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Devil's Claw and Other Herbals Effective for
Low-Back Pain in the Short Term
By Lise Millay Stevens, Contributing Writer
Health Behavior News Service
April 19, 2006 - The herbal preparations devil's
claw, white willow bark and cayenne plasters may be as effective as pain
medication for short-term low back pain and are better than placebo, a
new systematic review of studies has found.
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The review comprised 10 randomized controlled
trials involving nearly 1,600 adults who had acute, sub-acute or chronic
low back pain.
Editor's Note: Low back pain will strike
up to 85% of Americans at some point in their lives, but, interestingly,
the problem peeks at between 45 and 59 years of age. Fewer senior
citizens may have back pain, because it is often associated with
work-related injuries.
Led by Dr. Joel J. Gagnier of the Provincial
Medical Centre in Windsor, Canada, the review appears in the current
issue of The Cochrane Library, a publication of The Cochrane
Collaboration, an international organization that evaluates medical
research. Systematic reviews draw evidence-based conclusions about
medical practice after considering both the content and quality of
existing medical trials on a topic.
The authors looked at randomized controlled trials
of the three herbals that involved nearly 1,600 adults with acute,
sub-acute or chronic low back pain. The studies pitted devil's claw
(Harpago procumbens), white willow bark (Salix alba) and cayenne
(Capsicum frutescens) against sham pills and against Vioxx, the
painkiller since removed from the market amid concerns over its
long-term safety.
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 non-specific low-back pain, the authors
concluded. "These herbal medicines could be considered as treatment
options for acute episodes of chronic low back pain," they said.
But the authors cautioned that the long-term
efficacy and safety of the herbal treatments remain uncertain because
"there is insufficient evidence to make definitive conclusions regarding
those trials comparing herbal medicine interventions with standard
drugs."
The trials of devil's claw were the strongest in
terms of methodology, followed by white willow bark and cayenne, the
trials of which were rated "generally of low quality."
Low back pain afflicts eight out of 10 people at
some point in their lives, according to the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, and it is the second
most frequent cause of work absence in industrialized nations. In the
United States alone, back pain is the most common cause of disability in
people under 45 years of age and is responsible for direct costs of $20
billion, the authors report.
Current standard treatments include tissue
stimulation, pain medication, exercise and back braces. Drugs and
physical activity show the best results, the authors said.
The study found strong evidence that a 50 mg dose
of devil's claw was better than placebo in the short term but only
moderate evidence for a 100 mg dose.
In a much smaller trial, there did not appear to be
any difference between devil's claw and Vioxx.
In a trial of white willow bark versus placebo, the
stronger the dose, the more pain relief was found. The stronger dose of
white willow bark produced similar pain relief to Vioxx in the short
term.
A trial of cayenne plasters produced improvement in
pain versus placebo but no difference versus a homeopathic preparation.
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
medication-herbal medicine interactions must always be considered,
Gagnier said, cautioning, These treatments should not be tried without
the supervision of a qualified medical professional, he said.
Dr. Michael R. Marks, chief of the medical staff at
Norwalk Hospital in Connecticut, agreed that herbal treatment may be
tried but should not be seen as a replacement for conventional pain
killers. There is probably no reason for the individual without any
underlying medical problems not to try these treatments, Marks said.
But 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.
He also said 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.
About information source:
Gagnier JJ. Herbal medicine for low back pain
(review). The Cochrane Database of Systematic Reviews 2006, Issue 2.
The Cochrane Collaboration is an international
nonprofit, independent organization that produces and disseminates
systematic reviews of health care interventions and promotes the search
for evidence in the form of clinical trials and other studies of
interventions. Visit
http://www.cochrane.org for more information.
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