Herbal remedies effective for short-term pain relief, researchers say

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Herbal remedies effective for short-term pain relief, researchers say



May 1, 2006



Gandey



Windsor, ON - A systematic review of 10 randomized controlled trials

of patients with low back pain has found that herbal preparations of

devil's claw, white willow bark, and cayenne plasters may be as

effective as pain medication for short-term pain control [1]. " Given

that Vioxx was taken off the market due to safety concerns, at this

point, it would be desirable to recommend all three of the above

alternatives for short-term relief, but interactions between

medication and herbal medicine must always be considered, " lead

author Dr Gagnier (Ottawa Street Medical Centre, Windsor, ON)

told reporters. He added, " These treatments should not be tried

without the supervision of a qualified medical professional. "

In a news release about the study, Dr Marks, chief of the

medical staff at Norwalk Hospital in Connecticut, agreed that herbal

treatment may be tried, but he suggested that they should not be seen

as a replacement for conventional painkillers. Commenting on the

study for the press, Marks, who was not involved in the work, said,

" There is probably no reason for the individual without any

underlying medical problems not to try these treatments, " but he

added, " There is really too much unknown about the potential side

effects of these medications. A good deal of the herbal medicines

prolong bleeding time and interact with anesthetic agents. "

Marks also pointed out that patients don't always see the potential

danger in herbals because they are not regulated. " That is the major

concern among the medical community—the lack of consistency of the

preparations and exactly what the interactions are with traditional

medications. "

The systematic review, which appears in the April 19, 2006 issue of

the Cochrane Library, included about 1600 patients with acute,

subacute, or chronic low back pain. The studies evaluated Harpago

procumbens, otherwise known as devil's claw, Salix alba (white willow

bark), and Capsicum frutescens (cayenne) and compared these herbal

preparations with placebo and rofecoxib (Vioxx, Merck).

Long-term efficacy and safety remain uncertain

" The results of these 10 trials suggest that specific herbal

medicines may be effective for short-term (four to six weeks)

improvement in pain and functional status for individuals with acute

episodes of chronic nonspecific low back pain, " the authors write.

" These herbal medicines could be considered as treatment options for

acute episodes of chronic low back pain. "



" That is the major concern among the medical community—the lack of

consistency of the preparations and exactly what the interactions are

with traditional medications. "



But the researchers also caution that the long-term efficacy and

safety of the herbal treatments remain uncertain. " There is

insufficient evidence to make definitive conclusions regarding those

trials comparing herbal medicine interventions with standard drugs. "

Gagnier and colleagues report that the trials of devil's claw were

the strongest in terms of methodology, and these were followed by the

studies of white willow bark. Data on cayenne, they note, were

generally of low quality.

Two trials examining the effects of devil's claw found strong

evidence that daily doses standardized to 50 mg or 100 mg harpagoside

were better than placebo for short-term improvements in pain and

rescue medication. Another study demonstrated relative equivalence to

12.5 mg per day of rofecoxib.

Two other trials examining the effects of white willow bark found

moderate evidence that daily doses standardized to 120 mg or 240 mg

salicin were better than placebo for short-term improvements in pain

and rescue medication. An additional trial demonstrated relative

equivalence to 12.5 mg per day of rofecoxib.

The researchers add that three low-quality trials examining various

topical preparations of cayenne found moderate evidence that this

herbal remedy produced more favorable results than placebo and one

trial found equivalence to a homeopathic ointment.

The group calls for additional trials testing these products against

standard treatments, and they recommend that investigators refer to

the ConsolidatedStandards of Reporting Trials (CONSORT) statement

extension for reporting trials of herbal-medicine interventions.

Gagnier J, Vantulder M, Berman B, et al. Herbal medicine for low back

pain. Cochrane Database Syst Rev 2006; 19:CD004504. 16625605