Alternatives to the use of Cortisone

Written by

Urenus

in

J. Kersschot, M.D.
Belgium

BioMedical Therapy Magazine Symposium
At the Royal Society of Medicine, London
10. 5. 1997

A. Introduction

Although the use of corticosteroids is accepted as a standard technique in the treatment of several inflammatory diseases, we must recognize that specific injection techniques of anti-inflammatory products are gaining more and more interest. Most physicians, however, tend to regard these techniques as marginal phenomenons. The importance of these injections in the treatment of so-called inflammatory diseases is relatively unexplored and promises to be a fertile area for further investigation.
Since most physicians have never been trained in these techniques, they are anything but expert in this field. I think that every therapist should at least know about the existence of this strategy, even if he or she will not use injections in his or her own practice.
So, I will introduce to you today the therapeutical strategies that focus on injections of non-steroid products. Both chemotherapeutic and biotherapeutic products will be discussed, and several techniques of administrating them will be explained. The clinical cases will try to illustrate my strategies.
I have more than ten years of experience with these techniques in my private practice as a general practitioner in Belgium, and I have noticed that there is a very broad spectrum of medical problems that can be managed with this injection strategy. Today, however, I will only discuss two examples of alternatives for cortisone: the treatment of musculoskeletal pain and the treatment of asthma.
Still, I do not make any claims about the injections described in this lecture, involving the prevention or cure of any disease. Maybe the effects that I have noticed in my private practice are no more than a sophisticated placebo. I cannot be sure that what I am doing is best for the patient unless this practice has been rigorously tested; to check the items that I suggest, large-scale clinical studies are necessary. This lecture can be regarded as an invitation to do so in the near future.

B. Injection of biotherapeutics

B.1. Injection of biotherapeutics is not a very strategic novelty

Those familiar with biotherapeutics for injection know that many ampoules exist since several decades, especially in Germany. Especially Heel, Pflüger, Steigerwald, Dolisos, Cosmochema, Fides and Hevert are famous for their ampoule preparations. Thousands of them are injected every day, and clinical studies check their efficiency and control their possible side-effects (ref. 20, 21, 28, 29). A wide selection of homeopathic and phytotherapeutic preparations has been on the market in injection form for many years now, and they have been employed in daily medical practice with good success, especially by general practitioners, rheumatologists and orthopaedic doctors. Many authors have already mentioned the use of biotherapeutic ampoules for injection: Bianchi (ref. 3), Claussen (ref. 13), Coeugniet, de La Fuye (ref. 31), Diamond (ref. 44, 45), Fischer (ref. 36), Frase, Gellman (ref. 19), Graf von Ingelheim (ref. 27), Geyer (ref. 24), John, Kleinscholt, Küstermann, Lannugier-Bolling, Meltelmann (ref. 28, 29), Müller, Pollmann, Potrafki (ref. 21), Preusser, Reckeweg (ref. 14), Riley (ref. 16), Risch, Schmid (ref. 17), Subotnick (ref. 43, 48), Thiel (ref. 20), Timmermann (ref. 10), Vorstoffel (ref. 33), Wachter, Werthmann, Weiser (ref. 28), Zenner (ref. 29) and many others (see ref. 1: bibliography).
Since there was no specific name for all the methods that use biotherapeutics for injection on specific spots, I introduced in Belgium the term ‘biopuncture’ (ref. 1, 2, 5), in order to distinguish the use of homeotherapy according to de La Fuye (ref. 31), neural therapy according to Huneke (ref. 11), ampoules over nerve blocks according to Bracho (ref. 12) and segmental acupuncture according to Pistor (ref. 32). At the same time we want to give more credibility and respect to orthodox doctors as to therapists in natural medicine (ref. 1, ref. 8). In this way, we shall stimulate its use, so that the strategy of using these injections is developed in everyday practice.
Let us now go a little deeper:

C. Biotherapeutics for local injections?

C.1. Subcutaneous injection

One of the most familiar ways of using biotherapeutics in everyday practice. Most of you use them in the oral form, as tablets or drops.
Although you may not be interested in giving injections in your practice, I think it is good to know more about the enormous possibilities of these biotherapeutic drugs. And it might give you a broader view on natural medicine, because injections can act in a more powerful way than oral medication.
The exact choice of the remedy itself (ref. 1, 2, 5).

