Herbal medicine for low back pain

 

Abstract

Background

Low-back pain is a common condition and a substantial economic burden in industrialized societies. 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.

Objectives

To determine the effectiveness of herbal medicine for non-specific low-back pain.

Search methods

We searched the following electronic databases: Cochrane Complementary Medicine Field Trials Register (Issue 3, 2005), MEDLINE (1966 to July 2005), EMBASE (1980 to July 2005); checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this very specialized area.

Selection criteria

We included randomized controlled trials, examining adults (over 18 years of age) suffering from acute, sub-acute or chronic non-specific low-back pain. The interventions were herbal medicines, defined as plants that are used for medicinal purposes in any form. Primary outcome measures were pain and function.

Data collection and analysis

Two authors (JJG & MVT) conducted the database searches. One author contacted content experts and acquired relevant citations. Full references and abstracts of the identified studies were downloaded. A hard copy was retrieved for final inclusion decisions. Methodological quality and clinical relevance were assessed separately by two individuals. Disagreements were resolved by consensus.

Main results

Ten trials were included in this review. Two high quality trials examining the effects of Harpagophytum Procumbens (Devil's Claw) found strong evidence that daily doses standardized to 50 mg or 100 mg harpagoside were better than placebo for short-term improvements in pain and rescue medication. Another high quality trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (Vioxx). 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. Three low quality trials on Capsicum Frutescens (Cayenne), examining various topical preparations, found moderate evidence that Capsicum Frutescens produced more favourable results than placebo and one trial found equivalence to a homeopathic ointment.

Authors' conclusions

Harpagophytum Procumbens, Salix Alba and Capsicum Frutescens seem to reduce pain more than placebo. Additional trials testing these herbal medicines against standard treatments are needed. The quality of reporting in these trials was generally poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions.

 

Plain language summary

Herbal medicine for low-back pain

Significance of the review
Back pain is common, affecting as much as 35% of the population in a given month. Non-specific low-back pain is defined as pain between the lowest rib and the bottom of the buttocks that is not caused by serious, underlying problems such as rheumatoid arthritis, infection, fracture, cancer, or sciatica due to a herniated disc or other pressure on nerves. Oral and topical herbal medicines are being used to treat many conditions; several are used for back pain and have been tested in clinical trials.

Description of the trials
Three oral herbal medications were tested in ten randomized controlled trials that included 1567 adults with non-specific acute or chronic low-back pain. Two oral herbal medications, Harpagophytum Procumbens (Devil's Claw) and Salix Alba (White Willow Bark), were compared with placebo (fake pills) and with rofecoxib (Vioxx). Topical Capsicum frutescens (Cayenne) was compared with placebo and a homeopathic gel.

Findings
Devil's Claw, in a standardized daily dose of 50 mg or 100 mg harpagoside, seemed to reduce pain more than placebo; a standardized daily dose of 60 mg reduced pain about the same as a daily dose of 12.5 mg of Vioxx. While Willow Bark, in a standardized daily dose of 120 mg and 240 mg of salicin reduced pain more than placebo; a standardized daily dose of 240 mg reduced pain about the same as a daily dose of 12.5 mg of Vioxx. Cayenne was tested in plaster form and reduced pain more than placebo and about the same as the homeopathic gel Spiroflor SLR. Adverse effects were reported, but appeared to be primarily confined to mild, transient gastrointestinal complaints.

Limitations
Most of the trials were of moderate or high quality, but they only tested the effects of short term use (up to six weeks). The authors of half of the studies were judged to have a potential conflict of interest and two others did not discuss conflict of interest. Vioxx has been withdrawn from the market because of adverse effects, so all three substances should be compared with readily available pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, to test for relative effectiveness and safety.

Conclusion
Although there are good results with three herbal medicines in short-term trials, with strong evidence for a particular form of one of the herbal medicines, there is no evidence yet that any of these substances are safe and useful for long term use.

 

摘要

背景

草藥應用於下背痛

下背痛是一種常見的情況和工業化社會裡巨大的經濟負擔。其中大部分慢性下背痛患者採用補充和替代醫學(CAM)、拜訪CAM從業人員，或兩者兼而有之。幾種草藥已經聲稱用於下背痛。

目標

要確定草藥對非特異性下背痛的有效性。

搜尋策略

我們搜尋下列電子資料庫:Cochrane Complementary Medicine Field Trials Register (Issue 3, 2005), MEDLINE (1966 to 7月 2005), EMBASE (1980 to 7月 2005); 審查回顧文獻的相關文章,準則和檢索試驗，親自接觸在這專業的領域具專門知識的個人。.

