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Research has increasingly begun to study the use of herbal remedies that may help to manage various aspects of chronic pain, including pain relief, inflammation, and relaxation. It is important to realize that although these remedies are natural, they still contain active biochemical agents that can have potent effects. Because of this, it is important to discuss their use with a knowledgeable healthcare practitioner who understands their effectiveness and limitations, side effects, interactions with other medications, foods or herbs, contraindications for use, and other safety issues. When purchasing herbal remedies it is important to buy quality-controlled standardized products in order to guarantee that an herbal product contains a specific amount of the active ingredient in quantities sufficient to produce the desired effect. The web site www.consumerlab.com is a good information source on products that have undergone independent testing for quality control and active ingredients.
- Willow bark. White willow bark contains salicin which, like salicylic acid in aspirin, has anti-inflammatory and pain-relieving actions. Pain relief from willow bark will likely take longer than aspirin to begin, but there is some evidence that it will last longer than standard aspirin products. Side effects tend to be minimal and, like aspirin, can involve gastrointestinal upset. Willow bark is not recommended for people with ulcers or gastritis.
In a recent controlled study of willow bark extract for the treatment of low back pain, a higher dose of the extract (240 mg of salicin---equivalent to about 60 mg of acetylsalicylic acid {aspirin}) was found to be more effective than a lower dose (120 mg of salicin) for pain relief and both were more effective than placebo. (Chrubasik, 2000). Another study comparing the use of willow bark extract with the selective Cox-2 inhibitor rofecoxib showed that both appeared to be similar in effectiveness and safety, with both groups showing significant improvements in symptoms of pain after four weeks. (Chrubasik, 2001) Thus evidence suggests willow bark may be useful and safe for the treatment of low back pain.
- Devil's claw. There is some evidence that Harpagophytum extract or Devil's claw may be effective in treating the pain and inflammation of osteoarthritis, especially when used with non-steroidal anti-inflammatory drugs (NSAIDs), and may enable patients to decrease their use of NSAIDS for pain relief. Side effects are minimal and mostly consist of mild and infrequent moderate gastrointestinal symptoms such as loose stools or heartburn. Since devil's claw can promote the secretion of stomach acid, it is not recommended for patients with ulcers, heartburn or gastritis.
In one controlled trial, 10% of patients with chronic low back pain responded to Harpagophytm extract, as measured by relief of pain and the decreased need for the opioid medication tramadol. Further analysis suggested that Harpagophytm may be effective in patients with shorter exacerbations of pain, less severe pain, and without pain radiation to the legs (Chrubasik, 1999). In another multicenter study, after eight weeks of treatment results showed significant improvement of pain symptoms and mobility of the affected areas of the spine, with no serious side effects observed (Laudahn, 2001).
St. John's wort. Based on the majority of clinical studies, standardized forms of St. John's wort extracts have been shown to be effective for the treatment of mild to moderate depression (more effective than placebo and as effective as some forms of antidepressants) (Whiskey, 2001). It has not, however, proven effective for more severe depression. (Shelton, 2001). When used correctly, St. John's wort has a good safety profile. It should not be used in large doses of 1800 mg or more per day or in patients who are pregnant or lactating. It can have significant herb-drug interactions (both raising and lowering bodily levels of medications) by its effect on the liver's detoxifying mechanisms. This is an herb best used under a healthcare professional's supervision---this supervision is medically necessary if one is using any other supplement or medication.
Valerian. Valerian is primarily used for insomnia but may also be effective in reducing anxiety. Clinical studies have shown that valerian is more effective than placebo and as effective as standard sleep medications for people with insomnia, with an extremely low number of adverse events (Wheatley, 2001) (Donath, 2000). It has been shown to reduce time to sleep onset and improve sleep quality. Significant improvement, however, can require two to four weeks of treatment. Valerian appears safe to use on a short-term basis and in appropriate doses. (Wheatley, 2001, (Donath, 2000), (Fugh-Berman, 1999)
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