Know Your Herbs and Supplements!

Pain Management, November 2011, Volume 4, Issue 8

There are many herbs and supplements on the market that are thought to be effective by some patients and practitioners for managing pain. However, for many of these herbs and supplements, there is little in the way of reliable evidence supporting these claims. Nonetheless, millions of patients may be using these agents to supplement the pain care provided by their physicians and other clinicians, often without informing them of this fact.

There are many herbs and supplements on the market that are thought to be effective by some patients and practitioners for managing pain. However, for many of these herbs and supplements, there is little in the way of reliable evidence supporting these claims. Nonetheless, millions of patients may be using these agents to supplement the pain care provided by their physicians and other clinicians, often without informing them of this fact. Because many of these products can interact with other medications the patient is taking, or exacerbate pre-existing conditions, it is important for pain practitioners to be aware of the popularity of these products, learn more about their basic properties, and ask their patients if they are taking any herbs and/or supplements.

Here is a print-friendly version of this article you can download, print, and use as a handout in your office or clinic. Download PDF.

Turmeric root (Curcuma longa)

Also known as: Curcumin, Halada, Yu Jin

Used for: pain, arthritis pain

Evidence supporting this use: There is little evidence to support the use of turmeric for the relief of pain

Potential side effects/drug interactions: May slow blood clotting, so may possibly enhance the effects of anticoagulant and antiplatelet medications

For more information: http://1.usa.gov/gSC4Tg

Glucosamine and Chondroitin

Also known as: N/A

Used for: osteoarthritis, knee pain, back pain

Evidence supporting this use: The Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) found that “the dietary supplements glucosamine and chondroitin, taken alone or in combination, are generally ineffective for knee osteoarthritis (OA) pain” (http://1.usa.gov/cvh74V).

Potential side effects/drug interactions: May increase the effect of warfarin, may worsen asthma symptoms

For more information: http://1.usa.gov/vNekgu

Boswellia (Boswellia serrata, Boswellia carterii)

Also known as: Frankincense

Used for: rheumatoid arthritis, osteoarthritis, other painful conditions

Evidence supporting this use: There is little convincing evidence to support the use of boswellia for the relief of pain

Potential side effects/drug interactions: May interfere with anticoagulant drugs and leukotreine inhibitors (http://bit.ly/tsbzw2)

For more information: http://1.usa.gov/sYwIwr

Kava Kava (Piper methysticum)

Also known as: Ava root, Kawa Kawa, Maluk, Yangona

Used for: headache, muscle pain

Evidence supporting this use: There is insufficient evidence demonstrating the effectiveness of kava kava for the treatment of any painful conditions

Potential side effects/drug interactions: There are serious concerns regarding severe liver damage with this supplement (http://1.usa.gov/i1Ydi). It may also increase drowsiness in patients who are taking alprazolam and/or CNS depressants

For more information: http://1.usa.gov/t0CfWE

St. John’s Wort (Hypericum perforatum)

Also known as: Klamath weed, goatweed

Used for: headache, migraine, muscle pain, neuralgia, sciatica, fibromyalgia

Evidence supporting this use: Little to no reliable evidence supporting the use of St. John’s wort for the treatment of painful disorders

Potential side effects/drug interactions: May interfere with a wide range of medications, including antidepressants, anticoagulants, digoxin, seizure medications, and others (http://1.usa.gov/2WokQ4)

For more information: http://1.usa.gov/hYo2xc

Echinacea (Echinacea purpurea, Echinacea angustifolia, Echinacea pallida)

Also known as: Black Sampson, Coneflower, Snakeroot

Used for: pain, migraine, arthritis

Evidence supporting this use: There is little evidence supporting the use of Echinacea for the treatment of these conditions

Potential side effects/drug interactions: May exacerbate symptoms of autoimmune disorders, may interact with CYP3A4 and CYP1A2 substrates

For more information: http://1.usa.gov/b641T8

Valerian root (Valeriana officinalis)

Also known as: Indian valerian, Mexican valerian, Valeriana

Used for: joint and muscle pain, migraine

Evidence supporting this use: There is insufficient reliable evidence supporting the use of valerian for these conditions

Potential side effects/drug interactions: May add to the sedative effect of barbiturates and benzodiazepines, may change the rate at which CYP3A4 substrates are metabolized

For more information: http://1.usa.gov/tdCxY4

Black Cohosh (Actaea racemosa, Cimicifuga racemosa)

Also known as: black snakeroot, bugwort, rattleweed

Used for: arthritis, muscle pain

Evidence supporting this use: “There are not enough reliable data to determine whether black cohosh is effective for rheumatism or other uses” (http://1.usa.gov/3TToSs).

Potential side effects/drug interactions: May be associated with severe liver side effects, especially in women.

For more information: http://1.usa.gov/vx4okx

Bromelain (Ananas comosus)

Also known as: Pineapple Enzyme, Pineapple

Extract Used for: muscle soreness/pain, arthritis, knee pain

Evidence supporting this use: The NIH reports that bromelain may be effective for arthritis when used in combination with trypsin and rutin. There is insufficient evidence to determine its effectiveness in other conditions.

Potential side effects/drug interactions: May interact with amoxicillin and other antibiotics, may interact with anticoagulants and antiplatelet drugs.

For more information: http://1.usa.gov/eFLe3V

Feverfew (Tanacetum parthenium, Chrysanthemum parthenium)

Also known as: Bachelor’s Buttons, Featherfew

Used for: migraine, arthritis, muscle pain

Evidence supporting this use: The NIH reports that “there is some evidence that taking feverfew by mouth can reduce the frequency of migraine headaches” and reduce the pain associated with them (http://1.usa.gov/stNb7X). There is no strong evidence that it reduces the symptoms of rheumatoid arthritis.

Potential side effects/drug interactions: Possible interactions with a wide range of medications that are changed and broken down by the liver. May also enhance the effects of anticoagulants.

For more information: http://1.usa.gov/drDJcN

For more information on herbs and natural supplements for pain:

Office of Dietary Supplements of the National Institutes of Health

http://1.usa.gov/dwPvfH

MedlinePlus

http://1.usa.gov/k6XL

The National Center for Complementary and Alternative Medicine

http://1.usa.gov/ZWgc1

Natural Medicines Comprehensive Database

http://bit.ly/vL3wtb (subscription required)

The Natural Standard Research Collaboration

(subscription required)

http://bit.ly/19o3OX

Devil’s claw (Harpagophytum procumbens)

Also known as: Grapple Plant, Wood Spider

Used for: muscle pain, back pain, arthritis, migraine

Evidence supporting this use: The NIH reports that “taking devil’s claw alone or along with nonsteroidal anti-inflammatory drugs (NSAIDs) seems to help decrease osteoarthritis-related pain.” There is insufficient evidence to determine the effectiveness of this product for treating other conditions.

Potential side effects/drug interactions: Devil’s claw may increase the effects of warfarin, and may also decrease how quickly the liver breaks down some medications.

For more information: http://1.usa.gov/qaovtl

Cat’s claw (Uncaria guianensis, Uncaria tomentosa)

Also known as: Samento, Uña De Gato

Used for: herpes zoster, arthritis, bone pain

Evidence supporting this use: The NCCAM reports that “There is not enough scientific evidence to determine whether cat’s claw works for any health condition,” but also notes that “small studies in humans have shown a possible benefit of cat’s claw in osteoarthritis and rheumatoid arthritis.”

Potential side effects/drug interactions: May interact with “clotting agents, blood pressure medications and cyclosporine” (http://bit.ly/qQBDYx)

For more information: http://1.usa.gov/d6zM0R