Positive Health Online

Abstract

GAGNIER and colleagues, Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, j.gagnier@utoronto.ca, have reviewed (40 references) herbal remedies for low back pain.

Background

A large proportion of patients with chronic low back pain use complementary and alternative medicine. Several herbal medicines have been purported for use in low back pain. The aim of this study was to determine the effectiveness of herbal medicine compared with placebo, no intervention, or ‘conventional treatments’ for nonspecific low back pain.

Methodology

Relevant databases were searched. Additionally, reference lists in review articles, guidelines, and in the retrieved trials were checked. Randomized controlled trials, using adults suffering from acute, subacute, or chronic nonspecific low back pain were searched for. Types of interventions included herbal medicines. Primary outcome measures were pain and function. Methodological quality and clinical relevance were assessed separately by two individuals.

Results

10 trials were included in this review. Two high-quality trials utilizing Harpagophytum procumbens (Devil’s claw) found strong evidence for short-term improvements in pain and rescue medication for daily doses standardized to 50 mg or 100 mg Harpagoside with another high-quality trial demonstrating relative equivalence to 12.5 mg per day of rofecoxib. Two moderate-quality trials utilizing Salix alba (White willow bark) found moderate evidence for short-term improvements in pain and rescue medication for daily doses standardized to 120 mg or 240 mg salicin with an additional trial demonstrating relative equivalence to 12.5 mg per day of rofecoxib. Three low-quality trials using Capsicum frutescens (Cayenne pepper) using various topical preparations found moderate evidence for favourable results against placebo and one trial found equivalence to a homeopathic ointment.

Conclusion

Devil’s claw, willow bark, and Cayenne pepper seem to reduce pain more than placebo. The quality of reporting in these trials was generally poor; researchers should refer to the CONSORT statement in reporting clinical trials of herbal medicines.

References

Gagnier JJ, van Tulder MW, Berman B, Bombardier C. Herbal medicine for low back pain: a Cochrane review. Spine 32 (1): 82-92, Jan 1, 2007.   

Comment

Although the analgesic properties of Devil’s claw, White willow bark and Cayenne pepper have long been known within the Herbal Medicine Community, the reporting from the Medical Faculty will widen this knowledge, albeit with the caveats that research quality still needs to be improved.