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   Jan 15

How Effective Are Herbal Remedies for Treating Low-Back Pain?

Low-back pain (LBP) is considered a major public health problem accounting for millions of doctor visits and lost workdays. In the U.S., the direct and indirect costs associated with LBP and its related disability is in the billions.1 With prevalence increasing, the search for effective treatment continues to be a priority; however, there is widespread professional uncertainty about how to effectively treat patients with LBP. Clinical guidelines for LBP contain several interventions, although few have sufficient evidence to show benefit; exercise therapy, behavioral therapy, and short-term analgesic use appear to be somewhat effective for chronic LBP management. Interest in complementary and alternative medicine (CAM) also continues to grow and many herbal products have been reported to help with various types of pain. Back pain is one of the five most common conditions associated with CAM use; between 16.8% and 57.2% of patients with back problems have reported seeking CAM treatments.2

In a recent study published in The Cochrane Library, researchers sought to determine how effective herbal remedies are for LBP when compared to placebo, no intervention, or other interventions. Fourteen clinical trials involving 2,050 patients with non-specific acute or chronic LBP were included in the review.3 The six herbal products tested were: Harpagophytum procumbens(devil’s claw), Salix alba (white willow bark), Capsicum frutescens(cayenne), Symphytum officinale L. (comfrey), Solidago chilensis(Brazilian arnica), and lavender.

The following is a summary of the authors’ conclusions based on available study data:

Harpagophytum procumbens(devil’s claw)

Harpagoside 50mg or 100mg per day, from an aqueous extract of H. procumbens, may be better than placebo for short-term improvements in pain and may reduce rescue medication use (ie, tramadol) in chronic LBP (low quality evidence)
Harpagoside 60mg/day, from an aqueous extract of H. procumbens, showed relative equivalence to rofecoxib 12.5mg/day in chronic LBP (very low quality evidence)

Salix alba (white willow bark)

Salicin 120mg or 240mg per day, from an extract of S. alba, is probably better than placebo for short-term improvements in pain and rescue medication use (ie, tramadol) in chronic LBP (moderate quality evidence)
Salicin 240mg/day, from an extract of S. alba, showed relative equivalence to rofecoxib 12.5mg/day in chronic LBP (very low quality evidence)
S. alba, a platelet inhibitor, minimally affected platelet thrombosis vs. a cardioprotective dose of acetylsalicylate

Capsicum frutescens (cayenne)

Capsicum cream reduces pain and improves function compared to placebo in chonic LBP (moderate quality evidence)
Capsicum cream may possibly reduce pain more than placebo in acute LBP (verylow quality evidence)
Capsicum plaster reduces pain and improves function compared to placebo in chronic LBP (moderate quality evidence)
Capsici Oleoresin gel showed relative equivalence to Spiroflor SLR homeopathic gel in acute and chronic LBP (very low quality evidence)

Symphytum officinale L. (comfrey)

Comfrey extract ointment may possibly be better than placebo ointment for short-term improvements in pain as assessed by visual analogue scale in acute LBP (low quality evidence)
Solidago chilensis (Brazilian arnica)

Brazilian arnica-containing gel applied twice daily may improve pain and lumbar flexibility as compared to placebo gel in patients with lumbago (low quality evidence)

Lavender

Lavender essential oil applied by acupressure may reduce pain perception and improve lateral spine flexion and walking time in acute LBP (very low quality evidence)

Conclusion

Based on the results of this review, C. frutescens (cayenne) appears to reduce pain more than placebo; H. procumbens, S. alba, S. officinale L., S. chilensis, and lavender essential oil were possibly more effective than placebo. However, the quality of evidence for these herbal products is moderate at best. Within the studies used for this review, no significant adverse events were noted; mild transient GI complaints and skin irritations were primarily reported. The authors also point out that the type of preparation can also influence the amount of product per dose and therefore the efficacy. More trials would need to be conducted before these herbal products can be recommended for pain management in LBP.

References

Grabois M. Management of chronic low back pain. American Journal of Physical Medicine and Rehabilitation2005;84(3 Suppl):S29–S41.
Frass M, Strassl RP, Friehs H, Müllner M, Kundi M, Kaye AD. Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner Journal 2012;12(1): 45–56.
Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ. Herbal medicine for low-back pain. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD004504. doi: 10.1002/14651858.CD004504.pub4.

Source: Monthly Prescribing Reference

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