Introduction- Musculoskeletal pain is one of the reasons people seek out herbal medicine as an alternative to pharmaceutical treatments. There are a variety of botanicals that can be used in the treatment of low back pain (LBP) and osteoarthritis (OA), two very common musculoskeletal complaints that affect many people all over the world.
LBP is the fifth most common reason that people seek out the care of a medical professional, and billions are spent annually on this painful medical condition. It’s estimated that up to 80% of adults experience LBP at some point in their lives. LBP is also a common cause of job-related disability and of missed days at work. It can arise from heavy lifting or other physical activity, and or develop insidiously over a period of time. There is no “magic bullet” treatment for LBP, and most cases resolve within several weeks.
OA occurs due to the imbalance of cartilage synthesis and degradation, leading to the formation of bone spurs and osteophytes. Most people over the age of 65 have radiographic evidence of OA on x-rays. Knee OA is particularly debilitating, and one of the leading causes of impaired mobility in elderly patients.
Devil’s claw (Harpagophytum procumbens) :
Devil’s claw gets its name from the miniature, claw-like hooks that cover the fruit of this plant. It is native to southern Africa and grows well in the desert. It contains anti-inflammatory properties that are useful in treating musculoskeletal symptoms such as back or joint pain. A research study1 found devil’s claw to be not only better than placebo in the treatment of low back pain but as effective as nonsteroidal anti-inflammatory drugs (NSAIDs). It may also be useful in treating knee pain from OA.
This botanical should be avoided in patients with stomach ulcers and those who take blood thinners. Devil’s claw can potentially interact with diabetes medications and should be used with caution in these patients.
Willow bark (Salix alba) :
Dating to the time of Hippocrates, there is folk knowledge that using the bark of the white willow tree helps ease pain and treat fevers. It wasn’t until centuries later that researchers discovered that the bark of this tree contains salicylic acid, which was then synthetically modified to acetyl-salicylic acid, better known as aspirin! I like to think of willow bark as “nature’s aspirin,” and it’s useful in treating minor musculoskeletal pain.
It is milder and gentler on the stomach than aspirin, but the same safety rules apply: willow bark should be not be used in children due to the risk of Reye’s syndrome or in any person with an allergy to aspirin. Willow bark should be avoided in people who have kidney disease or asthma. It may increase risk of bleeding for people taking blood thinners.
Ginger (Zingiber officinale) :
Although probably best known for its culinary delights, ginger may also be an effective treatment for knee OA. Gingerol is one of the active constituents in ginger, and gives ginger its anti- inflammatory properties. A research trial2 looking at the effects of a ginger extract in the treatment of knee OA found the ginger extract to be superior to placebo. Mild gastrointestinal upset may occur with ginger consumption, and this botanical should be avoided in people who are taking blood thinners.
Capsaicin may be a reasonable option for those interested in a topical treatment for knee OA. It is an alkaloid derived from the common pepper plant, including hot peppers, and is probably best known as a spicy addition to culinary dishes. When applied topically over a period of time, capsaicin depletes local sensory nerve endings of something called substance P, a neurotransmitter involved in sending pain signals to the brain. The result is diminished pain wherever the cream was applied.
A localized burning sensation is a common side effect, but is tolerable. Care should be taken to avoid contact of the cream with the mouth or eyes, as it may cause irritation.
Mrs. Harshita Jain, Assistant Professor, School of Pharmacy, Career Point University, Kota