選擇標準

我們收納進隨機對照試驗，受試的成年人(大於18歲)患有急性，亞急性或慢性非特異性下背痛。以草藥治療，草藥定義為任何形式藥用植物。主要測量結果是疼痛和功能

資料收集與分析

兩位作者(JJG & MVT)進行數據庫搜索。一位作者聯繫內容專家，取得相關的引文。充分的研究引用資料和摘要被下載。為了最終納入，全文會被檢訂。分別由兩個人來進行方法學品質和臨床相關性評估。分歧是由共識來解決。

主要結論

這個回顧文章包括10個試驗。兩個高品質的試驗研究發現有力的實證顯示，每天服用標準50毫克或100毫克Harpagophytum Procumbens(魔鬼爪)在短期改善疼痛方面優於安慰劑和救援藥物。另一種高品質的測試證明了其與每天12.5毫克rofecoxib (Vioxx)相當。兩項試驗研究影響Salix Alba(白柳皮)發現證據顯示，每天服用標120毫克或240毫克Salix Alba在短期改善疼痛方面優於安慰劑和救援藥物。另一個測試證明了其與每天12.5毫克rofecoxib (Vioxx)相當。三個低品質的試驗研究各種Capsicum Frutescens (Cayenne)皮膚外用製劑，發現一些證據表明，Capsicum Frutescens (Cayenne) 比服用安慰劑有好的結果。另一試驗發現其等效同種療法(homeopathic)的藥膏。

作者結論

Harpagophytum Procumbens，Salix Alba和Capsicum Frutescens對減少疼痛似乎比安慰劑有效。額外的試驗來測試草藥對標準治療是必要的。這些試驗報告的品質普遍較差。試驗者應參照 CONSORT聲明來報告中藥治療試驗。

翻譯人

本摘要由臺灣大學附設醫院陳明峰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

草藥對下背痛本文重要性背部疼痛是常見的，在特定的月份影響到多達 35％的人口。非特異性下背痛定義為最低肋骨與臀部之間的疼痛，沒有嚴重的，潛在的問題，如類風濕關節炎，感染，骨折，癌症，或由椎間盤突出或其他神經壓迫造成的坐骨神經痛。口服和外用草藥已被用於治療許多情況;有幾個已用於背部疼痛，並已進行臨床試驗。試驗說明在10個隨機對照試驗中測試3種口服中藥藥物，其中包括1567位患有非特異性急性或慢性下背痛的成人。兩種口服中藥Harpagophytum Procumbens (魔鬼爪) 和 Salix Alba (白柳皮)，分別與安慰劑(假藥丸)和rofecoxib (Vioxx)相比.。外用Capsicum frutescens (Cayenne)與安慰劑、同種療法藥膏(homeopathic gel)相比較。 發現標準化的每日50毫克或100毫克Harpagophytum Procumbens(魔鬼爪)似乎比安慰劑能減輕疼痛。標準化的每日60毫克減少之疼痛相當於每天12.5毫克劑量的Vioxx。而在每日標準化120毫克和240毫克的Salix Alba(白柳皮)減少的痛苦多於安慰劑，一個標準化的每日240毫克減少之疼痛相當於每天12.5毫克劑量的Vioxx。以敷以膏藥形式測試Cayenne，發現減少痛苦多於安慰劑，和同種療法藥膏(homeopathic gel) Spirofl 或 SLR效果相當。有不良反應報告，但似乎主要限於輕微，短暫的胃腸不適。 限制大多數試驗是中度或高度品質，但他們只測試短期使用(最多6週)的效果。一半的研究作者被認為有潛在的利益衝突和其他兩個作者根本沒有討論到利益衝突。Vioxx因為不良的影響已退出市場，因此所有三個物質應與其他容易獲得的止痛藥如非類固醇類消炎藥(NSAIDs)和對乙?氨基酚 (acetaminophen) 比較，以測試相對有效性和安全性。 結論雖然3個中藥材短期試驗有好的結果，且其中某一形式之草藥具有力的證據。但沒有任何證據能證明，這些物質長期使用是安全和有益的。