Faculty of Health Sciences
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Item An exploration into the understanding and management of the symptoms of low back pain by the traditional healers from the Warwick Muti Market in Durban(2018) Mchunu, Thobile; Ross, Ashley Hilton Adrian; Sobuwa, SimpiweBackground Low back pain (LBP) is a major health problem that has been researched thoroughly in the western world, but poorly in the context of traditional healing. However, the LBP treatments, assessment and management strategies developed for the western world may have limited relevance for traditional healing. This paper presents the experience of the chiropractic student who is completing her Master’s degree at the Durban University of Technology in KwaZulu-Natal, South Africa. The focus of the study is in the traditional understanding and management of the symptoms of LBP by traditional healers from the Warwick Muti Market in Durban. It was deemed important to conduct such a study in order to develop an in-depth understanding of the way in which African traditional healers conceptualise and manage a LBP disorder. The research also highlights the causes of and common treatments for LBP by traditional healers in Durban in a cultural context. This was regarded as important because, clinical modern skills are required to adapt to cultural beliefs, pain perceptions and lifestyle contexts in the interests of improving the management of LBP. Aim of the study The aim of the study was to explore the understanding and management of the symptoms of low back pain by traditional healers’ from the Warwick Muti Market in Durban. Methodology A qualitative, interpretivist paradigm was used to explore the understanding and management of the symptoms of LBP by traditional healers from the Warwick Muti Market in Durban. All the relevant ethical issues in research were considered after which individual interviews were conducted. These interviews involved the use of interview guide and a voice recorder. The interviews were semi-structured and conducted in IsiZulu, after which they were translated into English and transcribed verbatim. NVivo® 11 was used to analyse data which had been obtained. Thereafter themes were derived. Results Generally, traditional healers interviewed appeared to understand the symptoms of LBP from a cultural perspective. It was noted that traditional healers emphasised the need to consider and understand the patient holistically, without separating the patient from the disease. They clearly believed that they were providing spiritual and cultural assistance appropriate for health care. They also placed considerable emphasis on the traditional and cultural frameworks in the understanding LBP. The traditional healers interviewed in the study described various treatments or management strategies for LBP problems. These treatments included plant remedies or traditional medicines (izinsizi, umhlabelo, imbiza) which have different healing properties, as well as certain animal extracts (animal fats). Other substances as well as specific rituals and traditional techniques and methods were also mentioned. These include making incisions (ukugcaba) in the painful areas, bowel cleansing (ukuchatha) and other treatments for cleaning the ‘dirty blood’ and toxins from within. Although it may be possible that some of these methods may not be very effective, nevertheless the traditional healers believed in the ability of the medicine they used to treat and manage the symptoms of LBP. The traditional healers interviewed reported various causes of LBP including ilumbo (a sexually transmitted disease, particularly affecting the youth, mainly males. It is characterised by penile sores, discharge, low sex drive and marked inguinal lymphadenopathy and is difficult to treat), umeqo or umbhulelo (a form of witchcraft in which sickness is believed to arise by walking or stepping over a traditional medicine), accidents and injuries to the back, work or job-related factors, old age, ancestors and culture. The information they provide on the causes of LBP showed that considerable emphasis was placed on both a holistic approach and a cultural understanding of the symptoms of LBP. However, the respondents also mentioned other factors such as infection and organic deterioration (kidneys), which were thought to contribute to LBP. The traditional healers tended to personalise the cause of the problem while the reasons for such problems were often sought in supernatural realm. It was, thus, deemed necessary to treat these causes in a traditional approach. The traditional healers who were interviewed mentioned various plants and herbs commonly used to treat the symptoms of LBP. These include roots and bark which may have different healing properties as well as different roles in the treatment of LBP. An important contributor to successful treatment appeared to be the belief in the plant’s ability to heal LBP. Some traditional healers also use certain animal products as an adjunct in the treatment of pain. Conclusion The study concluded that traditional healers understand LBP in terms of its biopsychosocial nature while their management and treatment of LBP focus on this complex pain disorder in a holistic context. The traditional beliefs in respect of LBP take into account both the cultural and biopsychosocial aspects of pain. African traditional plants and medicine play an important role in healthcare structure in South Africa. In addition, traditional medicine is an intrinsic aspect of the services offered by the traditional healers who are regularly consulted in Warwick Muti Market in Durban for the relief of low back symptoms.Item The efficacy of combined diclofenac therapy and spinal manipulation compared to combined placebo therapy and spinal manipulation in the treatment of mechanical low back pain(2001) White, Powan Harvey; Mathews, RobertThere are many non-surgical treatments that are available to patients with low back pain but few have been proven effective in controlled clinical trials. Arguably, the treatments with the greatest evidence for efficacy are nonsteroidal anti-inflammatory drugs (NSAIDs), some muscle relaxants and spinal manipulation (Deyo et al.(1983) and Shekelle et al.(1992). Non-steroidal antiinflammatory drugs are the most widely used agents for musculoskeletal pain and inflammation. The widespread use of NSAIDs augments the impact not only of their benefits but also the risk of their adverse effects. The effectiveness of chiropractic management is now firmly established for most patients with acute and chronic low-back pain (Koes et aI.1996). The purpose of this study was to determine the relative efficacy of combined diclofenac sodium therapy and spinal manipulation compared to combined placebo therapy and spinal manipulation in the treatment of mechanical low back pain. Sixty subjects were selected and randomly divided into two groups of thirty subjects. Subjects were treated four times over a two-week period, including a diclofenac or placebo medication course, taken three times daily for five days, starting from the first consultation. The results of the Numerical Pain Rating Scale-101, Revised Oswestry Low Back Pain Disability Questionnaire, Orthopaedic Rating Scale and Algometer readings were taken before the first, third and fourth consultations. The statistical tests used were the parametric two-sample unpaired t-tests and the paired t-tests, and the nonparametric intra-group Friedman test, multiple comparison procedure, Wilcoxon Signed Ranks test and the inter-group Mann Whitney U-test at the 95% level of significance using the SPSS statistical package. There was a statistically significant improvement in both treatment groups for both subjective and objective clinical findings, suggesting that spinal manipulation combined with either an NSAID or placebo medication will ultimately give relief to a patient suffering from lower back pain. The conclusions