Herbal Medicine for Low Back Pain
Monday, August 30, 2010 at 11:17PMAmericans spend about $34 billion dollars annually on alternative medicine.[i] That is a lot of money, especially in recessionary times. Researchers estimate that alternative medicine accounts for more than 11% of “out-of-pocket” spending on health care in the United States. [ii]
So what works and what doesn’t? I plan to review some “alternative” or “complementary” tools that are used for pain in a series of upcoming blog posts. I always get a lot of questions on about supplements or treatments that fall into these categories and it is worthwhile to consider the evidence that is out there on this subject.
For this discussion, we will specifically consider the issue of herbal supplements related to low back pain. “A large proportion of patients with chronic low-back pain use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in low-back pain.”[iii]
The Cochrane Collaboration looked at a number of different randomized controlled trials, examining adults (over 18 years of age) suffering from acute, sub-acute or chronic nonspecific low-back pain. The interventions were herbal medicines, defined as plants that are used for medicinal purposes in any form.
The authors came to the following conclusions: [iv]
- Devil’s Claw:
- There is strong evidence that Harpagophytum Procumbens (Devil’s Claw) in daily doses standardized to 50 mg or 100 mg harpagoside were better than placebo for short-term improvements in pain and rescue medication
- A high quality trial demonstrated relative equivalence [of Devil’s Claw] to 12.5 mg per day of rofecoxib (Vioxx)
- White Willow Bark:
- Two trials examining the effects of Salix Alba (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
- Capsaicin Cream:
- Three low quality trials on Capsicum Frutescens (Cayenne), examining various topical preparations, found moderate evidence that Capsicum Frutescens produced more favorable results than placebo
So am I going to go out tomorrow and prescribe Devil’s Claw or White Willow Bark for pain? Probably not (Not that there’s anything wrong with that). I was trained in a Western allopathic model and it is hard to break out of that mold sometimes. However, with information like this I can make informed recommendations to people asking about this type of supplement or herbal medicine use.
Besides, I know a ton of patients that loved Vioxx. A lot of them would probably still take it for pain even knowing it could cause heart disease. So, if Devil’s Claw or White Willow Bark can do that I’m all for it.
[i] http://www.msnbc.msn.com/id/32219873
[ii] http://www.msnbc.msn.com/id/32219873
[iii] Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004504.
[iv] Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004504.
Reader Comments (1)
Awesome info. Thanks for sharing.