C.2. Acupuncture point injections

Those doctors familiar with acupuncture, can enhance their therapeutic effect by injecting intracutaneously or subcutaneously a biotherapeutic product instead of dry needling. This method was mentioned before by de La Fuye, Geyer, Matz, Frase and many other authors.
It is theoretically possible to inject a single remedy into an acupuncture point that is known for certain indications. This combination of homeopathy and Chinese medicine (homoeosinaty) was introduced by de La Fuye. I will give you some examples:

Chelidonium on Liver 13 for drainage of the liver,
Nux Vomica on Bladder 21 for gastritis,
Gnaphalium on Bladder 34 for ischias,
Sulfur on Bladder 52 for eczema,
Cantharis on Kidney 11 for cystitis,
Lobelia on Kidney 27 for asthmatic bronchitis,
Naja Tripudians on Bladder 17 for cardiac neurosis,
Crataegus on Heart 3 for palpitations,
Thuja on Gallbladder 30 for coxarthrosis,
Echinacea on Jenn Mo 19 for cough, asthma, bronchitis
Echinacea on Jenn Mo 22 (for cough, asthma, bronchitis),
Lachesis on Small Intestine 19 for vertigo,
Sulfur on Bladder 31 for climacteric disorders.

Cralonin on Heart 3 for palpitations,
Cralonin on Bladder 15 for palpitations,
Engystol on Small Intestine 14 for asthma,
Vertigoheel on Small Intestine 19 for vertigo,
Mullein pro injectione on Urinary Bladder 31 for climacteric disorders,
Traumeel on Gall bladder 20 for headache,
Spigelon on Gall bladder 20 for headache,
Zeel on Gall bladder 30 for pain in the hip region,
Pulsatilla composition on Jenn Mo 6 for activation of the defensive system.

It is also possible to inject a complex remedy into several points of an acupuncture meridian, like for example Discus compositum over the Governor vessel. Subcutaneous or intracutaneous injections are given on the mid-line of the back, or at the level of every vertebra in the region of the pain.
Those allopathic products should always be used in a diluted way (half a normal dose, adding several ml of physiological fluid and several ml of a local anesthetic), and should be injected with more care than the biotherapeutic one. I use them as a replacement for corticosteroid injections (see also ref. 51). Of course, some injections are given at the physician’s own responsibility, when the product is used in a way for which it has not been registered. Ticlodil is officially designed for the intravenous/intramuscular injection only and an oral Feldene is officially designed for the intramuscular injection only. So, I can not make any claims about their safety and efficacy, until more large-scale clinical studies are performed.

F. Is it always necessary to give injections?

For those therapists who are not allowed to give injections, I can recommend to do trigger point therapy with stretch and spray, as Travell and Simons suggest. This is an easy and safe technique, and gives interesting results when dealing with several myofascial disorders. The patient is usually very enthusiastic, since he or she has almost immediate relief. Although this effect is temporary, long term effects are achieved with repeated sessions.
Even more interesting is ischemic compression. Ischemic compression is application of progressively stronger, painful pressure on a trigger point for the purpose of eliminating the trigger point’s tenderness and hyperirritability. Similar to acupressure and shiatsu, the thumb is used as the therapeutic tool. But we do not deal with acupuncture points, but solely with active trigger points, which can be found by clinical examination. The thumb action blanches the compressed tissues, which usually become flushed (hyperemic) on release of the pressure. The use of Traumeel ointment during and after the compression, enhances the effects of the treatment.
The clinical effects of the technique depend largely on the skills of the therapist. When looking for the active trigger points, wall plates can help. Textbooks (by Baldry, Travell and Simons) give more fundamental information on this subject. In Belgium, I am giving workshops on trigger point therapy, in order to show how this technique can be performed in everyday practice.

Case:

Clinical examination shows a painful zone in the right brachioradialis muscle and a small spot at the epicondylus radialis, that is painful on digital pressure. He had ischemic compression on two trigger points in the brachioradialis muscle, twice a week.
He also got a local application of Arnica comp. ointment (e.g. Traumeel) in the right brachioradialis muscle and on that small painful spot at the epicondylus radialis, three times a day. Additional oral treatment with Ferrum-Homaccord, ten drops three times daily, gave complete relief after two weeks.

Case:

A girl of twelve has suffered a contusion of the lateral part of the thigh while snowboarding. The examination on the evening shows an obvious swelling of the thigh and an extensive haematoma. The region is very sensitive to pressure, and she refuses a local injection. I give her Arnica comp. ointment (Traumeel ointment, which was cooled in the fridge) and she applied it every hour the first day, every two hours the second and third day and four times a day the three next days. Putting the ointment in a refrigerator before application gives an extra cooling down in an acute situation. As an additional therapy, she received Arnica comp. tablets: I told her to take them at the same frequency as the application of the ointment. I asked her to keep the tablets in the mouth as long as possible, to give the product maximum resorption via the oral mucosa. After six days the pain and swelling were completely gone.

G. Conclusion

Although the use of corticoids is accepted as a standard technique in the treatment of several inflammatory diseases, we must recognize that specific injection techniques of biotherapeutic products are gaining more and more interest. Most physicians, however, are not familiar with these techniques. That is why I wanted to show the importance of these injections in the treatment of so-called inflammatory diseases.
By using biotherapics (drops or tablets), I have experienced that the combination of oral application (drops or tablets) and local treatment (ointment and/or injections) gives interesting results, both in acute as in chronic cases.

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