Pain - Case Study

by Paul Bergner

Medical Herbalism 10-31-94 6(3): 1, 4-5

Patient: 43 year old man. Possible cervical disk injury; possible nerve irritation after series of minor accidents driving heavy equipment.

Symptoms: Spasm and severe pain radiating down left arm. Incapacitating. Accompanying insomnia. Had not slept through the night for three weeks when coming to me. Depressed, anxious, constant moderate pain.

Diagnosis: Had complete X-ray and CTS workups. Diagnosis: minor disk damage. No neck brace.

Other medical care: muscle relaxants.

Other medical problems: tinnitus, dizziness, facial neuralgia, also following the accidents. Supports possibility of nerve injury from minor whiplash.

Therapeutic strategy: Short term: promote rest and sleep by sedating and relieving pain at night.

Method: Use very strong high dose nervines and sedatives to reestablish the normal sleep-wake.

Formula:

Part 1

Valeriana off. (valerian root)

Salix alba (willow bark)

Viburnum opulus (cramp bark)

Decoction. One ounce of each. Bring two quarts of water to a boil, then simmer, covered on lowest heat for 20 minutes. Strain.
 
 

Part 2

Scutellaria lateriflora leaf (skullcap)

Hypericum perforatum leaf (St Johnswort)
 

Copyright 2001 Paul Bergner    334

Medical Herbalism: Clinical Articles and Case Studies

Infusion: One-half ounce of each. Place in quart canning jar. Fill with boiling water. Cover tightly and let cool to room temperature. Strain.

Mix the decoction and infusion. Take half cup one hour before bed, then a full cup at bedtime. Keep a cup beside the bed at night in case of waking. Take half-cup doses during the day as needed.

Practitioner Comments: I demonstrated to him how to make the tea at his home. I took a tablespoon tea and it made me drowsy. He took a whole cup. The first, he still woke up but sleep was deeper. Over subsequent two weeks, he took the tea every night, but in reduced amounts, restored restful sleep. During course of treatment, a physical therapist prescribed a neck brace, which also helped him to sleep throughout the night. He reported 100% satisfaction, and decided to study about herbs. His condition is now chronic, rather than acute, and he manages flare-ups with acupuncture treatments.

The formula has sedating, hypnotic, anti-pain, anti-spasmodic, and anti-depressant properties, and I use it or something like it to promote sleep when there is acute pain that interferes with sleep. I suggest a moderate dose an hour before bed, then a larger dose at bedtime, to reinforce the normal sleep-wake cycle, with only a light dose if a nap is desired during the day. This formula is very strong. A shot-glass of this is a potent sedative. I’ve seen a single cup of a similar tea put a five-year-old bum victim (second-degree on most of arm and shoulder) to sleep.

Valeriana off. root (valerian)

Valerian has central nervous system effects. it compares favorably with benzodiazepine drugs (Valium, Xanax) for inducing sleep, without the hangover or addictive potential of those drugs. No major side effects. It can cause a feeling of “burnout” if taken for two-three weeks in larger doses. Side benefits: improves digestion through bitter principles.

Scutellaria lateriflora leaf (skullcap)

Scullcap is nervine and sedative. Caution: sometimes adulterated with species of germander (Teucrium spp.), which may be hepatotoxic when taken for long periods. Know your source. Scullcap has no major side effects. Valerian and Scullcap are balanced “energetically” according to the parameters of Chinese medicine, i.e. Valerian is considered “warming,” and can cause idiosyncratic reactions (i.e. stimulation) in people with a “hot” constitution. Skullcap, on the other hand, is “cooling.” These concepts have no exact equivalent in Western medicine. A combination of equal parts of each herb is a common OTC sedative throughout Europe.

Salix alba bark (willow bark)

This is, of course, the source of the -sali- in salicylic acid, the base compound for aspirin. The dose equivalent from this herb cannot reach the level of even a few aspirin, yet it has been used for centuries to alleviate the pain of headache and arthritis. It has an advantage over aspirin and other non steroidal anti-inflammatory drugs in that the active constituents are released in the liver, and it does not present the risk of serious gastrointestinal side effects that those drugs do. It won’t obliterate pain, but is useful to “take the edge off” pain for people with mild-to-moderate chronic pain. No known side effects.
 

Copyright 2001 Paul Bergner    335

Medical Herbalism: Clinical Articles and Case Studies

Viburnum opulus bark (cramp bark)

This plant also contains aspirin-like compounds. It is used in herbalism as an antispasmodic. For some women, it is the only thing they can find that will ease their menstrual cramps. The antispasmodic principle has not been isolated. No major side effects.

Hypericum perforatum leaf (St. Johnswort)

Hypericum has been used traditionally both in homeopathy and in botanical medicine for “nerve pain” especially after crushing injuries. It is used in contemporary European phytomedicine as a mild antidepressant, with efficacy demonstrated in double-blind trials. Its action is hypothesized to be through MAO inhibition, but this is unlikely because the dietary and other side effects typical of MAO inhibition are totally absent. It’s approved for OTC use in Germany. It is used in Europe for “atypical” depression, or the German “vegetative dystonia.” In addition to its benefits for “pain of injured nerves,” it’s antidepressant effects make it valuable in a pain formula, because depression invariably accompanies chronic pain. A possible side effect is photosensitivity, i.e easy sunburning.
 

Copyright 2001 Paul Bergner    336