cells

101
Enzymes

• 6 main categories of enzymes
• Oxido-reductases-oxidation-reduction reactions
• Transferases-transfer of functional groups
• Hydrolases-hydrolysis reactions
• Lysases-addition to double bonds
• Isomerases-isomerization reactions-
• Ligases-formation of bonds with ATP cleavage

102
Enzymes

• Some rely on own structure for activity
• Others require cofactors
• Most are substrate and reaction-specific
• Diet should provide cofactors including vitamins,
  minerals, trace elements

103
Enzymes

• E.g. of enzymes requiring metal ions
• Zn-alcohol dehydrogenase, carbonic anhydrase
• Mg-Arginase, phosphotransferase
• Mn-phosphohydrolases, phosphotransferases
• Fe-cytochromes, peroxidases, catalases,
  ferredoxin
• Cu-tyrosinase
• K-pyruvate phosphokinase (also requires Mg)
• Na-plasma membrane ATPase

104
Wobenzym N

• Ingredients
• Pancreatin 100 mg
• Papain 60 mg
• Rutin 50 mg (rutosid)
• Bromelain 45 mg
• Trypsin 24 mg
• Chymotrypsin 1 mg

105
Wobenzym N

• Indications
• Injuries (prophylaxis or trauma treatment)
• Venous diseases
• Acute and chronic inflammation
• Rheumatic disorders
• Lymphedema
• Prostatitis
• Adjuvant therapy with antibiotics
• Post-surgery recovery

106
Wobenzym N

• Mechanism of action
• Immune regulation
• Accelerate breakdown of products of inflammation
• Rutin restores vascular permeability
• Reduces viscosity of blood
• Increases microcirculation
• Alleviates pain, accelerates healing

107
Wobenzym N

• Contraindications
• Patients with coagulation disorders
• Patients with allergies
• 24 hrs before surgery
• Organ transplant patients
• Patients on corticosteroid treatment
• Some diabetics
• Pregnant or nursing mothers

108
Wobenzym N

• Dosage
• 2 tablets t.i.d. with plenty of water as standard
  or maintenance dose
• In acute cases, up to 4-6 tablets t.i.d.
• Take on empty stomach, 1/2 hour to 1 hour ac with
  plenty of liquid

109
Wobenzym N

• Drug interactions
• Concurrent administration with antibiotics
  increases the antibiotic concentration at the
  site of action
• Side effects
• Change in consistency, odor, color of stool
• May induce allergies
• Diarrhea, flatulence, sensation of fullness,
  occasionally vomiting
• Reduces viscosity of blood

110
Thank you for your attention