Herbal medicine and lower back pain.
Subject: Backache (Drug therapy)
Backache (Research)
Medicine, Botanic (Health aspects)
Medicine, Botanic (Usage)
Medicine, Herbal (Health aspects)
Medicine, Herbal (Usage)
Author: Sarris, Jerome
Pub Date: 06/22/2007
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2007 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Summer, 2007 Source Volume: 19 Source Issue: 2
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 174818481
Full Text: Gagnier JJ, van Tulder M, Berman B, Bombardier C. 2006. Herbal medicine for low back pain (Review). Cochrane Database Systematic key 2. (JS)

A Cochrane systematic review was conducted to assess the current evidence of herbal medicines in treating acute and chronic lower back pain. The electronic databases Medline, Embase, Clinical Evidence and Cochrane Complementary Medicine Field Trials Registry were searched for randomised controlled trials that involved oral, topical and inhalant herbal interventions in ameliorating lower back pain. The types of outcomes assessed, involved pain intensity, functional status, subjective improvements, return to work and work status.

Of the 29 papers located, 19 were excluded due to improper study design, leaving 10 studies included in the review. Three studies evaluating Harpagophytum procumbens (HP) (devil's claw) against placebo and one against Vioxx[R] as the positive control were located. All studies used a large sample and rigorous methodology.

The results of the trials were in favour of HP treatment in improving outcome measures (reduction in pain, less analgesic rescue medications needed). Although it is difficult to compare the four trials due to variations of study design, evidence indicates that an aqueous extract of HP standardised to 50 mg of harpagoside appears to be the most effective preparation.

Four studies evaluated Salix alba (SA) (willow bark) standardised for salicin (120 mg and 240 mg). Evidence revealed that SA was effective against placebo and was comparable to 12.5 mg of rofecoxib as assessed via the Arhus Low Back Pain Index and a Visual Analogue Scale. The effect appears to be dose dependant with the 240 mg salicin preparation having greater effect. Four low quality studies evaluating Capsicum frutescens (CF) (chilli) topical plasters and creams revealed moderate evidence in reducing lower back pain.

The authors of the review concluded that clinical evidence supports the use of oral HP and SA, and topical CF to reduce lower back pain. Minor adverse effects were encountered in nine out of ten studies (gastrointestinal complaints). Primary limitations of the reviews were that the studies were mostly short in duration (4-6 weeks) and that a significant bias due to a potential conflict of interest existed in many studies.

Comment: The next herbal medicine that deserves research in acute and chronic back pain is Boswellia spp which has clinical evidence in treating osteoarthritis due to strong anti-inflammatory activity.

Jerome Sarris

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